Nonrecurrent laryngeal nerve: A rare clinical presentation in thyroid surgery- A report of 2 cases

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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The Role of Intraoperative Nerve Monitoring in the Detection of the Nonrecurrent Laryngeal Nerve During Thyroid Surgery

VideoEndocrinology ◽

10.1089/ve.2014.0019 ◽

2014 ◽

Vol 1 (3) ◽

Author(s):

Salem I. Noureldine ◽

Ralph P. Tufano

Keyword(s):

Thyroid Surgery ◽

Laryngeal Nerve ◽

Nerve Monitoring ◽

Nonrecurrent Laryngeal Nerve ◽

Intraoperative Nerve Monitoring

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Importance of pre-operative recognition of the nonrecurrent laryngeal nerve

The Journal of Laryngology & Otology ◽

10.1017/s0022215100126957 ◽

1994 ◽

Vol 108 (5) ◽

pp. 417-419 ◽

Cited By ~ 19

Author(s):

Ikuo Nagayama ◽

Yozo Okabe ◽

Hideaki Katoh ◽

Mitsuru Furukawa

Keyword(s):

Aortic Arch ◽

Thyroid Surgery ◽

Decisive Role ◽

Laryngeal Nerve ◽

Barium Swallow ◽

X Ray ◽

Aortic Arch Anomaly ◽

Abnormal Shadow ◽

Chest X Ray ◽

Nonrecurrent Laryngeal Nerve

AbstractThe nonrecurrent laryngeal nerve is vulnerable during thyroid surgery. Pre-operative recognition of this nerve allows surgeons to avoid injuring the nerve. This anomaly depends upon the aortic arch anomaly and, therefore, in some cases, surgeons are able to predict the presence of this nerve pre-operatively by chest X-ray or barium swallow. Two patients with nonrecurrent laryngeal nerve are reported, one of whom, a 48-year-old man, had an abnormal shadow of the aortic arch, which led to confirmation of a right aberrant subclavian artery. Barium swallow plays a decisive role in the diagnosis of nonrecurrent laryngeal nerve, and this test is mandatory in patients who complain of difficulty in swallowing.

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Ipsilateral nonrecurrent laryngeal nerve palsy and delayed palsy of the contralateral recurrent laryngeal nerve in a case of third-time reoperative thyroid surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0191 ◽

2019 ◽

Vol 101 (2) ◽

pp. e55-e58

Author(s):

S Wijerathne ◽

X Goh ◽

R Parameswaran

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Nerve Palsy ◽

Late Onset ◽

Contralateral Side ◽

Laryngeal Nerve ◽

Aberrant Right Subclavian Artery ◽

Appropriate Therapy ◽

Nonrecurrent Laryngeal Nerve ◽

Reoperative Thyroid Surgery

The occurrence of nonrecurrent laryngeal nerve and delayed nerve palsy of the contralateral nerve occurring simultaneously has never been described. A 67-year-old woman underwent reoperative completion thyroidectomy for enlarging thyroid nodules with recurrent hyperthyroidism and obstructive symptoms. Preoperative computed tomography of the neck showed a large compressive goitre with an aberrant right subclavian artery. At surgery, a type 1 nonrecurrent laryngeal nerve was found and inadvertently transected due to dense adhesions. It was repaired with ansa cervicalis graft. A fully preserved and functional recurrent laryngeal nerve was seen on the contralateral side at the end of surgery. However, the patient developed a delayed palsy on day 4 of the recurrent laryngeal nerve requiring a tracheostomy. Following successful speech and swallowing therapy, the patient was decannulated with good phonation and recovery of the left cord. Patients are at risk of bilateral nerve injury and late onset palsy in reoperative thyroid surgery. Management can be challenging and should be recognised to ensure appropriate therapy.

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Anatomical Variations in Recurrent Laryngeal Nerves in Thyroid Surgery

Ear Nose & Throat Journal ◽

10.1177/0145561320927565 ◽

2020 ◽

pp. 014556132092756 ◽

Cited By ~ 1

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.

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The Nonrecurrent Laryngeal Nerve Without Abnormal Subclavian Artery: Report of Two Cases and Review of the Literature

Ear Nose & Throat Journal ◽

10.1177/01455613211056547 ◽

2021 ◽

pp. 014556132110565

Author(s):

Ying Lu ◽

ChengHui Deng ◽

Ning Lan ◽

PinXiu Wang ◽

HuaZe Xi ◽

...

Keyword(s):

Carotid Artery ◽

Vagus Nerve ◽

Subclavian Artery ◽

Thyroid Surgery ◽

Laryngeal Nerve ◽

Inferior Laryngeal Nerve ◽

Review Of The Literature ◽

Nonrecurrent Inferior Laryngeal Nerve ◽

Nonrecurrent Laryngeal Nerve ◽

Neural Monitoring

As a variant of recurrent inferior laryngeal nerve (RILN), the nonrecurrent inferior laryngeal nerve (NRILN) is closely related to the occurrence of abnormal subclavian artery (ASA). The nonrecurrent inferior laryngeal nerve has been found in patients without arterial abnormalities, which is seen in the coexistence of NRILN and RILN, but it is easily confused with sympathetic-inferior laryngeal anastomosis branch (SILAB). We encountered 2 right NRILN patients without ASA during thyroid surgery. This article summarizes the characteristics of these cases and proposes methods to distinguish the coexistence of NRILN and RILN from SILAB. So far, 11 articles have reported 16 cases of NRILN without arterial abnormalities. In patients without artery abnormality, the vagus nerve could send out a descending branch NRILN at the bifurcation of the carotid artery and enter the larynx after anastomosis with RILN. Adequate dissection of the carotid sheath may avoid confusion with SILAB, and neural monitoring is also expected to provide a reference for the identification.

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Nonrecurrent Laryngeal Nerve: A Case Report and Literature Review

Journal of Clinical Otorhinolaryngology ◽

10.31579/2692-9562/005 ◽

2020 ◽

Vol 2 (1) ◽

pp. 01-04

Author(s):

Enrico Amadei

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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Nonrecurrent laryngeal nerve-an anatomical deviation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213301 ◽

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

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. 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. 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.

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