Key result
Preoperative ultrasound successfully identified a non-recurrent laryngeal nerve, enabling its safe preservation during thyroidectomy using intraoperative neuromonitoring without vocal cord paralysis.
Why the study?
Vocal cord paralysis from recurrent laryngeal nerve injury is a major complication of thyroidectomy with risk heightened by anatomical variations, prompting evaluation of tools like preoperative ultrasonography and intraoperative neuromonitoring.
Case Report (n=1)
No
Preoperative ultrasound combined with intraoperative neuromonitoring can successfully identify and preserve a non-recurrent laryngeal nerve in patients with an aberrant right subclavian artery undergoing thyroidectomy.
Preoperative CT may flag vascular anomalies signaling RLN variants; leaves open whether routine use reduces thyroidectomy complications.
Vocal cord paralysis, one of the most notable complications of thyroidectomy, is primarily caused by injury to the recurrent laryngeal nerve (RLN), with the risk increasing in cases of anatomical variation. To prevent such complications, tools like preoperative CT, ultrasonography, and intraoperative neuromonitoring (IONM) have been widely adopted and studied. We recently encountered a patient scheduled for thyroidectomy was found with an aberrant right subclavian artery identified on CT, suggesting the possibility of a right-sided non-recurrent laryngeal nerve (NRLN). Preoperative ultrasound showed a nerve branch arising directly from the vagus nerve at the level of the cricoid cartilage, supporting the suspicion of NRLN. IONM was used during surgery. The nerve was safely identified, allowing the surgery to proceed without complications such as vocal cord paralysis. This case suggests that preoperative ultrasonographic evaluation can enable the surgeons and radiologists to identify NRLN directly by ultrasonographic imaging.
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Kim et al. (2025) conducted a case report in Papillary thyroid cancer (n=1). Preoperative ultrasound and intraoperative neuromonitoring was evaluated on Preservation of the non-recurrent laryngeal nerve (avoidance of vocal cord paralysis). Preoperative ultrasound successfully identified a non-recurrent laryngeal nerve, enabling its safe preservation during thyroidectomy using intraoperative neuromonitoring without vocal cord paralysis.
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