A novel variation of the recurrent laryngeal nerve

Abstract

BackgroundInjury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Several anatomic variations of the nerve increase the likelihood of iatrogenic damage.Case presentationA 50-year-old woman was presented to our department with a nodule in the right thyroid lobe, and she reported no voice changes. She had no history of surgery or radiation to the head or neck. Fine-needle aspiration was recorded as papillary thyroid carcinoma. The preoperative laryngoscopy revealed left vocal cord paralysis. Right thyroid lobectomy was performed. A scarce course of the left recurrent laryngeal nerve was found during the operation that ascended along the medial edge of the superior thyroid pole and finally disappeared beneath the superior cornu of the thyroid cartilage without any tracheal, esophageal, or laryngeal branches. The patient was discharged on the third postoperative day with the diagnoses of papillary thyroid carcinoma and congenital left vocal cord paralysis.ConclusionsThe novel variation of the recurrent laryngeal nerve may challenge the current concept of the anatomy of the nerve. The vocal folds mobility should be examined routinely before surgery in patients undergoing thyroid operation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-017-0263-5) contains supplementary material, which is available to authorized users.

Systematic Review and Meta-Analysis: Recurrent Laryngeal Nerve Variants and Their Implication in Surgery and Neck Pathologies, Using the Anatomical Quality Assurance (AQUA) Checklist

“…Regarding the sex of the population studied in the articles with a total sample size equal to 1, the following characteristics were identified: 5 subjects were men (27.7%), 12 subjects were women (66.66%), and 1 study did not report the sex of the sample (5.55%). In relation to the 23 studies that presented a sample size greater than 1, the following data were collected: 5 studies [ 8 , 11 , 13 , 28 , 29 ] did not specify the sex of the subjects with a total sample size of 6531 (22.36% of the total sample of studies with a sample greater than 1; 2 studies [ 31 , 32 ] presented only women in their sample, which is equivalent to 10 (0.034% of the total sample of studies with a sample size greater than 1); finally, 16 studies [ 3 , 11 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] included both men and women in their sample and the following data were obtained: the total number of men was 4849 (16.6%) and that of women was 17,810 (60.99%). Individually, in the studies that presented both men and women, the percentage of men varied between 4.08% and 81% and had a mean of 26.64, while the percentage of women varied between 19% and 95.92% with a mean of 73.36% (see Table 3 ).…”

“…Regarding the clinical relationships reported by the studies included in this review, three studies did not report any type of clinical consideration related to the RLN and NRLN variants [ 45 , 49 ]. Thirty-eight studies reported clinical considerations associated with RLN and NRLN variants, which are as follows: 16 studies, within their results, reported possible injuries arising from surgical complications associated with surgeries such as thyroidectomies, parathyroidectomies, esophagectomies, laryngeal surgeries, or any other type of surgery of the cervical region surrounding the RLN and NRLN.…”

“…Three studies, within their clinical considerations, reported that the presence of RLN and NRLN variants could be associated with iatrogenic compromise of the vocal cords. In addition, these authors propose that when this variant is present, a medical team should perform an evaluation of the mobility of the vocal cords, especially before performing any type of laryngeal surgery [ 7 , 45 , 46 , 53 , 54 , 55 , 56 , 57 ]. Surgeons must be aware of considerable alterations in the anatomy of the RLN.…”

Support Vector Machine Parameter Optimization for Positron Emission Tomography Images for Estimation of Recurrent Laryngeal Nerve Injury with Thyroid Nodules

“…As the main motor nerve of the throat, the RLN was mainly responsible for the control of swallowing [19]. e degree of RLN injury was one of the indicators of the success of surgical treatment, and it was the most serious complication after TN [20]. e results of this study showed that the PPIR of RLN in the malignant TN group was higher in contrast to group B during the three months after the surgery, and the difference was dramatic (P < 0.01).…”