Non-recurrent laryngeal nerve, caused by aberrant right subclavian artery (arteria lusoria), in a female patient with recurrent papillary thyroid carcinoma: the first well-illustrated clinical case in Ukraine
Keywords:non-recurrent laryngeal nerve, arteria lusoria, thyroid surgery
Background. The aberrant right subclavian artery (lat. arteria lusoria, AL) is a rare vascular abnormality of the aortic arch in humans, which occurs with a frequency of 0.1–2.5 % and is of great clinical importance due to the associated abnormality of the lower laryngeal nerve (non-recurrent laryngeal nerve, NLN), the risk of damage to which during thyroid surgery increases dramatically. For the first time in Ukraine, the clinical case of preoperative diagnosis of AL, intraoperative identification of NLN is comprehensively described and the current state of the issue is analyzed. The purpose was to show the importance of studying the aortic arch anatomy with a possible presence of AL, which in turn causes abnormal embryonic formation of NLN with a high risk of its damage during thyroid surgery, based on the case history of a treated female patient with papillary thyroid cancer. Materials and methods. A case of recurrent papillary thyroid cancer in a young woman who underwent surgery twice (total thyroidectomy with left radical neck dissection, right lateral and central neck redissection) is described. Before the second surgery, an abnormal right subclavian artery has been identified using computed tomography. The presence of right NLN was suspected, which was confirmed by electrophysiological neuromonitoring during surgery. The analysis of the relevant world literature showed the urgency of the issue and the lack of similar case reports in Ukrainian scientific literature. Results. Based on the computed tomography scans (with 3D reconstruction of the main vascular structures of the neck), the aberrant right subclavian artery coming from the distal part of the aortic arch was found (AL). The existence of a nerve abnormality was assumed — right NLN. By the use of electroneuromonitoring and dissection of the right vagus nerve during the operation, the vascular-nervous anomaly was confirmed, which helped avoid surgical complications leading to laryngeal dysfunction and perform a surgical treatment for cervical metastases of thyroid cancer successfully. Conclusions. When a thyroid surgery is planned, one should keep in mind the possibility of a vascular abnormality of the aortic arch with a corresponding risk of damage to the inferior laryngeal nerve, which can be non-recurrent. X-ray or sonography may reveal an aberrant location of the right subclavian artery, and the use of electroneuromonitoring may facilitate the identification of NLN to avoid its damage during the neck surgery.
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