Browse > Article

Identification of the Nonrecurrent Laryngeal Nerve during Thyroid Surgery: Variations, Associated Vascular Malformation, Adequate Surgical Technique  

Lee Jan-Dee (Department of Surgery, Yonsei University College of Medicine)
Yun Ji-Sup (Department of Surgery, Yonsei University College of Medicine)
Lim Chi-Young (Department of Surgery, Yonsei University College of Medicine)
Nam Kee-Hyun (Department of Surgery, Yonsei University College of Medicine)
Chang Hang-Seok (Department of Surgery, Yonsei University College of Medicine)
Chung Woong-Youn (Department of Surgery, Yonsei University College of Medicine)
Park Cheong-Soo (Department of Surgery, Yonsei University College of Medicine)
Publication Information
Korean Journal of Head & Neck Oncology / v.22, no.1, 2006 , pp. 3-7 More about this Journal
Abstract
Purpose: The nonrecurrent laryngeal nerve(NRLN) is a rare anomaly that is associated with the developmentally aberrant subclavian artery. Although rare on the right side and exceptional on the left, an aberrant nonrecurrent pathway for RLN represents a major surgical risk. Three course variations of right NRLN can be distinguished: descending(type I) , horizontal(type II), ascending(type III). This study is performed to characterize the variations of NRLN, associated vascular anomaly, and proper surgical methods for preventing nerve damage. Materials and Methods: Between January 1998 and March 2006 3,381 thyroidectomy were performed at our institution, and during these operations a nonrecurrent laryngeal nerve was observed in 13 cases (0.38%). There were 1 men and 12 women with a median age of 48 years(range 28-57). All of them are identified on the right side. Results: In all cases, there were no clinical symptoms observed preoperatively. The nerve anomaly was diagnosed preoperatively in only one case. There were type I variations of right RLN in 2 cases and type II variations in 11 cases. The retroesophageal aberrant right subcalvian artery; no innominate(brachiocephalic) artery was found and the right common carotic artery was arising directly from the aortic arch, was seen in 12 cases. A vocal cord palaysis caused by NRLN damage during operation was observed in one patient(7.6%) , where the nerve was close to the superior thyroid artery. No other complications were noted. Conclusion: It can be possible to predict NRLN from signs associated with the vascular anomaly; clinical symptoms or imaging studies. When an vascular anomaly is not detected preoperatively, overlooking possibility of NRLN may lead to severe operative morbidity. Hence, It is most important to identify all the thyroid structures carefully during thyroid surgery and to be aware of the possibility of anatomic variations of RLN.
Keywords
Nonrecurrent laryngeal nerve; Aberrant subclavian artery; Nerve injury;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Toniato A, Mazzarotto R, Piotto A, et al: Identification of the Nonrecurrent Laryngeal Nerve during Thyroid Surgery: 20-Year Experience. World J Surg. 2004;28:659-661
2 Stedman GW: A singular distribution of some of the nerves and arteries of the neck and the top of the thorax. Edin Med Surg J. 1823;19:564-565
3 Nagayama I, Yozo D, Hideak K: Importance of pre-operative recognition of the non-recurrent laryngeal nerve. J Laryngol Otol. 1994;108:417-419
4 Srinivasan V, Premachandra DJ: Non-recurrent laryngeal nerve: Identification during thyroid surgery. ORL J Otorhinolaryngol Relat Spec. 1997;59:57-59   DOI   ScienceOn
5 Salama AB, McGrath P: Recurrent laryngeal nerve and the posterior fascial attachment of the thyroid gland. Aust NZ J Surg. 1992;62:444-449   DOI
6 Cannon CR: The anomaly of nonrecurrent laryngeal nerve: Idendification and management. Otolaryng HEAD NECK. 1996;120: 769-771
7 Pemberton J, Beaver MG: Anomaly of the right recurrent laryngeal nerve. Surg Gynecol Obstet. 1932;54:594-595
8 Weiand G, Mangold G: Variations in the course of the inferior laryngeal nerve. Surgical anatomy, classification, diagnosis. Chirurg. 2004;75 (2):187-195   DOI
9 Materazzi G, Berti P, Iacconi P, et al: Nonrecurrent laryngeal nerve predicted before thyroidectomy by preperative imaging. J Am Col Surg. 2000;191:580   DOI   ScienceOn
10 Bayford D: An account of a singular case of obstructed deglutition. Mem Med Soc London. 1789;2.271-272
11 Henry JF, Audiffret J, Denizot A, et al: The nonrecurrent inferior laryngeal nerve: Review of 33 cases, including two on the left side. Surgery. 1988;104:977-984
12 Deveze A, Sebag F, Hubbard J, et al: Identification of patients with a non-recurrent inferior laryngeal nerve by duplex ultrasound of the brachiocephalic artery. Surg Radiol Anat. 2003;25:263-269   DOI
13 Berlin DD: The recurrent laryngeal nerves in total ablation of the normal thyroid gland: an anatomical and surgical study. Surg Gynecol Obstet. 1935;60:19-26
14 Abbound B, Aouad R: Non-recurrent inferior laryngeal nerve in thyroid surgery: report of three cases and review of the literature. J Laryngol Otol. 2004;118 (2):139-142
15 Campbell PR, Serpell TW, Young AE: Non-recurrent laryngeal nerves. The role of distal subtraction angiography to identify subjects. Aust NZ J Surg. 1991;61:358-359   DOI