scholarly journals Non Recurrent Laryngeal Nerve and Arteria Lusoria: Rare and Little Known Association

2021 ◽  
Author(s):  
Azza Mediouni ◽  
Hela Sayedi ◽  
houda chahed ◽  
Ghazi Besbes
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Laryngeal Nerve ◽  
Aberrant Right Subclavian Artery ◽  
Rare Entity ◽  
Arteria Lusoria

Non recurrent laryngeal nerve (NRLN) is an extremely rare entity constantly associated with an aberrant right subclavian artery also called arteria lusoria. Knowing this association can help predicting a NRLN preoperatively and thus to prevent its injury. We present two patients in whome this association was proven.

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.

342 SURGICAL TREATMENT OF ESOPHAGEAL CANCER WITH VARIATIONS OF THE AORTIC ARCH AND ITS BRANCHES

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Baiwei Li ◽  
Liang Dai ◽  
Haoyao Jiang ◽  
Zhigang Li ◽  
Keneng Chen
Keyword(s):  
Esophageal Cancer ◽  
Surgical Treatment ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Laryngeal Nerve ◽  
Aberrant Right Subclavian Artery ◽  
Significant Group ◽  
Term Survival

Abstract   The variations of the aortic arch and its branches are rare. The surgical treatment of esophageal cancer would be challenged for combination with this anomaly. This study intends to review significant group cases to analyze the influence of this variation on esophagectomy. Methods From 2013 to 2019, 19 patients with aortic arch and brachiocephalic vessels variations underwent esophagectomy, accounting for 0.3% during the same period. The abnormalities were distributed as follows: left-sided aortic arch combined with aberrant right subclavian artery (LAA + ARSA) occurred 13 cases, right-sided aortic arch anomalies with mirror image arch branches (RAA + MIAB) in 1 case, and right-sided aortic arch combined with aberrant left subclavian artery (RAA + ALSA) in 5 case. Of the patients with LAA + ARSA, 11 patients underwent the McKeown esophagectomy, and 2 patients via transhiatal. All patients with RAA underwent left thoracotomy approach.Perioperative outcomes and long-term survival were analyzed. Results The tumors were mostly located in the upper and middle thorax (47.4% and 42.1%). The R0 resection rate was 89.5% (17/19). Recurrent laryngeal nerve injury occurred in 2 patients, anastomotic fistula in 1 patient. Two patients died within 30 days postoperatively. The yield of lymph nodes was 21.8 ± 9.4. The sampling rate of lymph nodes along the recurrent laryngeal nerve was 61.5% in LAA + ARSA group, while 16.7% in RAA group. Recurrence happened in 5 cases (29.4%), including 2 regional relapse. Four patients died after recurrence, with a median time to death of 20 months (range: 10–48 months). Conclusion For aortic arch and brachiocephalic artery variations in esophageal cancer, aberrant right subclavian artery and right-sided aortic arch are the most common types. The surgical strategy is closely related to the aortic arch position. Due to the combined variation of the recurrent laryngeal nerve, the upper mediastinal lymph nodes dissection would be conservative, but with acceptable oncologic results.

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.

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.

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 A Case of Non-Recurrent Laryngeal Nerve with Abnormal Right Subclavian Artery.

1992 ◽  
Vol 85 (9) ◽  
pp. 1457-1462
Author(s):  
Masaki Ohmura ◽  
Etsuo Yamamoto ◽  
Koichi Omori ◽  
Chikashi Mizukami ◽  
Hiroyuki Oiki ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Laryngeal Nerve

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.

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