Anatomical Character and Intraoperative Prevention of Non-Recurrent Laryngeal Nerve_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHEN Xi ¹ ,  LI Xiaoyi ² , LIU Yuewu ² , CHEN Shuguang ² , YUAN Hongwei ² , LIU Hongfeng ² , GAO Weisheng. ²

1.Department of Surgery， Peking Union Medical College Hospital， China Academy of Medical Science， Beijing 100730，China;;
2.Department of General Surgery， Peking Union Medical College Hospital， China Academy of Medical Science， Beijing 100730， China;

Corresponding author：

LI Xiaoyi, Email: li.xiaoyi@263.com

Keywords：

Non-recurrent laryngeal nerve; Recurrent laryngeal nerve; Thyroidectomy; Variation

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Objective 　To investigate the anatomical character and variation of non-recurrent laryngeal nerve （NRLN）， and to explore measurement to identify and prevent injury of this nerve during thyroidectomy.
Methods　 Clinical data of 2 211 patients who underwent thyroidectomy from Jan. 2007 to Jun. 2012 in Peking Union Medical College Hospital were analyzed retrospectively， and 114 patients with NRLN of related literature reviews were analyzed too.
Results 　There were 3 479 recurrent laryngeal nerve （2 211 cases） which were exposed during thyroid operation in Peking Union Medical College Hospital， of which 11 cases were confirmed to be right NRLN （0.32%， 11/3 479）. Of the 11 cases， 3 cases were typeⅠ， 7 cases were typeⅡA， and 1 case was typeⅡB， one case was also found to have a recurrent branch. None of them injured during operation. One hundred and fourteen cases of NRLN （0.14%-4%） were found in literature reviews. Of the 114 cases， 109 cases were confirmed to be right NRLN， of which 4 cases were typeⅠ （3.7%， 4/109）， 75 cases were typeⅡA （68.8%， 75/109）， 9 cases were typeⅡB （8.3%， 9/109）， 21 cases were unclear （19.3%， 21/109）， 3 cases were also found to have a recurrent branch （2.8%，3/109）. Five cases were confirmed to be left NRLN， of which 2 cases were typeⅡA， 3 cases were unclear， 1 case was also found to have a recurrent branch. Of all the 104 cases reported by treatises and case reports， 16 cases injured during operation， of which 1 case was typeⅠ， 9 cases were typeⅡA， 6 cases were unclear.
Conclusions 　NRLN， which is a rare anomaly， usually happens on the right， and very vulnerable during thyroid surgery. The most usually injured type is typeⅡA. Fully acknowledgment of the NRLN and its variant types is very helpful to avoid damage during thyroid surgery.

Citation： SHEN Xi,LI Xiaoyi,LIU Yuewu,CHEN Shuguang,YUAN Hongwei,LIU Hongfeng,GAO Weisheng.. Anatomical Character and Intraoperative Prevention of Non-Recurrent Laryngeal Nerve. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(1): 71-76. doi: Copy

