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Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

https://doi.org/10.14341/serg10354

Abstract

Background: According to the anatomical data, the non-recurrent laryngeal nerve is a rather common abnormality and can be found in 4.78% of people. At the same time, the non-recurrent laryngeal nerve is difficult to visualize during surgery, which increases the risk of its damage.


Aim: to determine the possibilities of ultrasound of neck vessels in the preoperative diagnosis of the aberrant right subclavian artery (arteria lusoria) and the abnormality of the branches of the vagus nerve.


Materials and methods: An observational, single-center, single-stage, randomized, uncontrolled clinical trial was performed, which included patients in whom surgery was performed due to thyroid and parathyroid pathology. In the preoperative period, all patients underwent the ultrasound of the right half of the neck vessels and the mediastinum with visualization of the brachiocephalic trunk and its branches. When the brachiocephalic trunk was detected in the preoperative period, mobilization of the thyroid gland during operation was started with ligation of the upper pole vessels, and followed by a search for the recurrent laryngeal nerve. However, if the brachiocephalic trunk was absent, the right common carotid artery was traced as low as possible to the aortic arch and assessed on its relationship with the right subclavian artery. In such cases, thyroid mobilization was started from the lateral surface of the lobe with the necessary visualization of all structures of this region and followed by a primary search for the inferior laryngeal nerve. When the non-recurrent laryngeal nerve was detected, the computed tomography of the brachiocephalic arteries was performed in the postoperative period.


Results: The study has shown that 202 (95.28%) patients out of the total 212 revealed the brachiocephalic trunk on preoperative ultrasound and the recurrent laryngeal nerve was located in a the typical place. Arteria lusoria was detected in 4 (1.89%) cases after the preoperative ultrasound. In this group of patients the non-recurrent laryngeal nerve was identified during operation and the aberrant right subclavian artery was confirmed at computed tomography. In 6 (2.83%) cases the brachiocephalic trunk could not be detected on ultrasound due to the constitutional features of the patient. However, in all these cases, the typical recurrent laryngeal nerve was identified during a surgery.


Conclusions: The ultrasound of the neck vessels is the effective method to detect arteria lusoria, which is the predictor of the non-recurrent laryngeal nerve.

About the Authors

Aleksandr A. Kuprin
A.K. Eramishanzev city clinical hospital
Russian Federation

MD, PhD


Viktor Y. Malyuga
Russian Clinical and Research Center of Gerontology
Russian Federation

MD, PhD


References

1. Бондаренко В.О. Лекция №15. Визуализация и выделение возвратного гортанного нерва при хирургическом лечении узловых образований щитовидной железы. В кн.: Избранные лекции по эндокринологии / Под ред. А.С. Аметова. – М.: Медицинское информационное агентство; 2009. – C. 385-403. [Bondarenko VO. Lektsiya №15. Vizualizatsiya i vydelenie vozvratnogo gortannogo nerva pri khirurgicheskom lechenii uzlovykh obrazovaniy shchitovidnoy zhelezy. In: Ametov AS, editor. Izbrannye lektsii po endokrinologii. Moscow: Meditsinskoe informatsionnoe agentstvo; 2009. p. 385-403. (In Russ.)]

2. Chandrasekhar SS, Randolph GW, Seidman MD, et al. Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg. 2013;148(6 Suppl): S1-37. doi: https://doi.org/10.1177/0194599813487301.

3. Gundara JS, Lee JC, Ip JC, Glover AR. The clinical importance of the non-recurrent inferior laryngeal nerve. OA Anatomy. 2013;1(2):14. doi: https://doi.org/10.13172/2052-7829-1-2-576.

4. Henry BM, Sanna S, Graves MJ, et al. The non-recurrent laryngeal nerve: a meta-analysis and clinical considerations. PeerJ. 2017;5:e3012. doi: https://doi.org/10.7717/peerj.3012.

5. Iacobone M, Citton M, Pagura G, et al. Increased and safer detection of nonrecurrent inferior laryngeal nerve after preoperative ultrasonography. Laryngoscope. 2015;125(7):1743-1747. doi: https://doi.org/10.1002/lary.25093.

6. Галушко Д.А., Асмарян А.Г., Пасько М.А. Клиническая анатомия и особенности невозвратного гортанного нерва в хирургии щитовидной железы. Клинический случай // Клиническая и экспериментальная тиреоидология. – 2016. – Т.12. – №3. – С. 31-36. [Galushko DA, Asmaryan HG, Pasko MA. Clinical anatomy and features non-recurrent inferior laryngeal nerve in thyroid surgery. Case report. Clinical and experimental thyroidology. 2016;12(3):31-36. (In Russ.)] doi: https://doi.org/10.14341/ket2016331-36.

