Nonrecurrent laryngeal nerve in the era of intraoperative. Oct 18, 2015 the recurrent laryngeal nerve is a branch of the vagus nerve that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. Prediction and early identification of non rln may minimize such a risk of injury. This study aims to determine the relationship between the recurrent laryngeal nerves and the inferior thyroid arteries during thyroidectomies, as well as any particularities and intraoperative complications. This study assessed the effect of intraoperative neuromonitoring ionm on the detection of non rln.
Because of the anatomical variations of the nerve, preservation of the nerve is the optimal strategy during surgery. A right nonrecurrent laryngeal nerve coursing near the superior pole vessels. In this condition, which has a frequency of between 0. Anatomical variations of recurrent laryngeal nerve. The recurrent laryngeal nerve exits the caudal brainstem as part of the vagus nerve cranial nerve x and descends along the trachea dorsal to the common carotid artery with a different course between the left and right recurrent laryngeal nerves. The recurrent laryngeal nerve rln innervates all the important laryngeal muscles except the cricothyroid.
Case report open access a nonrecurrent inferior laryngeal nerve in a man undergoing thyroidectomy. A novel variation of the recurrent laryngeal nerve gaosong wu1,2 and kun wang2 abstract background. Before entering the larynx, 35% to 80% of nerves may divide 6. Nonrecurrent inferior laryngeal nerve in thyroid surgery. Aug 17, 2016 recurrent laryngeal nerve paralysis 1. This anomaly is called nonrecurrent laryngeal nerve.
The superior laryngeal nerve is a branch of the vagus nerve. If it no longer meets these criteria, you can reassess it. Non recurrent laryngeal nerve in thyroid surgery a n hisham ms, a sarojah ms, a alvin ms, nteast and endoetine surgical unit, departmentofsurgety,kualalumpurhospital, kualalumpur, malaysia introduction the non recuncntlaryngeal nerve nrin is a rare clinical entity. We present a case of 19 year old female with follicular variant of papillary carcinoma of thyroid, where non recurrent laryngeal nerve was identified on the right side and ct angiography.
On the right a non recurrent laryngeal nerve was seen with its direct branch from the vagus at the level of the level of the isthmus entering the cricothyroid muscle 3 cm away from the vagus without a recurrent course. The nonrecurrent inferior laryngeal nerve nirln is a rare anomaly 0. P recurrent laryngeal nerve to the inferior thyroid artery on the right and left side would be important for surgeons who are doing thyroidectomy and any vascular surgery in the neck. Laryngeal nerve damage multimedia encyclopedia health. A pilot light of the right nonrecurrent laryngeal nerve. B right nonrecurrent laryngeal nerve loops around the. Recurrent laryngeal nerve radiology reference article.
Recurrent laryngeal nerve definition of recurrent laryngeal. Inferior laryngeal nerve definition of inferior laryngeal. Nonrecurrent inferior laryngeal nerve identification. Damage to this nerve during the surgical procedure may lead to severe iatrogenic morbidity. Factors lead to injury of the recurrent laryngeal nerve. Read more about the nonrecurrent laryngeal nerve a rare phenomenon which. Rln palsy should be an historical event for the thoracic surgeon. Recurrent laryngeal nerve injury causes and surgery lecturio. Non recurrent laryngeal nerve nrln is a rare anomaly which is reported in 0. The nonrecurrent inferior laryngeal nerve nriln is a nerve anomaly that can be associated with an increased risk of vocal fold paralysis. The nonrecurrent laryngeal nerve nrln is a rare embryologicallyderived variant of the recurrent laryngeal nerve rln.
Laryngeal nerve damage is injury to one or both of the nerves that are attached to the voice box. The full text of this article is available in pdf format. Original research article a study on the variations in the. However, the functions of this muscle and the anatomic variations of. West indian medical journal faculty of medical sciences, the university of the west indies, mona. Nonrecurrent laryngeal nerve nrln is a rare anomaly which is reported in 0. Functional laryngeal reinnervation depends upon the precise reinnervation of the laryngeal abductor and adductor muscle groups. Introduction the identification and preservation of recurrent laryngeal nerve is important during thyroid and parathyroid surgery. But again, adequate surgical technique maintains great importance. The various causes of recurrent laryngeal nerve paralysis that i have observed during the past 24 years are reported. Laryngeal intraoperative nerve monitoring lionm, recurrent or inferior laryngeal nerve, vagus. Jun 02, 2017 a new type of non recurrent inferior laryngeal nerve in a cadaver with a right retroesophageal subclavian artery, newton bw, rodgers sa, rau jn, hong my, terreberry rr.
