Intraoperative identification of the nonrecurrent laryngeal nerve during thyroid surgery / 中华普通外科杂志

Objective To discuss how to identify the nerve and prevent the injury of the nonrecurrent laryngeal nerve during thyroid surgery. Methods The clinical data of 3078 patients undergoing thyroid resection were retrospectively analyzed. Results From January 1981 to December 2001,3078 thyroidectomy was performed at our department with the routine exploration of the recurrent laryngeal nerve.4241 recurrent laryngeal nerves were identified,among them there were 12 nonrecurrent laryngeal nerves(0.28%,12/4241),ofwhich all were right-sided.One patient was male and 11 female.Of these 12 cases,there were 2 of type Ⅰ(16.67%,2/12),6 of type Ⅱ(50%,6/12)and 4 of type Ⅲ (33.33%,4/12).One ofthe type Ⅰ patients suffered from intraoperative injury of his nonreurrent laryngeal nerve.Conclusions The careful intraoperative identification of the nonrecurrent laryngeal nerve helps prevent it from the inadvertent injury.

Analysis of the Korean Cases of Nonrecurrent Laryngeal Nerve / 대한내분비외과학회지

PURPOSE: This study was performed to readjust the clinical implications of a nonrecurrent laryngeal nerve by assessing the reported Korean cases of a nonrecurrent laryngeal nerve. METHODS: We analyzed the cases of nonrecurrent laryngeal nerve that have been reported in Korea between 1997 and 2008 by reviewing the literature. An internet search was conducted in the NDSL (National Digital Science Library) and the Korean Medical Database. RESULTS: The data included 3 men and 25 women with an average age of 45.1 (age range: 28~58). All the cases were right-sided, and the incidence rate was 0.38% and 0.86% in two articles, respectively. There was a type I variation in 4 cases (17.4%), type IIa in 19 cases (82.6%), and the others are unknown. Twenty-five cases (89.3%) had the vascular anomaly called arteria lusoria. Only 8 cases (28.6%) were preoperatively predicted as possibly having a nonrecurrent laryngeal nerve. Iatrogenic nerve injury developed in 1 case (3.57%) with a type I variation during the postoperative period. CONCLUSION: A similar tendency for the incidence rate, the genderratio, the type distribution and vascular anomaly was observed when comparing the Korean reports with those reports of overseas. The nonrecurrent laryngeal nerve can be preoperatively predicted if proper attention is given when vascular anomaly is noted on CT or USG, and injury will be avoided by intraoperatively following the standard operation technique. There is currently an increasing incidence of thyroid diseases, and so adequate attention must be given to the possibility of a nonrecurrent laryngeal nerve and its management.

A Case of Concurrent Medullary and Papillary Microcarcinoma of the Thyroid with Nonrecurrent Laryngeal Nerve / 대한이비인후과학회지

We report a case of concurrent medullary and papillary microcarcinoma of the thyroid gland. We also found a nonrecurrent laryngeal nerve in the right side. The nonrecurrent laryngeal nerve is an unusual and potentially serious postoperative complication. A 36-year-old female underwent right hemithyroidectomy for follicular neoplasm, diagnosed by fine needle aspiration biopsy. The histopathologic report demonstrated a medullary microcarcinoma in one nodule with lymph node metastasis and papillary thyroid micocarcinoma in other two lesions. Incidentally, we also found an aberrant right subclavian artery by computed tomography and confirmed nonrecurrent laryngeal nerve in surgery. We performed completion thyroidectomy with central and lateral neck lymph nodes dissection. We could not find any more carcinoma on the pathologic examination. The patient was given radioactive iodine therapy for remnant thyroid ablation. The patient is scheduled to check serum calcitonin and CEA level every 3 months.

Nonrecurrent Laryngeal Nerve / 대한내분비외과학회지

The nonrecurrent laryngeal nerve is a rare anomaly that may increase the risk of nerve injury during thyroid surgery. We experienced a case of nonrecurrent laryngeal nerve seen in a 35-year-old woman with adenomatous hyperplasia on her right thyroid. The nonrecurrent laryngeal nerve was incidentally found during the right thyroid lobectomy. It directly branched from the right vagus nerve and followed a transverse path parallel to the trunk of the inferior thyroid artery. The right lobectomy was performed with a careful preservation of the nerve. Postoperatively, the review of CT scan which was taken preoperatively revealed an aberrant right subclavian artery, which arose from the aortic arch and crossed behind the esophagus. To avoid an inadvertent injury to the nonrecurrent laryngeal nerve during thyroid surgery, it is important to be aware of the possibility of a nonrecurrent laryngeal nerve, particularly when an aberrant right subclavian artery is recognized preoperatively.

Nonrecurrent laryngeal nerve: A case report and anatomical review.

The nonrecurrent laryngeal nerve is at risk of injury during thyroid surgery as it passes directly from the vagus nerve to the larynx. A patient with this nerve is reported. This anomaly depends upon the aortic arch anomaly. The presence of right aberrant subclavian artery was confirmed by the compression and distortion of the esophagus shown by barium swallow in this case. This report includes the anatomical review and its clinical significance.