7. Малюга В.Ю., Куприн А.А. Экстраларингеальные варианты расположения возвратного гортанного нерва. Клиническое наблюдение в хирургии щитовидной железы // Эндокринная хирургия. – 2017. – Т.11. – №3. – С. 146-156. [Malyuga VY, Kuprin AA. Extralaryngeal variants of the location of the recurrent laryngeal nerve. Clinical observation in thyroid surgery. Endocrine Surgery. 2017;11(3):146-156. (In Russ.)] doi: https://doi.org/10.14341/serg20173146-156.

8. Бондаренко В.О. Возвратный гортанный нерв в хирургии щитовидной и паращитовидной желез. Атлас. – М.; 2006. [Bondarenko VO. Vozvratnyy gortannyy nerv v khirurgii shchitovidnoy i parashchitovidnoy zhelez. Atlas. Moscow; 2006. (In Russ.)]

9. Citton M, Viel G, Iacobone M. Neck ultrasonography for detection of non-recurrent laryngeal nerve. Gland Surg. 2016;5(6):583-590. doi: https://doi.org/10.21037/gs.2016.11.07.

10. Monfared A, Gorti G, Kim D. Microsurgical anatomy of the laryngeal nerves as related to thyroid surgery. Laryngoscope. 2002;112(2):386-392. doi: https://doi.org/10.1097/00005537-200202000-00033.

11. Toniato A, Mazzarotto R, Piotto A, et al. Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg. 2004;28(7):659-661. doi: https://doi.org/10.1007/s00268-004-7197-7.

12. Maruthupandian D, Karunakaran K, Arul V. Right non recurrent laryngeal nerve associated with anomalous origin of right subclavian artery and a bicarotid trunk. Bangladesh Journal of Medical Science. 2016;15(3):485-487. doi: https://doi.org/10.3329/bjms.v15i3.22989.

13. Low T-H, Clifford A. Non-recurrent laryngeal nerve and aberrant vasculature. International Journal of Case Reports in Medicine. 2013;2013:224147. doi: https://doi.org/10.5171/2013.224147.

14. Ongaro D, Elia S, Cazzaniga R, Taglietti R. Right non-recurrent inferior laryngeal nerve discovered during carotid endarterectomy: a case report and literature review. Int J Cardiovasc Thorac Surg. 2016;2(4):29-33. doi: https://doi.org/10.11648/j.ijcts.20160204.14.

15. Yetisir F, Salman AE, Ciftci B, et al. Efficacy of ultrasonography in identification of non-recurrent laryngeal nerve. Int J Surg. 2012;10(9):506-509. doi: https://doi.org/10.1016/j.ijsu.2012.07.006.

16. Polguj M, Chrzanowski Ł, Kasprzak JD, et al. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations – a systematic study of 141 reports. Scientific World Journal. 2014;2014:292734. doi: https://doi.org/10.1155/2014/292734.

17. Shreesha M, Siew YH, Daubeney PE. Vascular rings, pulmonary slings, and other vascular abnormalities. In: Gatzoulis MA, Webb GD, Daubeney PE, editors. Diagnosis and management of adult congenital heart disease. 2nd ed. Philadelphia: Elsevier/Saunders; 2011. p. 277-285. doi: https://doi.org/10.1016/B978-0-7020-3426-8.00038-1.

18. Carles D, Pelluard F, André G, et al. [Aberrant right subclavian artery (arteria lusoria) and the risk for trisomy 21. Retrospective study of 11,479 fetopathological examinations. (In French).] J Gynecol Obstet Biol Reprod (Paris). 2014;43(9):698-703. doi: https://doi.org/10.1016/j.jgyn.2013.10.001.

19. Avisse C, Marcus C, Delattre JF, et al. Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases. Surg Radiol Anat. 1998;20(3):227-232. doi: https://doi.org/10.1007/s00276-998-0227-7.

20. Raj S, Padmakar Deo R, Mohiyuddin A, et al. Nonrecurrent laryngeal nerve: an Indian documentation. Int J Head Neck Surg. 2012;3(1):28-29. doi: https://doi.org/10.5005/jp-journals-10001-1087.

21. Devèze A, Sebag F, Hubbard J, et al. Identification of patients with a non-recurrent inferior laryngeal nerve by duplex ultrasound of the brachiocephalic artery. Surg Radiol Anat. 2003;25(3-4):263-269. doi: https://doi.org/10.1007/s00276-003-0135-9.

