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Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor
The thyroid gland's neurovascular relationship is commonly portrayed as the recurrent laryngeal nerve (RLN) coursing posteriorly to the thyroid gland. We report a rare case with the RLN running anteriorly to a thyroid tumor. A 56-year-old Japanese woman underwent a thyroidectomy for a benign th...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357722/ https://www.ncbi.nlm.nih.gov/pubmed/37475049 http://dx.doi.org/10.1186/s13044-023-00172-6 |
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author | Kihara, Minoru Miyauchi, Akira Fujishima, Makoto Ishizaka, Tomo Matsunaga, Akihide Kawano, Shiori Yamamoto, Masashi Sasaki, Takahiro Masuoka, Hiroo Higashiyama, Takuya Ito, Yasuhiro Onoda, Naoyoshi Miya, Akihiro Akamizu, Takashi |
author_facet | Kihara, Minoru Miyauchi, Akira Fujishima, Makoto Ishizaka, Tomo Matsunaga, Akihide Kawano, Shiori Yamamoto, Masashi Sasaki, Takahiro Masuoka, Hiroo Higashiyama, Takuya Ito, Yasuhiro Onoda, Naoyoshi Miya, Akihiro Akamizu, Takashi |
author_sort | Kihara, Minoru |
collection | PubMed |
description | The thyroid gland's neurovascular relationship is commonly portrayed as the recurrent laryngeal nerve (RLN) coursing posteriorly to the thyroid gland. We report a rare case with the RLN running anteriorly to a thyroid tumor. A 56-year-old Japanese woman underwent a thyroidectomy for a benign thyroid tumor. Preoperatively, computed tomography confirmed that part of the tumor had extended into the mediastinum and was descending posteriorly up to the brachiocephalic artery. Intraoperatively, when the sternothyroid muscle was incised to expose the thyroid gland, a cord (nerve)-like structure was observed directly anterior to the thyroid tumor. Although the course of this cord-like structure was clearly different from the "traditional" course of the right RLN, the possibility that the structure was the RLN could not be excluded. The structure was traced back in order to preserve it; we saw that it entered the larynx at the lower margin of the cricothyroid muscle and approximately at the level of the cricothyroid junction through the back of the normal thyroid tissue. With intraoperative neuromonitoring, the structure was identified as the RLN. As a result, the course of the RLN run anterior to the tumor but then posterior to the 'normal thyroid' i.e. into it normal anatomical position. Had we assumed that the RLN was behind the thyroid tumor, we would have damaged the RLN. It would not be possible to diagnose this abnormal running course of the RLN reliably before surgery, but extra care should be taken in similar cases, that is, when a large thyroid tumor is descending posteriorly up to the brachiocephalic artery on the right side. |
format | Online Article Text |
id | pubmed-10357722 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-103577222023-07-21 Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor Kihara, Minoru Miyauchi, Akira Fujishima, Makoto Ishizaka, Tomo Matsunaga, Akihide Kawano, Shiori Yamamoto, Masashi Sasaki, Takahiro Masuoka, Hiroo Higashiyama, Takuya Ito, Yasuhiro Onoda, Naoyoshi Miya, Akihiro Akamizu, Takashi Thyroid Res Case Report The thyroid gland's neurovascular relationship is commonly portrayed as the recurrent laryngeal nerve (RLN) coursing posteriorly to the thyroid gland. We report a rare case with the RLN running anteriorly to a thyroid tumor. A 56-year-old Japanese woman underwent a thyroidectomy for a benign thyroid tumor. Preoperatively, computed tomography confirmed that part of the tumor had extended into the mediastinum and was descending posteriorly up to the brachiocephalic artery. Intraoperatively, when the sternothyroid muscle was incised to expose the thyroid gland, a cord (nerve)-like structure was observed directly anterior to the thyroid tumor. Although the course of this cord-like structure was clearly different from the "traditional" course of the right RLN, the possibility that the structure was the RLN could not be excluded. The structure was traced back in order to preserve it; we saw that it entered the larynx at the lower margin of the cricothyroid muscle and approximately at the level of the cricothyroid junction through the back of the normal thyroid tissue. With intraoperative neuromonitoring, the structure was identified as the RLN. As a result, the course of the RLN run anterior to the tumor but then posterior to the 'normal thyroid' i.e. into it normal anatomical position. Had we assumed that the RLN was behind the thyroid tumor, we would have damaged the RLN. It would not be possible to diagnose this abnormal running course of the RLN reliably before surgery, but extra care should be taken in similar cases, that is, when a large thyroid tumor is descending posteriorly up to the brachiocephalic artery on the right side. BioMed Central 2023-07-20 /pmc/articles/PMC10357722/ /pubmed/37475049 http://dx.doi.org/10.1186/s13044-023-00172-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Case Report Kihara, Minoru Miyauchi, Akira Fujishima, Makoto Ishizaka, Tomo Matsunaga, Akihide Kawano, Shiori Yamamoto, Masashi Sasaki, Takahiro Masuoka, Hiroo Higashiyama, Takuya Ito, Yasuhiro Onoda, Naoyoshi Miya, Akihiro Akamizu, Takashi Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor |
title | Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor |
title_full | Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor |
title_fullStr | Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor |
title_full_unstemmed | Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor |
title_short | Recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor |
title_sort | recurrent laryngeal nerve’s course running anteriorly to a thyroid tumor |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357722/ https://www.ncbi.nlm.nih.gov/pubmed/37475049 http://dx.doi.org/10.1186/s13044-023-00172-6 |
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