scholarly journals Nonrecurrent laryngeal nerve-an anatomical deviation

2021 ◽  
Vol 7 (9) ◽  
pp. 1562
Author(s):  
E. Sivakumar ◽  
C. A. Swapna ◽  
Lavanya Karanam
Keyword(s):  
Thyroid Surgery ◽  
Vocal Cord Palsy ◽  
Needle Aspiration ◽  
Laryngeal Nerve ◽  
Nodular Goitre ◽  
Complications Of Thyroidectomy ◽  
Right Lobe ◽  
Nonrecurrent Laryngeal Nerve ◽  
Needle Aspiration Cytology ◽  
The Right

<p>Thyroidectomy is one of the most dispute and discussed surgery. Identification of recurrent laryngeal nerve is the most important step in this surgery. Among postop complications of thyroidectomy, the commoner is haematoma, transient hypocalcaemia and hoarseness.<strong> </strong>We report a rare case of nonrecurrent laryngeal nerve in a 25-year-old male with swelling in the right thyroid lobe. A 25-year-old male presented to the ENT OPD with complaints of swelling in thyroid region for 6 months with no other symptoms. On examination there was a 2×3 cm size nodule in the right lobe of thyroid. Rest of ORL examination was normal. On ultrasonogram there was an enlarged right lobe of thyroid with a nodular goitre. Fine needle aspiration cytology showed colloid goitre. Patient was planned for right hemithyroidectomy. Right side type 1 nonrecurrent laryngeal nerve was identified at the level of superior pole of thyroid branching from vagus and entering the larynx at the level of cricothyroid joint was identified intraoperatively.<strong> </strong>In conclusion, nonrecurrent laryngeal nerve though a very rare anomaly forms a crucial anatomical structure in thyroid surgery and is prone to injury. It is one of the preventable complications during thyroid surgery leading to postop vocal cord palsy. An in-depth anatomical knowledge and diligent surgical technique will help in identification and preservation of nonrecurrent laryngeal nerve.</p>

scholarly journals The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Emin Gurleyik ◽  
Sami Dogan ◽  
Omer Gunal ◽  
Mevlut Pehlivan
Keyword(s):  
Multinodular Goiter ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Adjacent Structures ◽  
Toxic Multinodular Goiter ◽  
Posterior Extension ◽  
Right Lobe ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Case Based

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy.

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 Hepatic Adenoma - A Case Report

2016 ◽  
pp. 59-62
Author(s):  
Tareq M Bhuiyan ◽  
Indrajit Kumar Datta ◽  
Md Mohsin Kabir ◽  
Md Nazmul Haque ◽  
Md Golam Azam ◽  
...  
Keyword(s):  
Oral Contraceptive Pill ◽  
Abdominal Ultrasound ◽  
Malignant Cell ◽  
Needle Aspiration ◽  
Posterior Aspect ◽  
Ct Guided ◽  
Right Lobe ◽  
Alpha Feto Protein ◽  
Needle Aspiration Cytology ◽  
The Right

We report the case of a 32-year-old female who presented to us with incidental findings of a space occupying lesion (SOL) in liver on abdominal ultrasound (USG). She was taking oral contraceptive pill for last 9 years. Clinical examination was unremarkable and liver investigation revealed mildly raised Serum alanine aminotrasferase (ALT). Dyslipidemia was also present. Computed tomography (CT) identified a 2.5 cm lesion in the right lobe of liver at posterior aspect which was isodense. Alpha-feto protein was normal. CT guided Fine Needle Aspiration Cytology (FNAC) showed adequate cellular material containing organized reactive hepatocytes in the background of blood. No granuloma or malignant cell was seen. Findings were suggestive of hepatic adenoma.Birdem Med J 2015; 5(1) Supplement: 59-62

scholarly journals Anatomical Variations in Recurrent Laryngeal Nerves in Thyroid Surgery

2020 ◽  
pp. 014556132092756 ◽  
Author(s):  
Chuanchang Yin ◽  
Bin Song ◽  
Xiaoyan Wang
Keyword(s):  
Thyroid Surgery ◽  
Vocal Cord Paralysis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Original Direction ◽  
Nonrecurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerves ◽  
The Right

Objective: To study terminal bifurcation of recurrent laryngeal nerves (RLNs) with original direction to larynx entry and to decrease the risk of vocal cord paralysis in thyroid patients. Methods: The RLNs of 294 patients (482 sides) were dissected according to the branches into the larynx, and the original direction of each RLN trunk in thyroid surgery was recorded. Results: (1) About 30.9% of the RLNs gave off multiple branches into the larynx. (2) Two and 3 branches of RLNs into the larynx were found in 25.5% and 5.4% of the cases, respectively. (3) In 0.4% or 2 cases, the RLN trunk combined with the inferior branch of the vagus nerve. (4) Nonrecurrent laryngeal nerve appeared in 2 cases. (5) On the left side, 68.0%, 25.6%, and 6.4% of cases were found with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. On the right side, 69.8%, 25.8%, and 4.4% cases were identified with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. (6) The combining dissection approach was proved as successful and safe for protecting the RLN with no permanent RLN paresis. Conclusions: Because of the anatomical variation in RLNs with extralaryngeal bifurcation, it is necessary to increase the awareness of surgeons about these variations so as to protect bifurcated nerves in thyroid surgery.

scholarly journals Solitary Intrathyroid Metastasis Occurring 23 Years after Resection of Renal Cell Carcinoma

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
X. Vandemergel
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Needle Aspiration ◽  
Thyroid Lobe ◽  
Aspiration Cytology ◽  
History Of ◽  
Right Lobe ◽  
Needle Aspiration Cytology ◽  
The Right

