Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging

Polednak, Anthony P.

doi:10.1007/s00276-019-02252-5

Cited by 9 publications

(11 citation statements)

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“…A meta-analysis on several series of non-recurrent inferior laryngeal nerve diagnosed preoperatively and intraoperatively discovered respectively a rate of 30.7% type 1 in 88 cases against 69.3% type 2 and 19.9% type 1 out of 146 cases against 80.1% type 2 [3]. Our cases concerned type 1.…”

Section: Discussionmentioning

confidence: 52%

“…The preoperative cervical ultrasound performed did not objectify a vascular anomaly and our patients showed no clinical signs. The incidence of an intraoperative lesion of the lower laryngeal nerve is 2 to 7% and can reach 12 to 14% in the event of non-recurrence of the nerve [3,5]. The different approaches of the recurrent nerve during the thyroidectomy take into account the classic landmarks.…”

Section: Discussionmentioning

confidence: 99%

“…The recurrent laryngeal nerve is a cervical branch of the vagus nerve that supplies motor, sensory and parasympathetic nerve fibers to the larynx [1,2]. Nonrecurrence of the nerve is a rare anatomical variant [3]. The first case was reported in 1823 by Stedman [4].…”

Section: Introductionmentioning

confidence: 99%

“…This variation is constantly associated with vascular malformations due to an abnormality in the development of the sixth brachial arch [5,6]. One series found a non-recurrent lower right laryngeal nerve at 0.6% in 4921 right cervical dissections and a nonrecurrent lower left laryngeal nerve at 0.04% in 4673 left cervical dissections [3,6]. The circumstances of discovery is either: By indirect signs.…”

Section: Introductionmentioning

confidence: 99%

“…Dysphonia is marked in the event of unilateral involvement; the symptomatology becomes noisy in the event of bilateral involvement, a major respiratory distress involving the life prognosis of the patient requiring a tracheotomy [1]. The incidence of an intraoperative lesion of the lower laryngeal nerve is from 0.4 to 7.2% for temporary paralysis and from 0 to 5.2% for permanent paralysis and can reach 12 to 14% in case non-recurrence of the nerve [3,5,8]. The increased incidence of recurrent lesion in the event of non-recurrence of the nerve is the source of many hypotheses according to the analysis of the different series.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The non-recurrent inferior laryngeal nerve: The clinical and surgical implication

Cissé

Issa

Wahab

et al. 2021

Acta Oto-Laryngologica Case Reports

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Objectives: We report two cases of a non-recurrent right inferior laryngeal nerve; per operative discovery during a thyroidectomy. Through these cases, we highlight the clinical and surgical implications by first analyzing the most appropriate technique. Results: The frequency of the recurrent non recurrent nerve was 1.3% with confidence interval between 0.2 and 4.6% in our center. We identified two patients who underwent a thyroidectomy, during which the discovery of the recurrent non-recurrent right nerve was made intraoperatively. The nerve approach was performed by the superior approach in front of a bulky and plunging goiter. The outcome was simple. Conclusion:The thyroid surgeon must keep in mind the probability of finding this nerve variation. For indirect signs, the superior approach would be the most suitable technique to avoid recurrent morbidity.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The non-recurrent inferior laryngeal nerve: The clinical and surgical implication

Cissé

Issa

Wahab

et al. 2021

Acta Oto-Laryngologica Case Reports

View full text Add to dashboard Cite

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Regional Vascular Anatomy

Imada

Chen

2021

Vascular Complications of Surgery and Intervention

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Non-recurrent laryngeal nerve in thyroid and parathyroid surgery

Kuprin,

Vetsheva,

Abuladze

2023

Endo Serg

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BACKGROUND: the main reason for postoperative vocal folds paresis is the variable anatomy of the recurrent laryngeal nerve. An example of such an “extreme form of embryonal development» is the non-recurrent laryngeal nerve. However, many surgeons consider this structure to be a rare anomaly with prevalence less than 0.5%. This opinion is associated with a six to seven-fold increase in the number of vocal folds paresis when a surgeon encounters with a non-recurrent laryngeal nerve. Meanwhile, in cadaveric studies a significantly higher prevalence of non-recurrent laryngeal nerve was demonstrated — 2.2%. The right aberrant subclavian artery was diagnosed during CT in 3.1% patients.AIM: the aim of the study is to determine the effectiveness of preoperative ultrasound in detecting the right aberrant subclavian artery and non-recurrent laryngeal nerve.MATERIALS AND METHODS: patients underwent thyroid and parathyroid surgery with identification of a right inferior laryngeal nerve. The preoperative neck ultrasound was performed on all patients with visualization of a brachiocephalic trunk (Y-sign) or a right aberrant subclavian artery (AL-sign). CT-angiography was performed in the postoperative period on patients who had a non-recurrent laryngeal nerve.RESULTS: the study included 1476 patients. The Y-sign was determined among 1338 (90.7%) patients. In these cases a typical anatomy of the recurrent laryngeal nerve was observed. In 138 (9.3%) cases, the Y-sign was not detected. In this subgroup of patients, in 20 (1.4%) cases, a non-recurrent laryngeal nerve and a right aberrant subclavian artery were noted. Thus, the sensitivity of the Y-sign in confirming the normal anatomy of the recurrent laryngeal nerve was 100%, specificity — 91.9%, positive prognostic value — 14.5%, negative prognostic value — 100%. On the contrary, AL-sign was notedall 20 (1.4%) patients with non-recurrent laryngeal nerve and right aberrant subclavian artery. False positive and false negative results were not observed. Three variants of the non-recurrent laryngeal nerve were identified: type I (superior type) — located behind the upper third of the thyroid lobe, has a direct descending way and forms an angle to the larynx of 30–50°; type III (inferior type) — has a direct ascending way (simulates the course of the recurrent laryngeal nerve) and forms an angle to trachea in 30–50°; type II (middle type) — all variants of the non-recurrent laryngeal nerve located between types I and III.CONCLUSION: the preoperative ultrasound detection of brachiocephalic trunk (Y-sign) confirms the presence of a recurrent laryngeal nerve (sensitivity 100%), and visualization of the right aberrant subclavian artery (AL-sign) determines a non-recurrent laryngeal nerve (sensitivity and specificity 100%).

show abstract

Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging

Cited by 9 publications

References 50 publications

The non-recurrent inferior laryngeal nerve: The clinical and surgical implication

The non-recurrent inferior laryngeal nerve: The clinical and surgical implication

Regional Vascular Anatomy

Non-recurrent laryngeal nerve in thyroid and parathyroid surgery

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