Non-Recurrent Laryngeal Nerve: Identification during Thyroid Surgery

Srinivasan, Venkat; Premachandra, D. J.

doi:10.1159/000276906

Cited by 19 publications

(15 citation statements)

References 8 publications

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“…Anhand vergleichsweise geringer Fallzahlen (9 resp. 16) werden 2 charakteristische Verläufe ausgewiesen, wobei ein Typ I mit Abgang auf Höhe der Articulatio cricothyreoidea von einem Typ II mit Abgang auf Höhe der Arteria thyreoidea inferior unterschieden wird [11,12,24,43,44,58,60,67]. Eine weitere Diversifizierung und Subtypisierung einer solchen, ohnehin sehr seltenen anatomischen Normvariante erscheint prä-tentiös.…”

Section: Klassifikationunclassified

Verlaufsvariet�ten des Nervus laryngeus inferior

Mangold

2004

Der Chirurg

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Because of multiple variations in course, the inferior laryngeal nerve shows a great variety of topographic relations to adjacent cervical structures. It may recur in the tracheoesophageal groove or anteriorly or posteriorly to it. It can pass under, over, or through the ramifications of the inferior thyroid artery. If Zuckerkandl's tubercle is enlarged, the nerve may be luxated. It is firmly fixed to the ligament of Berry by tight adhesions. Before entering the larynx, the nerve may show multiple ramifications. It may also recur around the inferior thyroid or vertebral artery. On the right, a nonrecurrent nerve is found in 0.6-0.8% of individuals, always in coincidence with a "lusorian" artery. Three course variations can be distinguished: descending (type I), horizontal (II), and ascending (III). A nonrecurrent nerve on the left is extremely rare, as it can only be found as a combination anomaly of a right-sided lusorian artery with situs inversus viscerum. The divided inferior laryngeal nerve shows recurrent and nonrecurrent ramifications. A nonrecurrent inferior laryngeal nerve can be indirectly ruled out preoperatively by demonstration of a normally developed brachiocephalic trunk via colour-coded duplex ultrasound.

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Section: Klassifikationunclassified

Verlaufsvariet�ten des Nervus laryngeus inferior

Mangold

2004

Der Chirurg

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“…With regard to Soustelle et al and Avisse et al one may classify the NRILN into type I with a horizontal course and type II with a more ascending route [2,18]. Most authors conclude that a NRILN is associated with a higher risk of nerve palsy [6,7,15,17,19]. Some authors discussed preoperative angiography of the aortic arch in patients with dysphagia for the diagnosis of a lusorial artery as an indicator for an NRILN [2,4,5] or a barium swallow test [14].…”

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confidence: 99%

Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation

Brauckhoff

Walls

Brauckhoff

et al. 2001

Langenbeck’s Arch Surg

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Neurostimulation of the vagal nerve distally of the separation of the inferior laryngeal nerve did not produce electromyographic signals in the intrinsic laryngeal musculature, perhaps due to the different modalities in the vagal fascicles. Negative electromyographic signals following neurostimulation of the distal vagal nerve opposite the lower thyroid pole should lead to proximal neurostimulation of the vagus opposite the upper thyroid pole. Positive electromyographic signals proximally and negative electromyographic signals distally predict the occurrence of a non-recurrent inferior laryngeal nerve which allows its diagnosis before surgical dissection of the thyroid gland and may prevent nerve palsy.

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“…The surgeon should also be cognizant of variations in RLN anatomy. Right-sided nonrecurrent laryngeal nerves have been reported in 0.5% of patients and are seen in association with abnormal subclavian artery development [50][51][52]. Approximately 0.2% of patients have simultaneous right-sided recurrent and nonrecurrent laryngeal nerves in which a small-diameter RLN merges into a larger nonrecurrent nerve [53].…”

Section: Intraoperative Nerve Monitoringmentioning

confidence: 99%