scholarly journals Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

2020 ◽  
Vol 13 (3) ◽  
pp. 118-132
Author(s):  
Aleksandr A. Kuprin ◽  
Viktor Y. Malyuga
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Laryngeal Nerve ◽  
Aberrant Right Subclavian Artery ◽  
Preoperative Period ◽  
Arteria Lusoria ◽  
Preoperative Ultrasound ◽  
Brachiocephalic Trunk ◽  
The Right ◽  
Neck Vessels

Background: According to the anatomical data, the non-recurrent laryngeal nerve is a rather common abnormality and can be found in 4.78% of people. At the same time, the non-recurrent laryngeal nerve is difficult to visualize during surgery, which increases the risk of its damage. Aim: to determine the possibilities of ultrasound of neck vessels in the preoperative diagnosis of the aberrant right subclavian artery (arteria lusoria) and the abnormality of the branches of the vagus nerve. Materials and methods: An observational, single-center, single-stage, randomized, uncontrolled clinical trial was performed, which included patients in whom surgery was performed due to thyroid and parathyroid pathology. In the preoperative period, all patients underwent the ultrasound of the right half of the neck vessels and the mediastinum with visualization of the brachiocephalic trunk and its branches. When the brachiocephalic trunk was detected in the preoperative period, mobilization of the thyroid gland during operation was started with ligation of the upper pole vessels, and followed by a search for the recurrent laryngeal nerve. However, if the brachiocephalic trunk was absent, the right common carotid artery was traced as low as possible to the aortic arch and assessed on its relationship with the right subclavian artery. In such cases, thyroid mobilization was started from the lateral surface of the lobe with the necessary visualization of all structures of this region and followed by a primary search for the inferior laryngeal nerve. When the non-recurrent laryngeal nerve was detected, the computed tomography of the brachiocephalic arteries was performed in the postoperative period. Results: The study has shown that 202 (95.28%) patients out of the total 212 revealed the brachiocephalic trunk on preoperative ultrasound and the recurrent laryngeal nerve was located in a the typical place. Arteria lusoria was detected in 4 (1.89%) cases after the preoperative ultrasound. In this group of patients the non-recurrent laryngeal nerve was identified during operation and the aberrant right subclavian artery was confirmed at computed tomography. In 6 (2.83%) cases the brachiocephalic trunk could not be detected on ultrasound due to the constitutional features of the patient. However, in all these cases, the typical recurrent laryngeal nerve was identified during a surgery. Conclusions: The ultrasound of the neck vessels is the effective method to detect arteria lusoria, which is the predictor of the non-recurrent laryngeal nerve.

Characteristic travelling patterns of non-recurrent laryngeal nerves

2014 ◽  
Vol 128 (6) ◽  
pp. 534-539 ◽  
Author(s):  
K H Hong ◽  
H T Park ◽  
Y S Yang
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Vocal Fold ◽  
Laryngeal Nerve ◽  
New Classification ◽  
Laryngeal Nerves ◽  
Brachiocephalic Trunk ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractBackground:The non-recurrent laryngeal nerve is subject to potential injury during thyroid surgery. Intra-operative identification and preservation of this nerve can be challenging. Its presence is associated with an aberrant subclavian artery and the developmental absence of the brachiocephalic trunk. This study aimed to evaluate the incidence of non-recurrent laryngeal nerves and present a new classification system for the course of these nerves.Methods:Non-recurrent laryngeal nerves were identified on the right side in 15 patients who underwent thyroidectomy. The incidence of non-recurrent laryngeal nerves (during thyroidectomy) and aberrant subclavian arteries (using neck computed tomography) was evaluated, and the course of the nerves was classified according to their travelling patterns.Results:The overall incidence of non-recurrent laryngeal nerves was 0.68 per cent. The travelling patterns of the nerves could be classified as: descending (33 per cent), vertical (27 per cent), ascending (20 per cent) or V-shaped (20 per cent).Conclusion:Clinicians need to be aware of these variations to avoid non-recurrent laryngeal nerve damage. A retroesophageal subclavian artery (on neck computed tomography) virtually assures a non-recurrent laryngeal nerve. This information is important for preventing vocal fold paralysis. Following a review of non-recurrent laryngeal nerve travelling patterns, a new classification was devised.

scholarly journals Non Recurrent Laryngeal Nerve and Arteria Lusoria: Rare and Little Known Association

2021 ◽  
Author(s):  
Azza Mediouni ◽  
Hela Sayedi ◽  
houda chahed ◽  
Ghazi Besbes
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Laryngeal Nerve ◽  
Aberrant Right Subclavian Artery ◽  
Rare Entity ◽  
Arteria Lusoria

