scholarly journals Relation of Nonrecurrent Laryngeal Nerve with Zuckerkandl’s Tubercle

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Carlos Alberto Ferreira de Freitas ◽  
Maria Margarida Morena Domingos Levenhagen ◽  
Isabela Salvador Constantino ◽  
Amauri Ferrari Paroni ◽  
Marcelo Resende Martins
Keyword(s):  
Ultrasound Examination ◽  
Asymptomatic Patient ◽  
Anatomical Variation ◽  
Thyroid Tissue ◽  
Anatomical Variations ◽  
Thyroid Stimulating Hormone ◽  
Laryngeal Nerve ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Hypoechoic Nodule

The nonrecurrent laryngeal nerve (NRLN) is a rare anatomical variation of the recurrent laryngeal nerve (RLN) that may hinder the identification and preservation of this nerve during surgery and is associated with increased iatrogenic risks. Zuckerkandl’s tubercle (ZT) is considered a useful reference for locating the RLN during thyroid surgery. We report the case of an asymptomatic patient with a 23 mm uninodular goitre suspicious for cancer. Ultrasound examination showed a hypoechoic nodule with regular contours and microcalcifications. The patient had normal thyroid-stimulating hormone and thyroxine levels, and aspiration biopsy was suspicious for follicular cancer. She was treated with total thyroidectomy after the intraoperative examination confirmed the presence of a papillary thyroid carcinoma. The standard approach to the RLN below the inferior thyroid artery was used on both sides. The nerve displayed anatomical variation in the nonrecurrent form (NRLN) on the right side and was associated with another variation that was not found in the consulted literature. It was completely surrounded by thyroid tissue in the region of ZT, and the surgeon was forced to remove it from within the thyroid tissue. This combination of anatomical variations seems to be quite rare. Knowledge of the anatomy of the RLN and its variations, as well as its identification and careful dissection, is essential to avoid injury to the nerve during surgical procedures.

scholarly journals Anatomical Variations in Recurrent Laryngeal Nerves in Thyroid Surgery

2020 ◽  
pp. 014556132092756 ◽  
Author(s):  
Chuanchang Yin ◽  
Bin Song ◽  
Xiaoyan Wang
Keyword(s):  
Thyroid Surgery ◽  
Vocal Cord Paralysis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Original Direction ◽  
Nonrecurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerves ◽  
The Right

Objective: To study terminal bifurcation of recurrent laryngeal nerves (RLNs) with original direction to larynx entry and to decrease the risk of vocal cord paralysis in thyroid patients. Methods: The RLNs of 294 patients (482 sides) were dissected according to the branches into the larynx, and the original direction of each RLN trunk in thyroid surgery was recorded. Results: (1) About 30.9% of the RLNs gave off multiple branches into the larynx. (2) Two and 3 branches of RLNs into the larynx were found in 25.5% and 5.4% of the cases, respectively. (3) In 0.4% or 2 cases, the RLN trunk combined with the inferior branch of the vagus nerve. (4) Nonrecurrent laryngeal nerve appeared in 2 cases. (5) On the left side, 68.0%, 25.6%, and 6.4% of cases were found with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. On the right side, 69.8%, 25.8%, and 4.4% cases were identified with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. (6) The combining dissection approach was proved as successful and safe for protecting the RLN with no permanent RLN paresis. Conclusions: Because of the anatomical variation in RLNs with extralaryngeal bifurcation, it is necessary to increase the awareness of surgeons about these variations so as to protect bifurcated nerves in thyroid surgery.

scholarly journals Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Emin Gurleyik ◽  
Gunay Gurleyik
Keyword(s):  
Early Stage ◽  
Anatomical Variation ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Proximal Point ◽  
Nerve Monitoring ◽  
Risk Of Injury ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Intraoperative Nerve Monitoring

