The Nonrecurrent Laryngeal Nerve: A Case Report Identifying Important Surgical Issues

Abstract

Introduction: Identification and preservation of the recurrent laryngeal nerve are a critical component of thyroidectomy. Nonrecurrent laryngeal nerves (NRLNs) are rare and can prove to be challenging for surgeons, prolonging surgery and possibly increasing the risk of nerve injury. In patients with an NRLN, early suspicion of its presence can markedly expedite surgery. Certain anatomical features are known to be associated with an NRLN. However, these may be missed without careful review of all of a patient's medical history, imaging, and procedures. In this video, we highlight the case of a 43-year-old female with a large thyroid goiter who was scheduled for thyroidectomy. Past imaging for a separate, unrelated condition revealed a retroesophageal subclavian artery, one anatomic variant that can result in an NRLN. Materials and Methods: Case study. The patient's preoperative imaging and video recordings from the operating room are presented. Results: Alerted preoperatively by the imaging, an NRLN was anticipated and immediately sought and identified during surgery. The NRLN was preserved with normal neural function at the end of the procedure. Conclusions: Before thyroidectomy, surgeons should consider all past imaging and procedures, which may reveal anatomic abnormalities relevant to the performance of safe and efficient surgery. Dr. Swegal does not have any conflicts of interest. Dr. Singer is a consultant for Medtronic. Runtime of video: 4 mins 41 secs