Non-recurrent nerve from the vagus anterio-medially located in the carotid sheath

Gürleyik, Emin

doi:10.5152/ucd.2015.2854

Cited by 7 publications

(10 citation statements)

References 7 publications

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“…An aberrant subclavian artery identified by angiography, CT-angoiography or magnetic resonance angiography, was often associated with the NRILN. [8][9][10] The role of intraoperative nerve monitoring (IONM) for predicting the non RILN was not negligible. Donatini et al also revealed the greatly reduced incidence of nerve palsy, particularly in case of NRLN, by soliciting IONM for surgery.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative discovery of nonrecurrent inferior laryngeal nerve: a report of 3 cases including one of left nonrecurrent inferior laryngeal nerve and literature review

Rahali¹,

Mssrouri²,

Mohamed³

et al. 2022

Int J Sci Rep

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<p>The nonrecurrent inferior laryngeal nerve (NRILN), a rare variant in the course of the inferior laryngeal nerve, passes transversely into larynx directly arising from the vagus nerve that increases the risk of damage to the nerve during thyroid and parathyroid surgery. We discussed clinical significance of non-recurrent laryngeal nerve during cervicotomy. Its importance was demonstrated in three clinical cases as well as the related literature reviews. All patients underwent bilateral thyroidectomy for a multinodular goiter. Two patients had identification of the NRILN on the right side. The third patient had the NRILN on the left side. The diagnosis of this anatomical variation was made per-operatively on all cases. The NRILN is an exceptional anomaly but overlooking its risk may lead to grave morbidity. This is a supplementary proof in favour of systematic dissection of the recurrent inferior laryngeal nerve (RILN) during all thyroid and parathyroid surgery.</p>

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Section: Discussionmentioning

confidence: 99%

Intra-operative discovery of nonrecurrent inferior laryngeal nerve: a report of 3 cases including one of left nonrecurrent inferior laryngeal nerve and literature review

Rahali¹,

Mssrouri²,

Mohamed³

et al. 2022

Int J Sci Rep

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“…Very little is described regarding NRLN anatomy within the carotid sheath. Gurleyik [ 7 ] described a case of a right-sided NRLN discovered during a total thyroidectomy in which they followed the NRLN back into the carotid sheath and found that the length of the nerve from its origin, the trunk of the vagus nerve, to the laryngeal entry point was 4 cm. In this case report of Gurleyik [ 7 ], the trunk of the vagus nerve ran parallel and antero-medially within the carotid sheath.…”

Section: Discussionmentioning

confidence: 99%

“…Gurleyik [ 7 ] described a case of a right-sided NRLN discovered during a total thyroidectomy in which they followed the NRLN back into the carotid sheath and found that the length of the nerve from its origin, the trunk of the vagus nerve, to the laryngeal entry point was 4 cm. In this case report of Gurleyik [ 7 ], the trunk of the vagus nerve ran parallel and antero-medially within the carotid sheath. The association between the vagus nerve being located medially, within the carotid sheath, to the common carotid and the presence of a NRLN is emphasised by Toniato et al [ 6 ], who describe this medial location of the vagal trunk as a “pilot light” to the possible presence of an NRLN.…”

Section: Discussionmentioning

confidence: 99%

Intra-Operative Detection of a Left-Sided Non-Recurrent Laryngeal Nerve during Vagus Nerve Stimulator Implantation