A case of solitary intrathyroid metastasis is described in a 60-year-old male patient. He had a history of renal cell carcinoma classified as T1b resected 23 years earlier. A mass was palpable in the right thyroid lobe. Ultrasound showed a hypoechoic polylobular nodule with intense vascularisation in the right lobe. Fine needle aspiration cytology was normal, but thyroidectomy was performed due to mass enlargement, the ultrasound pattern, and the oncological history. Histological examination revealed the presence of an intrathyroid metastasis of renal cell carcinoma. The bone scan and thoracoabdominal CT scan were normal. Postoperative care was uneventful.

scholarly journals Non-Hodgkin's Lymphoma in Thyroid Gland

2013 ◽  
Vol 14 (1) ◽  
pp. 83-84
Author(s):  
Md. Mahabubur Roshed ◽  
Sk. Manowar Ahsan ◽  
Kazi Abu Rashed
Keyword(s):  
Thyroid Gland ◽  
Fine Needle Aspiration ◽  
Rare Case ◽  
Large Mass ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Right Lobe ◽  
Needle Aspiration Cytology ◽  
The Right

A rare case of primary non-Hodgkin’s Lymphoma in a 52-year-old female presented with a large mass in the right lobe of thyroid. The diagnosis was established by fine needle aspiration cytology (FNAC) followed by surgery andfinally confirmed by histopathology.DOI: http://dx.doi.org/10.3329/jom.v14i1.14584 J MEDICINE 2013; 14 : 83-84

scholarly journals A study on the recurrent laryngeal nerve injuries in thyroid surgeries at PESIMSR, Kuppam

2019 ◽  
Vol 6 (5) ◽  
pp. 1673
Author(s):  
Balaji Sonnepalli ◽  
John M. Francis ◽  
Shivananda S.
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord Palsy ◽  
Needle Aspiration ◽  
Clinical Findings ◽  
Laryngeal Nerve ◽  
Postoperative Rehabilitation ◽  
Institutional Ethics ◽  
General Surgeons ◽  
Needle Aspiration Cytology ◽  
Operative Findings

Background: Thyroid surgeries are routinely performed by general surgeons all over India. Although the incidence of recurrent laryngeal nerve (RLN) injury is uncommon, it still carries a significant impact on patient’s quality of life post operatively. Hence this study was done to identify and discuss incidence and various factors involved in RLN injury.Methods: This is a prospective observational study carried out at a rural health care setup at PES Institute of Medical Sciences and Research (PESIMSR), Kuppam. A total of 60 patients who qualified the inclusion and exclusion criteria were studied from December 2016 to June 2018. All the patient data including relevant history, clinical findings, intra operative findings and post-operative follow up were recorded and the results were tabulated. Institutional ethics committee clearance was obtained before the start of the study.Results: Out of 60 patients 51 were females and 9 were males. 30 patients had unilateral involvement and the other 30 patients had bilateral involvement of thyroid lobes on clinical and ultrasound examination. On fine needle aspiration cytology (FNAC), 57 were benign, 2 were malignant and 1 was Hashimoto’s thyroiditis. Surgeries were done according to standard protocol. Intra operatively RLN was identified in 56 patients. In 3 of them there was a structural anomaly. Postoperative hoarseness of voice was seen in 8 patients, however long term vocal cord palsy was seen in 3 patients.Conclusions: This study shows the importance of intra-operative nerve identification, incidence of RLN injury and role of postoperative rehabilitation. 

scholarly journals Thyroid Carcinoma on the Side of the Absent Lobe in a Patient with Thyroid Hemiagenesis

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Hiroki Sato ◽  
Kiyoaki Tsukahara ◽  
Ray Motohashi ◽  
Midori Wakiya ◽  
Hiromi Serizawa ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Papillary Carcinoma ◽  
Thyroid Tissue ◽  
Needle Aspiration ◽  
Left Lobe ◽  
Thyroid Hemiagenesis ◽  
Poorly Differentiated ◽  
Node Metastases ◽  
Right Lobe ◽  
The Right

Background. Thyroid carcinoma complicated by hemiagenesis is very rare, and previous reports have not described this cancer on the side of the absent lobe. Methods and Results. We report the case of a 64-year-old woman in whom left thyroid hemiagenesis was discovered incidentally during investigations of abnormal sensation during swallowing. A tumorous 1.4 cm lesion was also found on the side of the absent lobe, left of the isthmus. Fine-needle aspiration biopsy revealed class V papillary carcinoma, but no lymph node metastases. Total thyroidectomy was performed for stage cT1bN0M0 carcinoma. Histopathology revealed normal thyroid tissues in the right lobe and isthmus, while the left lobe was absent. The mostly papillary carcinoma was adjacent to the truncated thyroid tissue, with a portion histologically consistent with poorly differentiated carcinoma. Conclusions. All previously reported cases of thyroid cancer complicated by hemiagenesis have represented carcinoma occurring within the present lobe. This case is extremely rare.

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.

scholarly journals Nonrecurrent Laryngeal Nerve: A Case Report and Literature Review

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Enrico Maria Amadei ◽  
Christopher Fabbri ◽  
Marco Trebbi
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Thyroid Surgery ◽  
Recent Literature ◽  
Follicular Adenoma ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Anatomical Variant ◽  
Nonrecurrent Laryngeal Nerve

We report the case of a patient submitted to a right hemithyroidectomy for a follicular adenoma, when we found a nonrecurrent laryngeal nerve. This is a really rare anatomical presentation that can seriously compromise the integrity and preservation of the inferior laryngeal nerve during thyroid surgery. We describe how we found and managed this anatomical variant and we conduct a review of the most recent Literature about nonrecurrent laryngeal nerve.

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