Recurrent laryngeal nerve preservation in thyroid cancer involving the ligament of berry

Publication date: Available online 22 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Nathan W. Hales, Dipti Kamani, GregoryW. Randolph
The ligament of Berry is a dense consolidation of pretracheal vascular fascia or suspensory ligament which anchors the thyroid to the trachea and is located medial and deep to the tubercle of Zuckerkandl. The ligament of Berry is closely related to the distal 2cm of the extralaryngeal course of the recurrent laryngeal nerve and to the superior parathyroid gland. When thyroid cancer is present in the ligament of Berry, proper preoperative imaging, meticulous dissection with extra caution in the area of the ligament of Berry and use of intraoperative nerve monitoring are helpful tools in preservation of recurrent laryngeal nerve. Additionally, when thyroid cancer is preoperatively suspected to involve ligament of Berry, proper preoperative counseling, detailed consent, as well as communication regarding accurate patient expectations are essential.



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