%0 Journal Article
%T Three variations of the laryngeal nerve in the same patient: a case report
%A Emin Gurleyik
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-266
%X A 56-year-old Caucasian man with a large toxic multi-nodular goiter was surgically treated with total thyroidectomy. Both his right and left ILNs were identified, fully exposed and preserved along their cervical courses. We discovered many variations during bilateral exploration of the two ILNs. His right ILN was non-recurrent. This non-recurrent ILN showed a terminal division before laryngeal entry. The left nerve had a usual course as a recurrent laryngeal nerve (RLN) at his tracheaesophageal groove. We also discovered bifurcation of his RLN beginning at a neurovascular (RLN and inferior thyroid artery) crossing point. Anterior and posterior branches of both nerves entered his larynx separately. The sympathetic inferior laryngeal anastomotic branch (SILAB) between the posterior branch of his left ILN and the cervical sympathetic chain was established in the distal part of the nerve before laryngeal entry.A non-recurrent nerve and extra-laryngeal branching of the ILN are two different variations. The coincidence of a right non-recurrent ILN and bilateral bifurcation of both nerves is a very interesting feature. SILAB is a rare additional finding as a third anatomic variation in the same patient. Extra-laryngeal terminal division of a non-recurrent ILN is an extremely unusual anatomic finding. Two anatomic variations have occurred in the same nerve, like "the variation of the variation".The inferior laryngeal nerve (ILN) is the most important structure in thyroid operations. Anatomic variations of a recurrent laryngeal nerve (RLN) may threaten the safety of thyroid surgery and so a complete knowledge of RLN anatomy, including all of its variations, must be mandatory for thyroid surgeons. Extra-laryngeal branching of the RLN as a terminal division is a common anatomic variation macroscopically discovered at surgical exploration. Terminal division of both right and left nerves seldom occurs bilaterally. Larger branches of the nerve bifurcation may affect laryngeal fun
%U http://www.jmedicalcasereports.com/content/5/1/266