DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20213301

Nonrecurrent laryngeal nerve-an anatomical deviation

E. Sivakumar, C. A. Swapna, Lavanya Karanam

Abstract


Thyroidectomy is one of the most dispute and discussed surgery. Identification of recurrent laryngeal nerve is the most important step in this surgery. Among postop complications of thyroidectomy, the commoner is haematoma, transient hypocalcaemia and hoarseness. We report a rare case of nonrecurrent laryngeal nerve in a 25-year-old male with swelling in the right thyroid lobe. A 25-year-old male presented to the ENT OPD with complaints of swelling in thyroid region for 6 months with no other symptoms. On examination there was a 2×3 cm size nodule in the right lobe of thyroid. Rest of ORL examination was normal. On ultrasonogram there was an enlarged right lobe of thyroid with a nodular goitre. Fine needle aspiration cytology showed colloid goitre. Patient was planned for right hemithyroidectomy. Right side type 1 nonrecurrent laryngeal nerve was identified at the level of superior pole of thyroid branching from vagus and entering the larynx at the level of cricothyroid joint was identified intraoperatively. In conclusion, nonrecurrent laryngeal nerve though a very rare anomaly forms a crucial anatomical structure in thyroid surgery and is prone to injury. It is one of the preventable complications during thyroid surgery leading to postop vocal cord palsy. An in-depth anatomical knowledge and diligent surgical technique will help in identification and preservation of nonrecurrent laryngeal nerve.


Keywords


Nonrecurrent laryngeal nerve, An anatomical variant, Thyroid surgery

Full Text:

PDF

References


Dralle H, Lorenz K, Machens A. Verdicts on malpractice claims after thyroid surgery: emerging trends and future directions. Head Neck. 2012;34(11):1591-6.

Townsend CM, Beauchamp DR, Evers MB, Mattox KL. Sabiston textbook of surgery: The biological basis of modern surgical practice (19th ed). Philadelphia, PA: Elsevier 2012;886.

Uludag M, Isgor A, Yetkin G, Citgez B. Anatomic variations of thenon-recurrent inferior laryngeal nerve. BMJ Case Rep. 2009.

Stedman GW. A singular description of some of the nerves and the arteries of the neck and the top of the thorax. Edin Med Surg J. 1823;19:564-65.

O’Neill JP, Fenton JE. The recurrent laryngeal nerve in thyroid surgery. Surgeon. 2008;6:373-77.

Pemberton J, Beaver MG. Anomaly of the right recurrent laryngeal nerve. Surg Gynecol Obstet. 1932;54:594-95.

Brandon MH, Silvia S, Matthew Graves J. The non-recurrent laryngeal nerve: a meta-analysis and clinical considerations. Peer J. 2017;5:e3012.

Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Pelizzo MR. Identification of the non-recurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg. 2004;28:659-61.

Casal D, Pecas A¸ Sousa D, Rosa-Santos J. A non-recurrent inferior laryngeal nerve in a man undergoing thyroidectomy: a case report. J Med Case Rep. 2010;4:386.

Raffaelli M, Iacobone M, Henry JF. The false non-recurrent inferior laryngeal nerve. Surgery. 2000;128:1082-7.

Schneider J, Baier R, Dinges C. Retroesophageal right subclavian artery (lusoria) as origin of traumatic aortic rupture. Eur J Cardiothorac Surg. 2007;32:385-7.