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Clinical relevance and surgical anatomy of non-recurrent laryngeal nerve: 7 year experience

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Abstract

Purpose

We report our clinical experience with non-recurrent inferior laryngeal nerve (NRLN).

Methods

We collected our data retrospectively during 7 years. Total thyroidectomies (TTEs; N = 626) and hemithyroidectomies (HTEs; N = 187) were performed in 766 patients (80.2 % of women) by the same group of surgeons. 47 two-steps operations were performed. The total number of inferior laryngeal nerves at risk was 1,439 (725 right sided, 714 left sided). The nerves were always identified according to anatomical landmarks. We did not use intra-operative nerve monitoring.

Results

We found four right-sided NRLNs (0.55 % of the right-sided nerves). NRLN arose directly from the vagus nerve, running transversally parallel to the trunk of the inferior thyroid artery in all our cases (type IIa). Combination with ipsilateral recurrent nerve and other non-recurrent types (I and III) were not observed. We observed unclear voicing postoperatively with fast spontaneous recovery in one NRLN case, while the voice quality and phonation were perfect in the remaining cases.

Conclusions

Thyroid surgeons should understand the variable topography of inferior laryngeal nerves. Non-recurrent laryngeal nerve is a vulnerable asymptomatic anatomical variation of recurrent laryngeal nerve. Optimal NRLN identification should be done prior to operation by routine X-ray and ultrasonography, based on abnormality of cervical vessels.

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Abbreviations

CT:

Computed tomography

HTE:

Hemithyroidectomy

IONM:

Intra-operative nerve monitoring

ITA:

Inferior thyroid artery

NRLN:

Non-recurrent inferior laryngeal nerve

RLN:

Recurrent inferior laryngeal nerve

TIA:

Total intraperineural area

TTE:

Total thyroidectomy

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Acknowledgments

This study was supported by Institutional support of the Ministry of Defence of the Czech Republic: IP MO 1012.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Surgical Clinic of 2nd Faculty of Medicine, Charles University and the Central Military Hospital, Prague U Vojenske nemocnice 1200, 16902, Prague 6, Czech Republic

    Radek Dolezel, Jiri Jarosek & Miroslav Ryska

  2. Hospital Base of ACR, 6th Field Hospital, Hradec Kralove, Czech Republic

    Ludek Hana

Authors
  1. Radek Dolezel
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  2. Jiri Jarosek
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  3. Ludek Hana
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  4. Miroslav Ryska
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Correspondence to Radek Dolezel.

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Dolezel, R., Jarosek, J., Hana, L. et al. Clinical relevance and surgical anatomy of non-recurrent laryngeal nerve: 7 year experience. Surg Radiol Anat 37, 321–325 (2015). https://doi.org/10.1007/s00276-014-1369-4

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  • DOI: https://doi.org/10.1007/s00276-014-1369-4

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