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J Surg Res. 2014 Jun 1;189（1）:75-80. doi: 10.1016/j.jss.2014.02.010. Epub 2014 Feb 15. Prediction of nonrecurrent laryngeal nerve before thyroid surgery--experience with 1825 cases. Gong RX1, Luo SH2, Gong YP1, Wei T1, Li ZH1, Huang JB3, Li ZL4, Li-Ling J5, Zhu JQ6. Author information 1Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 2Department of Thoracocardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 3Department of General Surgery, Municipal Medical Center, Qionglai, Sichuan, China. 4Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 5State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, China. 6Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: ncl2000@126.com.
Abstract BACKGROUND: Nonrecurrent laryngeal nerve （NRLN） is a rare anatomic anomaly, which often co-occurs with aberrant right subclavian artery （ARSA）. With this large case series, we present our experience of predicting the presence of NRLN by the means of chest X-ray film, thoracic computed tomography （CT）, and ultrasonography. MATERIALS AND METHODS: A prospective, nonrandomized study has been carried out. A total of 1825 patients with various thyroid disorders scheduled for surgery were recruited between January 2006 and July 2012. All patients underwent preoperative chest X-ray examination. Those suspected with ARSA further underwent thoracic CT scan. Unsuspected patients who had NRLN revealed by surgery were analyzed with ultrasonography postoperatively. RESULTS: A total of 41 patients （2.25%） were suspected to have ARSA by X-ray, of those 19 （46.3%） were confirmed by thoracic CT and proven to have NRLN upon subsequent surgery. No NRLN injury was inflicted. For the remaining 22 cases, CT scan suggested a normal right subclavian artery and none had NRLN upon surgery. For the 1784 unsuspected patients, 4 （0.22%） were discovered to have NRLN upon surgery, of those one was injured. For the 19 predicted NRLN, the time used for identifying the nerve was significantly shorter than the four cases with unsuspected NRLN （t = -15.978; P = 0.000）. After the operation, all these unsuspected NRLN were confirmed to have ARSA by ultrasonography. CONCLUSIONS: Patients scheduled for thyroid surgery should be screened for ARSA upon routine chest X-ray and thyroid ultrasonography before surgery. Detection of ARSA can accurately predict the existence of NRLN; hence prevent NRLN injury during subsequent surgery. Copyright © 2014 Elsevier Inc. All rights reserved. KEYWORDS: Aberrant right subclavian artery; Cervical ultrasound; Computer tomography; Nonrecurrent laryngeal nerve; Thyroid surgery PMID:24650455DOI:10.1016/j.jss.2014.02.010
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