Non recurrent laryngeal nerve (NRLN) is an extremely rare entity constantly associated with an aberrant right subclavian artery also called arteria lusoria. Knowing this association can help predicting a NRLN preoperatively and thus to prevent its injury. We present two patients in whome this association was proven.

scholarly journals Non-Recurrent Laryngeal Nerve - A Surgical Challenge

2020 ◽  
Vol 7 (43) ◽  
pp. 2508-2510
Author(s):  
Shib Shankar Paul ◽  
Subrata Kumar Sahu ◽  
Indranil Chatterjee
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Aberrant Right Subclavian Artery ◽  
Fascial Spaces ◽  
The Right ◽  
Tracheoesophageal Groove ◽  
Intrinsic Muscles

Both the cases discussed here had right sided NRLN, out of which one had associated aberrant right subclavian artery. None had iatrogenic nerve palsy. Dissection was difficult as during the routine procedure of dissection, the nerve was not found in its usual route and was found that the right laryngeal nerve was not recurrent and originated directly from the vagus nerve. The non-recurrent laryngeal nerve (NRLN) is a rare embryologically derived variant of the recurrent laryngeal nerve and is found in 0.25 to 0.99% of patients who undergo thyroid surgery. On the right side, NRLN is found in 0.3% to 0.8% of patients and it is extremely rare on the left (0.004%).[1-2] The right NRLN is found to be associated with an aberrant right subclavian artery (86.7%) In experienced hands, meticulous dissection in the region of the tracheoesophageal groove will result in identification of RLN. In any case, if the nerve is not seen / found longitudinally along the tracheoesophageal groove, then dissecting transversely along the fascial spaces between the carotid sheath and the larynx, will allow identification of the presence of NRLN. Recurrent laryngeal nerve is a branch of the vagus nerve that is associated with both motor function and sensation of the larynx. It supplies all the intrinsic muscles of the larynx except the cricothyroid muscles. The non-recurrent laryngeal nerve (NRLN) is a rare embryologically derived variant of the recurrent laryngeal nerve and occurs in 0.25 to 0.99% of patients who undergo thyroid surgery and was first reported by Steadman in 1823.[3] on the right side, NRLN is found in 0.3% to 0.8% of patients and on the left side, it is extremely rare (0.004%).[1-2] The right NRLN is found to be associated with an aberrant right subclavian artery (86.7%).[1],[4] The NRLN is usually an unexpected surgical discovery, specifically during thyroidectomy. Hence, adequate anatomic knowledge of the normal course and variations/types of NRLN, and careful dissection during surgery is necessary to prevent iatrogenic injury to the nerve. We are reporting two cases of NRLN, which were identified while performing total thyroidectomy in patients diagnosed with papillary ca thyroid.

scholarly journals An unusual origin of the right subclavian artery – arteria lusoria

2014 ◽  
Vol 27 (4) ◽  
pp. 234-236
Author(s):  
Agnieszka Mocarska ◽  
Miroslaw Szylejko ◽  
Elzbieta Staroslawska ◽  
Franciszek Burdan
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Left Common Carotid Artery ◽  
Left Vertebral Artery ◽  
Anatomical Anomaly ◽  
Arteria Lusoria ◽  
Brachiocephalic Trunk ◽  
The Right

Abstract The aortic arch usually gives off three major arterial branches: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The most frequently occurring developmental variations of arterial trunks origins are a joined brachiocephalic and left common carotid artery origin, the left vertebral artery branching from the aortic arch, a double aortic arch, and a change of sequence of branching arteries. The current report presents the rare asymptomatic situation of the right subclavian artery originating as the last individual branching from the aortic arch. This abnormality was accidentally discovered in a computed tomography examination of a 69-year old male patient. The examination showed that the artery went towards the neck posteriorly from the trachea. The anatomical anomaly was interpreted as being an arteria lusoria.

Pre-operative prediction of a right non-recurrent laryngeal nerve by computed tomography

2013 ◽  
Vol 127 (5) ◽  
pp. 525-527 ◽  
Author(s):  
B T Varghese ◽  
K P Desai ◽  
A Ramachandran
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
World Literature ◽  
Surgical Navigation ◽  
Central Compartment ◽  
Distal Portion ◽  
Laryngeal Nerve ◽  
Barium Swallow ◽  
The Right

