Nonrecurrent and recurrent inferior laryngeal nerve: A surgical pitfall in cervical exploration

Proye, C; Carnaille, B.; Goropoulos, Apostolos

doi:10.1016/0002-9610(91)90271-e

Cited by 63 publications

(40 citation statements)

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“…Die Erstbeschreibung erfolgte 1983 durch Sanders et al [54]. Einschließlich eines eigenen Falles finden sich insgesamt 12 Beschreibungen in der Literatur, alle rechtsseitig [10,32,51,52,54]. Im Rahmen des Neuromonitoring ergibt die jeweils separate Stimulation beider Ramifikationen eine Reizantwort, wodurch eine sichere Identifikation möglich ist (eigener Fall und [10]).…”

Section: Nervus Laryngeus Inferior Divisus (Nlid) Mit Rekurrenter Undunclassified

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: Nervus Laryngeus Inferior Divisus (Nlid) Mit Rekurrenter Undunclassified

Verlaufsvariet�ten des Nervus laryngeus inferior

Mangold

2004

Der Chirurg

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“…Discussion NRLN is a rare finding that occurs most often on the right side (0.3-6% of cases), whereas it is exceptional on the left side (0.04%) (2,(4)(5)(6)(7). When a NRLN is misdiagnosed, it is exposed to increased risk of injury during neck surgery.…”

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confidence: 99%

“…This anomaly is reported with a widely variable prevalence (0.3-6%) in literature (2,(4)(5)(6)(7)(8).…”

Section: Systematic Reviewmentioning

confidence: 99%

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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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“…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.…”

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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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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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Nonrecurrent and recurrent inferior laryngeal nerve: A surgical pitfall in cervical exploration

Cited by 63 publications

References 1 publication

Verlaufsvariet�ten des Nervus laryngeus inferior

Verlaufsvariet�ten des Nervus laryngeus inferior

Neck ultrasonography for detection of non-recurrent laryngeal nerve

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

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