KMID : 0361020090520100828
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Korean Journal of Otolaryngology - Head and Neck Surgery 2009 Volume.52 No. 10 p.828 ~ p.832
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Non-Recurrent Inferior Laryngeal Nerve in Thyroid Surgery: The Usefulness of Preoperative Neck CT and Clinical Review
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Lee Eun-Jung
Kong Il-Sung Cho Young-Joo Lyu Sun-Ho Lee Kyung-Suk Lee Jong-Min Kim Yon-Woo Yang Yun-Su Hong Ki-Hwan
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Abstract
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Background and Objectives:The non-recurrent inferior laryngeal nerve (NRILN) represents a risk factor for nerve injury during thyroid surgery. The intraoperative identification and preservation of NRILN may be an extremely challenging procedure. It is associated with the developmentally absence of the brachiocephalic trunk and the presence of an aberrant subclavian artery, the so called ¡°arteria lusoria¡±. The aim of this study is to investigate its prevalence and to verify the availability of preoperative neck CT in the research of NRILN by means of identification of arterial abnormalities and impact on NRILN morbidity.
Subjects and Method:Between January 1997 and July 2008, 1,639 patients underwent thyroid surgery. Of these cases, 1,469 cases (89.6%) were checked preoperative neck CT.
Results:Patients with preoperative neck CT, 10 cases (0.61%) show the absence of the brachiocephalic trunk and the retroesophageal aberrant right subclavian artery that arising directly form the aortic arch. Of these 10 cases, 9 cases (0.55%) NRILNs on the right side were exposed per-operatively. 7 cases were revealed high type (type I) of NRILN and 2 cases were low type (type II). There were no clinical symptoms such as dysphagia or dyspnea. The other 1 case was performed only left thyroidectomy, so we couldn¡¯t identify the NRILN. In all cases, No vocal cord paralysis was observed.
Conclusion:Preoperative neck CT could correctly identify NRILN, allowing earlier nerve identification and subsequently reduce the risk of accidental nerve damages.
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KEYWORD
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Non-recurrent inferior laryngeal nerve (NRILN), Anatomy, Preoperative neck CT, Thyroid surgery
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