Yano Masatsgu, Saito Yasufumi, Yoshida Makoto, Oshiro Takafumi, Fukda Toshikatsu, Ochi Makoto, Okamoto Yuzo, Ono Eiji, Ohdan Hideki
Department of Surgery, JR Hiroshima Hospital, Hiroshima, Japan.
Department of Surgery, JR Hiroshima Hospital, Hiroshima, Japan.
Int J Surg Case Rep. 2018;53:330-332. doi: 10.1016/j.ijscr.2018.11.009. Epub 2018 Nov 14.
Recurrent laryngeal nerve injury is a major complication of thyroid surgery. An endotracheal tube with electromyography electrodes attached to it was recently developed for intraoperative neuromonitoring during thyroid surgery. Here we describe the successful identification and preservation of an extralaryngeal bifurcation of the recurrent laryngeal nerve by intraoperative neuromonitoring in a patient undergoing thyroid surgery.
A 56-year-old woman presented for evaluation of a neck swelling found during a medical examination. Computed tomography (CT) revealed a tumor with a 5-cm diameter in the left thyroid lobe. Fine needle aspiration cytology revealed a Bethesda category III finding. Left thyroid lobe resection was scheduled. During surgery, the left recurrent laryngeal nerve was found to be adhered to the tumor. Careful exploration and intraoperative neuromonitoring allowed us to identify and preserve an extralaryngeal bifurcation of the recurrent laryngeal nerve.
The recurrent laryngeal nerve can demonstrate various anomalies and bifurcations. Failure to notice and correctly identify extralaryngeal bifurcation leads to recurrent laryngeal nerve injury. Motor branch injury has a particularly large effect. Intraoperative neuromonitoring has been reported to be useful for identifying and preserving the recurrent laryngeal nerve and its aberrations as well as the external branch of the superior laryngeal nerve during thyroid surgery.
The findings from this case suggest that an extralaryngeal bifurcation of the recurrent laryngeal nerve can be identified and safely preserved by intraoperative neuromonitoring.
喉返神经损伤是甲状腺手术的主要并发症。最近开发了一种附有肌电图电极的气管内导管，用于甲状腺手术中的术中神经监测。在此，我们描述了在一名接受甲状腺手术的患者中，通过术中神经监测成功识别并保留喉返神经的喉外分支。
一名56岁女性因体检时发现颈部肿胀前来评估。计算机断层扫描（CT）显示左甲状腺叶有一个直径5厘米的肿瘤。细针穿刺细胞学检查结果为贝塞斯达III类。计划进行左甲状腺叶切除术。手术过程中，发现左喉返神经与肿瘤粘连。通过仔细探查和术中神经监测，我们成功识别并保留了喉返神经的喉外分支。
喉返神经可能表现出各种异常和分支。未能注意到并正确识别喉外分支会导致喉返神经损伤。运动支损伤的影响尤为严重。据报道，术中神经监测有助于在甲状腺手术中识别和保留喉返神经及其变异以及喉上神经外支。
该病例的结果表明，通过术中神经监测可以识别并安全保留喉返神经的喉外分支。
