A non-recurrent inferior laryngeal nerve in a man undergoing thyroidectomy: a case report

Abstract

Introduction: A non-recurrent variant of the inferior laryngeal nerve has been seldom reported. These reports are mostly based on cadaveric dissection studies or large chart review studies in which the emphasis is placed on the determination of the frequency of the variation, and not on the clinical appearance of this variant. We graphically describe the intraoperative identification of a non-recurrent inferior laryngeal nerve.

Case presentation: A 44-year old Caucasian man was referred to the Head and Neck Surgery Outpatient Clinic with the diagnosis of a nodular mass in his left thyroid lobe that had been growing for one year. A fine needle aspiration puncture was compatible with thyroid papillary cancer. It was decided that the patient should undergo total thyroidectomy. During surgery, a non-recurrent right inferior laryngeal nerve was noted. This nerve emanated from the right vagus nerve, entering the larynx 3 cm after its origin. The nerve did not show a recurrent course. The nerve on the left side had a normal configuration. The surgery and post-operative period were uneventful, and the patient had no change in his voice.

Conclusion: This paper allows those interested to become acquainted with the normal intraoperative appearance of a non-recurrent inferior laryngeal nerve. This will undoubtedly be of significance for all of those performing invasive diagnostic and surgical procedures in the neck and upper thoracic regions, in order to minimize the risk of iatrogenic injury to this nerve. This is of extreme importance, since a unilateral lesion of this nerve may result in permanent hoarseness, and a bilateral lesion may lead to aphonia and life-threatening dyspnea.

Figure 1

Intra-operative right lateral view of the neck. The right Inferior Laryngeal Nerve (ILN) is seen originating perpendicularly from the Vagus Nerve (VN) and entering the Larynx between the Crycoid Cartilage (CC) and the Thyroid Cartilage (TC), just below the Crico-Thyroid Muscle (CT). The Thyroid Gland (TG) is being retracted medially to increase exposure of ILN and allowing visualization of the Trachea (TR). The right ILN does not have any recurrent path.