scholarly journals A novel way of identification of recurrent laryngeal nerve during thyroid surgeries

2021 ◽  
Vol 8 (10) ◽  
pp. 2956
Author(s):  
Joe Mathew
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Direct Observation ◽  
Laryngeal Nerve ◽  
Areolar Tissue ◽  
Review Of Literature ◽  
The Right

Background: This was a report of a movement of the recurrent laryngeal nerve which can be demonstrated during thyroid surgeries which can be used for locating the nerve, or identifying it if already exposed and causing confusion with other nearby structures or when alone too.Methods: The nerve is located by observing for a superior-inferior movement of the recurrent laryngeal nerve transmitted by the loose areolar tissue over it and dissecting over this site to locate the nerve right underneath it. This was by direct observation of the movement which will be there so long as the thyroid is held retracted to the opposite side and is not separated from the thyroid at the tissues that constitute the condensation of pre-tracheal fascia called the Berry’s ligament.Results: The recurrent laryngeal nerve originates from the vagus and loops posteriorly and then upwards around the arch of aorta on the left side and the subclavian artery on the right side. When the thyroid gland is retracted away and thus the nerve put on slight stretch, a superior-inferior to and fro- movement of the nerve can be seen. This movement can be used for identification and dissection of the nerve along its course.Conclusions: A review of literature has been done and it is clear that this movement has not been hitherto identified or published

Pre-operative prediction of a right non-recurrent laryngeal nerve by computed tomography

2013 ◽  
Vol 127 (5) ◽  
pp. 525-527 ◽  
Author(s):  
B T Varghese ◽  
K P Desai ◽  
A Ramachandran
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
World Literature ◽  
Surgical Navigation ◽  
Central Compartment ◽  
Distal Portion ◽  
Laryngeal Nerve ◽  
Barium Swallow ◽  
The Right

AbstractObjective:This paper reports a case of a non-recurrent laryngeal nerve which was accurately predicted pre-operatively using computed tomography.Case report:A 61-year-old man presented with papillary thyroid carcinoma with lymph node metastasis. Computed tomography scans of the neck and chest revealed an ill-defined, hypoattenuating nodule in the right lobe of the thyroid gland, with few upper paratracheal and prevascular nodes, and clear lung fields. The retro-oesophageal course of the right subclavian artery, which was arising from the distal portion of the arch of aorta, was also incidentally revealed in the computed tomography scan. A barium swallow further confirmed the presence of a retro-oesophageal subclavian artery. Total thyroidectomy was performed, with right neck dissection and central compartment clearance. This was carried out with the presence of a non-recurrent laryngeal nerve in mind, and the nerve was accurately localised and preserved.Conclusion:To our knowledge this is the first report in the world literature of accurate pre-operative incidental imaging of the right non-recurrent laryngeal nerve in a case of metastatic thyroid cancer, and the subsequent use of computed tomography to guide surgical navigation.

Characteristic travelling patterns of non-recurrent laryngeal nerves

2014 ◽  
Vol 128 (6) ◽  
pp. 534-539 ◽  
Author(s):  
K H Hong ◽  
H T Park ◽  
Y S Yang
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Vocal Fold ◽  
Laryngeal Nerve ◽  
New Classification ◽  
Laryngeal Nerves ◽  
Brachiocephalic Trunk ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractBackground:The non-recurrent laryngeal nerve is subject to potential injury during thyroid surgery. Intra-operative identification and preservation of this nerve can be challenging. Its presence is associated with an aberrant subclavian artery and the developmental absence of the brachiocephalic trunk. This study aimed to evaluate the incidence of non-recurrent laryngeal nerves and present a new classification system for the course of these nerves.Methods:Non-recurrent laryngeal nerves were identified on the right side in 15 patients who underwent thyroidectomy. The incidence of non-recurrent laryngeal nerves (during thyroidectomy) and aberrant subclavian arteries (using neck computed tomography) was evaluated, and the course of the nerves was classified according to their travelling patterns.Results:The overall incidence of non-recurrent laryngeal nerves was 0.68 per cent. The travelling patterns of the nerves could be classified as: descending (33 per cent), vertical (27 per cent), ascending (20 per cent) or V-shaped (20 per cent).Conclusion:Clinicians need to be aware of these variations to avoid non-recurrent laryngeal nerve damage. A retroesophageal subclavian artery (on neck computed tomography) virtually assures a non-recurrent laryngeal nerve. This information is important for preventing vocal fold paralysis. Following a review of non-recurrent laryngeal nerve travelling patterns, a new classification was devised.

