title: Pre-operative prediction of a right non-recurrent laryngeal nerve by computed tomography.
abstract: OBJECTIVE
  This paper reports a case of a non-recurrent laryngeal nerve which was accurately predicted pre-operatively using computed tomography.
  
  
  METHODS
  A 61-year-old man presented with papillary thyroid carcinoma with lymph node metastasis. Computed tomography scans of the neck and chest revealed an ill-defined, hypoattenuating nodule in the right lobe of the thyroid gland, with few upper paratracheal and prevascular nodes, and clear lung fields. The retro-oesophageal course of the right subclavian artery, which was arising from the distal portion of the arch of aorta, was also incidentally revealed in the computed tomography scan. A barium swallow further confirmed the presence of a retro-oesophageal subclavian artery. Total thyroidectomy was performed, with right neck dissection and central compartment clearance. This was carried out with the presence of a non-recurrent laryngeal nerve in mind, and the nerve was accurately localised and preserved.
  
  
  CONCLUSIONS
  To our knowledge this is the first report in the world literature of accurate pre-operative incidental imaging of the right non-recurrent laryngeal nerve in a case of metastatic thyroid cancer, and the subsequent use of computed tomography to guide surgical navigation.
authors: Department of Surgical Oncology (Head and Neck Service), Regional Cancer Centre, Trivandrum, India. bipintv@gmail.com
authors: B T
authors: BT
authors: Varghese
authors: K P
authors: KP
authors: Desai
authors: A
authors: A
authors: Ramachandran
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012009:Recurrent Laryngeal Nerve / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed