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Non recurrent laryngeal nerve with right aberrant subclavian artery in recurrent case of papillary carcinoma of thyroid: an interesting clinical entity

Background/objectives: A nonrecurrent laryngeal nerve is a rare anatomical variant and a routine preoperative imaging studies are not indicated. NRLN is related with absence of the brachiocephalic trunk and aberrant (mainly retroesophageal) course of the right subclavian artery which is evident on contrast enhanced CT scan of the chest.

Case report: The patient presented with a swelling in the neck for 4 months which is slowly increasing in size. Patient gives history of a surgery done in the neck with an old midline suprasternal scar which was done 40 years earlier.laryngoscopic mirror examinartion was normal with moving vocal cords. Rest of the oral and oropharyngeal examination along with complete blood picture and biochemical investigations were normal. The patient was not a known diabetic or hypertensive.

Conclusion: Accurate knowledge of frequent variations of the nerve along with the non recurrent variant reduces the risk of intraoperative injury. A nonrecurrent laryngeal nerve(NRLN) is a rare anatomical variant and a routine preoperative imaging studies are not indicated. NRLN is related with absence of the brachiocephalic trunk and aberrant (mainly retroesophageal) course of the right subclavian artery which is evident on contrast enhanced CT scan of the chest.

Author(s): Sudhir M Naik Purshottam Chavan Rajshekar Halkud Ashok M Shenoy Sumit gupta Latif zameer