Published: 2020-09-23

Non-recurrent inferior laryngeal nerve: a case report

Shah Urvin Manish, Boopathi Subbarayan, Saravanakumar Subbaraj, Tirou Aroul Tirougnanassambandamourty, S. Robinson Smile


The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.


Intra-operative neuro-monitoring, Non-recurrent inferior laryngeal nerve

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Forde R, Williams EW. The Non-recurrent Laryngeal Nerve -- A Rare Phenomenon Which Requires Vigilance. West Indian Med J. 2015;64(3):303-4.

Liu LX, Wu LF, Xue DB, Meng XZ, Zhang WH, Jiang HC. The importance of nonrecurrent laryngeal nerve in thyroid surgery. Zhonghua Wai Ke Za Zhi. 2006;44:904-6.

Epstein D.A., and Debord J.R. Abnormalities associated with aberrant right subclavian arteries- a case report. Vasc Endovascular Surg. 2002;36:297-303.

Lee MS. Relative direction and position of recurrent laryngeal nerve for anatomical configuration. Surg Radi-ol Anat. 2009;31:649-655.

Abboud B, Aouad R. Non-recurrent inferior laryngeal nerve in thyroid surgery: report of three cases and re-view of the literature. J Laryngol Otol. 2004;118(2):139-42.

Henry JF, Audiffret J, Plan M. The nonrecurrent inferior laryngeal nerve. Apropos of 19 cases including 2 on the left side. J Chir. 1985;122:391-7.

Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Pelizzo MR. Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg. 2004;28(7):659-61.

Qiao N, Wu LF, Gao W. Anatomic Characteristics, Identification, and Protection of the Nonrecurrent Laryn-geal Nerve during Thyroidectomy. Otolaryngol Head Neck Surg. 2017;157(2):210-216.

Choi HS, Shin DH, Kim KR, Park YA. Preoperative three-dimensional CT angiography to distinguish between an aberrant subclavian artery and a double aortic arch in thyroid surgery: Report of 2 cases. Auris Nasus Larynx. 2011;38:127-32.

Donatini G, Carnaille B, Dionigi G. Increased detection of non-recurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM). World J Surg. 2013;37:91-93.