The anomaly of nonrecurrent laryngeal nerve: Identification and management

The NRLN is an unusual but potentially serious complication of thyroid surgery. NRLN almost always occurs on the right side, although it can rarely present on the left. Findings that suggest the possibility of an NRLN are a right-sided thyroid mass with symptoms of dysphagia or an abnormal chest x- ray suggesting anomalous vessels. A much smaller subset includes those patients with a history of a previous right-sided thyroid surgery and a nonidentified RLN. At the time of surgery, the finding of an empty RLN triangle is pathognomonic of a nonrecurrent nerve. Surgery should then proceed with great caution. The plane of dissection should be in a transverse fashion across the neck and not longitudinally up the tracheoesophageal groove. A nerve-integrity monitor for intraoperative electrophysiologic monitoring of the status of this anomalous nerve during surgery is a valuable diagnostic and surgical adjunct.