Peculiar anatomic variation of recurrent laryngeal nerve and EMG change in a patient with right substernal goiter and pre-operative vocal cord palsy-case report

Jia Joanna Wang; I-Cheng Lu; Pi-Ying Chang; Che-Wei Wu; Ling-Feng Wang; Tzu-Yen Huang; Feng-Yu Chiang

doi:10.21037/gs.2020.03.36

Peculiar anatomic variation of recurrent laryngeal nerve and EMG change in a patient with right substernal goiter and pre-operative vocal cord palsy-case report

Gland Surg. 2020 Jun;9(3):802-805. doi: 10.21037/gs.2020.03.36.

Authors

Jia Joanna Wang¹, I-Cheng Lu^{2

3}, Pi-Ying Chang³, Che-Wei Wu^{1

2}, Ling-Feng Wang^{1

2}, Tzu-Yen Huang^{1

4}, Feng-Yu Chiang^{5

6}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Biological Science and Technology, National Chiao Tung University, ‎Hsinchu, Taiwan.
⁵ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁶ Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan.

Abstract

We report a patient with right substernal goiter and preoperative vocal cord palsy (VCP). During dissection, an anatomic variation of the recurrent laryngeal nerve (RLN) and a prolonged EMG were detected by intraoperative neuromonitoring (IONM). Symmetrical vocal cord movement was recorded one month after surgery. The potential for recovery of vocal cord function is high after surgical treatment of a thyroid tumor with preoperative VCP. An IONM enables early localization of the RLN position. To the best of our knowledge, this case of prolonged EMG in an abnormal acquired-ventral RLN trajectory is the first reported in the literature.

Keywords: Preoperative vocal cord palsy; abnormal acquired-ventral recurrent laryngeal nerve (RLN); case report; electromyography (EMG); intraoperative neuromonitoring (IONM); substernal goiter.

Publication types

Case Reports