scholarly journals Nonrecurrent Laryngeal Nerve : A Rare Entity

2012 ◽  
Vol 02 (01) ◽  
pp. 42-44 ◽  
Author(s):  
Shrinath D. Kamath P. ◽  
Pretty Rathnakar ◽  
Kishore Shetty
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Head And Neck ◽  
Situs Inversus ◽  
Postoperative Morbidity ◽  
Laryngeal Nerve ◽  
Rare Entity ◽  
Risk Of Injury ◽  
Nonrecurrent Laryngeal Nerve ◽  
High Index Of Suspicion

AbstractThe non recurrent laryngeal nerve (nRLN) is a rare abnormal condition that the head and neck surgeon must aware of in order to avoid postoperative morbidity. High index of suspicion, Preoperative recognition of patients with situs inversus, dysphagia lusoria, identification of medialised vagus nerve and meticulous dissection can minimise the risk of injury to nRLN intraoperatively.We are reporting a case of nRLN observed during hemithyroidectomy for a 53 year old female patient.

scholarly journals Nonrecurrent Laryngeal Nerve: An Indian Documentation

2012 ◽  
Vol 3 (1) ◽  
pp. 28-29 ◽  
Author(s):  
Sagaya Raj ◽  
Ravi Padmakar Deo ◽  
Azeem Mohiyuddin ◽  
Shuaib Merchant ◽  
Manaswini Ramachandra
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Head And Neck ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Vascular Anomaly ◽  
Signs And Symptoms ◽  
Nerve Damage ◽  
Laryngeal Nerve ◽  
Review Of Literature ◽  
Nonrecurrent Laryngeal Nerve

ABSTRACT Purpose of the study Aimed to highlight a rare anatomical variation of right recurrent laryngeal nerve and a brief review of literature. Nonrecurrent laryngeal nerve is a rare anatomical variation with an incidence of 0.5 to 0.7% in thyroid surgery. It is difficult to identify this variation preoperatively either by imaging or by signs and symptoms, unless a vascular anomaly is suspected. This study aims to underline the necessity of recognizing the possibility of non-RLN and also to follow a systematic dissection of recurrent laryngeal nerve during thyroid surgeries, to prevent intraoperative nerve damage. How to cite this article Raj S, Deo RP, Mohiyuddin A, Merchant S, Ramachandra M. Nonrecurrent Laryngeal Nerve: An Indian Documentation. Int J Head and Neck Surg 2012;3(1):28-29.

Cricotracheal separation: a review and a case with bilateral recovery of recurrent laryngeal nerve function

2006 ◽  
Vol 120 (6) ◽  
pp. 497-501 ◽  
Author(s):  
D J McCrystal ◽  
C Bond
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Unusual Case ◽  
Open Repair ◽  
Laryngeal Nerve ◽  
Clinical Suspicion ◽  
Nerve Function ◽  
Short Term ◽  
High Index Of Suspicion ◽  
Type Of Injury

Cricotracheal separation (CTS) is an uncommon injury, with a high index of suspicion required to establish the diagnosis. Computerized tomography (CT) plays a role in diagnosis but cannot necessarily be relied upon. Bilateral recurrent laryngeal nerve (RLN) palsies are usually associated with this type of injury. We recently treated a patient with CTS in whom one RLN was intact from the time of the injury and the other nerve recovered within three months. Computed tomography was inconclusive.Early open repair of the injury and frequent follow-up examinations led to successful decannulation after six weeks and excellent short-term voice and airway outcomes.A detailed discussion of this unusual case is followed by a review of the current literature on CTS, with particular emphasis on significant management dilemmas and controversies.Clinical suspicion remains more sensitive than investigations in diagnosing CTS. Permanent bilateral RLN palsies are not inevitable following these injuries.

scholarly journals Tracheoesophageal groove: a reliable landmark

2019 ◽  
Vol 5 (3) ◽  
pp. 545
Author(s):  
Nitika Gupta ◽  
Rohan Gupta ◽  
Inderpal Singh ◽  
Sunil Kotwal
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Head And Neck ◽  
Thyroid Surgery ◽  
Neck Surgery ◽  
Laryngeal Nerve ◽  
Posterior Half ◽  
Vocal Cords ◽  
Important Landmark ◽  
Tracheoesophageal Groove ◽  
The Brain

<p class="abstract"><strong>Background:</strong> Galen first described the recurrent laryngeal nerve (RLN) as a nerve that descended from the brain to the heart, then reversed the course and ascended to the larynx and caused the vocal cords to move. Tracheoesophageal groove is useful for identifying the RLN. In the present study we studied the course of RLN in tracheoesophageal groove and its anatomical position, in patients undergoing thyroid surgery.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in the Department of ENT and Head and Neck Surgery, SMGS Hospital, for a period of two years, on the patients who underwent thyroid surgeries. Tracheoesophageal groove was considered first landmark to identify RLN position and only after meticulous dissection in the groove, the nerve could be identified. The nerve was carefully dissected and its position evaluated in relation with trachea and esophagus.  </p><p class="abstract"><strong>Results:</strong> Trajectory of the nerves studied in the patients was mostly in the tracheoesophageal groove (TEG), seen in 113 (69.75%) nerves. 16.05% of the nerves were seen in the posterior half of the trachea while 4.94% of the nerves were seen to travel from TEG to anterior half of trachea and 1.85% from TEG to posterior half of trachea. 6.17% of nerves travelled from oesophagus to the TEG.</p><p class="abstract"><strong>Conclusions:</strong> A uniform dissection procedure should be followed and the recurrent laryngeal nerve must be first looked for in the TEG, which serves as important landmark and later any deviation must be considered.</p><p class="abstract"> </p>

