An Abnormal Route of the Recurrent Inferior Laryngeal Nerve with the Divergence of the Right Subclavian Artery at a High Position in a Patient

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

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Prevalence of the Right Nonrecurrent Inferior Laryngeal Nerve in a Series of 100 Total Thyroidectomies

International Journal of Morphology ◽

10.4067/s0717-95022018000100149 ◽

2018 ◽

Vol 36 (1) ◽

pp. 149-158

Author(s):

Blás Antonio Medina-Ruíz ◽

Marta Osorio-Fleitas ◽

María Belen Persano ◽

Héctor Ricardo Dami ◽

Ricardo Blasdimir Vega ◽

...

Keyword(s):

Laryngeal Nerve ◽

Inferior Laryngeal Nerve ◽

Nonrecurrent Inferior Laryngeal Nerve ◽

The Right

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

Case Reports in Medicine ◽

10.1155/2012/143049 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 5

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.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215113000054 ◽

2013 ◽

Vol 127 (5) ◽

pp. 525-527 ◽

Cited By ~ 1

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.

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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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