Citation Information :
Mejía LV, Bello LF, Gómez-Herrera J. Nonrecurrent Laryngeal Nerve in Total Thyroidectomy: Two Case Reports and Literature Review. Int J Head Neck Surg 2023; 14 (4):66-67.
Introduction: The non-recurrent laryngeal nerve (NRLN) is an indulgent and unusual entity, because of the low prevalence and knowledge; the diagnosis may be difficult. When injured it may lead to functional alterations such as vocal cords paralysis and airway obstruction, awareness of this diagnosis is definitive to avoid its damage surgical interventions.
Presentation of cases: In our two patients a total thyroidectomy was performed because of a benign pathology. during the intervention a laryngeal nerve without a recurrent pathway was found and documented their origin directly from the vagus nerve.
Discussion: The diagnosis of NRLN is usually incidental during a surgical procedure. That is the reason why it can be easily damaged in different ways (transection, electrothermal etc). NRLN is documented in the right side in higher percentage, and it is directly related to a vascular malformation known as lusoria artery.
Conclusion: The anatomy knowledge has a determining factor in the surgical outcomes. In this way the iatrogenic damage can be minimized and consequences due to the damage of the RLN can be prevented.
Chiang FY, Lu IC, Chen HC, et al. Anatomical variations of recurrent laryngeal nerve during thyroid surgery: how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci 2010;26(11):575–583. DOI: 10.1016/S1607-551X(10)70089-9
Asencio L, Osorio I, York E, et al. El nervio laríngeo no recurrente una variación anatómica a tener en cuenta en la cirugía tiroidea. Cirugía Española 2017;95:277
Page C, Monet P, Peltier J, et al. Non-recurrent laryngeal nerve related to thyroid surgery: report of three cases. J Laryngol Otol 2008;122(7):757–761. DOI: 10.1017/S0022215107008389
Yetisir F, Salman AE, Çiftçi B, et al. Efficacy of ultrasonography in identification of non-recurrent laryngeal nerve. Int J Surg 2012;10(9):506–509. DOI: 10.1016/j.ijsu.2012.07.006
Anand A, Nebhani D, Yadav SK, et al. Right-sided non-recurrent laryngeal nerve without any vascular anomaly: an anatomical trap. ANZ J Surg 2021;91(7-8):1635. DOI: 10.1111/ans.16891
Le QV, Ngo DQ, Ngo QX. Non-recurrent laryngeal nerve in thyroid surgery: a report of case series in Vietnam and literature review. Int J Surg Case Rep 2018;50:56–59. DOI: 10.1016/j.ijscr.2018.07.017
Pardal-Refoyo JL. Comments on the finding of right non recurrent laryngeal nerve during thyroidectomy. Acta Otorrinolaringol Esp (Engl Ed) 2017;68(6):375–376. DOI: 10.1016/j.otorri.2017.02.010
Dolezel R, Jarosek J, Hana L, et al. Clinical relevance and surgical anatomy of non-recurrent laryngeal nerve: 7 year experience. Surg Radiol Anat 2015;37(4):321–325. DOI: 10.1007/s00276-014-1369-4
Gong RX, Luo SH, Gong YP, et al. Prediction of nonrecurrent laryngeal nerve before thyroid surgery–experience with 1825 cases. J Surg Res 2014;189(1):75–80. DOI: 10.1016/j.jss.2014.02.010
Sadiq Z, Cheng L, Parker G, et al. Nonrecurrent laryngeal nerve in thyroid surgery - an important lesson. Brit J Oral Maxillofac Surg 2011;49:189.
