The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

Gürleyik, Emin; Doğan, Sami; Günal, Ömer; Pehlivan, Mevlüt

doi:10.1155/2012/143049

Cited by 8 publications

(13 citation statements)

References 15 publications

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“…Rates of RLN injury are reported to be as high as 10%. The RLN identification and protection during thyroid surgery is essential for avoiding intraoperative RLN injury [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] .…”

Section: Introductionmentioning

confidence: 99%

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

İrkörücü

2016

Annals of Medicine &Amp; Surgery

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BackgroundZuckerkandl tubercle (ZT) is a lateral projection from the lateral thyroid lobe which is a constant landmark for finding the recurrent laryngeal nerve during thyroid surgery. It is the condensed thyroid parenchyma located in the cricothyroid junction. Even today, ZT and its relationship with recurrent laryngeal nerve (RLN) is not well known by all surgeons. The objectives of the present study were to find out the incidence of ZT in our thyroidectomies and to investigate whether the ZT has a relationship with RLN. We also discussed how to prevent RLN injury during thyroidectomy.Materials and methodsOne hundred operations were performed by the same surgeon included in this study. All operations performed with intraoperative neuromonitorization (IONM) for proving the visualization of RLN. In each patient, particularly the ZT and its relationship with RLN searched and recorded. We also analyzed the patients in terms of sex, age, clinical diagnosis, and types of performed operations.ResultsIn 100 operations, 173 thyroid lobectomies were considered. 87 of these lobectomies were in right side and 86 in left side. The ZT was determined in 127 of 173 (73.41%) lobectomies. ZT was detected in 68 (78.16%) of right thyroid lobes whereas in 59 (68.60%) of left thyroid lobes. We observed that the ZT was detected more frequently in the right side. In 115 (90.55%) of these occasions, the recurrent nerve was directed upwards covered by the ZT.ConclusionsIf it is present, ZT is a real constant landmark pointing to the RLN. In order to find and protect RLN during thyroid surgery, a careful, bloodless, and meticulous dissection should be carried out around the ZT. Although our results are encouraging, further researches are still needed on this topic.

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Section: Introductionmentioning

confidence: 99%

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

İrkörücü

2016

Annals of Medicine &Amp; Surgery

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“…This subsequent prolongation of the lobe, which has its embryological origin in the merging of the central primordium originating from the floor of the pharynx and the lateral primordia of the fifth pharyngeal pouch, can make dissecting the nerve difficult (Gil-Carcedo Sañudo et al, 2012). On rare occasions it can be associated with a NRILN (Gurleyik, et al, 2012). Gurleyik et al (2017) report the case of a NRILN and extralaryngeal bifurcation of the ILN in close relation with Zuckerkandl's tubercle, all on the right side.…”

Section: Discussionmentioning

confidence: 95%

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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“…This nerve has anatomic variations. Non-recurrent nerve is a rare variation with prevalence of equal or below 1% (1,(3)(4)(5)(6)(7)(8). The non-recurrent nerve originates from the vagus, and has transverse course toward laryngeal entry point.…”

Section: Discussionmentioning

confidence: 99%

“…A thyroid surgeon must know anatomy of the inferior laryngeal nerve (ILN) including its anatomic variations. A rare variation like non-recurrent nerve increases complication rate of thyroid operations (1)(2)(3)(4)(5)(6)(7)(8). RLN is a branch of the vagus nerve which is normally located in the cervical neurovascular bundle posterior to the carotid artery and the jugular vein.…”

Section: Introductionmentioning

confidence: 99%

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

Gürleyik¹

2015

UCD

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Non-recurrent inferior laryngeal nerve (ILN) arising from the vagus nerve is a rare anatomic variation. The vagus descends vertically in the cervical neurovascular bundle, between and posterior to common carotid artery (CCA) and internal jugular vein (IJV). The vagus has also some anatomic variations. We present a case of two coincident anatomic variations both ILN and the vagus nerve. A patient with multinodular goiter was surgically treated with total thyroidectomy. Both two ILNs were identified, fully exposed and preserved along their cervical courses. We found that the right non-recurrent ILN directly arises from cervical vagal trunk, and enters the larynx at usual point after a short transverse course parallel to the inferior thyroid artery. The vagus nerve, easily exposed after dissection of the right lobe of the thyroid gland, is located medially to the CCA. We discovered the association of non-recurrent ILN and medially located vagus nerve in the same patient. Non-recurrent nerve and medially located vagus nerve in the cervical neurovascular bundle are two different variations. The coincidence of right non-recurrent ILN arising from cervical part of the vagus medial to the CCA in the same patient is a very interesting feature. The safety of thyroid operations is dependent on proper identification, dissection and full exposition of ILN. The safe procedure requires complete knowledge on the anatomy of neural structures including all their anatomic variations.

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The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

Cited by 8 publications

References 15 publications

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

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

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

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