Preoperative Computed Tomography Diagnosis of Non‐Recurrent Inferior Laryngeal Nerve

Watanabe, Akihito; Kawabori, Shinichi; Osanai, Hiroaki; Taniguchi, Masanobu; Hosokawa, Masao

doi:10.1097/00005537-200110000-00017

Cited by 58 publications

(67 citation statements)

References 17 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%

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%

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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“…Some studies have reported 100% accuracy for ultrasonography in detecting NRLN-associated vascular anomalies [19,20] , allowing earlier nerve identification and prevention of injuries [19] . Computed tomography is also being used as a routine examination before thyroid surgery in some institutions for this purpose [5] . Nevertheless, systematic preoperative use of imaging methods is not yet recommended.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative ultrasound or computed tomography may provide clues about the existence of an NRLN, thus avoiding iatrogenic injury to the nerve [5] .…”

Section: Introductionmentioning

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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“…The availability of a preoperative diagnosis of NRLN may reduce the risk of accidental nerve injuries (9)(10)(11)(12).…”

Section: Systematic Reviewmentioning

confidence: 99%

“…Several techniques for preoperative identification of this anomaly have been proposed (chest X-ray, barium swallowing test, CT, MR, esophageal endoscopy, and IONM) (7,11,(14)(15)(16)(17)(18)23,(30)(31)(32) but their routine use is limited by the variable diagnostic accuracy, invasiveness, and costs.…”

Section: Proposed In 1972 Stewart Et Al (24) Described Two Types Ofmentioning

confidence: 99%

Neck ultrasonography for detection of non-recurrent laryngeal nerve

Citton¹,

Viel²,

Iacobone³

2016

Gland Surg.

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Background: Non-recurrent laryngeal nerve (NRLN) is a rare anatomical variant (0.3-6%) that is associated with some arterial abnormalities (absence of the brachiocephalic trunk and presence of a right aberrant subclavian lusorian artery). The availability of a preoperative diagnosis of NRLN may reduce the risk of nerve injuries. Preoperative ultrasonography (US) has been suggested as a reliable diagnostic tool to detect the arterial abnormalities associated with NRLN, but the literature is relatively scarce. This paper was aimed to review the literature, in order to offer an up to-date on this technique and its results.Methods: A web search, focusing on humans, was performed by PubMed database, including papers published up to August 2016, using the key words "ultrasonography" AND "non-recurrent laryngeal nerve" or "nonrecurrent laryngeal nerve".Results: Eight papers, including 3,740 patients who underwent neck US for the detection of NRLN were selected. Only five studies focused on the preoperative use of US. The incidence of NRLN varied between 0.4% and 1.94%. The sensitivity and specificity varied between 99-100% and 41-100%, respectively.Conclusions: US is a simple, non-invasive and cost-effective method to detect NRLN, also if its accuracy is not absolute. It may be used preoperatively and to prevent the intraoperative nerve damage, since the risk of NRLN palsies is significantly reduced when a preoperative diagnosis is available.

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Preoperative Computed Tomography Diagnosis of Non‐Recurrent Inferior Laryngeal Nerve

Cited by 58 publications

References 17 publications

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

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

Neck ultrasonography for detection of non-recurrent laryngeal nerve

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