A 50yearold woman was presented to our department with a nodule in the right thyroid lobe, and she reported no voice changes. Overall incidence of transient rlnp is reported to be 0. It arises from the middle of the inferior ganglion of vagus nerve and in its course receives a branch from the superior cervical ganglion of the sympathetic nervous system. Non recurrent laryngeal is an incidental finding in surgeries for thyroid disorders. Management of unilateral recurrent laryngeal nerve injury. The recurrent laryngeal nerve may be traumatized during surgery on the thyroid and parathyroid glands. Bilateral recurrent laryngeal nerve paralysis can be a fatal emergency. Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Recurrent laryngeal nerve an overview sciencedirect topics. Nonrecurrent laryngeal nerve 2014, volume 30, issue 2. Malignant neoplasms of the lung and pulmonary tuberculosis were the most frequent causes of the paralysis. However, the two rlns are different from other nerves in that their courses are not symmetrical.
Feb 11, 2016 the non recurrent laryngeal nerve is an anomaly of the rln because its origin is cervical and it runs a direct course from the vagus nerve to the larynx without looping around any of the above named structures. This requires indirect laryngoscopy preoperatively, and, as soon as. What are the signs and symptoms of recurrent laryngeal. Ducharme, jon cheetham, in equine sports medicine and surgery second edition, 2014. Recurrent laryngeal nerve injury produces an abductor laryngeal paralysis. The nonrecurrent laryngeal nerve nrln is a rare anatomic variation that every head and neck surgeon must be aware of, in order to avoid intraoperative injury which leads to postoperative morbidity. B right nonrecurrent laryngeal nerve loops around the inferior thyroid artery. A nonrecurrent variant of the inferior laryngeal nerve has been seldom reported. Causes of recurrent laryngeal nerve paralysis jama. A new type of nonrecurrent inferior laryngeal nerve in a. The recurrent laryngeal nerves rln are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx. Case report nonrecurrent laryngeal nerve and aberrant. Laryngeal nerve damage can be caused by injury, tumors, surgery, or infection. The presence of a nonrecurrent laryngeal nerve fig.
Nonrecurrent nerve is a very rare variation of the inferior laryngeal nerve. The recurrent laryngeal nerve can be a real challenge to the surgeon operating in its area. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. These results indicate that a medial location of the vagus nerve may be considered as a pilot light of the nonrecurrent laryngeal nerve. The superior laryngeal nerve sln provides motor innervation to the cricothyroid muscle. We are reporting a case of a nrln in a 47 year old female patient with medullary thyroid carcinoma who was surgically treated with total. Electrophysiologic recurrent laryngeal nerve monitoring during. She had no history of surgery or radiation to the head or neck. Type 1 occurs where the nrln arises directly from the vagus and travels. Careful dissection of the rln during surgery reduces the risk of damage. The nonrecurrent laryngeal nerve a rare phenomenon. Idiopathic left recurrent laryngeal nerve palsy is a relatively common entity.
Of the 1776 visualized nerves on the right side, 6 were found to be non. The incidence of damage to the recurrent laryngeal nerve is reported to be between 0% and 4. External branch of the superior laryngeal nerve monitoring. Historically, the rln has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. Nonrecurrent laryngeal nerve in thyroid surgery a n hisham ms, a sarojah ms, a alvin ms, nteast and endoetine surgical unit, departmentofsurgety,kualalumpurhospital, kualalumpur, malaysia introduction the nonrecuncntlaryngeal nerve nrin is a rare. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. Anatomical variations of the recurrent laryngeal nerve in. The nonrln nrln is a rare anatomical anomaly of the rln, with an incidence of 0. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returnin. Several anatomic variations of the nerve increase the likelihood of iatrogenic damage. The nonrecurrent laryngeal nerve nrln is a rare variant of the recurrent laryngeal nerve rln that takes an aberrant course, not descending into the thorax as is usual fig. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returning up to achieve the tracheoesophageal groove and then the larynx. Nonrecurrent laryngeal nerve non rln is an anatomical variation increasing the risk of vocal cord palsy. The book is visually oriented with color illustrations and photomicrographs embracing all aspects of recurrent laryngeal nerve anatomy including branching patterns, relationship of the nerve and the inferior thyroid artery and the nonrecurrent recurrent laryngeal nerve.
