Nonrecurrent Laryngeal Nerve: An Indian Documentation

ABSTRACT Purpose of the study Aimed to highlight a rare anatomical variation of right recurrent laryngeal nerve and a brief review of literature. Nonrecurrent laryngeal nerve is a rare anatomical variation with an incidence of 0.5 to 0.7% in thyroid surgery. It is difficult to identify this variation preoperatively either by imaging or by signs and symptoms, unless a vascular anomaly is suspected. This study aims to underline the necessity of recognizing the possibility of non-RLN and also to follow a systematic dissection of recurrent laryngeal nerve during thyroid surgeries, to prevent intraoperative nerve damage. How to cite this article Raj S, Deo RP, Mohiyuddin A, Merchant S, Ramachandra M. Nonrecurrent Laryngeal Nerve: An Indian Documentation. Int J Head and Neck Surg 2012;3(1):28-29.

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Tracheoesophageal groove: a reliable landmark

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190967 ◽

2019 ◽

Vol 5 (3) ◽

pp. 545

Author(s):

Nitika Gupta ◽

Rohan Gupta ◽

Inderpal Singh ◽

Sunil Kotwal

Keyword(s):

Recurrent Laryngeal Nerve ◽

Head And Neck ◽

Thyroid Surgery ◽

Neck Surgery ◽

Laryngeal Nerve ◽

Posterior Half ◽

Vocal Cords ◽

Important Landmark ◽

Tracheoesophageal Groove ◽

The Brain

Background: Galen first described the recurrent laryngeal nerve (RLN) as a nerve that descended from the brain to the heart, then reversed the course and ascended to the larynx and caused the vocal cords to move. Tracheoesophageal groove is useful for identifying the RLN. In the present study we studied the course of RLN in tracheoesophageal groove and its anatomical position, in patients undergoing thyroid surgery.Methods: The study was conducted in the Department of ENT and Head and Neck Surgery, SMGS Hospital, for a period of two years, on the patients who underwent thyroid surgeries. Tracheoesophageal groove was considered first landmark to identify RLN position and only after meticulous dissection in the groove, the nerve could be identified. The nerve was carefully dissected and its position evaluated in relation with trachea and esophagus. Results: Trajectory of the nerves studied in the patients was mostly in the tracheoesophageal groove (TEG), seen in 113 (69.75%) nerves. 16.05% of the nerves were seen in the posterior half of the trachea while 4.94% of the nerves were seen to travel from TEG to anterior half of trachea and 1.85% from TEG to posterior half of trachea. 6.17% of nerves travelled from oesophagus to the TEG.Conclusions: A uniform dissection procedure should be followed and the recurrent laryngeal nerve must be first looked for in the TEG, which serves as important landmark and later any deviation must be considered.

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Nonrecurrent Laryngeal Nerve : A Rare Entity

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703556 ◽

2012 ◽

Vol 02 (01) ◽

pp. 42-44 ◽

Cited By ~ 1

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.

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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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Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies

The Journal of Laryngology & Otology ◽

10.1017/s0022215108004003 ◽

2008 ◽

Vol 123 (7) ◽

pp. 768-771 ◽

Cited By ~ 18

Author(s):

C Page ◽

P Cuvelier ◽

A Biet ◽

P Boute ◽

M Laude ◽

...

Keyword(s):

Thyroid Gland ◽

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Anatomical Variation ◽

Lateral Lobe ◽

Anatomical Variations ◽

Anatomical Landmark ◽

Laryngeal Nerve ◽

Surgical Experience ◽

The Right

AbstractObjective:To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery.Materials and methods:We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands.Results:A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side).Conclusion:The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the ‘processus posterior glandulae thyroideae’ described by Zuckerkandl.

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Muscle Spasms after Thyroidectomy: What Went Wrong?

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1117 ◽

2013 ◽

Vol 5 (1) ◽

pp. 16-17

Author(s):

Ryan M Antiel ◽

David R Farley ◽

Mark J Heidenreich ◽

Diana S Dean

Keyword(s):

Postoperative Complications ◽

Recurrent Laryngeal Nerve ◽

Hospital Discharge ◽

Thyroid Surgery ◽

Nerve Damage ◽

Laryngeal Nerve ◽

Cervical Hematoma ◽

Symptomatic Hypocalcemia ◽

Muscle Spasms

ABSTRACT Postoperative complications of thyroid surgery are generally limited, though not entirely rare. Cervical hematoma, recurrent laryngeal nerve damage and hypoparathyroidism are of greatest concern, with the latter being the most frequently encountered. We report a case of a Graves thyroid patient who experienced symptomatic hypocalcemia in a post-thyroidectomy setting. Episodes of paresthesia and tetany delayed the patient's hospital discharge, serving as a reminder of the potential morbidities thyroid surgery can entail. How to cite this article Heidenreich MJ, Antiel RM, Dean DS Farley DR. Muscle Spasms after Thyroidectomy: What Went Wrong? World J Endoc Surg 2013;5(1):16-17.

