Skip to main content

Advertisement

Log in

The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery

  • Current Concepts in Endocrine Surgery
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Backgrounds and aims

Nonrecurrent inferior laryngeal nerve (ILN) represents a risk factor for injury during neck surgery. It is associated to arterial abnormalities (absence of the brachiocephalic trunk and arteria lusoria) that can be identified by ultrasonography. The aim of the study was to verify the usefulness of preoperative ultrasonography in the research of nonrecurrent ILN by the means of identification of arterial abnormalities and the impact on ILN morbidity.

Patients and methods

The study included 750 patients who underwent neck surgery with right-side ILN dissection. A preoperative ultrasonography aimed to identify arterial abnormalities associated to nonrecurrent ILN was performed in 400 patients (Group A) while no preoperative attempts were performed in the remaining patients (Group B). Patients’ characteristics, time for intraoperative identification of the ILN, and morbidity were compared.

Results

Five and four nonrecurrent ILN were identified in groups A and B, respectively (p = NS). Preoperative ultrasonography correctly predicted nonrecurrent ILN in all cases (accuracy 100%). Nonrecurrent ILN palsy never occurred in group A, while three cases occurred in group B (p < 0.05). The mean time for intraoperative identification of both nonrecurrent and normally recurrent ILN was significantly shorter in group A (p < 0.01).

Conclusions

Preoperative ultrasonography can correctly identify nonrecurrent ILN, allowing earlier nerve identification and prevention of injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Henry JF, Audiffret J, Denizot A, Plan M (1988) The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side. Surgery 104:977–984

    PubMed  CAS  Google Scholar 

  2. Avisse C, Marcus C, Delattre JF, Marcus C, Cailliez-Tomasi JP, Palot JP et al (1998) Right non-recurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases. Surg Radiol Anat 20:227–232

    PubMed  CAS  Google Scholar 

  3. Defechereux T, Albert V, Alexandre J, Bonnet P, Hamoir E, Meurisse M (2000) The inferior non-recurrent laryngeal nerve: a major surgical risk during thyroidectomy. Acta Chir Belg 100:62–67

    PubMed  CAS  Google Scholar 

  4. Deveze A, Sebag F, Hubbard J, Jaunay M, Maweja S, Henry JF (2003) Identification of patients with a non-recurrent inferior laryngeal nerve by duplex ultrasound of the brachiocephalic artery. Surg Radiol Anat 25:263–269. doi:10.1007/s00276-003-0135-9

    Article  PubMed  CAS  Google Scholar 

  5. Materazzi G, Berti P, Iacconi P, Miccoli P (2000) Non-recurrent laryngeal nerve predicted before thyroidectomy by preoperative imaging. J Am Coll Surg 191:580. doi:10.1016/S1072-7515(00)00692-X

    Article  PubMed  CAS  Google Scholar 

  6. Watanabe A, Kawabori S, Osanai H, Taniguchi M, Hosokawa M (2001) Preoperative computed tomography diagnosis of a non-recurrent recurrent inferior laryngeal nerve. Laryngoscope 111:1756–1759. doi:10.1097/00005537-200110000-00017

    Article  PubMed  CAS  Google Scholar 

  7. Nagayama I, Okabe Y, Katoh H, Furukawa M (1994) Importance of pre-operative recognition of the nonrecurrent laryngeal nerve. J Laryngol Otol 108:417–419. doi:10.1017/S0022215100126957

    Article  PubMed  CAS  Google Scholar 

  8. Proye CAG, Carnaille BM, Goropoulos A (1991) Non-recurrent and recurrent inferior laryngeal nerve: a surgical pitfall in cervical exploration. Am J Surg 162:495–496. doi:10.1016/0002-9610(91)90271-E

    Article  PubMed  CAS  Google Scholar 

  9. Hermans R, Dewandel P, Debruyne F, Delaere PR (2003) Arteria lusoria identified on preoperative CT and non recurrent inferior laryngeal nerve during thyroidectomy: a retrospective study. Head Neck 25:113–117. doi:10.1002/hed.10180

    Article  PubMed  Google Scholar 

  10. De Luca L, Bergman JJ, Tytgat GN, Fockens PE (2000) EUS imaging of the arteria lusoria: case series and review. Gastrointest Endosc 52:670–673. doi:10.1067/mge.2000.109808

    Article  PubMed  Google Scholar 

  11. Katz AD, Nemiro P (1993) Anastomoses and bifurcation’s of the recurrent laryngeal nerve: report of 1,177 nerves visualized. Am Surg 59:188–191

    PubMed  CAS  Google Scholar 

  12. Raffaelli M, Iacobone M, Henry JF (2000) The ‘”false” nonrecurrent inferior laryngeal nerve. Surgery 128:1082–1087. doi:10.1067/msy.2000.109966

    Article  PubMed  CAS  Google Scholar 

  13. Yusuf T, Levy MJ, Wiersema MJ, Clain JE, Harewood GC, Rajan E et al (2007) Utility of endoscopic ultrasound in the diagnosis of aberrant right subclavian artery. J Gastroenterol Hepatol 22:1717–1721. doi:10.1111/j.1440-1746.2006.04622.x

    Article  PubMed  Google Scholar 

  14. Branscom JJ, Austin JHM (1973) Aberrant right subclavian artery. Findings seen on plain chest roentgenogram. Am J Roentgenol Radium Ther Nucl Med 119:539–542

    PubMed  CAS  Google Scholar 

  15. Brauckhoff M, Walls G, Brauckhoff K, Thanh PN, Thomusch O, Dralle H (2002) Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation. Langenbecks Arch Surg 386:482–487. doi:10.1007/s00423-001-0253-y

    Article  PubMed  Google Scholar 

  16. Brauckhoff M, Brauckhoff K, Lorenz K, Dralle H (2008) Electrophysiological studies in patients with nonrecurrent inferior laryngeal nerve. Langenbecks Arch Surg 393:433

    Google Scholar 

  17. Solorzano C, Carneiro-Pla D, Irvin G III (2006) Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg 202:18–24. doi:10.1016/j.jamcollsurg.2005.08.014

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Mrs. Lorraine Swinton for assistance in reviewing the English.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maurizio Iacobone.

Additional information

Best of Endocrine Surgery in Europe 2008.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iacobone, M., Viel, G., Zanella, S. et al. The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery. Langenbecks Arch Surg 393, 633–638 (2008). https://doi.org/10.1007/s00423-008-0372-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-008-0372-9

Keywords

Navigation