Recurrent laryngeal nerve

figure 33-12 Laryngotracheoesophageal cleft repair. Approach to the proximal segment. A, Removal of a segment of hyoid bone will expose the right superior laryngeal nerve and artery. This is not always necessary. The recurrent laryn-geal nerve is identified below. The pharyngeal wall is exposed through the inferior pharyngeal constrictor muscle. B, After the pharynx is opened laterally, the cleft larynx is incised from inferior to superior cornu of thyroid cartilage on each side, in preparation for layered closure. C, The intra-laryngeal mucosa is closed, connective tissue and laryngeal muscle is used to create a layer beneath this, and the mucosa of the pharynx bordering the laryngeal cleft is closed behind the laryngeal repair. The intralaryngeal suture line meets the membranous wall reconstruction inferiorly. Finally, the pharyngeal incision is closed.

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