scholarly journals Right non recurrent laryngeal nerve associated with anomalous origin of right subclavian artery and a bicarotid trunk

2016 ◽  
Vol 15 (3) ◽  
pp. 485-487 ◽  
Author(s):  
D Maruthupandian ◽  
K Karunakaran ◽  
V Arul
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Subclavian Artery ◽  
Anatomical Variation ◽  
Medical Science ◽  
Laryngeal Nerve ◽  
Anomalous Origin ◽  
Nodular Goitre ◽  
Ct Angiogram ◽  
The Right

Non recurrent laryngeal nerve is a rare anatomical variation with an incidence in literature of 0.3 % to 1.6 % on the right side. This variation places the nerve at risk of inadvertent injury during head and neck surgeries. Awareness about this abnormality and meticulous dissection of the nerve in every case is the only way to stay safeguarded. Here we present a case of right non recurrent laryngeal nerve in a 32 years old female patient who underwent near total thyroidectomy for nontoxic multi nodular goitre. During surgery, the right recurrent laryngeal nerve could not be identified in its normal location. Further dissection revealed a non recurrent laryngeal nerve arising from the vagal trunk. A CT angiogram was done post operatively and showed an anomalous origin of the right subclavian artery as the last branch of the aortic arch and a bi-carotid trunk. Every surgeon operating on the neck should be aware of and anticipate this variation of the recurrent laryngeal nerve especially when the nerve cannot be identified in the normal location.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.485-487

Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies

2008 ◽  
Vol 123 (7) ◽  
pp. 768-771 ◽  
Author(s):  
C Page ◽  
P Cuvelier ◽  
A Biet ◽  
P Boute ◽  
M Laude ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Lateral Lobe ◽  
Anatomical Variations ◽  
Anatomical Landmark ◽  
Laryngeal Nerve ◽  
Surgical Experience ◽  
The Right

AbstractObjective:To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery.Materials and methods:We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands.Results:A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side).Conclusion:The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the ‘processus posterior glandulae thyroideae’ described by Zuckerkandl.

scholarly journals Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

2020 ◽  
Vol 13 (3) ◽  
pp. 118-132
Author(s):  
Aleksandr A. Kuprin ◽  
Viktor Y. Malyuga
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Laryngeal Nerve ◽  
Aberrant Right Subclavian Artery ◽  
Preoperative Period ◽  
Arteria Lusoria ◽  
Preoperative Ultrasound ◽  
Brachiocephalic Trunk ◽  
The Right ◽  
Neck Vessels

Background: According to the anatomical data, the non-recurrent laryngeal nerve is a rather common abnormality and can be found in 4.78% of people. At the same time, the non-recurrent laryngeal nerve is difficult to visualize during surgery, which increases the risk of its damage. Aim: to determine the possibilities of ultrasound of neck vessels in the preoperative diagnosis of the aberrant right subclavian artery (arteria lusoria) and the abnormality of the branches of the vagus nerve. Materials and methods: An observational, single-center, single-stage, randomized, uncontrolled clinical trial was performed, which included patients in whom surgery was performed due to thyroid and parathyroid pathology. In the preoperative period, all patients underwent the ultrasound of the right half of the neck vessels and the mediastinum with visualization of the brachiocephalic trunk and its branches. When the brachiocephalic trunk was detected in the preoperative period, mobilization of the thyroid gland during operation was started with ligation of the upper pole vessels, and followed by a search for the recurrent laryngeal nerve. However, if the brachiocephalic trunk was absent, the right common carotid artery was traced as low as possible to the aortic arch and assessed on its relationship with the right subclavian artery. In such cases, thyroid mobilization was started from the lateral surface of the lobe with the necessary visualization of all structures of this region and followed by a primary search for the inferior laryngeal nerve. When the non-recurrent laryngeal nerve was detected, the computed tomography of the brachiocephalic arteries was performed in the postoperative period. Results: The study has shown that 202 (95.28%) patients out of the total 212 revealed the brachiocephalic trunk on preoperative ultrasound and the recurrent laryngeal nerve was located in a the typical place. Arteria lusoria was detected in 4 (1.89%) cases after the preoperative ultrasound. In this group of patients the non-recurrent laryngeal nerve was identified during operation and the aberrant right subclavian artery was confirmed at computed tomography. In 6 (2.83%) cases the brachiocephalic trunk could not be detected on ultrasound due to the constitutional features of the patient. However, in all these cases, the typical recurrent laryngeal nerve was identified during a surgery. Conclusions: The ultrasound of the neck vessels is the effective method to detect arteria lusoria, which is the predictor of the non-recurrent laryngeal nerve.

