Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine.

Global Spine J. 2019 Jun;9(4):383-387. doi: 10.1177/2192568218810198. Epub 2019 Feb 11.

Fisahn C, Yilmaz E, Iwanaga J, Schmidt C, Benca E, Chapman JR, Oskouian RJ, Tubbs RS.

---

Abstract

STUDY DESIGN:

Anatomical cadaver study.

OBJECTIVES:

Postoperative dysphagia is a significant complication following anterior approaches to the cervical spine and the etiology of this complication is poorly understood. Herein, we studied the esophageal branches of the recurrent laryngeal nerves to improve understanding of their anatomy and potential involvement in dysphagia.

METHODS:

Ten fresh frozen cadaveric human specimens were dissected (20 sides). All specimens were adults with no evidence of prior surgery of the anterior neck. The recurrent laryngeal nerves were identified under a surgical microscope and observations and measurements of their esophageal branches made.

RESULTS:

For each recurrent laryngeal nerve, 5-7 (mean 6.2) esophageal branches were identified. These branches ranged from 0.8 to 2.1 cm (mean 1.5 cm) in length and 0.5 to 2 mm (mean 1 mm) in diameter. They arose from the recurrent laryngeal nerves between vertebral levels T1 and C6. They all traveled to the anterior aspect of the esophagus. No statistical differences were seen between left and right sides or between sexes.

CONCLUSION:

The esophageal branches of the recurrent laryngeal nerve have been poorly described and could contribute to complications such as swallowing dysfunction following anterior cervical discectomy and fusion procedures. Therefore, a better understanding of their anatomy is important for spine surgeons. Our study revealed that these branches are always present on both sides and the anterior surface of the esophagus should be avoided while retracting it in order to minimize the risk of postoperative dysphagia.

KEYWORDS:

anatomy; anterior cervical discectomy; complications; dysphagia; neck; surgery; swallowing

Figure 1.

Label drawing illustrating the esophageal branches on the left side.

Figure 2.

Left cadaveric dissection noting the tracheoesophageal groove. The left recurrent laryngeal nerve is seen in purple. Branches to the esophagus and trachea are difficult to visualize in this position.