c l i n i c a l f o l i o s : n a r r a t i v e





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Thyroid Anatomy: 7

A D V E R T I S E M E N T

   
 

Rarely, one of the laryngeal nerves is not recurrent but takes a straight course to the larynx from above. This happens when an aortic arch developmental anomaly results in aberrant takeoff of a subclavian artery from the distal arch. The condition is rare and usually involves an aberrant right subclavian artery (less than 1% of the population) passing posterior to the esophagus. In that case the right nerve is non-recurrent. Compression of the esophagus is called dysphagia lusoria. Very rarely (1 in 2000), there is a right sided aortic arch with a mirror image anomaly resulting in a non-recurrent left nerve.     

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Thyroid Anatomy: 8

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The terminal portion of the recurrent nerve lies in the T-E groove about half the time. When not in the groove, it is most often more anterior and may be in the suspensory ligament (of Berry) or even in the gland itself. Most often (80%, Skandalakis) the nerve is posterior to the inferior thyroid artery.      

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Thyroid Anatomy: 9

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Venous drainage of the thyroid runs with the superior laryngeal arteries above, passes laterally (middle thyroid veins) directly into the internal jugular veins, and drains inferiorly into the brachiocephalic veins. The dominant lymphatic drainage accompanies the vessels within the loose areolar carotid sheaths. The veins form a plexus on the surface of the gland within the areolar thyroid (visceral) fascia. Remaining external to this capsule provides a relatively bloodless dissection. Entry into the capsule is a bloody mess.     

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This page was last modified on 12/10/1998.