22. Huang SM, Wu TJ. Neck ultrasound for prediction of right nonrecurrent laryngeal nerve. Head Neck. 2009;32(7):844-849. doi: https://doi.org/10.1002/hed.21263.

23. Satoh S, Tachibana S, Yokoi T, Yamashita H. [Preoperative diagnosis of nonrecurrent inferior laryngeal nerve – usefulness of CT and ultrasonography. (In Japanese).] Nihon Jibiinkoka Gakkai Kaiho. 2013;116(7):793-801. doi: https://doi.org/10.3950/jibiinkoka.116.793.

24. Iacobone M, Viel G, Zanella S, et al. The usefulness of preoperative ultrasonographic identification of nonrecurrent inferior laryngeal nerve in neck surgery. Langenbecks Arch Surg. 2008;393(5):633-638. doi: https://doi.org/10.1007/s00423-008-0372-9.

25. Tartaglia F, Blasi S, Tromba L, et al. Duplex ultrasound and magnetic resonance imaging of the supra-aortic arches in patients with non recurrent inferior laryngeal nerve: a comparative study. G Chir. 2011;32(5):245-250.

26. Wang Z, Zhang H, Zhang P, et al. Preoperative diagnosis and intraoperative protection of nonrecurrent laryngeal nerve: a review of 5 cases. Med Sci Monit. 2014;20:233-237. doi: https://doi.org/10.12659/msm.889942.


