American Association of Endocrine SurgeonsThe “false” nonrecurrent inferior laryngeal nerve*,**
Section snippets
Material and methods
All neck dissections that we performed from November 1998 to October 1999 were included in this study. During this period, we performed operations in 791 patients: 677 patients (85.6%) for thyroid lesions, 99 patients (12.5%) for parathyroid lesions, and 15 patients (1.9%) for concomitant lesions. In the case of thyroid lesions, benign diseases accounted for 83.7% of the cases (579/692 patients) and malignant lesions for the remaining 16.3% (113/692 patients). Primary hyperparathyroidism
Results
The ILN was identified in all cases. An NRILN was found on the right side in 3 patients (0.46% of the right ILNs); in all these cases, the presence of an aberrant right subclavian artery (“arteria lusoria”) was observed and documented after operation by the presence of an additional esophageal “notch” on barium swallow test. No left NRILN was encountered. A large SILAB, with the same diameter as the ILN, was found on the right side in 10 cases (1.5% of the right ILNs); no case was observed on
Discussion
The ILN is involved in most claims concerning thyroid surgery complications.5 Its identification and complete exposure during neck dissection is considered the safest approach for thyroid and parathyroid surgery by most authors.6, 7, 8, 9 Thus, a detailed knowledge of its anatomy and of its anatomic variations is of utmost importance to avoid injuries during neck dissection. Besides the difference in origin and course between the 2 sides, numerous anatomic variations are well known (concerning
Conclusions
SILABs may originate not only from the MCSG and ICSG but also from the SCSG and directly from the sympathetic trunk. Their exact function is not very well known, but they may play a role in the vasomotor control of the larynx and perhaps in the vocal cord function.15, 16 A large SILAB may mimic an NRILN and evoke the possible coexistence of a recurrent ILN and an ipsilateral nonrecurrent ILN. Large SILABs are encountered more frequently than NRILNs. Thus, the awareness of this anatomic
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Cited by (0)
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Reprint requests: Prof Jean François Henry, University Hospital La Timone, 264 Rue Saint Pierre, 13385 Marseilles Cedex 05, France.
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Surgery 2000;128:1082-7.