title: Efficient, effective, safe procedure to identify nonrecurrent inferior laryngeal nerve during thyroid surgery.
abstract: BACKGROUND
  The nonrecurrent inferior laryngeal nerve (NRILN) is always associated with the aberrant subclavian artery. CT images can detect this vascular anomaly, which predicts an NRILN. The purpose of this study was to report our procedure to identify the NRILN in patients with the aberrant subclavian artery.
  
  
  METHODS
  Four of 730 patients undergoing thyroid operation in our hospital were preoperatively diagnosed with aberrant subclavian artery by CT of the neck. To avoid vocal cord paralysis, we approached the vagal nerve first before dissecting the paratracheal region to discover the separation point of the NRILN from the vagal nerve.
  
  
  RESULTS
  The NRILN was identified without difficulty in all 4 patients. No patients showed vocal cord paralysis.
  
  
  CONCLUSIONS
  Approaching the vagal nerve first before dissecting the paratracheal region is an efficient, effective, and safe procedure to identify an NRILN in patients who are preoperatively diagnosed as having the aberrant subclavian artery.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Taniguchi
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Division of Voice Rehabilitation, Keiyukai Sapporo Hospital, Sapporo, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Surgery, Keiyukai Sapporo Hospital, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Hosokawa
authors.affiliation: Health Science University of Hokkaido, Ishikari-Tobetsu, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D000783:Aneurysm / Q000601:surgery*; D018376:Cardiovascular Abnormalities / Q000601:surgery*; D003680:Deglutition Disorders / Q000601:surgery*; D006801:Humans; D012009:Recurrent Laryngeal Nerve / Q000002:abnormalities* / Q000601:surgery; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery; D013961:Thyroid Gland / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014630:Vagus Nerve / Q000601:surgery*; D014826:Vocal Cord Paralysis / Q000517:prevention & control
keywords: aberrant subclavian artery; nonrecurrent inferior laryngeal nerve; preoperative diagnosis; thyroid operation; vagal nerve