Supplementary files

1. Fig. 1. Ultrasound of the vessels of the neck (color duplex scanning). Identification of the Y-sign. ACC - arteria carotis communis dexter, AS - arteria subclavia dexter, TBC - truncus brachiocephalicus.
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2. Fig. 2. The patient is 32 years old, body mass index (BMI) - 18.5. a - ultrasound of the vessels of the upper mediastinum with a convex sensor in B-mode (color duplex scanning is less informative due to a lot of interference from the aortic arch). The right common carotid artery was traced to the aortic arch (BCC was not detected). b - intraoperative picture. Type IIA NVGN (according to Avisse – Toniato) has a horizontal course. c - axial CT scan with angiography of the vessels of the aortic arch. AL is located behind the trachea and esophagus. d - computer three-dimensional reconstruction demonstrates AL syntopia with a common carotid artery. AL is the last, fourth branch of the aortic arch. ACC - arteria carotis communis dexter, TR - trachea, E - esophagus.
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3. Рисунок 2. Пациентка 32 лет, индекс массы тела (ИМТ) – 18.5. Б – Интраоперационная картина. НВГН IIA типа (по Avisse-Toniato) имеет горизонтальный ход
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4. Рисунок 2. Пациентка 32 лет, индекс массы тела (ИМТ) – 18.5. В – Аксиальный КТ-скан с ангиографией сосудов дуги аорты. AL располагается позади трахеи и пищевода.
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5. Рисунок 2. Пациентка 32 лет, индекс массы тела (ИМТ) – 18.5. Г – Компьютерная трехмерная реконструкция показывает синтопию AL с общей сонной артерией. AL является последней четвертой ветвью дуги аорты. ACC – arteria carotis communis dexter, TR – trachea, E – esophagus.
Subject
Type Other
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6. Fig. 3. The patient is 58 years old, BMI - 21.7. a - color duplex scanning of the vascular bundle of the right half of the neck with a linear sensor at the level of the right sternoclavicular joint. The right common carotid artery was traced to the place of “intersection” with the trachea (no BCC was detected). AL is located at a considerable distance from the right common carotid artery. b - intraoperative picture. Type I NVGN (according to Avisse – Toniato) has a downward direction and consists of two branches (arrows). c - axial CT scan with angiography of the vessels of the aortic arch. AL is located behind the trachea and esophagus. d - computer three-dimensional reconstruction demonstrates AL syntopia with a common carotid artery. AL is the last, fourth branch of the aortic arch. ACC - arteria carotis communis dexter, TR - trachea, E - esophagus. VJI - vena jugularis interna dexter, NV - nervus vagus dexter.
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7. Рисунок 3. Б – Интраоперационная картина. НВГН I типа (по Avisse-Toniato) имеет нисходящее направление и состоит из двух веток (указаны стрелками).
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8. Рисунок 3. В – Аксиальный КТ-скан с ангиографией сосудов дуги аорты. AL располагается позади трахеи и пищевода.
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Type Other
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9. Рисунок 3. Г – Компьютерная трехмерная реконструкция показывает синтопию AL с общей сонной артерией. AL является последней четвертой ветвью дуги аорты. ACC – arteria carotis communis dexter, TR – trachea, E – esophagus. VJI – vena jugularis interna dexter, NV – nervus vagus dexter.
Subject
Type Other
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10. Fig. 4. The patient is 68 years old, BMI - 31.6. a - ultrasound of the vascular bundle of the right half of the neck with a linear sensor in B-mode. b - color duplex scanning of the vascular bundle of the right half of the neck with a linear sensor. AL is parallel to the scan plane. The right common carotid artery and trachea are perpendicular to the sensor. in - an intraoperative picture. The right lobe of the thyroid gland was mobilized and mediated. NVGN consists of two branches (arrows). g - intraoperative picture. Thyroidectomy performed. Type IIA NVGN (according to Avisse – Toniato) has a horizontal course. d - axial CT scan with angiography of the vessels of the aortic arch. AL is located behind the trachea and esophagus. e - computer three-dimensional reconstruction demonstrates AL syntopia with a common carotid artery. AL is the last, fourth branch of the aortic arch. ACC - arteria carotis communis dexter, TR - trachea, E - esophagus.
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Type Other
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11. Рисунок 4. Б – Цветное дуплексное сканирование сосудистого пучка правой половины шеи линейным датчиком. AL расположена паралельно плоскости сканирования. Правая общая сонная артерия и трахея находятся перпендекулярно относительно датчика.
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12. Рисунок 4. В – Интраоперационная картина. Мобилизована правая доля ЩЖ, отведена медиально. НВГН и состоит из двух веток (указаны стрелками).
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13. Рисунок 4. Г – Интраоперационная картина. Выполнена тиреоидэктомия. НВГН IIA типа (по Avisse-Toniato) имеет горизонтальный ход.
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Type Other
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14. Рисунок 4. Д – Аксиальный КТ-скан с ангиографией сосудов дуги аорты. AL располагается позади трахеи и пищевода.
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Type Other
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15. Рисунок 4. Е – Компьютерная трехмерная реконструкция показывает синтопию AL с общей сонной артерией. AL является последней четвертой ветвью дуги аорты. ACC – arteria carotis communis dexter, TR – trachea, E – esophagus.
Subject
Type Other
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16. Fig. 5. The patient is 62 years old, BMI is 51.4. a - ultrasound of the vascular bundle of the right half of the neck with a convex sensor. AL “leaves” due to the trachea and is located almost horizontally, high on the border of the neck and upper mediastinum. b - intraoperative picture. Type IIA NVGN (according to Avisse – Toniato) has a horizontal course. c - axial CT scan with angiography of the vessels of the aortic arch. AL is located behind the trachea and esophagus. g - computer three-dimensional reconstruction (rear view). AL is the last, fourth branch of the aortic arch. ACC - arteria carotis communis (A - dexter, D - sinister), TR - trachea, E - esophagus. VJI - vena jugularis interna dexter, AS - arteria subclavia sinister.
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Type Other
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17. Рисунок 5. Б – Интраоперационная картина. НВГН IIA тип (по Avisse-Toniato) имеет горизонтальный ход.
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Type Other
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18. Рисунок 5. В – Аксиальный КТ-скан с ангиографией сосудов дуги аорты. AL располагается позади трахеи и пищевода.
Subject
Type Other
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19. Рисунок 5. Г – Компьютерная трехмерная реконструкция (вид сзади). AL является последней четвертой ветвью дуги аорты. ACC – arteria carotis communis (А – dexter, Г – sinister), TR – trachea, E – esophagus. VJI – vena jugularis interna dexter, AS – arteria subclavia sinister.
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Type Other
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20. Fig. 6. Ultrasound of the vascular bundle of the right half of the neck with a linear sensor at the level of the sternoclavicular joint. The absence of a Y-sign. The right common carotid and right subclavian arteries are located close and almost parallel to each other. BCS is located low in the mediastinum and imaging is not available. SHCHZH - a node of the right share of the thyroid gland with a partial retrosternal arrangement. ACC - arteria carotis communis dexter, VJI - vena jugularis interna dexter, AS - arteria subclavia dexter.
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Type Other
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21. Fig. 7. Variants of embryonic development of the human vascular bed. a - normal development of BCC and the right subclavian artery. b - an anomaly of the development of the right subclavian artery and the formation of AL.
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22. Рисунок 7. Б – аномалия развития правой подключичной артерией и формирование AL.
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Review

For citations:

Kuprin A.A., Malyuga V.Y. Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve. Endocrine Surgery. 2019;13(3):118-132. (In Russ.) https://doi.org/10.14341/serg10354

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