Cranial nerve injury during carotid endarterectomy (CEA), while infrequent, may have serious consequences. The recurrent laryngeal nerve is one of the most commonly injured cranial nerves. Fortunately, most of these injuries are temporary. Anatomic variations in the position of cranial nerves present challenges to surgeons during CEA. Although the occurrence of a non-recurrent laryngeal nerve (NRLN) is rare, proper recognition of this anatomic variation is critical in order to minimize complications. We present a case in which a NRLN was discovered intraoperatively and carefully preserved.
ManigliaA. J. and HanD. P., Cranial nerve injuries following carotid endarterectomy: an analysis of 336 procedures [see comments]. Head Neck, 1991, 13 (2), 121–124.
2.
AburahmaA. F. and LimR. Y., Management of vagus nerve injury afer carotid endarterectomy. Surgery, 1996, 119 (3), 245–247.
3.
ForssellC., KitzingP. and BergqvistD., Cranial nerve injuries after carotid artery surgery. A prospective study of 663 operations [see comments]. European Journal of Vascular and Endovascular Surgery, 1995, 10 (4), 445–449.
4.
CurranA. J., SmythD., SheehanS. J., Recurrent laryngeal nerve dysfunction following carotid endarterectomy. Journal of the Royal College of Surgeons Edinburgh, 1997, 42 (3), 168–170.
5.
BallottaE., Da GiauG., RenonL., Cranial and cervical nerve injuries after carotid endarterectomy: a prospective study. Surgery, 1999, 125 (1), 85–91.
6.
AvisseC., MarcusC., DelattreJ. F., Right non-recurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases. Surgical and Radiological Anatomy, 1998, 20 (3), 227–232.
7.
DoyleJ. L., WatkinsH. O. and HalbertD. S., Undescended laryngeal nerve. Texas Medicine, 1967, 63 (6), 53–56.
8.
FriedmanM., ToriumiD. M., GrybauskasV., Non-recurrent laryngeal nerves and their clinical significance. Laryngoscope, 1986, 96 (1), 87–90.
9.
HenryJ. F., AudiffretJ., DenizotA., The non-recurrent inferior laryngeal nerve: review of 33 cases, including two on the left side. Surgery, 1988, 104 (6), 977–984.
10.
MraZ. and WaxM. K., Non-recurrent laryngeal nerves: anatomic considerations during thyroid and parathyroid surgery. American Journal of Otolaryngology, 1999, 20 (2), 91–95.
PembertonJ. and BeaverM., Anomaly of the right recurrent laryngeal nerve. Surgical Gynecology and Obstetrics, 1932, 54 (5), 594–595.
13.
ProyeC. A., CarnailleB. M. and GoropoulosA., Non-recurrent and recurrent inferior laryngeal nerve: a surgical pitfall in cervical exploration. American Journal of Surgery, 1991, 162 (5), 495–496.
14.
SandersG., UyedaR. Y. and KarlanM. S., Non-recurrent inferior laryngeal nerves and their association with a recurrent branch. American Journal of Surgery, 1983, 146 (4), 501–503.
15.
SrinivasanV. and PremachandraD. J., Non-recurrent laryngeal nerve: identification during thyroid surgery. ORL Journal for Otorhino-laryngology and Related Specialties, 1997, 59 (1), 57–59.
16.
StewartG. R., MountainJ. C. and ColcockB. P., Non-recurrent laryngeal nerve. British Journal of Surgery, 1972, 59 (5), 379–381.
17.
AldooriM. I. and BairdR. N., Local neurological complication during carotid endarterectomy. Journal of Cardiovascular Surgery (Torino), 1988, 29 (4), 432–436.
18.
DehnT. C. and TaylorG. W., Cranial and cervical nerve damage associated with carotid endarterectomy. British Journal of Surgery, 1983, 70 (6), 365–368.
19.
CoadyM. A., AdlerF., DavilaJ. J., Non-recurrent laryngeal nerve during carotid artery surgery: case report and literature review. Journal of Vascular Surgery, 2000, 32 (1), 192–196.
20.
AyerdiJ., MoinuddeenK., LeonS., The Guthrie experience with carotid endarterectomy, five year analysis. Guthrie Journal, 1999, 68 (1), 6–11.
21.
SampsonL., AyerdiJ. and GuptaS., Intraprocedural monitoring. In Peripheral endovascular interventions, eds WhiteR. and FogartyT.. Springer, New York1998, pp. 93–102.
22.
