Importance of pre-operative recognition of the nonrecurrent laryngeal nerve

Nagayama, Ikuo; Okabe, Yozo; Katoh, Hiromasa; Furukawa, Mitsuru

doi:10.1017/s0022215100126957

Cited by 34 publications

(40 citation statements)

References 6 publications

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“…Dysphagia is the main symptom of arteria lusoria. Several preoperative diagnostic investigations for vascular anomaly have been described, including CT, barium swallow, and ultrasonography (Nagayama et al 1994;Watanabe et al 2001;Hermans et al 2003, Devèze et al 2003. In this patient, evaluation of preoperative CT including the neck to mediastinum was very useful and enabled the operation to be performed safely and fast.…”

Section: Discussionmentioning

confidence: 90%

“…If the fourth aortic arch disappears, the ILN reaches the larynx directly, resulting in a NRILN. In most instances, the right subclavian artery arises from the distal portion of the left subclavian artery and passes to the right behind the esophagus, becoming an aberrant subclavian artery (Gray et al 1976 Nagayama et al 1994). The presence of left NRILN is extremely rare and is always associated with situs inversus viscerum.…”

Section: Discussionmentioning

confidence: 99%

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Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

Tateda

Hasegawa

Sagai

et al. 2008

Tohoku J. Exp. Med.

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Inferior laryngeal nerve (ILN), which usually arises from vagus nerve, runs recurrent course and is called recurrent ILN (RILN). Intimate knowledge of normal and anatomic variants of the ILN reduces the risk of nerve injury and vocal cord paralysis in thyroid and parathyroid surgery. The nonrecurrent ILN (NRILN) is a rare nerve anomaly that is associated with a right aberrant subclavian artery. We encountered 2 patients with NRILN during thyroid surgery. Patient 1, a 57-year-old woman, had mediastinal thyroid tumor without vascular anomaly. Patient 2, a 47-year-old woman with a history of esophageal foreign body (fish bone), was suspected to have NRILN with vascular anomaly before surgery, as judged by preoperative enhanced CT. In the patient 1, we verified laryngeal mobility function of the NRILN by nerve stimulation, and confirmed the absence of RILN in usual recurrent course. The findings in the patient 1 indicate that NRILN without subclavian artery anomaly is a genuine entity. In both patients we performed thyroid surgery safely and fast by expectation and identification of NRILN by use of nerve stimulator. In conclusion, we confirm the existence of NRILN without vascular anomaly and show effectiveness of preoperative enhanced CT and valuable use of nerve stimulator for nerve preservation in the patients with NRILN.Nonrecurrent inferior laryngeal nerve; aberrant subclavian artery; esophageal foreign body; nerve stimulator; CT. Inferior laryngeal nerve (ILN) palsy is a major problem in thyroid and parathyroid surgery. Intimate knowledge of normal and anatomic variants of the ILN reduces the risk of nerve injury and vocal cord paralysis. It is generally accepted that the nonrecurrent inferior laryngeal nerve (NRILN) is a well-known but relatively rare anatomic variant. The prevalence of NRILN is less than 1% based on surgical reports (Henry et al. 1988;Proye et al. 1991;Avisse et al. 1998;Devèze et al. 2003; Toniate et al. 2004) and 1-2% based on anatomical reports (Avisse et al. 1998). The NRILN usually arises on the right side of the neck and is associated with malformation of the aortic arch and aberrant subclavian artery. In NRILN, there are several unsolved problems,

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

Tateda

Hasegawa

Sagai

et al. 2008

Tohoku J. Exp. Med.

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“…The only one congenital anomaly observed in this study was a direct branch from the common carotid artery which was seen crossing anterior to the nerve, piercing the trachea. 16 It is not supplying the thyroid gland. It is important that the surgeons must be aware of such an anomaly also.…”

Section: Discussionmentioning

confidence: 99%

A study on internal laryngeal nerve-its variation in the course, branching, anastamosis and relation to inferior thyroid artery

Sailaja

2016

Int J Res Med Sci

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“…Occasionally, the 4th arch disappears and the subclavian artery arises directly from the aorta (aberrant subclavian artery or arteria lusoria), distally to the normally positioned left subclavian artery, and crosses retroesophageally to the (right) upper limb. In these cases the nerve moves cranially and originates directly from the vagus where it becomes an NRLN [12] . The incidence of this vascular malformation is reportedly as high as 0.5-2% of the general population.…”

Section: Discussionmentioning

confidence: 99%

Nonrecurrent Laryngeal Nerve and Associated Anatomical Variations: The Art of Prediction

Morais¹,

Capela-Costa²,

Matos-Lima³

et al. 2015

Eur Thyroid J

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abnormality, an ultrasound and a computed tomography were performed which showed a right aberrant subclavian artery with a retroesophageal course and a common trunk of the common carotids in both patients. Discussion and Conclusion: The presence of an NRLN is a major risk during surgical procedures and the surgeon should be aware of the possibility of its existence. NRLN may be associated with rare vascular anomalies, such as arteria lusoria and a bicarotid trunk. This paper reveals this association in 2 patients for the first time. Key Words Recurrent laryngeal nerve · Thyroid surgery · Vascular anomalies · PredictionAbstract Introduction: A nonrecurrent laryngeal nerve (NRLN) is a rare anatomical variation in which the nerve enters the larynx directly off the cervical vagus nerve. Case Report: We present 2 patients who underwent thyroid surgery for benign disease. Intraoperatively, type 2a and 1 NRLN were identified. Due to the frequent association with a vascular

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Importance of pre-operative recognition of the nonrecurrent laryngeal nerve

Cited by 34 publications

References 6 publications

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

A study on internal laryngeal nerve-its variation in the course, branching, anastamosis and relation to inferior thyroid artery

Nonrecurrent Laryngeal Nerve and Associated Anatomical Variations: The Art of Prediction

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