Anatomical Studies of the Recurrent Laryngeal Nerve and the Subclavian Artery in Rough-Toothed Dolphins (Steno bredanensis) and Pacific White-Sided Dolphins (Lagenorhynchus obliquidens)

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.

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

Practica Oto-Rhino-Laryngologica ◽

10.5631/jibirin.85.1457 ◽

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

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Characteristic travelling patterns of non-recurrent laryngeal nerves

The Journal of Laryngology & Otology ◽

10.1017/s0022215114000978 ◽

2014 ◽

Vol 128 (6) ◽

pp. 534-539 ◽

Cited By ~ 14

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

International Surgery Journal ◽

10.18203/2349-2902.isj20213976 ◽

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

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

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i3.22989 ◽

2016 ◽

Vol 15 (3) ◽

pp. 485-487 ◽

Cited By ~ 1

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

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The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

PeerJ ◽

10.7717/peerj.3012 ◽

2017 ◽

Vol 5 ◽

pp. e3012 ◽

Cited By ~ 14

Author(s):

Brandon Michael Henry ◽

Silvia Sanna ◽

Matthew J. Graves ◽

Jens Vikse ◽

Beatrice Sanna ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Subclavian Artery ◽

Meta Analysis ◽

Laryngeal Nerve ◽

Iatrogenic Injury ◽

Aberrant Subclavian Artery ◽

Pooled Prevalence ◽

Increased Risk ◽

Clinical Considerations ◽

Reported Data

BackgroundThe Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of an NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery.MethodsThrough March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi2test and the I2statistic.ResultsFifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95% CI [0.6–0.9]). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases.ConclusionThe NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.

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

10.22541/au.162263055.54779717/v1 ◽

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.

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

Endocrine Surgery ◽

10.14341/serg10354 ◽

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.

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

Diseases of the Esophagus ◽

10.1093/dote/doab052.342 ◽

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.

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