AbstractObjective:This paper reports a case of a non-recurrent laryngeal nerve which was accurately predicted pre-operatively using computed tomography.Case report:A 61-year-old man presented with papillary thyroid carcinoma with lymph node metastasis. Computed tomography scans of the neck and chest revealed an ill-defined, hypoattenuating nodule in the right lobe of the thyroid gland, with few upper paratracheal and prevascular nodes, and clear lung fields. The retro-oesophageal course of the right subclavian artery, which was arising from the distal portion of the arch of aorta, was also incidentally revealed in the computed tomography scan. A barium swallow further confirmed the presence of a retro-oesophageal subclavian artery. Total thyroidectomy was performed, with right neck dissection and central compartment clearance. This was carried out with the presence of a non-recurrent laryngeal nerve in mind, and the nerve was accurately localised and preserved.Conclusion:To our knowledge this is the first report in the world literature of accurate pre-operative incidental imaging of the right non-recurrent laryngeal nerve in a case of metastatic thyroid cancer, and the subsequent use of computed tomography to guide surgical navigation.

scholarly journals A novel way of identification of recurrent laryngeal nerve during thyroid surgeries

2021 ◽  
Vol 8 (10) ◽  
pp. 2956
Author(s):  
Joe Mathew
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Direct Observation ◽  
Laryngeal Nerve ◽  
Areolar Tissue ◽  
Review Of Literature ◽  
The Right

Background: This was a report of a movement of the recurrent laryngeal nerve which can be demonstrated during thyroid surgeries which can be used for locating the nerve, or identifying it if already exposed and causing confusion with other nearby structures or when alone too.Methods: The nerve is located by observing for a superior-inferior movement of the recurrent laryngeal nerve transmitted by the loose areolar tissue over it and dissecting over this site to locate the nerve right underneath it. This was by direct observation of the movement which will be there so long as the thyroid is held retracted to the opposite side and is not separated from the thyroid at the tissues that constitute the condensation of pre-tracheal fascia called the Berry’s ligament.Results: The recurrent laryngeal nerve originates from the vagus and loops posteriorly and then upwards around the arch of aorta on the left side and the subclavian artery on the right side. When the thyroid gland is retracted away and thus the nerve put on slight stretch, a superior-inferior to and fro- movement of the nerve can be seen. This movement can be used for identification and dissection of the nerve along its course.Conclusions: A review of literature has been done and it is clear that this movement has not been hitherto identified or published

scholarly journals Right non recurrent laryngeal nerve associated with anomalous origin of right subclavian artery and a bicarotid trunk

2016 ◽  
Vol 15 (3) ◽  
pp. 485-487 ◽  
Author(s):  
D Maruthupandian ◽  
K Karunakaran ◽  
V Arul
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Subclavian Artery ◽  
Anatomical Variation ◽  
Medical Science ◽  
Laryngeal Nerve ◽  
Anomalous Origin ◽  
Nodular Goitre ◽  
Ct Angiogram ◽  
The Right

Non recurrent laryngeal nerve is a rare anatomical variation with an incidence in literature of 0.3 % to 1.6 % on the right side. This variation places the nerve at risk of inadvertent injury during head and neck surgeries. Awareness about this abnormality and meticulous dissection of the nerve in every case is the only way to stay safeguarded. Here we present a case of right non recurrent laryngeal nerve in a 32 years old female patient who underwent near total thyroidectomy for nontoxic multi nodular goitre. During surgery, the right recurrent laryngeal nerve could not be identified in its normal location. Further dissection revealed a non recurrent laryngeal nerve arising from the vagal trunk. A CT angiogram was done post operatively and showed an anomalous origin of the right subclavian artery as the last branch of the aortic arch and a bi-carotid trunk. Every surgeon operating on the neck should be aware of and anticipate this variation of the recurrent laryngeal nerve especially when the nerve cannot be identified in the normal location.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.485-487

scholarly journals Anatomic Investigation of Two Cases of Aberrant Right Subclavian Artery Syndrome, Including the Effects on External Vascular Dimensions

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 592
Author(s):  
Mitchell H. Mirande ◽  
Madelyn R. Durhman ◽  
Heather F. Smith
Keyword(s):  
Risk Assessment ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Relative Size ◽  
Aberrant Right Subclavian Artery ◽  
Normal Sample ◽  
Surgical Interventions ◽  
Brachiocephalic Trunk ◽  
The Right

The retroesophageal aberrant right subclavian artery (ARSA) is a variation of the aortic arch that occurs asymptomatically in most patients. However, when symptomatic, it is most commonly associated with dysphagia. ARSA has also been noted as a location of potentially severe aneurysms in some patients, as well as posing a risk during surgical interventions in the esophageal region. This case study analyzes two individuals with ARSA morphology in comparison to a normal sample in order to gain a better anatomical understanding of this anomaly, potentially leading to better risk assessment of ARSA patients going forward. The diameter of the ARSA vessel was found to be substantially larger than both the right subclavian artery and brachiocephalic trunk of the subjects with classic aortic arch anatomy. As many ARSA individuals are asymptomatic, we hypothesize that the relative size of the ARSA may dictate its contribution to the presence and/or severity of associated symptomatology.

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