Identification and protection of non-recurrent laryngeal nerve in thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIAO Na , WU Linfeng ,  WANG Gang , SUN Bei , QU Fengzhi , CAO Chengliang , LI Panquan

Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P.R.China;

Corresponding author：

WANG Gang, Email: wgilu79@163.com

Keywords：

thyroidectomy; non-recurrent laryngeal nerve; recurrent laryngeal nerve; anatomical variation

DOI：

10.7507/1007-9424.201610009

Video：

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Objective To explore anatomical features and variation of non-recurrent laryngeal nerve and to summarize identification method, operation skill, and damage treatment experience of it. Method The clinical data of 15 patients with non-recurrent laryngeal nerve in 4 054 patients who underwent thyroidectomy from our division by the same medical group from January 2006 to January 2016 were retrospectively analyzed. Results A total of 6 626 recurrent laryngeal nerve (left side 3 248, right side 3 378) were exposed in 4 054 cases. Fifteen patients with non-recurrent laryngeal nerve were detected with an incidence of 0.23% (15/6 626), all located on the right side. There were 3 males and 12 females. There were 3 cases of type Ⅰ, 10 cases of type Ⅱa, 2 cases of type Ⅱb. And 2 patients with non-recurrent laryngeal nerve were injured. Conclusions Incidence of non-recurrent laryngeal nerve is lower, most of which occur on right side of neck, there is a high injury rate for its special anatomical location. It’s key to prevent nerve injury for careful interpreting preoperative auxiliary examination results and improving awareness of non-recurrent laryngeal nerve, fining dissection, conventional exposuring recurrent laryngeal nerve, and accurate using nerve monitor during operation.

Citation： QIAO Na, WU Linfeng, WANG Gang, SUN Bei, QU Fengzhi, CAO Chengliang, LI Panquan. Identification and protection of non-recurrent laryngeal nerve in thyroidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 464-468. doi: 10.7507/1007-9424.201610009 Copy

