SUSPENSORY LIGAMENT OF BERRY - ITS RELATIONSHIP TO RECURRENT LARYNGEAL NERVE AND ANATOMIC EXAMINATION OF 24 AUTOPSIES

Background. It is important to clarify the relation ship between the r ecurrent laryngeal nerve (RLN) and the ligament of Berry to prevent da mage to the RLN in thyroid surgery. The purpose of the present paper i s to identify this relationship to prevent surgical complications. Met hods. Among the 486 thyroid surgery cases, 689 RLNs were identified an d their course detected. Topography of the laryngotracheoesophageal re gion and the histology of the ligament of Berry were studied in detail in 25 autopsied cadavers. Results. All nerves identified by surgery a nd autopsy were located laterodorsally to the ligament of Berry. They were clearly separated, and no nerve penetrated the ligament nor was m edially located to it. The ligament of Berry strongly connected the th yroid gland to the trachea and was identified as a whitish connective tissue band. No paralysis of the RLN occurred during identification of the nerve during surgery. Conclusions. It was confirmed that the RLN never penetrates the ligament of Berry but is located laterally to it. From these topographic findings, no injury to the RLN will occur from a separation close to the goiter in thyroid surgery. (C) 1998 John Wi ley & Sons, Inc.