1.	Aburahma AF， Choueiri MA. Cranial and cervical nerve injuries after repeat carotid endarterectomy[J] . Vasc Surg， 2000， 32(4)：649-654.
2.	李新营，吕新生，王志明，等. 非返性喉返神经损伤的预防[J].中华耳鼻咽喉科杂志， 2004， 39(7)：415-418.
3.	Flament JB， Delattre JF， Palot JP. Anatomic pitfalls of recurrent laryngeal nerve dissection[J]. J Chir (Paris)， 1983， 120(5)：329-333.
4.	Toniato A， Mazzarotto R， Piotto A， et al. Identification of the nonrecurrent laryngeal nerve during thyroid surgery：20-year exp-erience[J]. World J Surg， 2004， 28(7)：659-661.
5.	Fellmer PT， Böhner H， Wolf A， et al. A left nonrecurrent inferiorlaryngeal nerve in a patient with right-sided aorta， truncus arteriosuscommunis， and an aberrant left innominate artery[J]. Thyroid， 2008， 18(6)：647-649.
6.	张平，张浩，李璇，等. 非返性喉返神经的术前判定及术中处理[J]. 中国实用外科杂志， 2010， 30(8)：680-683.
7.	Sanders G， Uyeda RY， Karlan MS. Nonrecurrent inferior laryngeal nerves and their association with a recurrent branch[J]. Am J Surg， 1983， 146(4)：501-503.
8.	Avisse C， Marcus C， Delattre JF， et al. Right nonrecurrent inferior laryngeal nerve and arteria lusoria：the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases[J]. Surg Radiol Anat， 1998， 20(3)：227-232.
9.	Henry JF， Audiffret J， Denizot A， et al. The nonrecurrent inferiorlaryngeal nerve：review of 33 cases， including two on the left side[J]. Surgery， 1988， 104(6)：977-984.
10.	Brauckhoff M， Walls G， Brauckhoff K， et al. Identification of thenon-recurrent inferior laryngeal nerve using intraoperative neurostimulation[J]. Langenbecks Arch Surg， 2002， 386(7)：482-487.
11.	Hermans R， Dewandel P， Debruyne F， et al. Arteria lusoria identified on preoperative CT and nonrecurrent inferior laryngeal nerve during thyroidectomy：a retrospective study[J]. Head Neck， 2003， 25(2)：113-117.
12.	Nagayama I， Okabe Y， Katoh H， et al. Importance of pre-operativerecognition of the nonrecurrent laryngeal nerve[J]. J Laryngol Otol， 1994， 108(5)：417-419.
13.	Materazzi G， Berti P， Iacconi P， et al. Nonrecurrent laryngeal nerve predicted before thyroidectomy by preoperative imaging[J]. J Am Coll Surg， 2000， 191(5)：580.
14.	龚日祥，肖琴，徐惠珍. 喉不返神经及其临床重要性 (附2例报告)[J]. 中国普外基础与临床杂志， 2000， 7(5)：338-339.
15.	Coady MA， Adler F， Davila JJ， et al. Nonrecurrent laryngeal nerve during carotid artery surgery：case report and literature review[J]. J Vasc Surg， 2000， 32(1)：192-196.
16.	Branscom JJ， Austin JH. Aberrant right subclavian artery. Findings seen on plain chest roentgenograms[J]. Am J Roentgenol Radium Ther Nucl Med， 1973， 119(3)：539-542.
17.	Huang SM， Wu TJ. Neck ultrasound for prediction of right nonrecurrent laryngeal nerve[J]. Head Neck， 2010， 32(7)：844-849.
18.	Lee YS， Son EJ， Chang HS， et al. Computed tomography is usefulfor preoperative identification of nonrecurrent laryngeal nerve in thyroid cancer patients[J]. Otolaryngol Head Neck Surg， 2011， 145(2)：204-207.
19.	Watanabe A， Kawabori S， Osanai H， et al. Preoperative computed tomography diagnosis of non-recurrent inferior laryngeal nerve[J]. Laryngoscope， 2001， 111(10)：1756-1759.
20.	王宇，李端树，嵇庆海，等. 非返性喉返神经的术前CT诊断与临床意义[J]. 中华外科杂志， 2009， 47(6)：472-473.
21.	邵堂雷，杨卫平，王海，等. 甲状腺外科手术中喉不返神经的解剖研究[J]. 中华普通外科杂志， 2009， 24(12)：963-965.
22.	孙辉，付言涛，王可人，等. 非返性喉返神经——3例报告并国内文献复习[J]. 内分泌外科杂志， 2008， 2(4)：237-240.
23.	Brauckhoff M， Machens A， Sekulla C， et al. Latencies shorter than 3.5 ms after vagus nerve stimulation signify a nonrecurrent inferior laryngeal nerve before dissection[J]. Ann Surg， 2011， 253(6)：1172-1177.
24.	孙辉，刘晓莉，赵涛，等. 术中神经监测识别非返性喉返神经6例经验[J]. 中华内分泌外科杂志， 2010， 4(6)：402-404.
25.	樊哲，张静潭，潘吉勇，等. 喉不返神经1例[J]. 中国耳鼻咽喉头颈外科， 2011， 18(9)：512.

