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Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging

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Abstract

The right non-recurrent (inferior) laryngeal nerve (NRLN) is a rare anatomical variant associated with an arterial anomaly, the aberrant right subclavian artery (ARSA), that is detectable by pre-operative imaging (POI) using computed tomography and/or ultrasound. Most surgical studies have utilized two major types, NRLNs arising near the upper pole of the thyroid gland (type 1), vs. at a lower level (type 2) but with two subtypes defined by relationships to the inferior thyroid artery (ITA). This review found 8 English language surgical studies using POI that reported at least 1 NRLN and had anatomical information; of the 88 right NRLNs, 69.3% were classified as type 2 and 30.7% as type 1. Meta-analysis yielded a weighted proportion of 74.0% for type 2, but with substantial heterogeneity. For a subgroup of 5 POI studies with information on subtypes, 22 (59.5%) of 37 type 2 nerves were type 2a (i.e., running at or above the ITA). Similarly, a separate review of large surgical series without POI found that 60.4% of all 91 type 2 NRLNs were type 2a. The study findings should be relevant to the increasing numbers of anterior neck surgeries including bilateral thyroidectomies. A need was identified for studies on inter-observer reliability (agreement) among surgeons on NRLN types, and on injury rates (and related symptoms) by the type of NRLN.

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  1. Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, USA

    Anthony P. Polednak

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Polednak, A.P. Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging. Surg Radiol Anat 41, 943–949 (2019). https://doi.org/10.1007/s00276-019-02252-5

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