Evidence map›Paper›PMID 41495514›Full record

ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026

An analysis of vascular pattern in modified P1 zone and relationship with recurrent laryngeal nerve.

Rubine Zeinuddeen Challakkara, Jeyashanth Riju, Natarajan Ramlingam, Rajiv C Michael, Amit Jiwan Tirkey, Remya Rajan, Lisa Abraham, Jino Johns Lalitha, Elanthenral Sigamani, Shalini Sahu and 1 more

Abstract read
PubMed Publisher
In one paragraph

Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Rubine Zeinuddeen ChallakkaraDepartment of Head and Neck Surgery, CMC Hospital Campus, 2nd Floor, Paul Brand Building, Vellore, Tamil Nadu, 632004, India.
Jeyashanth RijuDepartment of Head and Neck Surgery, CMC Hospital Campus, 2nd Floor, Paul Brand Building, Vellore, Tamil Nadu, 632004, India. jjriju@yahoo.co.in.ORCID http://orcid.org/0000-0003-4750-8111
Natarajan RamlingamDepartment of Head and Neck Surgery, CMC Hospital Campus, 2nd Floor, Paul Brand Building, Vellore, Tamil Nadu, 632004, India.
Rajiv C MichaelDepartment of Head and Neck Surgery, CMC Hospital Campus, 2nd Floor, Paul Brand Building, Vellore, Tamil Nadu, 632004, India.
Amit Jiwan TirkeyDepartment of Head and Neck Surgery, CMC Hospital Campus, 2nd Floor, Paul Brand Building, Vellore, Tamil Nadu, 632004, India.
Remya RajanDepartment of Endocrinology, CMC Hospital Campus, Vellore, Tamil Nadu, 632004, India.ORCID http://orcid.org/0000-0003-4136-9843
Lisa AbrahamDepartment of Head and Neck Surgery, CMC Hospital Campus, 2nd Floor, Paul Brand Building, Vellore, Tamil Nadu, 632004, India.
Jino Johns LalithaDepartment of Head and Neck Surgery, CMC Hospital Campus, 2nd Floor, Paul Brand Building, Vellore, Tamil Nadu, 632004, India.
Elanthenral SigamaniDepartment of Pathology, CMC Hospital Campus, 4th floor, Asha Building, Vellore, Tamil Nadu, 632004, India.
Shalini SahuDepartment of Radiodiagnosis, CMC Hospital Campus, Vellore, Tamil Nadu, 632004, India.
Jhansi RaniDepartment of Medical Biostatistics, Christian Medical College, Vellore, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeModified P1 zone is defined as the zone related to the recurrent laryngeal nerve(RLN) 1 cm proximal to the nerve entry point to the larynx, where the vessels cross the nerve at a vertical plane. RLN injuries are common in this zone during thyroidectomy. This study aims to describe the vascular pattern at the modified P1 zone.

methodsThis prospective analysis included 131 consecutive subjects who underwent thyroid surgery between October 2023 and June 2024. Various clinical, radiological, histopathological and intraoperative parameters were studied.

resultsThe study included 212 nerves at risk(NAR). The mean age of the study population was 43 ± 12.6 years. Immediate post-operative vocal cord palsy was noted in 3.3% of NAR. 100% of patients had at least one vessel in relation to RLN in the modified P1 zone. The mean number of vessels in this zone was 3 ± 1.2. Type 3 vascular pattern(presence of vessels anterior and posterior to the nerve) was the most common(68.9%). Multivariate analysis showed the presence of Pelizzo grade 2 tubercle of Zuckerkandl (OR 2.4; 95% CI: 1.07-5.37, p = 0.033) and the presence of stage 2 or 3 tumor stage(OR 2.2; 95% CI: 1.10- 4.55, p = 0.026) were independent predictors of the increased number of vessels(> 2 vessels).

conclusionThe study describes the consistent vascular pattern and its relationship with RLN in the modified P1 zone. Awareness of this may help surgeons to prevent RLN injury during thyroid surgery and effectively tackle the vessels in modified P1 zone.

Indexed as

Recurrent Laryngeal NerveRecurrent Laryngeal Nerve InjuriesThyroidectomyThyroid GlandVocal Cord ParalysisAdultFemaleHumansMaleMiddle AgedPostoperative ComplicationsProspective StudiesBlood vesselsLaryngeal nerve contusionsRecurrent laryngeal nerve injuryThyroidectomyVocal cord palsy

Identifiers

PMID41495514

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.