Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly: Review of 17 cases

Abstract

The authors report 17 cases of a right non-recurrent inferior laryngeal n. (NRILN) observed during 15 years of practice of thyroid and parathyroid surgery. In their last two cases, the existence of an aberrant right subclavian a., constantly associated with NRILN, was confirmed by MRI angiography. On the basis of the literature and their own experience, the authors review the incidence of this double anomaly, its embryologic explanation and its anatomic and surgical importance. They stress the diagnostic factors and the therapeutic implications, very different in children and adults, of a particular vascular anomaly whose outcome is little understood.

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

“…The first anatomical case with right aberrant subclavian artery was described by Hunauld in 1785, but the first clinical case of retroesophageal right subclavian artery was described in 1794 by Bayford in a patient who suffered from dysphagia: the term "dysphagia lusoria" has been used to describe this symptomatic consequence of the vascular anomaly (Henry et al 1988;Avisse et al 1998). Arkin naturally named the abnormal artery arteria lusoria (Henry et al 1988).…”

“…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.…”

Retroesophageal Right Subclavian Artery with Nonrecurrent Laryngeal Nerve: Unique Variation of Surgical Importance

“…21 Inferior laryngeal nerve is the nerve Normally, the fifth left and right aortic arches as well as the distal part of the right sixth aortic arch, would regress and the nerve would follow its recurrent course toward the cricothyroid membrane differently on the right side. 22 On the left side, it would pass under the distal part of the sixth arch-ductus arteriosus and under the fourth arch which will form the aortic arch. 22 The right subclavian artery is formed from the distal part of the right dorsal aorta and from the seventh segmental artery.…”

“…22 On the left side, it would pass under the distal part of the sixth arch-ductus arteriosus and under the fourth arch which will form the aortic arch. 22 The right subclavian artery is formed from the distal part of the right dorsal aorta and from the seventh segmental artery. 23 Arising retroesophageal course, but could sometimes be intertracheoesophageal, exceptionally pretracheal.…”

“…29 The common consensus on the anomaly is the presence of the vascular defect called arteria lusoria where the fourth right aortic arch is abnormally absorbed and the vessel fails to drag the right RLN caudally when the cardia descends and neck elongates during embryonic development. 22,30 The incidence of arteria lusoria globally is 0.5 to 2% and is defined as the right subclavian artery arising as a branch of normal aortic arch and passing upward to the right behind the esophagus. 31 The anomaly is usually asymptomatic but sometimes presents as dysphagia called as dysphagia lusoria due to arterial tortuosity or premature arteriosclerosis and a rarely an aneurysm is seen.…”