Abstract: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.Key words: non recurrent laryngeal nerve; thyroidectomy; multi nodular goitre; anomalous right subclavian artery; nerve injury; carotid trunk Case report: A 32 yr old female presented with a swelling in front of the neck .clinical examination showed a thyroid swelling with multiple palpable nodules in both lobes which were firm in consistency and had no retro sternal extension. There were no palpable cervical lymph nodes. An USG of neck confirmed this findings. The patient was clinically and biochemically euthyroid. FNAC was consistent with nodular goiter. On direct laryngoscopy vocal cord function was normal bilaterally. With the diagnosis of euthyroid multinodular goitre the patient was posted for near total thyroidectomy. During thyroidectomy the recurrent laryngeal nerve could not be identified in its usual location. Instead there was a white cord like structure transversing parallel to and between the branches of the inferior thyroid artery. This structure was traced laterally in to the carotid sheath and was found to arise from the right vagal trunk. Medially this structure was found to enter the crico thyroid membrane and hence identified to be non recurrent laryngeal nerve. Thyroidectomy was completed and the recurrent laryngeal nerve on the left side had a normal course. The postoperative period of the patient was uneventful and a vocal cord examination showed equal movement on both sides. A CT angiogram done retrospectively revealed an anomalous origin of a right subclavian artery as the last branch of the aortic arch. This artery crossed from left to right posterior to the esophagus. Moreover the right and left common carotid artery originated from the aortic arch as a common trunk (bicarotid trunk) which was the first branch of the aortic arch. A normal left subclavian artery arose between the bicarotid trunk and the anomalous right subclavian artery. The patient did not have any difficulty in swallowing (dysphagia lusoria) on retrospective questioning.
The influence of filler shape and volume fraction on the dynamic mechanical characteristics of rigid glass filler epoxy composites is investigated. Two variants of glass fillers, spherical particle and slender (milled) fibers, are doped into the epoxy matrix till 10% volume fraction. The composites are room temperature cured and tested to measure their viscoelastic properties. The dynamic mechanical analyses performed in the temperature range of 20–180°C at 10 Hz suggest that the milled fiber composites display consistently higher storage and loss moduli, whereas the higher loss factor peaks were noted for the spherical particle composites. The C‐factor, filler reinforcement efficiency of the composites and entanglement density, evaluated from the storage modulus values, indicate that the milled fibers composites are more effective in transferring the loads in both glassy and rubbery zones when compared against the spherical particle case. Also, the filler/matrix adhesion factor (A factor) and the interphase adhesion factor, calculated from the loss factor curves reveal stronger filler/matrix interactions in the case of milled fiber epoxy composites. Interestingly, the filler geometry or volume fraction has only marginal influence on the glass transition temperature of the composites.
The importance of port closure after laparoscopic surgeries is emphasized by the extensive number of techniques being described for the same. Even so, the search for a simple, time-saving, and effective technique still continues. One commonly overlooked factor is the obliquity of laparoscopic ports, which makes direct visualization of the rectus fascia through the skin incision difficult. Also, our patients, mostly of Indian ethnicity, tend to have relatively thick subcutaneous fat that again acts as a constraint during port closure. We have described a simple and effective method of laparoscopic port closure using Moynihan's aneurysm needle and a skin hook. This technique is particularly advantageous in the above-mentioned scenarios. We have been successfully using this technique in our institution for the past 6 years, and we have not encountered any case of port-site hernia. Our technique does not require expensive instruments or the need for visualization via a camera.
Anamolous Course of Carotid Artery is one of the rarest of the rare anamoly, we describe one such case of anamolous Course of Right Common Carotid Artery.Keywords Anamolous carotid artery . Anamolous artery A 28-year-old woman with multinodular goiter admitted to our ward was posted for near-total thyroidectomy.During surgery, we started our procedure from the left lobe of thyroid, which appeared to be normal.After finishing the left lobe when we moved on to the right lobe, we found it hard and fixed; for facilitating the dissection, we injected saline to create a cleavage plane. After ligating
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