Invasion of the thyroid gland is uncommon in the context of laryngopharyngeal squamous cell carcinoma. Clinical and pathological features such as invasion of the anterior commissure, subglottis and cricoid cartilage are more associated with glandular invasion.
Background. Identifying the inferior laryngeal nerve is one of the main concerns in thyroid surgery. The typical recurrent position occurs due the relative position between the vagus nerve and the larynx during the last 3 branchial arches development. In rare cases, this nerve does not loop under the right subclavian artery or the aortic arch. This abnormality is present in 0.7% of patients and is associated with the presence of anatomical vascular anomalies. The left non-recurrent inferior laryngeal nerve is an even rarer abnormality, with only six cases described in the literature to date. Method. A 46- years old female patient referred to total thyroidectomy for symptomatic multinodular benign goiter. Results. A left non-recurrent inferior laryngeal nerve was found with difficulty and then a partial thyroidectomy was performed. CT scan showed dextroposition of the vessels of the base of the heart and an aberrant left subclavian artery. Conclusion. An association of a right-sided aortic arch and aberrant left subclavian artery, or the presence of situs inversus, although rare anatomical variations, are associated to a non-recurrent inferior left laryngeal nerve. Proper identifying these abnormalities may help to properly identify and salvage this structure.
Objectives: (1) Evaluate the frequency of invasion of the thyroid gland in patients with laryngeal or hypopharyngeal squamous cell carcinoma (SCC) submitted to total laryngectomy (TL) or pharyngolaryngectomy (TPL) associated with thyroidectomy. (2) Determine whether clinico-pathological characteristics can predict glandular involvement. Methods: A retrospective study was conducted in an academically affiliated tertiary care referral center. Charts and anatomopathological reports of surgical specimens of 93 patients treated in the period from January 1998 to July 2013 were reviewed. All patients presented with laryngeal or hypopharyngeal SCC and underwent TL or TPL in association with thyroidectomy. Adjuvant therapy was indicated when tumor or neck conditions required it. Sociodemographic data, frequency of thyroid gland invasion, and other clinico-pathological variables were analyzed. Results: Tumor was staged as T2 in 10 patients, T3 in 26 patients, and T4 in 53 patients. Five patients had initial stage II and 88 had advanced stage III-IV disease. The overall frequency of invasion of the thyroid gland was 16.1%. Carcinomas that invaded the thyroid gland were more advanced ( P = .005) and more frequently staged as T4a ( P = .001). Glandular involvement was associated with invasion of the anterior commissure (odds ratio [OR] = 5.9; confidence interval [CI]–95% 1.2-27.7), subglottis (OR = 12.0; CI-95% 1.5-95.8), thyroid cartilage (OR = 4.2; CI-95% 1.1-16.1), and cricoid cartilage (OR = 18.7; CI-95% 5.0-70.2). Conclusions: Invasion of the thyroid gland is uncommon in the context of laryngopharyngeal SCC. Clinico-pathological features such as advanced tumors, T4a tumors, anterior commissure, subglottis, thyroid cartilage, and cricoid cartilage involvement are more associated with glandular invasion. Indications for thyroidectomy should be refined in order to reduce morbidity of the surgical treatment.
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