1. Aburahma AF， Choueiri MA. Cranial and cervical nerve injuries after repeat carotid endarterectomy[J] . Vasc Surg， 2000， 32(4)：649-654.
2. 李新营，吕新生，王志明，等. 非返性喉返神经损伤的预防[J].中华耳鼻咽喉科杂志， 2004， 39(7)：415-418.
3. Flament JB， Delattre JF， Palot JP. Anatomic pitfalls of recurrent laryngeal nerve dissection[J]. J Chir (Paris)， 1983， 120(5)：329-333.
4. Toniato A， Mazzarotto R， Piotto A， et al. Identification of the nonrecurrent laryngeal nerve during thyroid surgery：20-year exp-erience[J]. World J Surg， 2004， 28(7)：659-661.
5. Fellmer PT， Böhner H， Wolf A， et al. A left nonrecurrent inferiorlaryngeal nerve in a patient with right-sided aorta， truncus arteriosuscommunis， and an aberrant left innominate artery[J]. Thyroid， 2008， 18(6)：647-649.
6. 张平，张浩，李璇，等. 非返性喉返神经的术前判定及术中处理[J]. 中国实用外科杂志， 2010， 30(8)：680-683.
7. Sanders G， Uyeda RY， Karlan MS. Nonrecurrent inferior laryngeal nerves and their association with a recurrent branch[J]. Am J Surg， 1983， 146(4)：501-503.
8. Avisse C， Marcus C， Delattre JF， et al. Right nonrecurrent inferior laryngeal nerve and arteria lusoria：the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases[J]. Surg Radiol Anat， 1998， 20(3)：227-232.
9. Henry JF， Audiffret J， Denizot A， et al. The nonrecurrent inferiorlaryngeal nerve：review of 33 cases， including two on the left side[J]. Surgery， 1988， 104(6)：977-984.
10. Brauckhoff M， Walls G， Brauckhoff K， et al. Identification of thenon-recurrent inferior laryngeal nerve using intraoperative neurostimulation[J]. Langenbecks Arch Surg， 2002， 386(7)：482-487.
11. Hermans R， Dewandel P， Debruyne F， et al. Arteria lusoria identified on preoperative CT and nonrecurrent inferior laryngeal nerve during thyroidectomy：a retrospective study[J]. Head Neck， 2003， 25(2)：113-117.
12. Nagayama I， Okabe Y， Katoh H， et al. Importance of pre-operativerecognition of the nonrecurrent laryngeal nerve[J]. J Laryngol Otol， 1994， 108(5)：417-419.
13. Materazzi G， Berti P， Iacconi P， et al. Nonrecurrent laryngeal nerve predicted before thyroidectomy by preoperative imaging[J]. J Am Coll Surg， 2000， 191(5)：580.
14. 龚日祥，肖琴，徐惠珍. 喉不返神经及其临床重要性 (附2例报告)[J]. 中国普外基础与临床杂志， 2000， 7(5)：338-339.
15. Coady MA， Adler F， Davila JJ， et al. Nonrecurrent laryngeal nerve during carotid artery surgery：case report and literature review[J]. J Vasc Surg， 2000， 32(1)：192-196.
16. Branscom JJ， Austin JH. Aberrant right subclavian artery. Findings seen on plain chest roentgenograms[J]. Am J Roentgenol Radium Ther Nucl Med， 1973， 119(3)：539-542.
17. Huang SM， Wu TJ. Neck ultrasound for prediction of right nonrecurrent laryngeal nerve[J]. Head Neck， 2010， 32(7)：844-849.
18. Lee YS， Son EJ， Chang HS， et al. Computed tomography is usefulfor preoperative identification of nonrecurrent laryngeal nerve in thyroid cancer patients[J]. Otolaryngol Head Neck Surg， 2011， 145(2)：204-207.
19. Watanabe A， Kawabori S， Osanai H， et al. Preoperative computed tomography diagnosis of non-recurrent inferior laryngeal nerve[J]. Laryngoscope， 2001， 111(10)：1756-1759.
20. 王宇，李端树，嵇庆海，等. 非返性喉返神经的术前CT诊断与临床意义[J]. 中华外科杂志， 2009， 47(6)：472-473.
21. 邵堂雷，杨卫平，王海，等. 甲状腺外科手术中喉不返神经的解剖研究[J]. 中华普通外科杂志， 2009， 24(12)：963-965.
22. 孙辉，付言涛，王可人，等. 非返性喉返神经——3例报告并国内文献复习[J]. 内分泌外科杂志， 2008， 2(4)：237-240.
23. Brauckhoff M， Machens A， Sekulla C， et al. Latencies shorter than 3.5 ms after vagus nerve stimulation signify a nonrecurrent inferior laryngeal nerve before dissection[J]. Ann Surg， 2011， 253(6)：1172-1177.
24. 孙辉，刘晓莉，赵涛，等. 术中神经监测识别非返性喉返神经6例经验[J]. 中华内分泌外科杂志， 2010， 4(6)：402-404.
25. 樊哲，张静潭，潘吉勇，等. 喉不返神经1例[J]. 中国耳鼻咽喉头颈外科， 2011， 18(9)：512.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Anatomical Character and Intraoperative Prevention of Non-Recurrent Laryngeal Nerve

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