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Case Reports
. 2017 Mar 17:2017:bcr2016218280.
doi: 10.1136/bcr-2016-218280.

Non-recurrent laryngeal nerve with a coexisting contralateral nerve demonstrating extralaryngeal branching

James D Constable  1 , Srinivasalu Bathala  1 , Jacob J Ahmed  1 , Julian A McGlashan  1
Affiliations
Case Reports

Non-recurrent laryngeal nerve with a coexisting contralateral nerve demonstrating extralaryngeal branching

James D Constable et al. BMJ Case Rep. .

Abstract

Non-recurrence and extralaryngeal branching are 2 of the more frequently encountered anomalies of the recurrent laryngeal nerve. If not anticipated intraoperatively, these abnormalities can put the nerve at risk, with subsequent vocal cord palsy. It is therefore important to report on and understand these abnormalities. We present a unique case of a non-recurrent laryngeal nerve with a coexisting contralateral nerve demonstrating extralaryngeal branching. This case allows us to demonstrate the importance of arteria lusoria in head and neck surgery, and to conclude that non-recurrence and extralaryngeal branching can occur separately within individual nerves in the same patient. The case also highlights the importance of a systematic intraoperative approach to the identification of every recurrent laryngeal nerve, especially in bilateral procedures having already exposed an anomalous nerve on one side.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT thorax: (i) normal anatomy for comparison in axial plane; (ii) the patient's AL in axial plane; (iii) 3D reconstruction of the patient's AL. 3D; AA, aortic arch; AL, arteria lusoria; BCT, brachiocephalic trunk; CCA, common carotid arteries; LCCA, left common carotid artery; LSA, left subclavian artery; O, oesophagus; roAL, root of arteria lusoria.
Figure 2
Figure 2
Intraoperative photographs (same patient): (1) extralaryngeal bifurcation of the left recurrent laryngeal nerve; (2) right-sided non-recurrent laryngeal nerve. bRLN, bifid recurrent laryngeal nerve; NRLN, non-recurrent laryngeal nerve.
Figure 3
Figure 3
The aortic arches in embryo (modified illustration from Gray's ‘Anatomy of the Human Body’, figure 47313).
See this image and copyright information in PMC

References

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