Nonrecurrent laryngeal nerve (non-RLN) is an anatomical variation increasing the risk of vocal cord palsy. Prediction and early identification of non-RLN may minimize such a risk of injury. This study assessed the effect of intraoperative neuromonitoring (IONM) on the detection of non-RLN. A total of 462 (236 right) nerves in 272 patients were identified and totally exposed, and all intraoperative steps of IONM were sequentially applied on the vagus nerve (VN) and RLN. Right predissection VN stimulation at a distal point did not create a sound signal in three cases (3/236; 1.27%). Proximal dissection of the right VN under IONM guidance established a proximal point, creating a positive signal. The separation point of non-RLN from VN was discovered in all three patients. Non-RLNs were exposed from separation to laryngeal entry. Positive IONM signals were obtained after resection of thyroid lobes, and postoperative period was uneventful in patients with non-RLN. Absence of distal VN signal is a precise predictor of the non-RLN. IONM-guided proximal dissection of the right VN leads to identification of the non-RLN. The prediction of non-RLN by the absence of the VN signal at an early stage of surgery may prevent or minimize the risk of nerve injury.

Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies

2008 ◽  
Vol 123 (7) ◽  
pp. 768-771 ◽  
Author(s):  
C Page ◽  
P Cuvelier ◽  
A Biet ◽  
P Boute ◽  
M Laude ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Lateral Lobe ◽  
Anatomical Variations ◽  
Anatomical Landmark ◽  
Laryngeal Nerve ◽  
Surgical Experience ◽  
The Right

AbstractObjective:To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery.Materials and methods:We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands.Results:A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side).Conclusion:The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the ‘processus posterior glandulae thyroideae’ described by Zuckerkandl.

Non-recurrent laryngeal nerve related to thyroid surgery: report of three cases

2007 ◽  
Vol 122 (7) ◽  
pp. 757-761 ◽  
Author(s):  
C Page ◽  
P Monet ◽  
J Peltier ◽  
B Bonnaire ◽  
V Strunski
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Frequency Of Occurrence ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractPurpose of the study:We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery.Materials and methods:Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed.Results:Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery.Discussion:Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches.Conclusion:The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.

Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽  
2011 ◽  
Vol 40 (5) ◽  
pp. 404-407
Author(s):  
Maras ◽  
Tzormpatzoglou ◽  
Papas ◽  
Papanas ◽  
Kotsikoris ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Local Anaesthesia ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Variable Degree ◽  
Operative Complications ◽  
The Right ◽  
Ica Stenosis ◽  
Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

scholarly journals Anatomical Variations of the Recurrent Laryngeal Nerve and Implications for Injury Prevention during Surgical Procedures of the Neck

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 670
Author(s):  
Alison M. Thomas ◽  
Daniel K. Fahim ◽  
Jickssa M. Gemechu
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Surgical Procedures ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Branching Pattern ◽  
The Right ◽  
Relationship Of ◽  
Intrinsic Laryngeal Muscles ◽  
Formalin Fixed

Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury and ultimately guide best clinical and surgical practices. The present study aims to assess the potential anatomical variability of RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which makes it vulnerable during surgical procedures of the neck. Fifty-five formalin-fixed cadavers were carefully dissected and examined, with the course of the RLN carefully evaluated and documented bilaterally. Our findings indicate that extra-laryngeal branches coming off the RLN on both the right and left side innervate the esophagus, trachea, and mainly intrinsic laryngeal muscles. On the right side, 89.1% of the cadavers demonstrated 2–5 extra-laryngeal branches. On the left, 74.6% of the cadavers demonstrated 2–3 extra-laryngeal branches. In relation to the inferior thyroid artery (ITA), 67.9% of right RLNs were located anteriorly, while 32.1% were located posteriorly. On the other hand, 32.1% of left RLNs were anterior to the ITA, while 67.9% were related posteriorly. On both sides, 3–5% of RLN crossed in between the branches of the ITA. Anatomical consideration of the variations in the course, branching pattern, and relationship of the RLNs is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy and anterior cervical discectomy and fusion (ACDF) surgery. The information gained in this study emphasizes the need to preferentially utilize left-sided approaches for ACDF surgery whenever possible.

