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Verlaufsvarietäten des Nervus laryngeus inferior

Chirurgische Anatomie, Klassifikation, Diagnostik

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Zusammenfassung

Der Nervus laryngeus inferior weist aufgrund seiner zahlreichen Verlaufsvarietäten sehr unterschiedliche, oft seitendifferente topographische Beziehungen zu den benachbarten zervikalen Strukturen auf. Rekurrierend kann er im Sulcus oesophagotrachealis, in hierzu anteponierter oder retroponierter Position liegen. Die Arteria thyreoidea inferior wird überkreuzt, unterkreuzt oder zwischen ihren Ramifikationen durchlaufen. Bei Vergrößerung des Tuberculum Zuckerkandl kann dieses den Nerven luxieren. Im Bereich des Ligamentum Berry bestehen straffe Adhäsionen. Vor Eintritt in den Kehlkopf kann der Nerv multiple Ramifikationen aufweisen. Er kann auch um die Arteria thyreoidea inferior oder vertebralis rekurrieren. Rechtsseitig findet sich ein Nervus laryngeus inferior non-recurrens bei 0,6–0,8% der Patienten, stets in Koinzidenz mit einer Arteria „lusoria“. Es können 3 Verlaufsvarietäten unterschieden werden: Typ I deszendierend, Typ II horizontal, Typ III aszendierend. Linksseitig ist der nichtrekurrierende Nervenverlauf extrem selten, da er nur als Kombinationsanomalie mit rechtsseitiger Arteria „lusoria“ bei situs inversus viscerum zu finden ist. Der Nervus laryngeus inferior divisus weist eine rekurrierende und eine nichtrekurrierende Ramifikation auf. Ein Nervus laryngeus inferior non-recurrens kann präoperativ indirekt durch die Darstellung eines normal entwickelten Truncus brachiocephalicus per farbkodierter Duplexsonographie ausgeschlossen werden.

Abstract

Because of multiple variations in course, the inferior laryngeal nerve shows a great variety of topographic relations to adjacent cervical structures. It may recur in the tracheoesophageal groove or anteriorly or posteriorly to it. It can pass under, over, or through the ramifications of the inferior thyroid artery. If Zuckerkandl’s tubercle is enlarged, the nerve may be luxated. It is firmly fixed to the ligament of Berry by tight adhesions. Before entering the larynx, the nerve may show multiple ramifications. It may also recur around the inferior thyroid or vertebral artery. On the right, a nonrecurrent nerve is found in 0.6–0.8% of individuals, always in coincidence with a “lusorian” artery. Three course variations can be distinguished: descending (type I), horizontal (II), and ascending (III). A nonrecurrent nerve on the left is extremely rare, as it can only be found as a combination anomaly of a right-sided lusorian artery with situs inversus viscerum. The divided inferior laryngeal nerve shows recurrent and nonrecurrent ramifications. A nonrecurrent inferior laryngeal nerve can be indirectly ruled out preoperatively by demonstration of a normally developed brachiocephalic trunk via colour-coded duplex ultrasound.

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  1. Klinik für Visceral-Gefäß-Thoraxchirurgie, Klinikum Lahr. Akademisches Lehrkrankenhaus der Universität Freiburg im Breisgau

    G. Weiand & G. Mangold

  2. Klinik für Visceral-Gefäß-Thoraxchirurgie, Klinikum Lahr, Klostenstraße 19, 77933 , Lahr

    G. Weiand

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Weiand, G., Mangold, G. Verlaufsvarietäten des Nervus laryngeus inferior. Chirurg 75, 187–195 (2004). https://doi.org/10.1007/s00104-003-0776-6

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