Concurrent Ipsilateral Recurrent and Nonrecurrent Laryngeal Nerve During Thyroidectomy: A Case Report

Abstract

Coexisting ipsilateral nonrecurrent and recurrent laryngeal nerves have been described previously, but its existence is still debated. We report a case of a concurrent nonrecurrent and recurrent ipsilateral laryngeal nerves that were incidentally found during a total thyroidectomy with intraoperative nerve monitoring signal from both branches. A 57-year-old female was found to have a right thyroid lobe nodule during surveillance whole body positron emission tomography scan and a left 1.7 cm thyroid nodule on ultrasound. The patient underwent a total thyroidectomy and right central cervical lymph node dissection. Exposure of the right recurrent laryngeal nerve revealed a typical recurrent branch as well as a type 2 nonrecurrent laryngeal nerve branch. Intraoperative nerve monitoring demonstrated signal from both the recurrent and nonrecurrent laryngeal nerve branches, implicating innervation of the larynx from both branches. A coexisting ipsilateral nonrecurrent and recurrent laryngeal nerve was identified in this case with novel demonstration of intraoperative nerve monitoring signal from both branches. This case highlights that the identification of either a recurrent or nonrecurrent nerve does not exclude the possibility of a coexisting recurrent or nonrecurrent nerve. While the consequences of damage to either of these nerve branches is currently unknown, both nerve branches may be functionally important and injury to either branch may result in morbidity.