1.	Henry JF, Audiffret J, Denizot A,et al. The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side. Surgery, 1988, 104(6): 977-984.
2.	Mahmodlou R, Aghasi MR, Sepehrvand N. Identifying the non-recurrent laryngeal nerve: preventing a major risk of morbidity during thyroidectomy. Int J Prev Med, 2013, 4(2): 237-240.
3.	Dolezel R, Jarosek J, Hana L,et al. Clinical relevance and surgical anatomy of non-recurrent laryngeal nerve: 7 year experience. Surg Radiol Anat, 2015, 37(4): 321-325.
4.	柳麓崙, 王培松, 王硕, 等. 非返性喉返神经解剖特征及术中保护策略. 中国实用外科杂志, 2016, 36(8): 901-903.
5.	Stewart GR, Mountain JC, Colcock BP. Non-recurrent laryngeal nerve. Br J Surg,1972, 59(5): 379-381.
6.	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(7): 659-661.
7.	Fellmer PT, Böhner H, Wolf A,et al. A left nonrecurrent inferior laryngeal nerve in a patient with right-sided aorta, truncus arteriosus communis, and an aberrant left innominate artery. Thyroid, 2008, 18(6): 647-649.
8.	李新营, 吕新生, 王志明, 等. 非返性喉返神经损伤的预防. 中华耳鼻咽喉科杂志, 2004, 39(7): 415-418.
9.	Mohebati A, Shaha AR. Anatomy of thyroid and parathyroid glands and neurovascular relations. Clin Anat, 2012, 25(1): 19-31.
10.	Babademez MA, Günbey E, Ozmen E,et al. Anomalous relationship of coexisting ipsilateral recurrent and nonrecurrent inferior laryngeal nerves during thyroid surgery. J Craniofac Surg, 2013, 24(2): e190-e192.
11.	Barczyński M, Konturek A, Pragacz K,et al. Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations: results of a retrospective cohort study. World J Surg, 2014, 38(3): 599-606.
12.	张平, 贺亮, 董文武, 等. 右侧非返性喉返神经的术前诊断及术中保护. 中华外科杂志, 2013, 51(9): 854-855.
13.	Coady MA, Adler F, Davila JJ,et al. Nonrecurrent laryngeal nerve during carotid artery surgery: case report and literature review. J Vasc Surg, 2000, 32(1): 192-196.
14.	Henry JF, Audiffret J, Plan M. The nonrecurrent inferior laryngeal nerve. Apropos of 19 cases including 2 on the left side. J Chir (Paris), 1985, 122(6-7): 391-397.
15.	Gong RX, Luo SH, Gong YP,et al. Prediction of nonrecurrent laryngeal nerve before thyroid surgery-experience with 1 825 cases. J Surg Res, 2014, 189(1): 75-80.
16.	Gao EL, Zou X, Zhou YH,et al. Increased prediction of right nonrecurrent laryngeal nerve in thyroid surgery using preoperative computed tomography with intraoperative neuromonitoring identification. World J Surg Oncol, 2014, 12: 262.
17.	邵堂雷, 黄河, 王海, 等. 探讨一种新的喉返神经变异. 中国实用外科杂志, 2013, 33(6): 509-514.
18.	申曦, 李小毅, 刘跃武, 等. 非返性喉返神经的解剖特点及术中损伤的预防. 中国普外基础与临床杂志, 2013, 20(1): 71-76.
19.	Geraci G, Lo Nigro C, Sciuto A,et al. Non-recurrent laryngeal nerve coexisting with ipsilateral recurrent nerve: personal experience and literature review. G Chir, 2011, 32(5): 251-254.
20.	Sagayaraj A, Deo RP, Merchant S,et al. Medially placed vagus nerve in relation to common carotid artery: a pointer to a non-recurrent laryngeal nerve. Eur Arch Otorhinolaryngol, 2015, 272(10): 3027-3030.
21.	Kamani D, Potenza AS, Cernea CR,et al. The nonrecurrent laryngeal nerve: anatomic and electrophysiologic algorithm for reliable identification. Laryngoscope, 2015, 125(2): 503-508.
22.	孙辉. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 33(6): 470-474.
23.	Brauckhoff M, Walls G, Brauckhoff K,et al. Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation. Langenbecks Arch Surg, 2002, 386(7): 482-487.
24.	Donatini G, Carnaille B, Dionigi G. Increased detection of non-recurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM). World J Surg, 2013, 37(1): 91-93.
25.	Pelizzo MR, Toniato A, Gemo G. Zuckerkandl’s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg, 1998, 187(3): 333-336.
26.	Gurleyik E, Dogan S, Gunal O,et al. The rare coincidence: nonrecurrent laryngeal nerve pointed by a Zuckerkandl’s Tubercle. Case Rep Med, 2012, 2012: 143049.
27.	Yalçin B, Ozan H. Relationship between the Zuckerkand’s tubercle and entrance point of the inferior laryngeal nerve. Clin Anat, 2007, 20(6): 640-643.