The recurrent laryngeal nerve rln shows some anatomical variations that can potentially compromise the safety of thyroid surgery. Non recurrent laryngeal nerve is a rare anatomical variation which should be carefully identified during thyroid surgery to prevent post operative morbidity. In the second patient there were three anatomical variations, namely an extra laryngeal bifurcation of the nerve, a prevascular position of the nerve and a branch connecting the vagus nerve and the recurrent nerve. The recurrent laryngeal nerve rln branches off the vagus nerve and supplies function to some muscles of the larynx voice box. The nonrecurrent laryngeal nerve a rare phenomenon which. The recurrent and superior laryngeal nerves springerlink. Nonrecurrent laryngeal nerve during thyroid surgery. The risk of injury to the recurrent laryngeal nerve.
Extralaryngeal branching of the recurrent laryngeal nerve. These anatomical differences between the course of the nerve on both sides could be attributed to the embryological development which varies between sides. Treatment of recurrent laryngeal nerve injury jama surgery. The recurrent laryngeal nerve divides into a motor branch and a sensory branch, usually within the larynx.
Recurrent inferior laryngeal nerve in thyroid surgery. A common claim by evolutionists is that the mammalian left recurrent laryngeal nerve was poorly designed because it travels downward past the larynx, then around the aorta and, last, back up to the larynx. The incidence of nonrecurrent laryngeal nerve is 0. In this case report, we present a nonrecurrent laryngeal nerve abnormality in a patient who underwent parathyroidectomy, thyroidectomy and functional. Recurrent laryngeal nerve injury causes and surgery. Like the normal left rln, the variant nerve branches from the vagus nerve and wraps around the arch of the. Laryngeal reinnervation for unilateral vocal fold paralysis using ansa cervicalis nerve to recurrent laryngeal nerve anastomosis. Recurrent laryngeal nerve request pdf researchgate. Pdf surgical anatomy of the recurrent laryngeal nerve. Read more about sigmoid volvulus and chronic colonic schistosomiasis. This article highlights the normal anatomy, anatomical variants and ways to identify the nerve as the. A new type of nonrecurrent inferior laryngeal nerve in a cadaver with a right retroesophageal subclavian artery, newton bw, rodgers sa, rau jn, hong my, terreberry rr. The wide variability of this extralaryngeal branching elb has significant implications for the risk of. Pdf relationship between the recurrent laryngeal nerve.
However, very occasionally, a sinister mediastinal cause is diagnosed. While simple endtoend anastomosis of the recurrent laryngeal nerve rln main trunk results in synkinesis, functional reinnervation can be achieved by selective anastomosis of the abductor and adductor rln divisions. During the performance of 2101 thyroid operations, 3496 recurrent laryngeal nerves were identified and exposed. Combined recurrent laryngeal and phrenic nerve paralysis due to. The anatomical variations of the nerve concerned the nonrecurrent lar\ yngeal nerve in the first patient. Its peculiar route results from evolutionary lengthening of the neck. The presence of an nrln significantly increases the risk of. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the inferior parathyroid gland and middle thyroid veins used as. It then branches into the superior and recurrent laryngeal nerves rln, of which the latter is remarkably interesting from the point of view of evolutionary biology. The presence of an nrln significantly increases the risk of iatrogenic injury and operative complications.
It arises almost exclusively on the right howtocitethisarticlehenry et al. Electrophysiologic recurrent laryngeal nerve monitoring. The proximity of the rln to the inferior thyroid artery ita was noted in 444 90. An unusual anomaly is the socalled nonrecurrent laryngeal nerve. The branches provide both sensory and motor fibers. The need to identify the inferior laryngeal nerve during thyroid and related surgery to prevent its injury is well established. Treatment depends on the cause and extent of the laryngeal nerve damage. Case report open access a nonrecurrent inferior laryngeal. Background the nonrecurrent laryngeal nerve nrln is a rare embryologicallyderived variant of the recurrent laryngeal nerve rln. You have two, one on each side, as you do with other nerves. The non recurrent laryngeal nerve nrln is a rare variant of the recurrent laryngeal nerve rln that takes an aberrant course, not descending into the thorax as is usual fig. In 4 patients with recurrent laryngeal nerve paralysis, the left recurrent nerve was most commonly involved. Injury to the left and right laryngeal nerves at the same time can cause a breathing problem. A nonrecurrent inferior laryngeal nerve is a rare anomaly in which the nerve enters the larynx directly off the cervical vagus nerve, without descending to the thoracic level.
