Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan.
Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan.
Auris Nasus Larynx. 2021 Apr;48(2):317-321. doi: 10.1016/j.anl.2020.02.011. Epub 2020 Mar 13.
Non-recurrent inferior laryngeal nerve (NRILN) is rare but one of the important anatomical variations in thyroid and parathyroid surgery. Almost all cases were observed on the right side with aberrant right subclavian artery and left NRILN have been reported in only five cases so far. Here, we reported a 38 year-old Japanese male with left NRILN accompanying adenomatous goiter. He was referred to our hospital for the surgical treatment of left thyroid goiter. Preoperative computed tomography revealed right-sided aortic arch and aberrant left subclavian artery with no signs of complete situs inversus viscerum, suggesting possible left NRLN. Left hemithyroidectomy was performed using nerve monitoring system. Intraoperatively, left recurrent laryngeal nerve was not identified along tracheoesophageal groove, but directly originated from vagal nerve and was running horizontally to larynx. Mobility of vocal cords were not impaired and postoperative course was uneventful. During thyroid surgery for the patients with right-sided aortic arch, meticulous care should be taken using nerve monitoring system to avoid nerve injury.
非返性喉下神经（NRILN）较为罕见，但在甲状腺和甲状旁腺手术中是一种重要的解剖变异。几乎所有病例均发生于右侧，且伴发右位锁骨下动脉，迄今为止仅有 5 例报告左侧 NRILN。本研究报道了 1 例 38 岁日本男性，患有左侧腺瘤性甲状腺肿伴左侧 NRILN。患者因左侧甲状腺肿就诊于我院，拟行手术治疗。术前 CT 显示右侧主动脉弓和左侧迷走锁骨下动脉，无完全内脏反位的迹象，提示可能存在左侧 NRLN。采用神经监测系统行左侧甲状腺次全切除术。术中于气管食管沟内未识别出左侧喉返神经，而是直接发自迷走神经，呈水平走向至喉部。声带活动不受影响，术后恢复顺利。对于右侧主动脉弓患者，在甲状腺手术中应使用神经监测系统仔细操作，以避免神经损伤。
