Henry J F, Audiffret J, Denizot A, Plan M
Department of Endocrine Surgery, University Hospital de la Timone, Marseille, France.
Surgery. 1988 Dec;104(6):977-84.
In 6307 cervicotomies for thyroid and parathyroid excision, 33 cases of nonrecurrent inferior laryngeal nerve were identified (0.52%). The anomaly was observed in 31 cases from 4921 dissections on the right side (0.63%) and in two cases from 4673 dissections on the left side (0.04%). Of the 31 patients who were initially seen with this anomaly on the right side, no innominate (brachiocephalic) artery was found; the right common carotid artery was arising directly from the aortic arch. The aberrant subclavian artery could always be felt against the vertebral column behind the esophagus. The two patients with the anomaly on the left side had a right aortic arch associated with situs inversus viscerum. In one case of invasive thyroid carcinoma, the nerve had to be sacrificed. In all of the other patients, postoperative laryngoscopic findings were normal. The nervous anomaly was of vascular anomaly origin in all cases. Predisposing factors for its onset during aortic arch development are discussed. Before surgical treatment, the diagnosis may only be made if vascular anomaly is suspected. Impairment of swallowing is the only clinical symptom to be looked for. The retroesophageal subclavian artery may be detected on chest x-ray films (20%) or by the compression and distortion of the esophagus shown during barium swallow tests (97%). Although rare on the right side and exceptional on the left, an aberrant nonrecurrent pathway for the inferior laryngeal nerve represents a major surgical risk. This is an additional argument in favor of systematic dissection of the inferior laryngeal nerve during thyroid or parathyroid excision.
在6307例甲状腺和甲状旁腺切除的颈部手术中，发现33例非返行性喉返神经（发生率为0.52%）。在右侧4921例手术中有31例观察到该异常（发生率为0.63%），左侧4673例手术中有2例（发生率为0.04%）。在最初右侧发现该异常的31例患者中，未发现无名（头臂）动脉；右颈总动脉直接发自主动脉弓。异常的锁骨下动脉总能在食管后方的脊柱上摸到。左侧有该异常的2例患者伴有内脏反位的右位主动脉弓。在1例侵袭性甲状腺癌患者中，不得不牺牲该神经。在所有其他患者中，术后喉镜检查结果正常。所有病例中神经异常均源于血管异常。讨论了其在主动脉弓发育过程中发病的易感因素。在手术治疗前，只有怀疑血管异常时才能做出诊断。吞咽障碍是唯一需要留意的临床症状。食管后锁骨下动脉可在胸部X光片上检测到（20%），或在吞钡试验中显示的食管受压和变形时检测到（97%）。尽管右侧罕见，左侧罕见，但喉返神经的非返行异常路径是一个主要的手术风险。这是支持在甲状腺或甲状旁腺切除术中系统解剖喉返神经的又一论据。