Normal embryological evolution left and in case of nonrecurrent inferior laryngeal nerve right. Background the non recurrent laryngeal nerve nrln is a rare embryologicallyderived variant of the recurrent laryngeal nerve rln. Routine exposure of recurrent laryngeal nerve in thyroid surgery can. Dec, 2014 it is a branch of the vagus nerve cranial nerve x. We found a case of right nonrecurrent laryngeal nerve in a case of carcinoma thyroid operated for total thyroidectomy figure 1 and figure 2. A variant nerve that mimics the left recurrent laryngeal nerve peerj.
Quite a number of atheopaths have recently been using the mammalian recurrent laryngeal nerve as an argument against design. Accurate diagnosis can be made only by visualizing the vocal cords while the patient is awake. A total of 462 236 right nerves in 272 patients were identified and totally exposed, and all. The recurrent laryngeal nerve rln is a branch of the vagus nerve cranial nerve x that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. Recurrent laryngeal nerve injury in the chest is due to cardiac surgery, lung cancer, pulmonary tuberculosis, oesophageal cancer, mitral stenosis, and thoracic aortic aneurysm. Non recurrent laryngeal nerve west indian medical journal. Anatomy of recurrent laryngeal nerveanatomy of recurrent. There are two recurrent laryngeal nerves, right and left. Damage to the recurrent laryngeal nerve rln consequent to thyroid surgery is a complication that has been recognized for over a century. The vocal cord assumes a median or paramedian position. The laryngeal nerve is a nerve branching down from the vagus nerve towards the larynx. The origin of the nrln is cervical and there are three types. The recurrent and superior laryngeal nerves gregory w.
Our aim was to provide a comprehensive metaanalysis of the overall prevalence of the nrln, its origin, and its association with an aberrant subclavian artery. The recurrent and superior laryngeal nerves pdf download. A novel variation of the recurrent laryngeal nerve bmc. The left recurrent laryngeal nerve design in mammals is not poor design. Rln paralysis may pass undetected as about one introduction. Relationship between the recurrent laryngeal nerve and the. There are two recurrent laryngeal nerves right and left in the human body both arising from the vagus nerve but they follow slightly different courses on the left and right side. Relationship of the recurrent laryngeal nerve rln to the left and right inferior thyroid arteries. Identification of the recurrent laryngeal nerve during thyroid surgeries is recommended to preserve its functionl integrity.
Ta the terminal branch of the recurrent laryngeal nerve as the latter passes deep to the inferior pharyngeal constrictor. Nonrecurrent laryngeal nerve nrln is a rare anomaly that head and neck surgeons encounter a surprise during thyroid surgeries. The role of digital subtraction angiography to identify subjects. However, meticulous dissection helps not only to identify but also to preserve the integrity of the nerve. This svg file contains embedded text that can be translated into your language, using the svg translate tool or any capable svg editor.
Recurrent laryngeal nerve rln injury is considered to be the most severe complication in thyroid surgery. Anatomy of the thoracic recurrent laryngeal nerves from a. A new classification system for recurrent laryngeal nerve anatomy is proposed. It is mostly caused by thyroid and cervical surgery, trauma, endotracheal intubation, central. Background in this study, we have tried to find out a pattern of variable relationship between recurrent laryngeal nerve and inferior thyroid artery close to the lower pole of thyroid gland. Jul 12, 2019 recurrent laryngeal nerve injury in the chest is due to cardiac surgery, lung cancer, pulmonary tuberculosis, oesophageal cancer, mitral stenosis, and thoracic aortic aneurysm. We report a case of 62 year old male with papillary carcinoma thyroid having an aberrant right subclavian artery and a non recurrent inferior laryngeal nerve. In most series the incidence is reportedto beless than 1%. The recurrent laryngeal nerve does not refute intelligent design. A nonrecurrent inferior laryngeal nerve nriln, a variant of the right recurrent laryngeal nerve, was also noted. The importance of the recurrent laryngeal nerve in surgery on the anterior region of the neck has motivated many published papers on critical points of its pathway, relationship with the inferior thyroid artery, penetration in the larynx, division outside the larynx, and branches communicating with the internal branch of the superior laryngeal nerve. The recurrent laryngeal nerve enters the larynx deep to the inferior constrictor muscle and posterior to the cricothyroid joint. It was direct branch from the right vagus nerve, no branch seen along the tracheaesophageal groove. Identification and preservation of recurrent laryngeal nerve inferior laryngeal nerve is one of the most important step during thyroid and parathyroid surgery.
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