The Nonrecurrent Laryngeal Nerve in Thyroid Surgery

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.

scholarly journals Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)

2011 ◽  
Vol 3 (3) ◽  
pp. 144-150 ◽  
Author(s):  
Henning Dralle ◽  
Antonio Sitges-Serra ◽  
Peter Angelos ◽  
Manuel C Durán Poveda ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Superior Laryngeal Nerve ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Visual Identification ◽  
Current State ◽  
Monitoring Procedure ◽  
Intraoperative Nerve Monitoring

ABSTRACT One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neural identification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngeal nerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complications related to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with an adjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoring procedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This will include a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve during surgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which will diminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.

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

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.

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

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.

scholarly journals Complications of Thyroid Surgery & Their Risk Factors: A Prospective Study at a Tertiary Care Center of Eastern Nepal

2019 ◽  
Vol 2 (1) ◽  
pp. 25-33
Author(s):  
Niranjan Panthi ◽  
S T Chettri ◽  
S P Shah ◽  
D Poudel ◽  
S Manandhar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Neck Dissection ◽  
Thyroid Surgery ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Central Compartment ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Palsy

Background: Thyroid surgery is one of the commonest surgeries performed by otolaryngologists. Currently, the main postoperative complications are hypocalcemia and recurrent laryngeal nerve (RLN) palsy. Extent of surgery, lack of identification of RLN/ parathyroid glands, malignancy, central compartment neck dissection, lateral neck dissection, previous surgery and size of goiter are the risk factors for complications. The objectives of this study were to determine the frequency of postoperative complications after thyroid surgery and to analyze the risk factors of complications. Methods: It was a prospective study of 45 patients undergoing thyroid surgery in eastern Nepal from March 2014 to September 2015. The postoperative complications and the risk factors associated with these complications were evaluated. Results: There were total of 45 cases of thyroid surgery, with the mean age of 39.04 years. The main postoperative complications were: hypocalcaemia (6 or 13.33% cases) and vocal cord palsy due to recurrent laryngeal nerve injury (5 or 11.11% cases). Temporary hypocalcaemia was observed in 3(6.67%) cases while permanent hypocalcaemia developed in other 3 (6.67%) cases. Similarly, the temporary and permanent recurrent laryngeal nerve palsy occurred in 3 (6.67%) cases and 2 (4.44%)cases respectively. The risk factors associated with hypocalcaemia were: malignancy, repeat operation, central compartment neck dissection and non-identification of parathyroid glands during surgery. Similarly, recurrent laryngeal nerve palsy was observed in cases of malignancy and central compartment neck dissection. Conclusion: The major postoperative complications of thyroid surgery were hypocalcaemia and recurrent laryngeal nerve palsy. Malignancy and central compartment neck dissection had effect on incidence of complications. Sound knowledge of anatomy and meticulous surgical technique are needed to reduce the incidence of complications.

scholarly journals Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery

2015 ◽  
Vol 6 (4) ◽  
pp. 149-154
Author(s):  
Chetan Bansal ◽  
Aparna Bhardwaj ◽  
Sonam Rathi ◽  
Alok Agrahari ◽  
Virendra P Singh
Keyword(s):  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Complication Rate ◽  
Tertiary Care ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

ABSTRACT Background To study the frequency of postoperative complications after thyroid surgery indicated for various benign and malignant lesions and to corroborate the results in relation to the extent of surgery and a clinical overview of evolution of thyroid surgery. Materials and methods An analytical study was carried out at a tertiary care center over a period of 3 years from January 2011 to December 2013. Data were collected from 80 patients who underwent thyroidectomies for various thyroid diseases at this center. Results Hemithyroidectomy, isthmusectomy, subtotal, neartotal, and total thyroidectomies were performed in 36 (45%), 6 (7.5%), 8 (10%), 10 (12.5%), and 20 (25%) cases respectively. The overall postoperative complication rate was 20%. Postoperative hypocalcemia and recurrent laryngeal nerve injury were the most common complications. Permanent hypocalcemia and permanent recurrent laryngeal nerve injury were observed in 3.75 and 2.5% of all operated cases respectively. The less common complications were wound hematoma, seroma formation, and superior laryngeal nerve injury. There was no mortality observed in our series. Conclusion The overall complication rate can be minimized by operating in a bloodless field, doing a meticulous dissection, and correctly identifying and preserving recurrent and superior laryngeal nerves along with parathyroid glands, if feasible. How to cite this article Pandey AK, Maithani T, Agrahari A, Varma A, Bansal C, Bhardwaj A, Singh VP, Rathi S. Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery. Int J Head Neck Surg 2015;6(4):149-154.

scholarly journals Nonrecurrent Laryngeal Nerve: An Indian Documentation

2012 ◽  
Vol 3 (1) ◽  
pp. 28-29 ◽  
Author(s):  
Sagaya Raj ◽  
Ravi Padmakar Deo ◽  
Azeem Mohiyuddin ◽  
Shuaib Merchant ◽  
Manaswini Ramachandra
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Head And Neck ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Vascular Anomaly ◽  
Signs And Symptoms ◽  
Nerve Damage ◽  
Laryngeal Nerve ◽  
Review Of Literature ◽  
Nonrecurrent Laryngeal Nerve

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.

scholarly journals Preservation of the Recurrent Laryngeal Nerve and the External Branch of the Superior Laryngeal Nerve during Thyroid Surgery.

1997 ◽  
Vol 48 (6) ◽  
pp. 458-462 ◽  
Author(s):  
Masao Mitsui ◽  
Kentaro Ochi ◽  
Hiroaki Nakajima ◽  
Takuji Kaneko ◽  
Hirotsugu Kinoshita ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
External Branch
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