The Non Recurrent Laryngeal Nerve—A Rare Phenomenon which Requires Vigilance

Forde, R; Williams, EW

doi:10.7727/wimj.2014.223

Cited by 11 publications

(14 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 This anomaly was first noticed in 1823 by Steadman when he was doing a cadaveric dissection, he also noticed an anomalous origin and course of the right subclavian artery. 2 Nonrecurrent laryngeal nerve is a rare anatomical variation that present mostly on the right side, its estimated percentages are around 0.3% to 0.7%; in the left side this variation is extremely rare, estimated to be around 0.04%. Studies have shown a significant difference during cadaveric dissection, being twice more common.…”

Section: Introductionmentioning

confidence: 99%

Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for the First Time

Mohammed

Arif

2020

Ear Nose Throat J

View full text Add to dashboard Cite

Introduction: The recurrent laryngeal nerve gains its name because after branching from the vagus nerve, it turns superiorly (recur) around the subclavian artery on the right and around the ligamentum arteriosum on the left, the nonrecurrent nerve has a straight direct course to the larynx and doesn’t follow this course. It presents mostly on the right side. The presence of this variation places the nerve at higher risk of injury during neck surgery especially thyroid operations. Case Presentation: A 45-year-old lady presented with painless thyroid enlargement for 1 year. Thyroid examination showed a 3-cm firm nodule at the right thyroid lobe with normal thyroid function tests. Right thyroid lobectomy was done and the histopathology showed a benign follicular lesion. During surgery, we discovered 2 nonrecurrent laryngeal nerves at the right side which were arising from the vagus nerve and both were entering the larynx. Conclusion: Failure in identification of the nerve or overlooking the possibility of the non-recurrent laryngeal nerve may result in a serious sequelae of nerve damage, ipsilateral injury may lead to permanent hoarseness and bilateral injury may result in severe dyspnea or aphonia. Currently, there are 3 types of nonrecurrent laryngeal nerve courses. Type 1 passes near to the superior thyroid vessels. Type 2 (2A) passes parallel to the inferior thyroid artery and has a transverse course above it. Type 3 (2B) passes parallel to the inferior thyroid artery and transversely between branches of or under the inferior thyroid artery, we can add to this classification type 4, which are 2 nonrecurrent laryngeal nerves (double nerves) passing above and parallel to the inferior thyroid artery.

show abstract

Section: Introductionmentioning

confidence: 99%

Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for the First Time

Mohammed

Arif

2020

Ear Nose Throat J

View full text Add to dashboard Cite

show abstract

“…The nRLN anatomic variation was first reported by Steadman in 1823, in a cadaver, along with an anomaly of the origin and course of the right subclavian artery (4).…”

Section: Discussionmentioning

confidence: 88%

Non-Recurrent Right Laryngeal Nerve: a Rare Anatomic Variation Encountered During a Total Thyroidectomy

Chrysikos

Σγάντζος

Tsiaoussis

et al. 2019

Acta Med. (Hradec Kralove, Czech Repub.)

View full text Add to dashboard Cite

The non-recurrent laryngeal nerve (nRLN) is a rare anatomic variation that every head and neck surgeon must be aware of, in order to avoid intraoperative injury which leads to postoperative morbidity. We are reporting a case of a nRLN in a 47 year old female patient with medullary thyroid carcinoma who was surgically treated with total thyroidectomy and lymph node dissection. Both two inferior laryngeal nerves were identified, fully exposed and preserved along their cervical courses. However, we found that the right inferior laryngeal nerve was non-recurrent and directly arised from the cervical vagal trunk, entered the larynx after a short transverse course and parallel to the inferior thyroid artery. The safety of thyroid operations is dependent on high index of suspicion, meticulous identification and dissection of laryngeal nerves either recurrent or non-recurrent. This leads to minimum risk of iatrogenic damage of the nerves. Complete knowledge of the anatomy of these neural structures, including all their anatomic variations is of paramount importance.

show abstract

“…5 ILN is the nerve of the 6th branchial arch which, with the descent of the heart loops around 6th aortic arch and ascends to the larynx in the tracheoesophageal groove. 1 On the right side, normally the distal portion of the 6th and 5th aortic arches disappears and the nerve moves up beneath the 4th aortic arch (Figure 2), which becomes the future right subclavian artery. Occasionally, the 4th arch disappears, and the subclavian artery arises directly from the aorta distal to the origin of the left subclavian artery (aberrant subclavian artery or arteria lusoria), Figure 2 and 3.…”

Section: Discussionmentioning

confidence: 99%

“…The inferior laryngeal nerve is traditionally named recurrent due to the fact that it loops around the subclavian artery on the right side and the arch of aorta on the left side. 1 The inferior laryngeal nerve (ILN) innervates the intrinsic muscles of the larynx except the cricothyroid. It also innervates the mucosa of the laryngeal region inferior to the vocal cords.…”

Section: Introductionmentioning

confidence: 99%

Non-recurrent inferior laryngeal nerve: a case report

et al. 2020

View full text Add to dashboard Cite

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

show abstract

The Non Recurrent Laryngeal Nerve—A Rare Phenomenon which Requires Vigilance

Cited by 11 publications

References 4 publications

Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for the First Time

Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for the First Time

Non-Recurrent Right Laryngeal Nerve: a Rare Anatomic Variation Encountered During a Total Thyroidectomy

Non-recurrent inferior laryngeal nerve: a case report

Contact Info

Product

Resources

About