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The Ligament of Berry

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The Recurrent and Superior Laryngeal Nerves

Abstract

The last 2 cm of the extralaryngeal course of the recurrent laryngeal nerve is an area of critical anatomical importance. It is the site of greatest risk for neuropraxia, the site of development of the artificial genu and point of maximal tension within the recurrent laryngeal nerve at thyroidectomy and the site of bifurcation of the recurrent laryngeal nerve. In this last 2 cm segment, the Ligament of Berry which attaches the thyroid to the trachea is located. Two fascial layers are described in the region of the Ligament of Berry, covering the last 2 cm of the extralaryngeal course of the recurrent nerve. The more superficial layer, the superficial vascular fascial layer, contains branches of the inferior thyroid artery, the superior parathyroid gland, and the Tubercle of Zuckerkandl. Following dissection and division of this layer, the recurrent laryngeal nerve will be seen to lie on the deeper layer, the more fibrous and denser true Ligament of Berry. At thyroidectomy, once the fibrous Ligament of Berry layer is divided, the recurrent laryngeal nerve relaxes and adopts a serpiginous course in the tracheoesophageal groove. The Ligament of Berry maybe in two layers with thyroid tissue between the two layers. Because of anteromedial rotation of the thyroid and larynx and trachea, the recurrent laryngeal nerve lies lateral to the Ligament of Berry and deep to the superficial vascular fascial layer. The recurrent laryngeal nerve thus lies between the two layers but does not pass through the Ligament of Berry.

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Authors and Affiliations

  1. Nepean Hospital, Kingswood, NSW, Australia

    Niranjan Sritharan BSc (Med), MBBS, FRACS (OHNS)

  2. University of Western Sydney, Sydney, NSW, Australia

    Niranjan Sritharan BSc (Med), MBBS, FRACS (OHNS)

  3. Department of Surgery, Monash University, Alfred Hospital and Monash Health, Melbourne, VIC, Australia

    Paul M. Paddle MBBS (Hons), FRACS (OHNS), MPH

  4. School of Allied Health, LaTrobe University, Melbourne, VIC, Australia

    Paul M. Paddle MBBS (Hons), FRACS (OHNS), MPH

  5. Division of Surgical Oncology, Texas A&M University Health Science Center, Baylor Scott & White Health, Scott & White Clinic, 2401 South 31st Street, Temple, TX, 76508, USA

    Samuel K. Snyder M.D., F.A.C.S.

  6. Monash University Endocrine Surgery Unit, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia

    Jonathan W. Serpell MBBS, MD, MEd, FRACS, FACS

Authors
  1. Niranjan Sritharan BSc (Med), MBBS, FRACS (OHNS)
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  2. Paul M. Paddle MBBS (Hons), FRACS (OHNS), MPH
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  3. Samuel K. Snyder M.D., F.A.C.S.
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  4. Jonathan W. Serpell MBBS, MD, MEd, FRACS, FACS
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Corresponding author

Correspondence to Jonathan W. Serpell MBBS, MD, MEd, FRACS, FACS .

Editor information

Editors and Affiliations

  1. The Claire and John Bertucci Endowed Cha, Harvard Medical School, Boston, Massachusetts, USA

    Gregory W. Randolph

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Sritharan, N., Paddle, P.M., Snyder, S.K., Serpell, J.W. (2016). The Ligament of Berry. In: Randolph, G. (eds) The Recurrent and Superior Laryngeal Nerves. Springer, Cham. https://doi.org/10.1007/978-3-319-27727-1_10

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  • DOI: https://doi.org/10.1007/978-3-319-27727-1_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27725-7

  • Online ISBN: 978-3-319-27727-1

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