ABSTRACT
Non-recurrent laryngeal nerve (NRLN) is a rare anatomic variation of the recurrent laryngeal nerve, which is often associated with right subclavian artery variation on the right side and more rare on the left side, usually accompanied with visceral inversion. Injury will lead to permanent paralysis of the vocal cord, bilateral nerve injury will even contribute to dyspnea in patients, breathing only with the aid of ventilator, in which case postoperative tracheotomy treatment is needed, leading to obvious influence on the daily life of patients. We reviewed the progress of NRLN in terms of histology and embryology development, anatomical classification, improvement and identification of related preoperative examination, intraoperative nerve identification, exploration and protection, and postoperative injury response, with the aim to provide some reference for improvement of thyroid surgery in clinical diagnosis and treatment.
ABSTRACT
La variante no recurrente del nervio laríngeo recurrente (NLR) tiene una frecuencia que oscila entre el 0,25 y el 0,99% según las diferentes series informadas. El NLNR (nervio laríngeo no recurrente) es consecuencia de un desarrollo embriológico anómalo del tronco epiaórtico. Se presenta el caso de una paciente con la variante tipo I del NLNR como hallazgo intraoperatorio durante una tiroidectomía total. El NLNR es un variante anatómica rara; debe pensarse siempre que se haya buscado exhaustivamente de forma reglada el nervio laríngeo inferior derecho sin localizarlo en su sitio anatómico habitual.
The non-recurrent laryngeal nerve (NRLN) is a variant of the recurrent laryngeal nerve (RLN) with an incidence between 0.25 and 0.99% according to the different series reported. The NRLN is consequence of a vascular anomaly during the embryological development of the epiaortic trunk. We report the case of a woman with type-1 NRLN as an intraoperative finding during total thyroidectomy. The NRLN is a rare anatomic variant that should be suspected when the right inferior RLN cannot be identified in the usual anatomic location after a standardized exploration.
ABSTRACT
Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for non-recurrent laryngeal nerve (NRLN).Methods From Oct.2013 to Apr.2016,2846 patients underwent thyroidectomy with the application of IONM,and 11 patients with non-recurrent laryngeal nerve were analyzed.Results 11 cases of NRLN were all accurately identified by IONM,and no injury of NRLN occurred during thyroid surgery.Conclusions NRLN is uncommon in clinical and it is difficult to be predicted before surgery and easy to be injured.The application of IONM can reduce the possibility of NRLN injury remarkably.
ABSTRACT
Background and purpose:A non-recurrent course is a rare anatomic variation of the recurrent laryngeal nerve, which is highly predisposed to injury in thyroidectomy. The study was to summarize preoperative judgment and injury prevention of non-recurrent laryngeal nerve (NRLN) during thyroidectomy.Methods:Preoperative diagnosis and precautions during thyroidectomy were investigated, clinical data from eleven cases of NRLN were analyzed and related literature was reviewed as well.Results:All eleven cases were NRLN of type 1. Among those, the right subclavian artery was found posteriorly to the trachea and esophagus shown by preoperative CT in seven cases. One case who had NRLN injury underwent nerve anastomosis.Conclusion:NRLN is a rare anatomical variation. Preoperative neck CT scan identifies presence of a NRLN, which may reduce the incidence of nerve injures by using intraoperative capsular dissection.
ABSTRACT
Objective To find new way to reduce non-recurrent laryngeal nerve (NRLN) injuries by applying intraoperative neuromonitoring(IONM) to identify NRLN in thyroidectomy. Methods Records of 279 patients who underwent complex thyroidectomy by applying IONM to identify and monitor RLN from Mar. 2009 to Jan. 2010 were veviewed. We proposed the skills to identify and monitor NRLN and predict RLN varition through exploring vagus nerve and RLN before RLN dissection. Results 6 cases NRLN located on the right side were all accurately identified by IONM, thus no injury of NRLN occurred during thyroid operations. Conclusions NRLN is difficult to be predicted preoperatively and identified by naked eyes. The application of IONM to predict, identify and monitor NRLN could remarkably reduce the possibility of NRLN injury.
ABSTRACT
A non-recurrent laryngeal nerve is a rare nerve anomaly that is associated with a developmentally aberrant subclavian artery. During thyroidectomy,this aberrant nerve may become inadvertently damaged, causing permanent ipsilateral vocal cord paralysis. However, it is possible to predict the presence of a non-recurrent laryngeal nerve by preoperative diagnosis of an aberrant subclavian artery. We report a case of thyroid surgery associated with a right non-recurrent laryngeal nerve that was unnoticed preoperatively in a CT scan of the neck, but was encountered incidentally during the thyroidectomy. The preoperative CT scan showed a retroesophageal aberrant right subclavian artery, but it was unnoticed. The female patient underwent a total thyroidectomy with central compartment node dissection for a thyroid cancer. The recurrent laryngeal nerve on the left side was identified, as was the non-recurrent laryngeal nerve on the right side. Postoperatively, the patient had normal vocal cord function. It is possible to predict preoperatively a right non-recurrent laryngeal nerve by identifying an aberrant right subclavian artery on the CT scan of the neck, which likely enables prevention of vocal cord paralysis.
Subject(s)
Female , Humans , Diagnosis , Laryngeal Nerves , Neck , Recurrent Laryngeal Nerve , Subclavian Artery , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , Tomography, X-Ray Computed , Vocal Cord Paralysis , Vocal CordsABSTRACT
A non-recurrent laryngeal nerve is rarely encountered condition, and its anomalous path makes it more vulnerable to injury during thyroid surgery and compression by a thyroid mass. This anomaly appears as a consequence of an aberrant subclavian artery, which arises from an anomaly in the primitive forth aortic arch. So, the surgeon must always be aware of the possibility of a nonrecurrent laryngeal nerve. Pre-operative recognition of this nerve allows surgeons to avoid the nerve injury. In some cases, surgeons are able to predict the presence of this nerve pre-operatively by way of clinical symptoms, chest X-ray or barium swallow. We experienced a case of right nonrecurrent laryngeal nerve during a total thyroidectomy in a 47-year-old female, and report with literature review.