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Predictive indicators of an unfavorable prognosis for the restoration of laryngeal functions in unilateral lesions of the recurrent laryngeal nerve in thyroid surgery

Clinical endocrinology and endocrine surgery ◽

10.30978/cees-2021-4-21 ◽

2021 ◽

pp. 21-27

Author(s):

N. V. Solomennikova ◽

J. V. Deeva ◽

V. O. Palamarchuk ◽

V. V. Kuts

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Vertical Plane ◽

Nerve Damage ◽

Laryngeal Nerve ◽

Adequate Treatment ◽

Laryngeal Paralysis ◽

Medical Institutions ◽

Number Of Patients ◽

General Signs

Recurrent laryngeal nerve (RLN) damage in thyroid surgery is a very dangerous complication. An otolaryngologist, especially at primary care institutions,should administer conservative or surgical treatment in a timely manner and depending on the type of nerve damage (transient, permanent), i. e., to analyze possible prognosis of the disease. Only few studies to predict disease developmentin RLN have been performed. One of the most modern and informative methods is laryngeal electromyography using needle electrodes, but despite the sufficient number of patients with this pathology, in most medical institutions in Ukraine it is not performed, given the technical difficulties of implementation, invasiveness and difficulty in interpreting the results of this method.Aim — to analyze the laryngoscopic signs of paresis and paralysis of the larynx in thyroid surgery and to identify the most significant from them, which together can serve as prognostic criteria of the lack of recovery of laryngeal mobility (paralysis).Materials and methods. A single-site prospective study was conducted in the years 2018—2021 that involved 164 patients with postoperative laryngeal movement disorders, who were divided into two groups: subjects with laryngeal paralysis (n = 33) and patients with laryngeal paresis (n = 131). All patients underwent phoniatric examination. The following signs have been identified: general signs, including age, number of operations, scope of surgical intervention, and 18 laryngoscopicsigns, each of them had two to seven grades. For the convenience, the grades were coded with numbers and, if possible, arranged in ascending order of severity. The obtained results were processed with Fisher angular transformation.Results. Among 18 laryngoscopic and general signs, 10main (predictors) were identified, that affect the absence or presence of laryngeal paralysis. They included:elements of mobility of the paralyzed vocal cords (VC) (absent), flotation of the «paralyzed» VC (insignificant and pronounced), mobility of the arytenoid cartilage (absent), closure of the VC (complete non-closure), synchronicity of oscillations VC (absence of movement of the paralyzed VC), restriction of the movement of the «paralyzed» VC (absent (the GE is motionless), level of the VC in the vertical plane (not on the same level), the tension of the median edge of the VC (incurvate), patient’s age > 45 years, the position of the «paralyzed» VC (median and intermedian). The mathematical analysis showed that none of the isolated laryngoscopic signs can be used as an independent criterion in assessing the predictions of the laryngeal mobilityrestoration.Conclusions. Prognostic laryngoscopic signs of recurrent laryngeal nerve damage in the thyroid surgery allow to create a prognostic model of recovery or lack of recovery of laryngeal motility, which is important for the appointment of timely adequate treatment.

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The Nonrecurrent Laryngeal Nerve in Thyroid Surgery

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1044 ◽

2011 ◽

Vol 3 (1) ◽

pp. 1-2

Author(s):

Dennis Kraus ◽

Ashok R Shaha ◽

James Paul O'Neill ◽

Jennifer La Femina

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Superior Laryngeal Nerve ◽

Central Compartment ◽

Laryngeal Nerve ◽

Vocal Cord Dysfunction ◽

Arteria Lusoria ◽

Nonrecurrent Inferior Laryngeal Nerve ◽

Retrosternal Goiter ◽

Nonrecurrent Laryngeal Nerve

ABSTRACT A nonrecurrent laryngeal nerve is a rare anomaly and estimated to be present in 0.25 to 0.99% of patients.1 The identification and preservation of the recurrent laryngeal nerve is an essential part of thyroid surgery. It is now well-known that the recurrent laryngeal nerve is not only a single nerve but also a complex branching network of innervation. Thyroid surgery demands a precise understanding of the anatomical intimacy between the gland and surrounding structures, including the parathyroid glands and neurovascular tissue. The morbidity associated with thyroid surgery, in the short-term, generally relates to hematoma collection and hypocalcemia. Long-term morbidity is more commonly seen with dysphonia and vocal cord dysfunction due to superior laryngeal nerve damage and its role in explosive sound formation, the recurrent laryngeal nerve, its tortuous anatomical course, and its role in laryngeal musculature innervation. We review the literature on this subject and report three cases of the rare nonrecurrent anomaly, firstly a 75-year-old lady with a large retrosternal goiter. During her initial work-up which included a CT scan of the thorax, an ‘arteria lusoria' was identified in the retroesophageal plane. Intraoperatively, a right-sided nonrecurrent inferior laryngeal nerve (NRILN) was identified. The second case is of a 63-year-old lady with a right-sided type 1 nonrecurrent laryngeal nerve which we identified and photographed when medially retracting the gland off the central compartment and ligament of Berry. The third case is that of a 45-year-old lady with a right-sided thyroid nodule and a right-sided NRILN identified intraoperatively.

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