Abstract
The recurrent laryngeal nerve (RLN) has many anatomical variations and various relations with adjacent structures. Identification and total exposure of the cervical part of the RLN was performed during operations on the thyroid gland. An extremely rare anatomical variation of the nerve was encountered during the surgical procedure. Coexistence of both right RLN and non-RLN was observed in one patient surgically treated with total thyroidectomy. We first exposed the right RLN with an extralaryngeal terminal bifurcation at its usual position. Thereafter, we also identified an ipsilateral non-RLN joining the anterior branch of the RLN just before laryngeal entry. A Zuckerkandl's tubercle has pointed out the junction of the two nerves. In this period, the incidence of coexistence of non-RLN and RLN was 0.2% in our series. A non-recurrent course is a rare anatomical variation of the inferior laryngeal nerve. The coexistence of both non-RLN and RLN is an extremely rare anatomical finding which should be taken into account during thyroid surgery.
Highlights
In terms of complications, the recurrent laryngeal nerve (RLN) is the most important structure in thyroid surgery
Full knowledge of the anatomy of the RLN including all its variations is mandatory for complication-free thyroidal surgery
Anatomical variations of the RLN which increase injury rate threaten the safety of thyroid surgery
Summary
The recurrent laryngeal nerve (RLN) is the most important structure in thyroid surgery. A non-RLN is always found on the right side This nerve originating from the cervical part of the vagus enters the larynx after a short course without recurrence under the subclavian artery. We discovered a second inferior laryngeal nerve which entered the surgical area from the posterior side of the carotid artery and traversed directly to the larynx with a nonrecurrent short horizontal course. The non-RLN joined the anterior branch of ipsilateral RLN before laryngeal entry. The cervical part of bifurcated right recurrent laryngeal nerve (RLN) is fully exposed at its usual position until laryngeal entry. A secondary non-RLN which has a transversal course joins to anterior branch of the RLN.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
