Recurrent laryngeal nerve
Recurrent laryngeal nerve | |
---|---|
tracheal and bronchial lymph glands, with the left and right recurrent nerves visible on either side. | |
Details | |
From | vagus nerve |
Innervates | larynx posterior cricoarytenoid lateral cricoarytenoid arytenoid thyroarytenoid aryepiglottis esophagus heart trachea inferior pharyngeal constrictor muscle |
Identifiers | |
Latin | nervus laryngeus recurrens |
MeSH | D012009 |
TA98 | A14.2.01.166 |
TA2 | 6344 |
FMA | 6246 |
Anatomical terms of neuroanatomy] |
The recurrent laryngeal nerve (RLN) is a branch of the
The recurrent laryngeal nerves supply sensation to the larynx below the vocal cords, give cardiac branches to the
The recurrent laryngeal nerves are the nerves of the sixth pharyngeal arch. The existence of the recurrent laryngeal nerve was first documented by the physician Galen.
Structure
The recurrent laryngeal nerves branch from the
The vagus nerves, from which the recurrent laryngeal nerves branch, exit the skull at the
Unlike the other nerves supplying the larynx, the right and left RLNs lack
Nucleus
The
Development
During human and all vertebrate development, a series of pharyngeal arch pairs form in the developing embryo. These project forward from the back of the embryo towards the front of the face and neck. Each arch develops its own artery, nerve that controls a distinct muscle group, and skeletal tissue. The arches are numbered from 1 to 6, with 1 being the arch closest to the head of the embryo, and the fifth arch only existing transiently.[10]: 318–323
Arches 4 and 6 produce the laryngeal cartilages. The nerve of the sixth arch becomes the recurrent laryngeal nerve. The nerve of the fourth arch gives rise to the superior laryngeal nerve. The arteries of the fourth arch, which project between the nerves of the fourth and sixth arches, become the left-sided arch of the aorta and the right subclavian artery. The arteries of the sixth arch persist as the ductus arteriosus on the left, and are obliterated on the right.[10]: 318–323
After birth, the ductus arteriosus regresses to form the ligamentum arteriosum. During growth, these arteries descend into their ultimate positions in the chest, creating the elongated recurrent paths.[10]: 318–323
Variation
In roughly 1 out of every 100–200 people, the right inferior laryngeal nerve is nonrecurrent, branching off the vagus nerve around the level of the cricoid cartilage. Typically, such a configuration is accompanied by variation in the arrangement of the major arteries in the chest; most commonly, the right subclavian artery arises from the left side of the aorta and crosses behind the esophagus. A left nonrecurrent inferior laryngeal nerve is even more uncommon, requiring the aortic arch be on the right side, accompanied by an arterial variant which prevents the nerve from being drawn into the chest by the left subclavian.[11]: 10, 48
In about four people out of five, there is a connecting branch between the inferior laryngeal nerve, a branch of the RLN, and the
As the recurrent nerve hooks around the subclavian artery or aorta, it gives off several branches. There is suspected variability in the configuration of these branches to the cardiac plexus, trachea, esophagus and inferior pharyngeal constrictor muscle.[15]
Function
The recurrent laryngeal nerves control all
The nerves also carry sensory information from the mucous membranes of the larynx below the lower surface of the
Clinical significance
Injury
The recurrent laryngeal nerves may be injured as a result of trauma, during surgery, as a result of tumour spread, or due to other means.
Surgery
The nerve receives close attention from surgeons because the nerve is at risk for injury during neck surgery, especially
Tumors
The RLN may be compressed by tumors. Studies have shown that 2–18% of lung cancer patients develop hoarseness because of recurrent laryngeal nerve compression, usually left-sided.[26] This is associated with worse outcomes, and when found as a presenting symptom, often indicates inoperable tumors. The nerve may be severed intentionally during lung cancer surgery in order to fully remove a tumor.[27]: 330 The RLN may also be damaged by tumors in the neck, especially with malignant lymph nodes with extra-capsular extension of tumor beyond the capsule of the nodes, which may invade the area that carries the ascending nerve on the right or left.
Other disease
In Ortner's syndrome or cardiovocal syndrome, a rare cause of left recurrent laryngeal nerve palsy, expansion of structures within the heart or major blood vessels impinges upon the nerve, causing symptoms of unilateral nerve injury.[28]
Other animals
Horses are subject to equine recurrent laryngeal neuropathy, a
Although uncommon in dogs, bilateral recurrent laryngeal nerve disease may be the cause of wheezing (stridor) when middle-aged dogs inhale.[30]: 771
In
Evidence of evolution
The extreme detour of the recurrent laryngeal nerves, about 4.6 metres (15 ft) in the case of
History
Ancient Greek physician
Notes
- Vocalis muscle
References
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- ^ "Recurrent". Medical definition and more. Merriam-Webster. Retrieved March 1, 2013.
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- ^ a b c Yau AY, Verma SP (February 20, 2013). Meyers AD (ed.). Laryngeal Nerve Anatomy. Retrieved January 5, 2014.
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ignored (help) - ^ ISBN 978-91-7409-123-6.)
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- ^ Yamamoto, Natsuhiro, Yamaguchi, Yoshikazu, Nomura, Takeshi, et al. Successful Assessment of Vocal Cord Palsy Before Tracheal Extubation by Laryngeal Ultrasonography in a Patient After Esophageal Surgery: A Case Report. A&A Case Reports. 2017;9(11):308-310. doi:10.1213/XAA.0000000000000601.
- PMID 34258495.
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- ISBN 978-1-4165-9478-9. Retrieved November 21, 2009.
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- ^ Owen R (1841). "Notes on the dissection of the Nubian giraffe". Transactions of the Zoological Society of London. Zoological Society of London. pp. 217–248. Retrieved February 27, 2013.
- ISBN 978-0-00-219818-9. Retrieved February 27, 2013.
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External links
- Anatomy figure: 21:04-01 at Human Anatomy Online, SUNY Downstate Medical Center
- cranialnerves at The Anatomy Lesson by Wesley Norman (Georgetown University) (X)
- Dissection of a giraffe displaying the laryngeal nerve (youTube)