与右位主动脉弓相关的喉上神经外支类返支走行：一种罕见的解剖变异

文献信息

中文摘要

在甲状腺手术中准确识别喉神经对于防止神经损伤和保留发声功能至关重要。虽然喉返神经（RLN）的变异，尤其是非返性喉返神经（NRLN），已被广泛认识并常与血管异常相关联而预期出现，但喉上神经的变异较少被预料。我们报告一例60岁女性甲状腺乳头状癌患者，接受了全甲状腺切除术。术前计算机断层扫描显示右位主动脉弓伴迷走左锁骨下动脉（ALSA），提示可能存在喉神经变异。术中，双侧RLN均呈现正常的返支走行。相反，发现喉上神经外支（EBSLN）的一种不寻常变异，其起源于颈部迷走神经，并沿类似返支的上升走行，最初模仿NRLN。本病例表明，喉神经解剖并不总是与预期的血管发现相对应，并强调了术中仔细识别神经和系统性手术解剖以防止误认和神经损伤的重要性。

英文摘要

Accurate identification of the laryngeal nerves during thyroid surgery is essential to prevent nerve injury and preserve vocal function. While variations of the recurrent laryngeal nerve (RLN), particularly the non-recurrent laryngeal nerve (NRLN), are well recognized and often anticipated in association with vascular anomalies, variations of the superior laryngeal nerve are less commonly expected. We report a case of a 60 year-old female with papillary thyroid carcinoma who underwent total thyroidectomy. Preoperative computed tomography revealed a right-sided aortic arch with an aberrant left subclavian artery (ALSA), raising consideration of possible laryngeal nerve variation. Intraoperatively, both RLNs demonstrated a normal recurrent course. Instead, an unusual variation of the external branch of the superior laryngeal nerve (EBSLN) was identified, originating from the cervical vagus nerve and following a recurrent-like ascending course that initially mimicked NRLN. This case demonstrates that laryngeal nerve anatomy may not always correspond to expected vascular findings and highlights the importance of careful intraoperative nerve identification and systematic surgical dissection to prevent misidentification and nerve injury.