Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for...

Area of Science:

• Anatomy
• Surgery
• Neurology

Background:

• The non-recurrent laryngeal nerve (NRLN) is an anatomical variation where the nerve takes a direct course to the larynx, unlike the typical recurrent laryngeal nerve.
• This variation most commonly occurs on the right side and increases the risk of iatrogenic injury during neck surgeries, particularly thyroidectomies.
• Failure to identify the NRLN can lead to significant complications such as hoarseness, dyspnea, or aphonia.

Observation:

• A 45-year-old female presented with a thyroid nodule requiring a right thyroid lobectomy.
• During the surgical procedure, two distinct non-recurrent laryngeal nerves were identified on the right side.
• Both identified nerves originated from the vagus nerve and entered the larynx directly.

Findings:

• The case presents a previously unclassified anatomical variation: double non-recurrent laryngeal nerves (Type 4).
• This finding expands the known classifications of NRLN courses, highlighting the diversity of laryngeal innervation.
• The presence of double NRLN further underscores the importance of meticulous surgical technique and anatomical awareness.

Implications:

• Accurate identification of the non-recurrent laryngeal nerve is crucial to prevent surgical complications.
• This case highlights the need to consider variations like double NRLN in surgical planning and execution.
• Understanding these anatomical anomalies is vital for improving patient outcomes and minimizing the risk of vocal cord dysfunction or airway compromise after neck surgery.