Preoperative diagnosis and intraoperative protection of nonrecurrent laryngeal nerve: A review of 5 cases

Background Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroidectomy or parathyroidectomy. It is usually associated with abnormal vasculature that can be identified by several imaging methods. The aim of this study was to retrospectively analyze the preoperative diagnosis and intraoperative protection of NRLN. Material/Methods Of the 7169 patients who underwent thyroid surgery at our hospital between August 2008 and January 2013, 5 patients with NRLN were identified. Preoperative chest X-rays, neck ultrasonography (US), and computed tomography (CT) findings were reviewed. NRLNs were carefully and systematically searched for in surgery. Results Preoperative CT predicted NRLN in all 5 cases (100% accuracy). The detection rate of NRLN by CT was 0.4% (5/1170). NRLNs were confirmed in surgery. All of them were right-sided NRLN with type IIA variant. The CT scans clearly revealed the vascular anomalies. The review of US images suggested that vascular anomalies could be identified on the images in 1 patient. No postoperative complications occurred in any patient. Conclusions The preoperative CT scan was a reliable and effective method for identifying abnormal vasculature to indirectly predict NRLN. Combining the CT and US findings with adequate surgical technique may help to reduce the risk of nerve damage, in addition to preventing nerve palsy.

[1]  Anil Singh,et al.  Metastatic papillary thyroid carcinoma with absence of tumor focus in thyroid gland , 2013, The American journal of case reports.

[2]  C. Sekulla,et al.  Latencies Shorter than 3.5 ms After Vagus Nerve Stimulation Signify a Nonrecurrent Inferior Laryngeal Nerve Before Dissection , 2011, Annals of surgery.

[3]  W. Chung,et al.  Computed Tomography Is Useful for Preoperative Identification of Nonrecurrent Laryngeal Nerve in Thyroid Cancer Patients , 2011, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[4]  Yong-xue Zhu,et al.  Preoperative CT diagnosis of right nonrecurrent inferior laryngeal nerve , 2011, Head & neck.

[5]  S. Kook,et al.  Clinical and Imaging Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinomas , 2010, World Journal of Surgery.

[6]  M. Iacobone,et al.  The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery , 2008, Langenbeck's Archives of Surgery.

[7]  C. Sekulla,et al.  Intraoperative Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery , 2008, World Journal of Surgery.

[8]  A. Toniato,et al.  Identification of the Nonrecurrent Laryngeal Nerve during Thyroid Surgery: 20-Year Experience , 2004, World Journal of Surgery.

[9]  F. Debruyne,et al.  Arteria lusoria identified on preoperative CT and nonrecurrent inferior laryngeal nerve during thyroidectomy: A retrospective study , 2003, Head & neck.

[10]  A. Watanabe,et al.  Preoperative Computed Tomography Diagnosis of Non‐Recurrent Inferior Laryngeal Nerve , 2001, The Laryngoscope.

[11]  H. Dralle,et al.  Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation , 2001, Langenbeck’s Archives of Surgery.

[12]  P. Fockens,et al.  EUS imaging of the arteria lusoria: case series and review. , 2000, Gastrointestinal endoscopy.

[13]  P. Miccoli,et al.  Nonrecurrent laryngeal nerve predicted before thyroidectomy by preoperative imaging. , 2000, Journal of the American College of Surgeons.

[14]  A. Toniato,et al.  Zuckerkandl's tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark) , 1998, Journal of the American College of Surgeons.

[15]  J Barkmeier,et al.  Spasmodic dysphonia and vocal fold paralysis: outcomes of voice problems on work-related functioning. , 1998, Journal of voice : official journal of the Voice Foundation.

[16]  I. Nagayama,et al.  Importance of pre-operative recognition of the nonrecurrent laryngeal nerve , 1994, The Journal of Laryngology & Otology.

[17]  K. Kern.  Medicolegal analysis of errors in diagnosis and treatment of surgical endocrine disease. , 1993, Surgery.

[18]  J. Henry,et al.  The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side. , 1988, Surgery.

[19]  G. Stedman.  A Singular Distribution of Some of the Nerves and Arteries in the Neck, and the Top of the Thorax , 1823, Edinburgh medical and surgical journal.