1. Henry JF, Audiffret J, Denizot A,et al. The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side. Surgery, 1988, 104(6): 977-984.
2. Mahmodlou R, Aghasi MR, Sepehrvand N. Identifying the non-recurrent laryngeal nerve: preventing a major risk of morbidity during thyroidectomy. Int J Prev Med, 2013, 4(2): 237-240.
3. Dolezel R, Jarosek J, Hana L,et al. Clinical relevance and surgical anatomy of non-recurrent laryngeal nerve: 7 year experience. Surg Radiol Anat, 2015, 37(4): 321-325.
4. 柳麓崙, 王培松, 王硕, 等. 非返性喉返神经解剖特征及术中保护策略. 中国实用外科杂志, 2016, 36(8): 901-903.
5. Stewart GR, Mountain JC, Colcock BP. Non-recurrent laryngeal nerve. Br J Surg,1972, 59(5): 379-381.
6. 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(7): 659-661.
7. Fellmer PT, Böhner H, Wolf A,et al. A left nonrecurrent inferior laryngeal nerve in a patient with right-sided aorta, truncus arteriosus communis, and an aberrant left innominate artery. Thyroid, 2008, 18(6): 647-649.
8. 李新营, 吕新生, 王志明, 等. 非返性喉返神经损伤的预防. 中华耳鼻咽喉科杂志, 2004, 39(7): 415-418.
9. Mohebati A, Shaha AR. Anatomy of thyroid and parathyroid glands and neurovascular relations. Clin Anat, 2012, 25(1): 19-31.
10. Babademez MA, Günbey E, Ozmen E,et al. Anomalous relationship of coexisting ipsilateral recurrent and nonrecurrent inferior laryngeal nerves during thyroid surgery. J Craniofac Surg, 2013, 24(2): e190-e192.
11. Barczyński M, Konturek A, Pragacz K,et al. Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations: results of a retrospective cohort study. World J Surg, 2014, 38(3): 599-606.
12. 张平, 贺亮, 董文武, 等. 右侧非返性喉返神经的术前诊断及术中保护. 中华外科杂志, 2013, 51(9): 854-855.
13. Coady MA, Adler F, Davila JJ,et al. Nonrecurrent laryngeal nerve during carotid artery surgery: case report and literature review. J Vasc Surg, 2000, 32(1): 192-196.
14. Henry JF, Audiffret J, Plan M. The nonrecurrent inferior laryngeal nerve. Apropos of 19 cases including 2 on the left side. J Chir (Paris), 1985, 122(6-7): 391-397.
15. Gong RX, Luo SH, Gong YP,et al. Prediction of nonrecurrent laryngeal nerve before thyroid surgery-experience with 1 825 cases. J Surg Res, 2014, 189(1): 75-80.
16. Gao EL, Zou X, Zhou YH,et al. Increased prediction of right nonrecurrent laryngeal nerve in thyroid surgery using preoperative computed tomography with intraoperative neuromonitoring identification. World J Surg Oncol, 2014, 12: 262.
17. 邵堂雷, 黄河, 王海, 等. 探讨一种新的喉返神经变异. 中国实用外科杂志, 2013, 33(6): 509-514.
18. 申曦, 李小毅, 刘跃武, 等. 非返性喉返神经的解剖特点及术中损伤的预防. 中国普外基础与临床杂志, 2013, 20(1): 71-76.
19. Geraci G, Lo Nigro C, Sciuto A,et al. Non-recurrent laryngeal nerve coexisting with ipsilateral recurrent nerve: personal experience and literature review. G Chir, 2011, 32(5): 251-254.
20. Sagayaraj A, Deo RP, Merchant S,et al. Medially placed vagus nerve in relation to common carotid artery: a pointer to a non-recurrent laryngeal nerve. Eur Arch Otorhinolaryngol, 2015, 272(10): 3027-3030.
21. Kamani D, Potenza AS, Cernea CR,et al. The nonrecurrent laryngeal nerve: anatomic and electrophysiologic algorithm for reliable identification. Laryngoscope, 2015, 125(2): 503-508.
22. 孙辉. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 33(6): 470-474.
23. Brauckhoff M, Walls G, Brauckhoff K,et al. Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation. Langenbecks Arch Surg, 2002, 386(7): 482-487.
24. Donatini G, Carnaille B, Dionigi G. Increased detection of non-recurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM). World J Surg, 2013, 37(1): 91-93.
25. Pelizzo MR, Toniato A, Gemo G. Zuckerkandl’s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg, 1998, 187(3): 333-336.
26. Gurleyik E, Dogan S, Gunal O,et al. The rare coincidence: nonrecurrent laryngeal nerve pointed by a Zuckerkandl’s Tubercle. Case Rep Med, 2012, 2012: 143049.
27. Yalçin B, Ozan H. Relationship between the Zuckerkand’s tubercle and entrance point of the inferior laryngeal nerve. Clin Anat, 2007, 20(6): 640-643.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Identification and protection of non-recurrent laryngeal nerve in thyroidectomy

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