Increased and safer detection of nonrecurrent inferior laryngeal nerve after preoperative ultrasonography.
نویسندگان
چکیده
OBJECTIVES/HYPOTHESIS Right nonrecurrent inferior laryngeal nerve (NRLN) is an anatomical variant reported with a variable prevalence (0.3%-6%). It is associated with some arterial abnormalities (absence of the brachiocephalic trunk and presence of a right aberrant subclavian lusorian artery) that may be identified by preoperative ultrasonography (pUS). NRLN represents a major morbidity risk factor during neck surgery. The aim of this study was to verify pUS accuracy in predicting NRLN and to assess the impact of this technique on NRLN detection rate and laryngeal morbidity. STUDY DESIGN Retrospective. METHODS The study included 1,477 patients undergoing thyroid and parathyroid surgery with right-side inferior laryngeal nerve exploration. pUS was performed in 878 patients (pUS group); no preoperative attempts were performed in the remaining 599 patients (controls). Demographics, disease type, intraoperative inferior laryngeal nerve anatomy, and laryngeal morbidity were compared. RESULTS No differences occurred between the two groups concerning demographics and disease type. NRLN was detected in 17 patients (1.9%) of the pUS group and in four patients (0.6%) of controls (P < 0.05). pUS predicted NRLN in all cases, with an overall accuracy > 98%. Overall laryngeal nerves morbidity was 1.8% in the pUS group and 4.2% in the controls (P < 0.05). NRLN palsy never occurred in the pUS group, whereas it occurred three times in the controls (P < 0.005). CONCLUSION NRLN is accurately predicted by pUS. It occurs more frequently than expected because it may be misdiagnosed when no preoperative suspicion is available. Preoperative NRLN detection by pUS prevents inferior laryngeal nerve injuries.
منابع مشابه
A Rare Variation of Inferior Laryngeal Nerve: Nonrecurrent Laryngeal Nerve.
A nonrecurrent laryngeal nerve variant of the inferior laryngeal nerve is very rarely seen, and surgeons should keep it in mind during thyroid surgery. Preoperative findings, like situs invertus and dysphagia lusoria, may be suggestive of a nonrecurrent laryngeal nerve. However, these findings always have not to be together with nonrecurrent laryngeal nerve, like our case.
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متن کاملLatencies longer than 3.5 ms after vagus nerve stimulation does not exclude a nonrecurrent inferior laryngeal nerve
BACKGROUND It has recently been reported that a signal latency shorter than 3.5 ms after electrical stimulation of the vagus nerve signify a nonrecurrent course of the inferior laryngeal nerve. We present a patient with an ascending nonrecurrent inferior laryngeal nerve. In this patient, the stimulation latency was longer than 3.5 ms. CASE PRESENTATION A 74-years old female underwent redo sur...
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BACKGROUND Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroidectomy or parathyroidectomy. It is usually associated with abnormal vasculature that can be identified by several imaging methods. The aim of this study was to retrospectively analyze the preoperative diagnosis and intraoperative protection of NRLN. MATERIAL AND METHODS Of the 7169 patients who unde...
متن کاملNonrecurrent inferior laryngeal nerve without vascular anomaly as a genuine entity.
Inferior laryngeal nerve (ILN), which usually arises from vagus nerve, runs recurrent course and is called recurrent ILN (RILN). Intimate knowledge of normal and anatomic variants of the ILN reduces the risk of nerve injury and vocal cord paralysis in thyroid and parathyroid surgery. The nonrecurrent ILN (NRILN) is a rare nerve anomaly that is associated with a right aberrant subclavian artery....
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عنوان ژورنال:
- The Laryngoscope
دوره 125 7 شماره
صفحات -
تاریخ انتشار 2015