Brief report

Nonrecurrent and recurrent inferior laryngeal nerve: A surgical pitfall in cervical exploration

Recurrent laryngeal nerve (RLN) injury is one of the most critical complications in thyroid surgery. Anatomic variations of the RLN often account for iatrogenic nerve injury. The coexistence of ipsilateral non-recurrent laryngeal nerve (NRLN) and RLN is an extremely rare variation with only few reports. Thus, surgeons should have a clear understanding of this variation. In this paper, we first present a case of left NRLN coexisting with left RLN and emphasize the importance of this rare anatomic pitfall.

In this chapter, thyroid and parathyroid embryology and surgical anatomy are described, with a particular focus on the clinical implications of anatomic variations.

The close proximity of the recurrent laryngeal nerves (RLN) to the thyroid gland places the nerve at risk of injury during thyroid surgery. Furthermore, thyroid surgery can put both the right and the left RLNs at risk during a single surgical procedure. RLN injury or invasion by cancer can cause vocal cord paralysis (VCP) that leads to substantial morbidity arising from voice, swallowing and breathing issues. Unilateral VCP can lead to voice changes that may greatly impact professional voice users, as well as can cause potential dysphagia and aspiration, whereas bilateral VCP may require tracheostomy. Along with excellent anatomical understanding, intraoperative neural monitoring (IONM) can help in nerve mapping and identification. Additionally, IONM can help predict neural injury as well as play a role in management of invaded nerve and surgical decision-making. Several general surgical principles should be closely followed to protect RLNs during thyroid surgery. Based on the pathology and indication for surgery, different surgical approaches to the RLN: lateral, superior or inferior, can be used. Following standards of IONM and a good understanding of normative IONM characteristics for RLN are essential for accurate monitoring and proper interpretation of IONM data during a thyroid surgery. With the increasing use of IONM and given its value in intraoperative surgical management, it is important that the surgeon has a preoperative discussion with the patient regarding the use and implications of IONM on intraoperative surgical decision-making.

This article discusses the procedure and technique for performing a thyroidectomy, explaining complications, potential pitfalls and methods of avoiding them. We discuss the indications for surgery and the preoperative workup required including for thyrotoxic patients and those with retrosternal goitres and give a brief overview of the minimally invasive techniques used. We also discuss the issues with informed patient consent and how thyroid surgeons are monitored in the UK.

This article discusses the procedure and technique for performing a thyroidectomy: explaining complications, potential pitfalls and methods of avoiding them. We also discuss the indications for surgery and the preparation required especially for thyrotoxic patients and those with retrosternal goitres. We also discuss the ever increasing issues with consent and how thyroid surgeons are monitored in the UK.

Les variations anatomiques des troncs supra anatomiques ont une origine embryonnaire commune. Elles sont souvent asymptomatiques de découverte fortuite, parfois à l’origine de tableaux cliniques sévères dès la naissance. L’angioscanner multi-détecteur a nettement amélioré l’approche diagnostique de ces anomalies. Il permet de dresser une cartographie vasculaire précise grâce à sa bonne résolution spatiale et aux différentes méthodes de reconstructions d’images. Les auteurs se proposent d’illustrer les principales variations anatomiques des troncs supra-aortiques (TSA) et de rappeler l’intérêt de leur mise en évidence.

Anatomic variations of the supra-aortic trunks have a common embryonic origin. They are often asymptomatic and discovered fortuitously. They can cause serious clinical disorders from birth. Multidetector row computed tomography angiography distinctly improved the diagnostic approach to this anomaly. It enabled the definition of vascular maps with good spatial resolution as well as several modalities for image reconstruction. We propose illustrations of the main anatomic variations of the supra-aortic trunks and recall the importance of diagnosis.