Identification of the Nonrecurrent Laryngeal Nerve during Thyroid Surgery: 20‐Year Experience

Abstract

The nonrecurrent laryngeal nerve, which is rarely observed during thyroidectomy, is at high risk for damage. During a 20-year period 6000 thyroidectomies were performed at our institution, and during these operations inferior laryngeal nerves were routinely identified in all the patients with a standard procedure based on the usual anatomic landmarks. A nonrecurrent laryngeal nerve was observed on the right side in 31 cases (0.51%), with no anatomic anomalies found on the left side. The nerve anomaly was diagnosed preoperatively in five patients. A vocal cord deficit, caused by a nerve lesion, was observed in four cases (12.9%). Our results suggest that the best way to avoid morbidity is routine identification of the nerve. This can be done by carefully identifying all the thyroid structures and being suspicious of the presence of the abnormality when the inferior laryngeal nerve is not found in a classic position.

Carcinoma Showing Thymus-like Differentiation (CASTLE) with Non-Recurrent Laryngeal Nerve: A Case Report

“…The risk of non-RLN injury is 10-times higher than normal RLN if it is not detected preoperatively. 6) We checked the CT preoperatively in this case and found the aberrant retroesophageal subclavian artery, which indicated the possibility of non-RLN. As a result, we could save the non-RLN, which is the only functional RLN in this patient.…”

Non-Recurrent Laryngeal Nerve and Aberrant Vasculature

“…The incidence of non-RLN is reported to be 0.54%; this leads to increased risk of inadvertent injury to the nerve in inexperienced hand (Toniato et al, 2004).…”

“…Anomaly of subclavian artery on the right side leads to the failure of the right RLN to descend (Defechereux et al, 2000 andAbboud andAouad, 2004). Right subclavian artery in these cases often courses behind the oesophagus, the incidence of which is reported to be around 0.5%-2% (Campbell et al, 1991, Casal et al, 2010, and Toniato et al, 2004. It is also important to note that a small proportion of these patients with retro-oesophageal subclavian artery (with normal-sized thyroid gland) will complain of symptoms of dysphagia (Cannon, 1999 andCasal et al, 2010).…”

A variant nerve that mimics the left recurrent laryngeal nerve: a case study in human anatomy

“…Non-recurrent inferior laryngeal nerves occur reasonably frequently on the PrePrints right side, in 0.3%-1.6% of patients. Non-recurrent nerves on the left are much less frequent (0.04%), and they are always associated with situs inversus, in which the normal bilateral asymmetry of the internal organs is reversed from left to right (Toniato et al, 2004). In cases where the inferior laryngeal nerve is non-recurrent, it is always the case that the right subclavian artery (or left subclavian artery, in patients with situs inversus) is formed by a segmental branch from the descending aorta, distal to the contralateral subclavian artery.…”