{"title":"Non-Recurrent Laryngeal Nerve: Surgical Risk of Injury in Comparison With the Normal Recurrent Laryngeal Nerve—A Systematic Review and Meta-Analysis","authors":"Jensen Tsun-Ki So, C. S. G. Thompson","doi":"10.1111/coa.14312","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>The non-recurrent laryngeal nerve (NRLN) is a known anatomical variation of the normal recurrent laryngeal nerve (RLN). Its prevalence is estimated to be < 1% and has a higher risk of iatrogenic injury. The risk during thyroid surgery has been reported variably in current literature, from 0% to 12%. This study aimed to systematically review the incidence of NRLN injury and present the results through meta-analysis. The incidence of injury to NRLN and RLN was compared statistically to determine its significance.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>The PRISMA protocol was followed for an online search of prominent literatures. Studies were selected according to specific criteria. Quality assessment was performed before data extraction. Meta-analysis was conducted for the incidence of injury of the NRLN and its comparison to the RLN. Results were presented in the form of a systematic review.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Final analysis included 17 studies. The pooled risk of NRLN injury was 7% and the risk ratio of injury in comparison to the RLN was 3.8, showing a statistically significant difference.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This is the first study to report the overall risk of NRLN injury and establish a statistically significant difference compared to the injury of the normal RLN. The NRLN is highly associated with the vascular anomaly of aberrant subclavian artery, which is radiologically predictable. The use of intra-operative nerve monitoring can significantly reduce the risk of injury to this nerve when it is identified pre-operatively, and the thyroid surgery should be performed by experienced thyroid surgeons with extra care to minimise the risk.</p>\n </section>\n </div>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":"50 4","pages":"654-663"},"PeriodicalIF":1.5000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Otolaryngology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/coa.14312","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
The non-recurrent laryngeal nerve (NRLN) is a known anatomical variation of the normal recurrent laryngeal nerve (RLN). Its prevalence is estimated to be < 1% and has a higher risk of iatrogenic injury. The risk during thyroid surgery has been reported variably in current literature, from 0% to 12%. This study aimed to systematically review the incidence of NRLN injury and present the results through meta-analysis. The incidence of injury to NRLN and RLN was compared statistically to determine its significance.
Methods
The PRISMA protocol was followed for an online search of prominent literatures. Studies were selected according to specific criteria. Quality assessment was performed before data extraction. Meta-analysis was conducted for the incidence of injury of the NRLN and its comparison to the RLN. Results were presented in the form of a systematic review.
Results
Final analysis included 17 studies. The pooled risk of NRLN injury was 7% and the risk ratio of injury in comparison to the RLN was 3.8, showing a statistically significant difference.
Conclusion
This is the first study to report the overall risk of NRLN injury and establish a statistically significant difference compared to the injury of the normal RLN. The NRLN is highly associated with the vascular anomaly of aberrant subclavian artery, which is radiologically predictable. The use of intra-operative nerve monitoring can significantly reduce the risk of injury to this nerve when it is identified pre-operatively, and the thyroid surgery should be performed by experienced thyroid surgeons with extra care to minimise the risk.
期刊介绍:
Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with:
current otorhinolaryngological practice
audiology, otology, balance, rhinology, larynx, voice and paediatric ORL
head and neck oncology
head and neck plastic and reconstructive surgery
continuing medical education and ORL training
The emphasis is on high quality new work in the clinical field and on fresh, original research.
Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject.
• Negative/null results
In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.