Dolezel Radek, Jarosek Jiri, Hana Ludek, Ryska Miroslav
Surgical Clinic of 2nd Faculty of Medicine, Charles University and the Central Military Hospital, Prague U Vojenske nemocnice 1200, 16902, Prague 6, Czech Republic,
Surg Radiol Anat. 2015 May;37(4):321-5. doi: 10.1007/s00276-014-1369-4. Epub 2014 Sep 9.
We report our clinical experience with non-recurrent inferior laryngeal nerve (NRLN).
We collected our data retrospectively during 7 years. Total thyroidectomies (TTEs; N = 626) and hemithyroidectomies (HTEs; N = 187) were performed in 766 patients (80.2% of women) by the same group of surgeons. 47 two-steps operations were performed. The total number of inferior laryngeal nerves at risk was 1,439 (725 right sided, 714 left sided). The nerves were always identified according to anatomical landmarks. We did not use intra-operative nerve monitoring.
We found four right-sided NRLNs (0.55% of the right-sided nerves). NRLN arose directly from the vagus nerve, running transversally parallel to the trunk of the inferior thyroid artery in all our cases (type IIa). Combination with ipsilateral recurrent nerve and other non-recurrent types (I and III) were not observed. We observed unclear voicing postoperatively with fast spontaneous recovery in one NRLN case, while the voice quality and phonation were perfect in the remaining cases.
Thyroid surgeons should understand the variable topography of inferior laryngeal nerves. Non-recurrent laryngeal nerve is a vulnerable asymptomatic anatomical variation of recurrent laryngeal nerve. Optimal NRLN identification should be done prior to operation by routine X-ray and ultrasonography, based on abnormality of cervical vessels.
我们报告关于非返喉下神经（NRLN）的临床经验。
我们回顾性收集了7年的数据。同一组外科医生对766例患者（80.2%为女性）实施了全甲状腺切除术（TTE；N = 626）和半甲状腺切除术（HTE；N = 187）。进行了47例两步手术。面临风险的喉下神经总数为1439条（右侧725条，左侧714条）。神经始终根据解剖标志进行识别。我们未使用术中神经监测。
我们发现4条右侧非返喉下神经（占右侧神经的0.55%）。在我们所有病例中，非返喉下神经均直接发自迷走神经，与甲状腺下动脉干横向平行走行（IIa型）。未观察到与同侧喉返神经及其他非返类型（I型和III型）合并存在的情况。在1例非返喉下神经病例中，术后出现声音不清，但恢复迅速，而其余病例的声音质量和发声均正常。
甲状腺外科医生应了解喉下神经的可变走行。非返喉返神经是喉返神经一种易被忽视的无症状解剖变异。应基于颈部血管异常，在术前通过常规X线和超声对非返喉下神经进行最佳识别。