Labuschagne

Hammer

2020

Medicina

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Left sided non-recurrent laryngeal nerves (NRLN) are very rarely observed during surgery in the head and neck region. Arising directly from the cervical aspect of the vagus nerve, the NRLN lies in a vulnerable position distant from its normal location. NRLNs are normally associated with embryological branchial arch aberrations and subsequent vascular anomalies. The anomalous course of the NRLN makes it more susceptible to injury during surgery in the neck region. Knowledge of this anatomical variant will reduce the potential for injury and resultant vocal cord paralysis. During microsurgical dissection of the carotid sheath for the implantation of a vagus nerve stimulator in a 19-year-old female patient with refractory epilepsy, a moderate-sized branch of the main vagus nerve trunk was identified postero-medially within the carotid sheath. Intra-operative stimulation of this nerve resulted in a compound muscle evoked potential from the left vocal cord. Thus, this branch was confirmed to be a left-sided NRLN. The patient had no associated vascular anomalies. This is first reported case of a left-sided NRLN found during VNS insertion. Awareness of the possibility of an NRLN is imperative to prevent iatrogenic injury. A medial location of the vagus nerve within the carotid sheath should alert the surgeon to the possible presence of an NRLN. The absence of fourth branchial arch remnant anomalies is not a guarantee as to the absence of a left-sided NRLN. The addition of intra-operative nerve monitoring for vagus nerve stimulator (VNS) implantation procedures should be strongly considered to help avoid iatrogenic injury.

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“…The vagus can also display some anatomical variations, and these may or may not coincide with the origin and anomalous course of the ILN. Among the related variations, we draw attention to the location that it presents within the neurovascular bundle in the neck, occupying an anterior or medial position instead of the usual central or posterior one (Gurleyik, 2015;Kato et al).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of the Right Nonrecurrent Inferior Laryngeal Nerve in a Series of 100 Total Thyroidectomies

et al. 2018

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The right nonrecurrent inferior laryngeal nerve (NRILN) is a rare occurrence generally associated with an aberrant right subclavian artery. Its prevalence ranges from 0.3 to 1.8 %. It is found mainly in thyroid surgeries, the most frequently performed cervical surgeries. This neural anomaly is almost never diagnosed preoperatively. Dysphagia may be a warning symptom, sometimes being incorrectly related to esophageal compression due to a goiter or thyroid cancer. The postoperative diagnosis of an accompanying aberrant right subclavian artery should be done to confirm the clinical picture and inform the patient of any possible future medical/ surgical procedures. The aim of this work is to determine the prevalence of the NRILN in patients undergoing total thyroidectomy in two reference centers for head and neck surgery in Paraguay. Prospective cross-sectional study in a series of 100 consecutive total thyroidectomies in the INCAN and the ORL Service in the Hospital Central of the IPS. 100 patients underwent a total thyroidectomy, 90 of whom were women. The average age was 47 years. 6 % also underwent a neck dissection for thyroid cancer. The preoperative diagnosis was multinodular goiter (MNG) in 84 cases and thyroid cancer in the remaining 16 (16 %). In one man aged 47 years (1 %) operated on for MNG and presenting slight to solid dysphagia, there was difficulty finding the right NRILN. It was located at the level of the lower edge of the inferior pharyngeal constrictor and its downward anomalous course was proven. Postoperatively, after confirmation of the diagnosis that the thyroid pathology was benign, a color echo-Doppler and a CT angiography corroborated the diagnosis of an associated aberrant right subclavian artery. Given the difficulty in locating the recurrent inferior laryngeal nerve in thyroid surgery, it is advisable to consider the possibility that it may be nonrecurrent and should be looked for at the level of its entrance to the larynx below the inferior constrictor. In such cases it is recommended that the patient be examined postoperatively to rule out an associated vascular anomaly. A tomography study of each patient with a thyroid pathology and dysphagia could contribute to the diagnosis of the vascular anomaly and maximize precautions in the nerve dissection, including use of a neurostimulator. The NRILN is a rare entity. In this case study, it represents 1 % of the patients operated on for thyroid pathology in the INCAN and IPS in a 1-year period (July 2016-June 2017).

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Non-recurrent nerve from the vagus anterio-medially located in the carotid sheath

Cited by 7 publications

References 7 publications

Intra-operative discovery of nonrecurrent inferior laryngeal nerve: a report of 3 cases including one of left nonrecurrent inferior laryngeal nerve and literature review

Intra-operative discovery of nonrecurrent inferior laryngeal nerve: a report of 3 cases including one of left nonrecurrent inferior laryngeal nerve and literature review

Intra-Operative Detection of a Left-Sided Non-Recurrent Laryngeal Nerve during Vagus Nerve Stimulator Implantation

Prevalence of the Right Nonrecurrent Inferior Laryngeal Nerve in a Series of 100 Total Thyroidectomies

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