204 



3. The Relations of the Inferior Tliyroid Artery and the 

 Recurrent Laryngeal Nerye. 



By Thomas Dwight M. D. Packman Professor of Anatomy at the Har- 

 vard Medical School. Boston TJ. S. A. 



Text books of anatomy say little on this point, which however 

 may be of much practical importance. Luschka, Quain, Holden, and 

 Sappey teach that the nerve passes behind the artery. Other au- 

 thors give the same impression without distinctly asserting it. Cru- 

 VEiLHiER is, I believe, the only one who teaches the contrary. Sappey's 

 account is the most precise one. „Dans ce trajet eile (I'artere) decrit 

 deux courbures : Tune ä concavite inf^rieure et anterieure qui embrasse 

 la jugulaire interne, la carotide primitive, le pneumogastrique ; I'autre 

 a concavite sup^rieure et post6rieure qui contient le nerf recurrent." 



Having observed some time ago that the relations are not always 

 the same but that the nerve may be found before the artery as well 

 as behind it, I began a series of observations with the help of my 

 assistants in the anatomical department. I had intended to continue 

 the observations for another year, but finding that the subject has 

 been discussed in Germany I determined to publish my results. 



The relative position of the nerve and artery may be of interest 

 in oesophagotomy but its chief importance is in operations for the 

 removal of the whole or a part of the thyroid, and it is in this con- 

 nection that German observers have studied the question. Woelfler ^ ) 

 stated that the nerve always passes before a branch of the artery. 

 Kocher 2), on the other hand, describes the artery as passing behind 

 the nerve, coming forward on its inner side and bending over it. 

 Rotter 3) made some fifteen examinations and found the artery in 

 one third as described by Kocher. In one third the artery passed 

 before the nerve. The remainder were not easily classified as the 

 nerve ran among the branches of the artery. Dr. Streckeisen *) in 

 an elaborate paper „zur Morphologie der Schilddrüse" re- 

 ports the results of the examination of both sides of 56 bodies. He 



1) Wiener med. Wochenschrift 1879. 



2) Archiv für klin. Chirurgie. Bd. 29. 1883. 



3) „ „ „ „ Bd. 31. 1885. 



4) ViKCHOw's Archiv Bd. 103. 1886, I first learned from this pa- 

 per that attention had been given to this point. 



