title: Preoperative diagnosis and intraoperative protection of nonrecurrent laryngeal nerve: a review of 5 cases.
abstract: BACKGROUND
  Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroidectomy or parathyroidectomy. It is usually associated with abnormal vasculature that can be identified by several imaging methods. The aim of this study was to retrospectively analyze the preoperative diagnosis and intraoperative protection of NRLN.
  
  
  METHODS
  Of the 7169 patients who underwent thyroid surgery at our hospital between August 2008 and January 2013, 5 patients with NRLN were identified. Preoperative chest X-rays, neck ultrasonography (US), and computed tomography (CT) findings were reviewed. NRLNs were carefully and systematically searched for in surgery.
  
  
  RESULTS
  Preoperative CT predicted NRLN in all 5 cases (100% accuracy). The detection rate of NRLN by CT was 0.4% (5/1170). NRLNs were confirmed in surgery. All of them were right-sided NRLN with type IIA variant. The CT scans clearly revealed the vascular anomalies. The review of US images suggested that vascular anomalies could be identified on the images in 1 patient. No postoperative complications occurred in any patient.
  
  
  CONCLUSIONS
  The preoperative CT scan was a reliable and effective method for identifying abnormal vasculature to indirectly predict NRLN. Combining the CT and US findings with adequate surgical technique may help to reduce the risk of nerve damage, in addition to preventing nerve palsy.
authors: Department of General Surgery, First Hospital of China Medical University, Shenyang, China (mainland).
authors: Zhihong
authors: Z
authors: Wang
authors: Department of General Surgery, First Hospital of China Medical University, Shenyang, China (mainland).
authors: Hao
authors: H
authors: Zhang
authors: Department of General Surgery, First Hospital of China Medical University, Shenyang, China (mainland).
authors: Ping
authors: P
authors: Zhang
authors: Department of General Surgery, First Hospital of China Medical University, Shenyang, China (mainland).
authors: Liang
authors: L
authors: He
authors: Department of General Surgery, First Hospital of China Medical University, Shenyang, China (mainland).
authors: Wenwu
authors: W
authors: Dong
mesh_terms: D000328:Adult; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006801:Humans; D061224:Laryngeal Nerve Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012009:Recurrent Laryngeal Nerve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography