A case report of the rare non recurrent laryngeal nerve in a resource limited setting: The first Ethiopian documentation

INTRODUCTION AND IMPORTANCEA non-recurrent laryngeal nerve (NRLN) is an unusual variant of the recurrent laryngeal nerve. It is seen in 0.3-0.8 % of individuals. During neck surgery, the NRLN is predisposed to be injured due to its abnormal anatomic position which results in vocal cord paralysis. CASE PRESENTATIONWe report two patients who underwent thyroid surgery. The indication for surgery was controlled toxic diffuse goiter and multinodular goiter with pressure symptoms in the first and second patients respectively. Intraoperatively we employed the lateral approach using the inferior thyroid artery as a landmark to dissect for the RLN. Once we couldn't find the nerve in its normal position the possibility of NRLN came into picture. Through gentle dissection between the larynx and the carotid sheath the nerve was found entering the larynx directly at right angle in both cases and the diagnosis of NRLN was made and intraoperative pictures were taken. CLINICAL DISCUSSIONThe NRLN is a rare congenital anomaly of the recurrent laryngeal nerve. It is almost always diagnosed on the right side. Three types have been described. In most cases, the NRLN is diagnosed intraoperative. Both of our patients had type 2A right sided NRLN which was diagnosed intraoperative. CONCLUSIONThrough intraoperative careful dissection and search the RLN can be identified and also its rare anomaly, the NRLN, can be diagnosed and injury to the nerve can be avoided.