Variant anatomy of non-recurrent laryngeal nerve: when and how should it be taught in surgical residency?

Zheng, Victoria; Rajeev, Reshma; Pinto, Mario De; Jong, Mechteld C. de; Sreenivasan, Dinesh Kumar; Parameswaran, Rajeev

doi:10.1007/s00423-023-02928-y

Cited by 7 publications

(7 citation statements)

References 63 publications

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“…However, when the right fourth aortic arch is abnormally lost in the early embryonic stage, an ARSA is formed by a compensatory seventh intersegmental artery [15]. As a result, the right inferior laryngeal nerve does not pass into the thoracic cavity and branches directly from the cervical vagus nerve without forming a recurrent loop [22]. The ARSA most commonly follows a retroesophageal course (80-84%), which is between the trachea and esophagus (12.7-15%), or a pretracheal course (4.2-5%) [11,12].…”

Section: Resultsmentioning

confidence: 99%

Surgical Anatomy of Non-Recurrent Inferior Laryngeal Nerves Observed Between 2011–2023

Sato,

Sugino,

Nishihara

et al. 2024

Preprint

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Purpose: To avoid complications during thyroid surgery, it is important to be aware of anatomical variations. This study aimed to analyze the clinical aspects of non-recurrent inferior laryngeal nerves (NRILNs) at a hospital in Japan. Methods: We retrospectively analyzed thyroid surgery cases at our institution over the last 12 years (2011–2023). The study included 2187 patients (1676 women, 76.6%) who underwent total thyroidectomy (TT; N = 512) or hemithyroidectomy (HT; N = 1611). The HT group included 850 right and 761 left thyroidectomies, and 82 patients underwent complementary TTs (40 right and 42 left). The total number of inferior laryngeal nerves identified during surgery was 2717 (1402 right and 1315 left). All patients underwent preoperative neck and thoracic computed tomography (CT) and neck ultrasonography (US). NRILN is classified into two types: Type 1, in which the NRILN branches at the level of the inferior thyroid artery and ascends along the trachea; and Type 2, in which the NRILN branches at the level of the superior pole of the thyroid gland and runs directly to the larynx. Results: We identified 12 NRILN cases. The nerve anomaly was diagnosed preoperatively in all patients. Of these cases, eight were Type 1 and four were Type 2. No inferior laryngeal nerve injury was observed after surgery. Conclusion: To avoid inferior laryngeal nerve injury, preoperative diagnosis of NRILNs is essential. NRILN is associated with an aberrant right subclavian artery; hence, its presence should be evaluated using routine US and CT before surgery.

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Section: Resultsmentioning

confidence: 99%

Surgical Anatomy of Non-Recurrent Inferior Laryngeal Nerves Observed Between 2011–2023

Sato,

Sugino,

Nishihara

et al. 2024

Preprint

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“…The embryological reason for the occurrence of NRLN is still a matter of debate. The inferior laryngeal nerve is formed during the fifth to sixth week of gestation, and is associated with the sixth branchial arch [ 4 ]. The aortic arch is created cranial to the larynx at an early gestational stage, but the neck elongates during gestation and the larynx moves cranially [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The aortic arch is created cranial to the larynx at an early gestational stage, but the neck elongates during gestation and the larynx moves cranially [ 29 ]. At this point, the inferior laryngeal nerve is already connected to the larynx, and the movement of the larynx causes the loop-like configuration of the right RLN around the right subclavian artery [ 4 ]. This also explains why the NRLN is often associated with the occurrence of an aberrant right subclavian artery as the arterial course differs [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…About 1–2% of the human population show an anatomical variant of the right RLN, the so-called non-recurrent laryngeal nerve (NRLN) [ 1 , 2 ]. Various courses of the NLRN are described in the literature, but Type 1 (sometimes called the “descending”, coursing along the superior thyroid pedicle; see Figure 1 —course 1), Type 2a (parallel and above the inferior thyroid artery; see Figure 1 —course 2) and Type 2b (parallel and below the inferior thyroid artery; see Figure 1 —course 3) are the most common variants [ 1 , 3 , 4 ]. Of note, NLRN is often associated with the presence of an arteria lusoria, an aberrant right subclavian artery arising from the descending aorta, and the absence of the brachiocephalic trunk [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…3) are the most common variants [1,3,4]. Of note, NLRN is often associated with the presence of an arteria lusoria, an aberrant right subclavian artery arising from the descending aorta, and the absence of the brachiocephalic trunk [5].…”

Section: Introductionmentioning

confidence: 99%

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Continuous Intraoperative Nerve Monitoring of a Non-Recurrent Laryngeal Nerve: Real-Life Data of a High-Volume Thyroid Surgery Center

Lederer,

Staubitz-Vernazza,

Margies

et al. 2024

Cancers

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Thyroid surgery is associated with a risk of injury to the recurrent laryngeal nerve, especially in the presence of anatomical variants such as a non-recurrent laryngeal nerve (NRLN). Injury to the nerve leads to transient or permanent vocal cord palsy (VCP). A novel method to prevent VCP is continuous intraoperative nerve monitoring (cIONM), but less is known about the applicability of this method in patients with NRLN. The aim of this study was to evaluate our own data regarding feasibility and detailed characteristics of cIONM in NRLN patients. We performed a monocentric retrospective cohort analysis including clinical data and intraoperative nerve monitoring data (measured by Inomed Medizintechnik GmbH, Emmendingen, ‘C2’ and ‘C2 Xplore’ device) of all thyroid surgery patients, showing NRLN between 2014 and 2022. Of 1406 patients who underwent thyroid surgery with cIONM between 2014 and 2022, 12 patients (0.9%) showed NRLN intraoperatively. Notably, cIONM was feasible in eight patients (67%). In all cases the onset latency of the right vagus nerve was shorter (<3.0 ms) than usually expected, suggesting that a short latency might be suitable to distinguish NRLN. None of the patients had a post-operative VCP. Overall, cIONM appears to be feasible and safe in NRLN patients and provides helpful information to prevent VCP.

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Presentation of Arteria Lusoria with Non Recurent Laryngeal Nerve

Afzal,

Wasif,

Akhtar

et al. 2024

Indian J Otolaryngol Head Neck Surg

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Variant anatomy of non-recurrent laryngeal nerve: when and how should it be taught in surgical residency?

Cited by 7 publications

References 63 publications

Surgical Anatomy of Non-Recurrent Inferior Laryngeal Nerves Observed Between 2011–2023

Surgical Anatomy of Non-Recurrent Inferior Laryngeal Nerves Observed Between 2011–2023

Continuous Intraoperative Nerve Monitoring of a Non-Recurrent Laryngeal Nerve: Real-Life Data of a High-Volume Thyroid Surgery Center

Presentation of Arteria Lusoria with Non Recurent Laryngeal Nerve

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