StedmanG., A singular distribution of some of the nerves and arteries in the neck, and the top of the thorax. Edinburgh Medicine and Surgery, 1823, 19 (9), 564–565.
23.
PalmerE., Dysphagia lusoria, clinical aspects in the adult. Annals of Internal Medicine, 1955, 42 (6), 1173–1180.
24.
WelchE. L. and GearyJ. E., Vocal cord paralysis following carotid endarterectomy. Journal of Cardiovascular Surgery (Torino), 1979, 20 (4), 393–394.
25.
HertzerN. R., FeldmanB. J., BevenE. G., A prospective study of the incidence of injury to the cranial nerves during carotid endarterectomy. Surgical Gynecology and Obstetrics, 1980, 151 (6), 781–784.
26.
LusbyR. J. and WylieE. J., Complications of carotid endarterectomy. Surgical Clinics of North America, 1983, 63 (6), 1293–1302.
27.
DownsA. R., JessenM. and LyeC. R., Peripheral nerve injuries during carotid endarterectomy. Canadian Journal of Surgery, 1987, 30 (1), 22–24.
28.
KnightF. W., YeagerR. M. and MorrisD. M., Cranial nerve injuries during carotid endarterectomy. American Journal of Surgery, 1987, 154 (5), 529–532.
29.
NemiroffP. M. and KatzA. D., Extralaryngeal divisions of the recurrent laryngeal nerve. Surgical and clinical significance. American Journal of Surgery, 1982, 144 (4), 466–469.
30.
KarlanM. S., CatzB., DunkelmanD., A safe technique for thyroidectomy with complete nerve dissection and parathyroid preservation. Head Neck Surgery, 1984, 6 (6), 1014–1019.
31.
PatowC. A., NortonJ. A. and BrennanM. F., Vocal cord paralysis and reoperative parathyroidectomy. A prospective study. Annals of Surgery, 1986, 203 (3), 282–285.
32.
NagayamaI., OkabeY., KatohH., Importance of preoperative recognition of the non-recurrent laryngeal nerve. Journal of Laryngology and Otolarnygology, 1994, 108 (5), 417–419.
33.
AstorF. C., SantilliP. and TuckerH. M., Incidence of cranial nerve dysfunction following carotid endarterectomy. Head Neck Surgery, 1983, 6 (2), 660–663.
34.
BuchholzD. W., Clinically probable brainstem stroke presenting primarily as dysphagia and nonvisualized by MRI. Dysphagia, 1993, 8 (3), 235–238.
35.
VenketasubramanianN., SeshadriR. and CheeN., Vocal cord paresis in acute ischemic stroke. Cerebrovascular Disease, 1999, 9 (3), 157–162.
36.
ChervuA. and MooreW. S., Carotid endarterectomy without arteriography. Annals of Vascular Surgery, 1994, 8 (3), 296–302.
37.
StrandnessD. E.Jr., Angiography before carotid endarterectomy. Archives of Neurology, 1995, 52 (8), 832–833.
38.
TanigawaK., InoueY. and IwataS., Protection of recurrent laryngeal nerve during neck surgery: a new combination of neu-tracer, laryngeal mask airway, and fiberoptic bronchoscope [letter] [see comments]. Anesthesiology, 1991, 74 (5), 966–967.
39.
PremachandraD. J., RadcliffeG. J. and StearnsM. P., Intraoperative identification of the recurrent laryngeal nerve and demonstration of its function [see comments]. Laryngoscope, 1990, 100 (1), 94–96.
40.
PremachandraD. J., Application of the laryngeal mask airway to thyroid surgery and the preservation of the recurrent laryngeal nerve [letter]. Annals of the Royal College of Surgeons England, 1992, 74 (3), 226.
41.
SpahnJ. G., BizalJ., FergusonS., Identification of the motor laryngeal nerves — a new electrical stimulation technique. Laryngoscope, 1981, 91 (11), 1865–1868.
42.
LiptonR. J., McCaffreyT. V. and LitchyW. J., Intraoperative electrophysiologic monitoring of laryngeal muscle during thyroid surgery. Laryngoscope, 1988, 98 (12), 1292–1296.
43.
HvidegaardT., VaseP., DalsgaardS. C., Endolaryngeal devices for perioperative identification and functional testing of the recurrent nerve. Otolaryngology and Head Neck Surgery, 198492 (3), 292–294.
44.
WolteringE. A., DumondD., FerraraJ., A method for intraoperative identification of the recurrent laryngeal nerve. American Journal of Surgery, 1984, 148 (4), 438–440.