scholarly journals Bilateral anatomical variations of the hand extensors

2016 ◽  
Vol 15 (2) ◽  
pp. 278-282
Author(s):  
Humberto Ferreira Arquez
Keyword(s):  
Anatomical Variation ◽  
Medical Science ◽  
Ring Finger ◽  
Anatomical Variations ◽  
Extensor Digitorum ◽  
Left Hand ◽  
Extensor Tendons ◽  
Right Hand ◽  
The Right ◽  
Little Finger

Background: The purpose of this paper is to describe an anatomical variation of the hand extensor on the little finger of the right hand which receives four tendons, condition unknown, as it is the first case reported so far in the literature. The human extensor tendons of hand often display an array of variations. Awareness of the anatomy and variations of the extensor tendons on the dorsum of the hand is necessary not only for the anatomist but also for surgeons when considering tendons for hand surgery, tendon rerouting or transplants. Materials and Methods: Bilateral anatomical variation in the upper limb was found during routine dissection in a 75-year-old male cadaver in the Morphology Laboratory at the University of Pamplona. The variations were recorded and photographed. Result: In the left hand the extensor digitorum there was a single tendon to the index, double tendon to the middle, triple tendon to the ring finger, a single tendon to the little finger or digiti minimi. The extensor digiti minimi has double tendon. In the right hand the extensor digitorum there was a single tendon to the index, triple tendon to the middle finger, triple tendons to the ring finger, a double tendon to the little finger. The extensor digiti minimi has double tendon. The little finger receives four tendons, 2 of extensor digitorum and 2 of extensor digiti minimi. The dorsum of the left hand and right showed juncturae tendinum type 2, between the extensors tendons in the 3rd intermetacarpal space; type 3, between the extensors tendons in the 4th inter metacarpal space. Conclusion: The presence of multiple tendons may alter the kinematics around the site of attachment to the phalanx. Knowledge of anatomical variations and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.278-282

scholarly journals Non-recurrent inferior laryngeal nerve: a case report

2020 ◽  
Vol 7 (10) ◽  
pp. 3469
Author(s):  
Shah Urvin Manish ◽  
Boopathi Subbarayan ◽  
Saravanakumar Subbaraj ◽  
Tirou Aroul Tirougnanassambandamourty ◽  
S. Robinson Smile
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nodular Goiter ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Anatomical Landmarks ◽  
Inferior Laryngeal Nerve ◽  
Nonrecurrent Inferior Laryngeal Nerve ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
The Right

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

scholarly journals The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Emin Gurleyik ◽  
Sami Dogan ◽  
Omer Gunal ◽  
Mevlut Pehlivan
Keyword(s):  
Multinodular Goiter ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Adjacent Structures ◽  
Toxic Multinodular Goiter ◽  
Posterior Extension ◽  
Right Lobe ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Case Based

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy.

scholarly journals The Recurrent Laryngeal Nerve in Relation to the Inferior Thyroid Artery in Adult Filipino Cadavers

2011 ◽  
Vol 26 (2) ◽  
pp. 13-17 ◽  
Author(s):  
Jacob S. Matubis ◽  
Karen June P. Dumlao ◽  
Ryner Jose C. Carrillo
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variations ◽  
The Philippines ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right ◽  
Relationship Of

Objective: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature. Methods: Study design: Descriptive, cross-sectional Setting: University of the Philippines College of Medicine Anatomy Laboratory Subjects: Fifty-four (54)  preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both  the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into 2 variations: non-branching or branching prior to insertion at the cricothyroid joint, under the inferior constrictor muscle.  The ITA was also classified into non-branching and branching.  The results were compared to two foreign studies using a Z-test for two proportions. Results: Fifty four (54) cadavers (108) sides were dissected. Among the  cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA.               The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA  but differs from those of Brazilians where the RLN is usually between ITA branches.    Conclusion: There are multiple anatomical variations with regards to the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon’s knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery. Keywords: recurrent laryngeal nerve, inferior thyroid  artery, thyroid surgery, Filipino cadavers, anatomical variations

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