MUSTAFA GÜVENÇER, Amaç KIRAY, İpek ERGÜR, Cenk ERDAL

Retro-oesophagial arteria subclavia dextra ve non-recurrent nervus laryngealis inferior dextra'nın birlikte bulunduğu olgu sunumu

Retro-oesophageal arteria subclavia (ROAS) dextra ve non-rççurrent., nervus laryııgeus inferior (NRNLI) dextra, embriyolojik gelişimleri sırasındaki ilişkileri nedeniyle, çoğunlukla birlikte görülürler. NRNLI, preoperatif olarak hiç bulgu vermez. ROAS ise oesophagus ve trachea'ya bası oluşturarak daha çok disfaji ve bununla birlikte solunum distresi oluşturur. Ateroskleroz, vaskuler inflamasyçıni gibitablolar eklendiğinde belirginleşir. Bu nedenle çoğunlukla tiroid ve .paratiroid, cerrahisi, trakeotomi, perkutanoz trakeostomi, mediastinoskopi ve karotid endarterektomi gibi girişimler şırasında farkına varılır, fark edilmezse komplikasyon riski oluşturur. ROAS'da oluşacak vaskuler hasarkânanıaya yol açarken, NRNLInin hasari öncelikle vokal kord paralizisine neden olur. Servikal bölge cerrahisi uygulamalarında ROAS, %0,4-1,8 sıklıkla görüldüğü bildirilmiştir. NRNLI yaralanma insidansı ise %12,9'a kadar çıkmaktadır. ROAS ve bununla birlikte-görülen NRNLI'nın bulunabileceğinin dikkate alınması, kanama ve vokal kord paralizi gibi,kpmplikasyonların görülme sıklığını azaltacaktır.

Anahtar Kelimeler:

Subklavian arter, Aort, torasik, Kadavra, Larinks sinirleri, Erkek, Orta yaşlı

The right retro-oesophageal subclavian artery and the right non-recurrent inferior laryngeal nerve case report

The right retro-oesophageal subclavian artery (ROSA) and the right non-recurrent inferior laryngeal nerve (NRILN) frequently exist together because of their relations during their embryologic developments. The- NRILN doesn't show any signs preoperatively. By applying pressure on the oesophagus and the trachea, the ROSA forms much more disphagia and respiration distress accordingly. However, the ROSA becomes evident when pathologies such as vascular inflammation or arterioscgical procedures such as thyroid and parathyroid operations, tracheostomy, percutaneous tracheostomy, mediastinescopy and carotid endartherectomy and if it's not noticed, it exposes the risk of complication. While the vascular injury that'Will occur on the ROSA causes bleeding, injury of the NRILN causes: the paralysis of the plica vocalis at first sight. It's been reported that the ROSA is observed at the rate of 0.4-1.8% during the cervical region operations in the literature. The incidence of injury of NRILN can go : up to 12.9% in literature. Taking into consideration die possibility of the existence of the ROSA and the NRILN,which is observed accordingly, will decrease the incidence of complications such as bleeding and the paralysis of the vocal cord.

Keywords:

Subclavian Artery, Aorta, Thoracic, Cadaver, Laryngeal Nerves, Male, Middle Aged,

