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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1420697

Electrophysiological monitoring of the nonrecurrent inferior laryngeal nerve and radiological evaluation of concurrent vascular anomalies

Provisionally accepted
Ismail C. Sormaz Ismail C. Sormaz 1*Ahmet Y. Iscan Ahmet Y. Iscan 1Fatih Tunca Fatih Tunca 1Mehmet Kostek Mehmet Kostek 2Nurcihan Aygun Nurcihan Aygun 2Tugba Matlim Ozel Tugba Matlim Ozel 3Yigit Soytas Yigit Soytas 3Arzu Poyanli Arzu Poyanli 1Serkan Sari Serkan Sari 3Mehmet Uludag Mehmet Uludag 2Yasemin Giles Senyürek Yasemin Giles Senyürek 1
  • 1 Istanbul University, Istanbul, Türkiye
  • 2 Department of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Türkiye
  • 3 Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye

The final, formatted version of the article will be published soon.

    Purpose: The objective of this study was to characterize the electrophysiological characteristics of nonrecurrent inferior laryngeal nerves (NRILNs) that were dissected via intraoperative neuromonitoring (IONM) and concomitant vascular anomalies in patients with NRILNs. Methods: A retrospective analysis was conducted on 7865 patients who underwent thyroidectomy with IONM at three tertiary referral centers. The study included 42 patients in whom an NRILN was detected. IONM data and postoperative vocal cord (VC) examinations were recorded for all patients. The absence of an initial vagal EMG response and/or a short (<3.5 ms) latency period during the initial vagal stimulation or the inability to identify the RLN within the Beahrs triangle was considered highly suspicious for the presence of an NRILN. Postoperative cross-sectional imaging was performed in 36 out of 42 patients to assess any concurrent vascular anomalies.Results: The prevalence of NRILN was 0.53%. An NRILN was suspected due to EMG findings in 32 (76%) patients and the inability to identify the RLN within the Beahrs triangle in the remaining 10 (24%) patients. The mean right VN latency period was 3.05 ± 0.15 ms. The V1 latency period of the right VN was shorter than 3.5 ms in 39 (93%) and longer than 3.5 ms in 3 (7%) patients. One of these three patients with latency>3.5ms had a large mediastinal goiter. Transient VC paralysis occurred in one (2.4%) patient. Of the 36 patients with postoperative imaging data, 33 (91.4%) had vascular anomalies. All 33 patients had aberrant right subclavian arteries, and 13 (39.4%) also had accompanying additional vascular anomalies.Conclusions: The NRILN is an anatomical variation that increases the risk of nerve injury. Observation of an absent EMG response and/or a short latency period during the initial vagal stimulation facilitates the detection of an NRILN at an early stage of thyroidectomy in the majority of patients.

    Keywords: Nonrecurrent inferior laryngeal nerve, arterial lusoria, Intraoperative nerve monitoring, Aberrant right subclavian artery, Kommerell diverticulum, abnormal vertebral artery

    Received: 20 Apr 2024; Accepted: 03 Sep 2024.

    Copyright: © 2024 Sormaz, Iscan, Tunca, Kostek, Aygun, Matlim Ozel, Soytas, Poyanli, Sari, Uludag and Giles Senyürek. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Ismail C. Sormaz, Istanbul University, Istanbul, Türkiye

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