Stimulation of vagal C-fibers alters timing and distribution of respiratory motor output in cats

1989 ◽  
Vol 67 (6) ◽  
pp. 2249-2256 ◽  
Author(s):  
H. R. Holmes ◽  
J. E. Remmers
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Breathing Pattern ◽  
Laryngeal Nerve ◽  
C Fibers ◽  
Vascular Congestion ◽  
Vagal Afferent ◽  
Posterior Cricoarytenoid ◽  
The Right ◽  
Decerebrate Cats

Pulmonary vascular congestion or pulmonary embolism in humans produces shallow tachypnea, and indirect experimental evidence suggests that this characteristic breathing pattern may result from activation of vagal unmyelinated afferents from the lung. We have investigated, in decerebrate cats, reflex changes in breathing pattern and in the activation of the diaphragm, posterior cricoarytenoid, and thyroarytenoid muscles caused by activating C-fiber afferents in the vagus nerve. The right vagus nerve was sectioned distal to the origin of the recurrent laryngeal nerve, eliminating vagal afferent traffic although preserving motor innervation of the larynx on that side. The left cervical vagus was stimulated electrically, and efferent activation of the laryngeal muscles was avoided by cutting the left recurrent laryngeal nerve. Transmission to the brain of vagal afferent traffic resulting from this stimulation was controlled by graded cold block of the nerve cranial to the site of application of the stimulus. Activation of C-fibers, when A-fibers were blocked, significantly decreased respiratory period and amplitude of diaphragm inspiratory burst. In addition, this selective activation of vagal C-fibers augmented postinspiratory activity of the diaphragm and recruited phasic expiratory bursts in the thyroarytenoid. We conclude that, in unanesthetized decerebrate cats, afferent traffic of vagal C-fibers initiates a pontomedullary reflex that increases respiratory frequency, decreases tidal volume, and augments braking of expiratory airflow.

Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury

Head & Neck ◽  
2012 ◽  
Vol 35 (11) ◽  
pp. 1591-1598 ◽  
Author(s):  
Rick Schneider ◽  
Gregory W. Randolph ◽  
Carsten Sekulla ◽  
Eimear Phelan ◽  
Phuong Nguyen Thanh ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

scholarly journals Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Emin Gurleyik ◽  
Gunay Gurleyik
Keyword(s):  
Early Stage ◽  
Anatomical Variation ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Proximal Point ◽  
Nerve Monitoring ◽  
Risk Of Injury ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Intraoperative Nerve Monitoring

Nonrecurrent laryngeal nerve (non-RLN) is an anatomical variation increasing the risk of vocal cord palsy. Prediction and early identification of non-RLN may minimize such a risk of injury. This study assessed the effect of intraoperative neuromonitoring (IONM) on the detection of non-RLN. A total of 462 (236 right) nerves in 272 patients were identified and totally exposed, and all intraoperative steps of IONM were sequentially applied on the vagus nerve (VN) and RLN. Right predissection VN stimulation at a distal point did not create a sound signal in three cases (3/236; 1.27%). Proximal dissection of the right VN under IONM guidance established a proximal point, creating a positive signal. The separation point of non-RLN from VN was discovered in all three patients. Non-RLNs were exposed from separation to laryngeal entry. Positive IONM signals were obtained after resection of thyroid lobes, and postoperative period was uneventful in patients with non-RLN. Absence of distal VN signal is a precise predictor of the non-RLN. IONM-guided proximal dissection of the right VN leads to identification of the non-RLN. The prediction of non-RLN by the absence of the VN signal at an early stage of surgery may prevent or minimize the risk of nerve injury.

scholarly journals Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for the First Time

2020 ◽  
pp. 014556132091898
Author(s):  
Ayad Ahmad Mohammed ◽  
Sardar Hassan Arif
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Neck Surgery ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Thyroid Function Tests ◽  
Ligamentum Arteriosum ◽  
Laryngeal Nerves ◽  
Thyroid Lobectomy ◽  
The Right

Introduction: The recurrent laryngeal nerve gains its name because after branching from the vagus nerve, it turns superiorly (recur) around the subclavian artery on the right and around the ligamentum arteriosum on the left, the nonrecurrent nerve has a straight direct course to the larynx and doesn’t follow this course. It presents mostly on the right side. The presence of this variation places the nerve at higher risk of injury during neck surgery especially thyroid operations. Case Presentation: A 45-year-old lady presented with painless thyroid enlargement for 1 year. Thyroid examination showed a 3-cm firm nodule at the right thyroid lobe with normal thyroid function tests. Right thyroid lobectomy was done and the histopathology showed a benign follicular lesion. During surgery, we discovered 2 nonrecurrent laryngeal nerves at the right side which were arising from the vagus nerve and both were entering the larynx. Conclusion: Failure in identification of the nerve or overlooking the possibility of the non-recurrent laryngeal nerve may result in a serious sequelae of nerve damage, ipsilateral injury may lead to permanent hoarseness and bilateral injury may result in severe dyspnea or aphonia. Currently, there are 3 types of nonrecurrent laryngeal nerve courses. Type 1 passes near to the superior thyroid vessels. Type 2 (2A) passes parallel to the inferior thyroid artery and has a transverse course above it. Type 3 (2B) passes parallel to the inferior thyroid artery and transversely between branches of or under the inferior thyroid artery, we can add to this classification type 4, which are 2 nonrecurrent laryngeal nerves (double nerves) passing above and parallel to the inferior thyroid artery.

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