PDF

___

1. Moore K, Persaud TVN. Çeviri Editörleri: Yıldırım M, Okar İ, Dalcık H. Klinik Yönleriyle İnsan Embriyolojisi. 1.baskı, Nobel Tıp Kitabevi, İstanbul 2002;387-391.
2. Brown DL, Chapman WC, Edwards WH, Coltharp WH, Stoney WS. Disphagia lusoria: Aberrant right subclavian artery with a KommerelPs diverticulum. Am Surg 1993; 59: 582-586.
3. Loukas M, Giannikopoulos P, Fudalej M, Dimopoulos C. A retro-esophageal right subclavian artery originnating from the left aortic arch- a case report and review of the literature.Folia Morphol 2004; 63:141-145.
4. Henry JF, Audiffret J, Denizot A, Plan M. The nonrecurrent inferior laryngeal nevre: Review of 33 cases, including two on the left side. Surgery 1988; 104:977-984.
5. Defechereux T, Albert V, Alexandre J, Bonnet P, Hamoir E, Meurisse M. The inferior non recurrent laryngeal nerve: A major surgical risk during thyroidectomy. Acta Chir Belg 2000; 100:62-67.
6. Garcia VA, Terol FF, Correa-Lacarcel J, Lloret J, Robles J, Sanchez del Campo F. Retroesophageal subclavian artery: A case report. Surgical and Radiologic Anatomy 2002; 24:231-233.
7. Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Pelizzo MR. Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20- year experience. World Journal of Surgery 2004; 28:659-661.
8. Watanabe A, Kawabori S, Osanai H, Taniguchi M, Hosokawa M. Preoperative computed tomography diagnosis of non-recurrent inferior laryngeal nevre. The Laryngoscope 2001; 111:1756-1759.
9. Nakatani T, Tanaka S, Mizukami S. Anomalous triad of a left-sided inferior vena cava, a retroesophageal right subclavian artery, and bilateral superficial brachial arteries in one individual. Clin Anat 1998;11:112-117.
10. Gluncic V, Marusic A. Association of the truncus bicaroticus, common trunk of the left subclavian and vertebral arteries, and retroesophageal right subclavian artery. Case report. Anat Anz 2000; 182:281-283.
11. Hermans Dewandel P, Debruyne F, Delaere PR. Arteria lusoria identified on preoperative CT and nonrecurrent inferior laryngeal nerve during thyroidectomy: a retrospective study. Head&Neck 2003; 25:113-117.
12. Brauckhoff M, Walls G, Brauckhoff K, Thanh PN, Thomusch O, Dralle H. Identification of the nonrecurrent inferior laryngeal nerve using intraoperative neurostimulation. Langenbecks Arch Surg 2002; 386:482-487.
13. Chadha NK, Chitti-Batelli S. Tracheostomy reveals a rare aberrant right subclavian artery; a case report. BMC Ear, Nose and Throat Disorders 2004; 4:1.
14. Nathan H,Seidel MR. The association of a retroesophageal right subclavian artery, a right-sided terminating thoracic duct, and a left vertebral artery of aortic origin: Anatomical and clinical considerations. Acta Anat 1983; 117:362-373.
15. Feugier P, Lemoine L, Gruner L, Bertin-Maghit M, Rousselet B, Chevalier JM. Arterioesophageal fistula: A rare complication of retroesophageal subclavian artery. Annals of Vascular Surgery 2003; 17:302-305.
16. Gil-Jaurena JM, Murtra M, Goncalves A, Miro L. Aortic coarctation, vascular ring, and right aortic arch with aberrant subclavian artery. Ann Thorac Surg 2002;73:1640-1642.
17. Delgado C, Mestre J, Barturen F. Right aortic arch with left aberrant subclavian artery Rev Esp Cardiol 2003;56:817.
18. Bove T, Demanet H, Casimir G, Viart P, Goldstein JP, Deuvaert FE. Tracheobroncheal compression of vascular origin. Review of experience in infants and children. J Cardiovasc Surg 2001; 42:663-666.
19. Ballotta E, Mion E, Bardini R. Right-sided aortic arch and aberrant left subclavian artery. J Cardiovasc Surg 2003;44:783-784.
20. Subramanyan R, Venugopalan P, Narayan R. Vascular rings: an important cause of persistent respiratory symptoms in infants and children. Indian Pediatr 2003;40:951-957.
21. Planche C, Roussin R, Paul JF, Belli E, Serraf A. A rare form of aortic arch anomaly: left aortic and right descending aortic arch. Arch Mai Coeur Vaiss 2004 97:549-553.
22. Sala F, Bouillane PJ, Francisci MP et al. Retroesophageal subclavian artery aneurysm arising from Kommerell's divertiulum. Ann Vase Surg 2001;15:699-702.
23. Austin EH, Wolfe GW. Aneurysm of aberrant subclavian artery with a review of the literature. J Vase Surg 1985; 2:571-577.
24. Cina CS,Althani H, Pasenau J, Abouzahr L. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. Journal of Vascular Surgery 2004; 39:131-139.
25. Stewart GR, Mountain JC, Colcock BP. Nonrecurrent laryngeal nerve. Br J Surg 1972; 59:379-381.
26. Steinberg JL, Khane GJ, Fernandes CMC, Nel JP. Anatomy of the recurrent laryngeal nerve: a redescription. J Laryngol Otol 1986; 100:919-927.
27. Raffaelli M, Iacobone M, Henry JF. The false nonrecurrent inferior laryngeal nevre. Surgery 2000; 128:1082-1087.
28. Donnelly LF, Fleck RJ, Pacharn P, Ziegler MA, Fricke BL, Cotton RT. Aberrant subclavian arteries: cross- sectional imaging findings in infants and children referred for evaluation of extrinsic airway compression. AJR AmJ Roentgenol 2002;178:1269-1274.
29. Coady MA, Adler F, Davilla J, Gahtan V. Nonrecurrent laryngeal nerve during carotid artery surgery: Case report and literature review. Journal Vascular Surgery 2000; 32:192-196.
30. Chaoui R, Schneider MB, Kalache KD. Right aortic arch with vascular ring and aberrant left subclavian artery: prenatal diagnosis assisted by three-dimensional power Doppler ultrasound. Ultrasound Obstet Gynecol 2003;22:661-663.
31. Rauch R, Rauch A, Koch A et al. Laterality of the aortic arch and anomalies of the subclavian arteryreliable indicators for 22q 11.2 deletion syndromes? Eur J Pediatr 2004;163:642-645.
32. McKenna E, Kelly BE, Khan M. Dysphagia due to an aberrant left subclavian artery in a right-sided aortic arch. Ulster Med J 2001;70:64-66.
33. Tsukube T, Ataka K, Sakata M, Wakita N, Okita Y. Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery. Ann Thorac Surg2001;71:1710-1711.
34. Abboud B, Aouad R. Non-recurrent inferior laryngeal nevre in thyroid surgery: report of three cases and review of the literature. The Journal of The Laryngology and Otology 2004; 118:139-142.
35. Cannon CR. The anomaly of nonrecurrent laryngeal nevre: Identification and management. Otolaryngology-Head and Neck Surgery 1999;120:769-771.