{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:40:53Z","timestamp":1787809253790,"version":"build-2784847793"},"reference-count":43,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Recurrent laryngeal nerve injury is one of the major complications of thyroidectomy, with the lateral thyroid ligament (Berry\u2019s ligament) being the most frequent site of nerve injury. Neuromonitoring during thyroidectomy revealed three possible anatomical regions of the recurrent laryngeal nerve P1, P2, and P3. P1 represents the recurrent laryngeal nerve\u2019s caudal extralaryngeal part and is primarily associated with Berry\u2019s ligament. The aim of this systematic review is to identify the anatomical region with the highest risk of injury of the recurrent laryngeal nerve (detected via neuromonitoring) during thyroidectomy and to demonstrate the significance of Berry\u2019s ligament as an anatomical structure for the perioperative recognition and protection of the nerve. Materials and Methods: This study conducts a systematic review of the literature and adheres to all PRISMA system criteria as well as recommendations for systematic anatomical reviews. Three search engines (PubMed, Scopus, Cochrane) were used, and 18 out of 464 studies from 2003\u20132018 were finally included in this meta-analysis. All statistical data analyses were performed via SPSS 25 and Microsoft Office XL software. Results: 9191 nerves at risk were identified. In 75% of cases, the recurrent laryngeal nerve is located superficially to the ligament. In 71% of reported cases, the injury occurred in the P1 area, while the P3 zone (below the location where the nerve crosses the inferior thyroid artery) had the lowest risk of injury. Data from P1, P2, and P3 do not present significant heterogeneity. Conclusions: Berry\u2019s ligament constitutes a reliable anatomical structure for recognizing and preserving recurrent laryngeal nerves. P1 is the anatomical area with the greatest risk of recurrent laryngeal nerve damage during thyroidectomy, compared to P2 and P3.<\/jats:p>","DOI":"10.3390\/medicina58060755","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T12:48:31Z","timestamp":1654087711000},"page":"755","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Surgical Significance of Berry\u2019s Posterolateral Ligament and Frequency of Recurrent Laryngeal Nerve Injury into the Last 2 cm of Its Caudal Extralaryngeal Part(P1) during Thyroidectomy"],"prefix":"10.3390","volume":"58","author":[{"given":"Stylianos","family":"Mantalovas","sequence":"first","affiliation":[{"name":"Third Department of General Surgery, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2050-8392","authenticated-orcid":false,"given":"Konstantinos","family":"Sapalidis","sequence":"additional","affiliation":[{"name":"Third Department of General Surgery, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Manaki","sequence":"additional","affiliation":[{"name":"Third Department of General Surgery, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2298-9333","authenticated-orcid":false,"given":"Vasiliki","family":"Magra","sequence":"additional","affiliation":[{"name":"Third Department of General Surgery, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6687-4278","authenticated-orcid":false,"given":"Styliani","family":"Laskou","sequence":"additional","affiliation":[{"name":"Third Department of General Surgery, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stelian","family":"Pantea","sequence":"additional","affiliation":[{"name":"Surgery Clinic II, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Lagopoulos","sequence":"additional","affiliation":[{"name":"Third Department of General Surgery, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaak","family":"Kesisoglou","sequence":"additional","affiliation":[{"name":"Third Department of General Surgery, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,1]]},"reference":[{"key":"ref_1","first-page":"663","article-title":"Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society Consensus Statement","volume":"40","author":"Fundakowski","year":"2018","journal-title":"Otolaryngol. 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