scholarly journals Non-Recurrent Laryngeal Nerve - A Surgical Challenge

2020 ◽  
Vol 7 (43) ◽  
pp. 2508-2510
Author(s):  
Shib Shankar Paul ◽  
Subrata Kumar Sahu ◽  
Indranil Chatterjee
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Aberrant Right Subclavian Artery ◽  
Fascial Spaces ◽  
The Right ◽  
Tracheoesophageal Groove ◽  
Intrinsic Muscles

Both the cases discussed here had right sided NRLN, out of which one had associated aberrant right subclavian artery. None had iatrogenic nerve palsy. Dissection was difficult as during the routine procedure of dissection, the nerve was not found in its usual route and was found that the right laryngeal nerve was not recurrent and originated directly from the vagus nerve. The non-recurrent laryngeal nerve (NRLN) is a rare embryologically derived variant of the recurrent laryngeal nerve and is found in 0.25 to 0.99% of patients who undergo thyroid surgery. On the right side, NRLN is found in 0.3% to 0.8% of patients and it is extremely rare on the left (0.004%).[1-2] The right NRLN is found to be associated with an aberrant right subclavian artery (86.7%) In experienced hands, meticulous dissection in the region of the tracheoesophageal groove will result in identification of RLN. In any case, if the nerve is not seen / found longitudinally along the tracheoesophageal groove, then dissecting transversely along the fascial spaces between the carotid sheath and the larynx, will allow identification of the presence of NRLN. Recurrent laryngeal nerve is a branch of the vagus nerve that is associated with both motor function and sensation of the larynx. It supplies all the intrinsic muscles of the larynx except the cricothyroid muscles. The non-recurrent laryngeal nerve (NRLN) is a rare embryologically derived variant of the recurrent laryngeal nerve and occurs in 0.25 to 0.99% of patients who undergo thyroid surgery and was first reported by Steadman in 1823.[3] on the right side, NRLN is found in 0.3% to 0.8% of patients and on the left side, it is extremely rare (0.004%).[1-2] The right NRLN is found to be associated with an aberrant right subclavian artery (86.7%).[1],[4] The NRLN is usually an unexpected surgical discovery, specifically during thyroidectomy. Hence, adequate anatomic knowledge of the normal course and variations/types of NRLN, and careful dissection during surgery is necessary to prevent iatrogenic injury to the nerve. We are reporting two cases of NRLN, which were identified while performing total thyroidectomy in patients diagnosed with papillary ca thyroid.

Non-recurrent laryngeal nerve related to thyroid surgery: report of three cases

2007 ◽  
Vol 122 (7) ◽  
pp. 757-761 ◽  
Author(s):  
C Page ◽  
P Monet ◽  
J Peltier ◽  
B Bonnaire ◽  
V Strunski
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Frequency Of Occurrence ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractPurpose of the study:We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery.Materials and methods:Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed.Results:Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery.Discussion:Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches.Conclusion:The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.

Anatomical and developmental aspects of iatrogenic injury to the right recurrent laryngeal nerve in surgical resections of substernal goiter

2021 ◽  
Author(s):  
Rossano Kepler Alvim Fiorelli ◽  
Alfredo Jorge Vasconcelos Duarte ◽  
Aline de Quadros Teixeira ◽  
Thiago Scharth Montenegro ◽  
Pedro Eder Portari Filho ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Iatrogenic Injury ◽  
Substernal Goiter ◽  
The Right

Neonatal Vocal Cord Paralysis Following Extracorporeal Membrane Oxygenation

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 793-796 ◽  
Author(s):  
Robert E. Schumacher ◽  
Irvin J. Weinfeld ◽  
Robert H. Bartlett
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Membrane Oxygenation ◽  
The Right ◽  
Unilateral Vocal Cord Paralysis

Five cases of unilateral vocal cord paralysis/ paresis were diagnosed following extracorporeal membrane oxygenation for newborn respiratory failure. All were right sided and transient in nature. None of the five patients had other findings commonly associated with vocal cord palsy. The extracorporeal membrane oxygenation procedure requires surgical dissection in the carotid sheath on the right side of the neck, an area immediately adjacent to both the vagus and recurrent laryngeal nerve. It is speculated that vocal cord paralysis in these infants was acquired as a result of the extracorporeal membrane oxygenation cannulation. Although the vocal cord paralysis resolved in all cases, two patients had difficult courses after extracorporeal membrane oxygenation. Therefore, laryngoscopic examination should be considered for patients after extracorporeal membrane oxygenation.

Sign in / Sign up

Export Citation Format

Share Document