Images in Clinical Medicine

By Dr. Suresh B Parmeshwarappa , Prof. P Sampatkumr
Corresponding Author Dr. Suresh B Parmeshwarappa
Department of surgery, Kasturba Medical College, - India 576104
Submitting Author Dr. Suresh B Parmeshwarappa
Other Authors Prof. P Sampatkumr
Department of Surgery, KMC, Manipal, - India 576104


Recurrent Laryngeal Nerve, Non-Recurrent, Thyroid Surgery

Parmeshwarappa SB, Sampatkumr P. Non-Recurrent Laryngeal Nerve During Thyroid Surgery. WebmedCentral SURGERY 2012;3(1):WMC002915
doi: 10.9754/journal.wmc.2012.002915

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 23 Jan 2012 06:47:46 PM GMT
Published on: 24 Jan 2012 06:24:53 PM GMT

Case summary

A 25 year lady presented with anterior neck swelling diagnosed as multinodular goiter. Thyroid profile was within normal limits. Indirect laryngoscope was normal. Patient was planned for subtotal thyroidectomy (Dunhill procedure). During the procedure, we identified the non-recurrent laryngeal nerve on right side (figure1). It was direct branch from the right vagus nerve, no branch seen along the trachea-esophageal groove. We preserved the nerve without any damage. No anomaly found on opposite side. In the literature review, the non-recurrent laryngeal nerve (NRLN) is a rare anomaly (0.5–0.6%) on the right side (1), extremely rare on the left side (0.004%). This increases the risk of damage to the nerve during surgery. Only during dextrocardia we can see a left non-recurrent laryngeal nerve (1). This rare anatomical variation on right side associated to anatomical irregularities of the subclavian arteries (1). The right subclavian artery is retro-esophageal arising directly from the aortic arch (2). According to many authors, the chances of an injury is greater during thyroid surgery due to either unfamiliarity from surgeon of this variation or technical difficulty to recognize and preserve the nerve in these cases(3). The diagnosis of this anatomical variation is rarely performed before surgery and only a CT scan of the neck showing a retro-esophageal subclavian artery will make us suspect of its occurrence(4). Detection of an anomalous nerve usually occurs during surgery and incidentally. So we wish to aware surgeons who performing thyroidectomies and the importance of the non-recurrent laryngeal nerve exposure, avoiding its incidental injury.


1. M Uludag, A Isgor, G Yetkin, B Citgez (2009) Anatomic variations of the nonrecurrentinferior laryngeal nerve. BMJ Case Rep. 27 March 2009.
2. Abboud B, Aouad R. Non-recurrent inferior laryngeal nerve in thyroid surgery: report of three cases and review of the literature. J Laryngol Otol. 2004: 118: 139-42.
3. Sciume C, Geraci G, Pisello F, Li Volsi F, Facella T, Licata A, Modica G. Non recurrent laryngeal nerve. Personal experience. G Chir. (2005): 26: 434-7.
4. Abboud B. Preoperative diagnosis of right nonrecurrent inferior laryngeal nerve by CT scan: report of a case and review of the literature. J Med Liban. 2007: 55: 46-9

Source(s) of Funding

On behalf of all the authors, I certify that we have participated sufficiently in the conception and design of the study, the analysis of the data, and drafting and critical appraisal of the manuscript to take public responsibility for it. We have reviewed the final version of the manuscript and approve it for publication. Neither this manuscript nor one with sufficiently similar content under our authorship has been published, or is being considered for publication elsewhere, except as described in the enclosed article. We have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter of materials disclosed in the manuscript.

I accept the responsibility for releasing this material on behalf of all coauthors.

Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

4 reviews posted so far

Good photos but no originality
Posted by Prof. Pietro G Calo on 25 Jan 2012 02:31:02 PM GMT

Not a novel report.
Posted by Dr. Kavin G Shah on 24 Jan 2012 07:45:14 PM GMT

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)