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非返喉神经:甲状腺半切术中发现的一种罕见解剖变异

Non-Recurrent Laryngeal Nerve: A Rare Anatomical Entity in a Patient Undergoing Hemithyroidectomy.

作者信息

Dash Manisha, Deshmukh Prasad, Gaurkar Sagar S, Singh Chandra Veer, Sandbhor Ajinkya

机构信息

Otolaryngology-Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.

Otolaryngology-Head and Neck Surgery and Surgical Oncology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.

出版信息

Cureus. 2022 Oct 5;14(10):e29935. doi: 10.7759/cureus.29935. eCollection 2022 Oct.

Abstract

A non-recurrent laryngeal nerve (NRLN) is a common anatomical modification with an occurrence rate ranging from 0.5% to 0.7% in surgical procedures related to thyroid pathology [1]. In this condition cervical vagus nerve reaches the larynx directly, increasing the likelihood of vocal cord palsy. Non-RLN injury can be reduced by anticipating it and identifying it early. This case report describes how a non-recurrent inferior laryngeal nerve was discovered intraoperatively during systemic dissection, averting intra-operative nerve injury. A 40-year-old female reported to the department of Otorhinolaryngology and Head and Neck Surgery Outpatient Clinic for a nodular tumor in her neck that has been increasing for the previous five years. The colloid multi-nodular thyroid of the right lobe was confirmed by a fine needle aspiration cytology (FNAC). The patient was lined up for a surgical procedure requiring resection of the right lobe of the thyroid. A non-recurrent right inferior laryngeal nerve was discovered during surgery. The operation and recovery went smoothly, and there was no change in his voice in subsequent follow-ups. For those who are related to this professional line, this presentation provides a summary of what a non-recurrent laryngeal nerve looks like during surgery. This is critical for anyone undergoing diagnostic and surgical procedures which demand to be invasive in the region involving the neck and upper thorax, as it lowers the risk of iatrogenic nerve injury. A solitary trauma of this nerve can induce irreversible hoarseness, whereas a multilateral lesion might result in aphonia and potentially deadly dysphonia.

摘要

非返喉返神经(NRLN)是一种常见的解剖变异,在与甲状腺病变相关的手术中发生率为0.5%至0.7%[1]。在这种情况下,颈迷走神经直接到达喉部,增加了声带麻痹的可能性。通过预先判断并早期识别非返喉返神经,可以降低其损伤风险。本病例报告描述了在系统性解剖过程中如何在术中发现非返喉返神经,从而避免了术中神经损伤。一名40岁女性因颈部结节性肿物就诊于耳鼻咽喉头颈外科门诊,该肿物在过去五年中逐渐增大。细针穿刺细胞学检查(FNAC)证实为右叶胶样多结节性甲状腺肿。该患者被安排进行甲状腺右叶切除术。术中发现右侧非返喉返神经。手术及恢复过程顺利,后续随访中患者声音无变化。对于从事该专业领域的人员来说,本病例展示了非返喉返神经在手术中的表现。这对于任何需要在颈部和上胸部区域进行侵入性诊断和手术的患者都至关重要,因为它降低了医源性神经损伤的风险。该神经的单一损伤可导致不可逆的声音嘶哑,而双侧损伤可能导致失音以及潜在的致命性发声障碍。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/19fc/9634855/0a70049e29cb/cureus-0014-00000029935-i01.jpg

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