title: Right-sided aortic arch and aberrant left subclavian artery with or without a left nonrecurrent inferior laryngeal nerve.
abstract: In thyroid surgery, preserving the recurrent laryngeal nerve (RLN) is crucial for preventing postoperative phonatory dysfunction. Right nonrecurrent laryngeal nerves (NRLNs) are not particularly rare, and they are vulnerable to injury during surgery. This anomaly is associated with a right aberrant subclavian artery. Thus, a right-sided aortic arch with an aberrant left subclavian artery (LSA) suggests a possible left NRLN.
  
  
  
  We report the cases of 4 patients with right-sided aortic arch and aberrant LSA. Preoperative imaging studies revealed those anomalies, but no signs of situs inversus. During the surgeries, only 1 of the 4 cases had a left NRLN. We retrospectively evaluated the patients' imaging studies.
  
  
  
  An aortic diverticulum was found at the point at which the aberrant LSA originated in the 3 patients with left-RLNs, but not in the patient with the left-NRLN.
  
  
  
  In right-sided aortic arch + aberrant LSA cases, the absence of an aortic diverticulum suggests a left NRLN. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-E2511, 2016.
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Japan. masuoka@kuma-h.or.jp.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Masuoka
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Higashiyama
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yabuta
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Kihara
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Miya
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging*; D000328:Adult; D000783:Aneurysm; D001013:Aorta, Thoracic / Q000002:abnormalities*; D018376:Cardiovascular Abnormalities; D005260:Female; D006801:Humans; D007823:Laryngeal Nerves / Q000002:abnormalities*; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000002:abnormalities*; D013965:Thyroidectomy / Q000379:methods; D055815:Young Adult
keywords: aberrant left subclavian artery; chromosome 22q11 deletion; intraoperative neural monitoring; left nonrecurrent laryngeal nerve; right aortic arch