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Identification Of Patients With A Non-recurrent Inferior Laryngeal Nerve By Duplex Ultrasound Of The Brachiocephalic Artery

A. Devèze, F. Sebag, J. Hubbard, M. Jaunay, S. Maweja, J. Henry
Published 2003 · Medicine

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A non-recurrent inferior laryngeal nerve (NRILN) is a rare anomaly that may increase the risk of injury during thyroid surgery. A NRILN results from an embryologic developmental abnormality of the aortic arches, demonstrated by the absence of the brachiocephalic artery and the presence of an aberrant subclavian artery (arteria lusoria). In our experience 100% of 104 patients with a NRILN were shown to have these abnormalities. We postulated that duplex scanning of the brachiocephalic artery could identify patients at risk of a NRILN. Twelve patients with an operative diagnosis of a right NRILN and associated vascular abnormalities underwent postoperative duplex scanning of the brachiocephalic artery. The examination was performed using a 7.5 or 3.5 MHz transducer. The average duration of assessment was 5 min. The absence of the brachiocephalic artery and the direct origin of the right common carotid artery from the arch of the aorta were demonstrated in each patient. Duplex scanning is a simple noninvasive method of identifying patients with the arterial abnormalities responsible for a NRILN. This may be used in the preoperative assessment of selected patients.RésuméLe nerf laryngé inférieur non-récurrent (NRILN) est une anomalie rare qui expose à un risque accru de paralysie récurrentielle lors de la chirurgie thyroïdienne et parathyroïdienne. Cette anomalie du côté droit est la conséquence d'une anomalie embryologique du développement des arcs branchiaux, comme l'atteste l'absence d'artère brachiocéphalique (ABC) et la présence d'une artère subclavière aberrante (arteria lusoria). Dans notre expérience, la totalité des 104 patients porteurs d'un NRILN présentaient ces anomalies vasculaires. A l'inverse de certaines méthodes invasives ou coûteuses (artériographie, IRM), l'échographie Doppler de l'ABC nous est apparue comme un moyen simple et fiable de diagnostiquer indirectement la présence d'un NRILN. Douze patients présentant un NRILN droit et une absence d'ABC diagnostiqués en cours d'intervention ont bénéficié d'une échographie Doppler de l'ABC. Les sondes utilisées étaient de deux types, une sonde 7,5 Hz ou une sonde 3,5 Hz. La durée moyenne d'examen a été de 5 minutes. L'absence d'ABC ainsi que l'origine de l'artère carotide commune droite directement depuis l'arc de l'aorte ont été retrouvées dans tous les cas. L'échographie Doppler apparaît comme être une méthode simple et non invasive pour identifier les patients présentant les anomalies vasculaires associées à un NRILN. Nous pensons que cet examen devrait être proposé dans le bilan pré-opératoire de certains patients à risque.
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