Trapped: Right-sided Nonrecurrent Laryngeal Nerve without Any Vascular Aberration

Ankur Jain¹, Ashutosh Silodia², Sanjay Kumar Yadav³https://orcid.org/0000-0002-0682-4970

^1–3Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India

Corresponding Author: Sanjay Kumar Yadav, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India, Phone: +91 8127095090, e-mail: sky1508@gmail.com

How to cite this article: Jain A, Silodia A, Yadav SK. Trapped: Right-sided Nonrecurrent Laryngeal Nerve without Any Vascular Aberration. Indian J Endoc Surg Res 2022;17(2):73–74.

Source of support: Nil

Conflict of interest: None

Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics clearance was obtained and informed consent was taken from the patient.

This is to declare that all authors have contributed to the study. No part of the manuscript has been sent for consideration elsewhere or published in any international or national journal. The authors clearly certify that there is no aspect of plagiarism. All the conflicts of interest have been clearly defined and the source of the grant disclosed. Due ethical permission/consent has been obtained for carrying out the study. In case of any dispute, the authors will be held fully responsible for the statement disclosed in the cover letter. The authors are also aware of the copyright rules and also declare that they will not reproduce any published text without due permission from the journal.

Received on: 02 September 2022; Accepted on: 22 October 2022; Published on: 30 December 2022

Keywords: Endocrine, Thyroid, Thyroid surgery.

Dear Editor,

The recurrent laryngeal nerve (RLN), a branch of the cervical vagus nerve enters the larynx after looping around the subclavian artery on the right and ligamentum arteriosum on the left. Damage to the RLN is one of the dreaded complications while operating on the thyroid and parathyroid gland leading to hoarseness or life-threateting dyspnea or aphonia. A nonrecurrent laryngeal nerve (NRLN) is one of the rare variations of RLN, which is reported to be 0.004% on the left side and 0.4–0.6% on the right side.¹ The right-sided NRLN is often reported along with a vascular anomaly, i.e., the absence of the right brachiocephalic trunk or arteria lusoria. Herein, we are reporting right NRLN without any vascular aberration. A 23-year-old male patient with a diagnosis of benign multinodular goiter with congenital hypothyroidism was planned for total thyroidectomy. Contrast-enhanced computed tomography of the neck done to evaluate retrosternal extension showed no vascular aberrations (Figs 1 and 2). During the right lobectomy, RLN was found originating directly from the cervical vagus nerve traversing horizontally to the right lobe of the thyroid, which was meticulously dissected out and preserved. The surgery was completed and the patient had an uneventful recovery postoperatively with no hoarseness of voice. This was the second report from our department with the right NRLN without any vascular anomaly.² Therefore, knowledge of RLN, NRLN, and meticulous dissection of RLN before cutting any structure is a must while performing over thyroid or parathyroid glands to prevent postoperative complications.

Fig. 1: Showing the NRLN arising from vagus nerve in the cervical region

Fig. 2: Showing normal vascular anatomy

ORCID

Sanjay Kumar Yadav https://orcid.org/0000-0002-0682-4970

REFERENCES

1. Toniato A, Mazzarotto R, Piotto A, et al. Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg 2004;28:659–661. https://doi.org/10.1007/s00268-004-7197-7.

2. Anand A, Nebhani D, Yadav SK, et al. Right-sided non-recurrent laryngeal nerve without any vascular anomaly: An anatomical trap. ANZ J Surg 2021;91(7–8):1635. DOI: 10.1111/ans.16891.

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