{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:18:21Z","timestamp":1760239101096,"version":"build-2065373602"},"reference-count":16,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T00:00:00Z","timestamp":1600819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Leipzig, DEAL","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Left sided non-recurrent laryngeal nerves (NRLN) are very rarely observed during surgery in the head and neck region. Arising directly from the cervical aspect of the vagus nerve, the NRLN lies in a vulnerable position distant from its normal location. NRLNs are normally associated with embryological branchial arch aberrations and subsequent vascular anomalies. The anomalous course of the NRLN makes it more susceptible to injury during surgery in the neck region. Knowledge of this anatomical variant will reduce the potential for injury and resultant vocal cord paralysis. During microsurgical dissection of the carotid sheath for the implantation of a vagus nerve stimulator in a 19-year-old female patient with refractory epilepsy, a moderate-sized branch of the main vagus nerve trunk was identified postero-medially within the carotid sheath. Intra-operative stimulation of this nerve resulted in a compound muscle evoked potential from the left vocal cord. Thus, this branch was confirmed to be a left-sided NRLN. The patient had no associated vascular anomalies. This is first reported case of a left-sided NRLN found during VNS insertion. Awareness of the possibility of an NRLN is imperative to prevent iatrogenic injury. A medial location of the vagus nerve within the carotid sheath should alert the surgeon to the possible presence of an NRLN. The absence of fourth branchial arch remnant anomalies is not a guarantee as to the absence of a left-sided NRLN. The addition of intra-operative nerve monitoring for vagus nerve stimulator (VNS) implantation procedures should be strongly considered to help avoid iatrogenic injury.<\/jats:p>","DOI":"10.3390\/medicina56100489","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T09:28:08Z","timestamp":1600853288000},"page":"489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Intra-Operative Detection of a Left-Sided Non-Recurrent Laryngeal Nerve during Vagus Nerve Stimulator Implantation"],"prefix":"10.3390","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6567-0131","authenticated-orcid":false,"given":"Jason John","family":"Labuschagne","sequence":"first","affiliation":[{"name":"Netcare Unitas Hospital, Centurion 0140, South Africa"},{"name":"Department of Neurosurgery, University of Witwatersrand, Johannesburg 2193, South Africa"},{"name":"Department of Pediatric Neurosurgery, Nelson Mandela Children\u2019s Hospital, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Macroscopic and Clinical Anatomy, Medical University of Graz, 8010 Graz, Austria"},{"name":"Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, 04109 Leipzig, Germany"},{"name":"Fraunhofer Institute for Machine Tools and Forming Technology, 01187 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1002\/ca.22613","article-title":"A systematic review of variations of the recurrent laryngeal nerve","volume":"29","author":"Ling","year":"2016","journal-title":"Clin. Anat."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ijscr.2018.07.017","article-title":"Non-recurrent laryngeal nerve in thyroid surgery: A report of case series in Vietnam and literature review","volume":"50","author":"Le","year":"2018","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1620\/tjem.216.133","article-title":"Nonrecurrent inferior laryngeal nerve without vascular anomaly as a genuine entity","volume":"216","author":"Tateda","year":"2008","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1017\/S0022215100100325","article-title":"Anatomy of the recurrent laryngeal nerve: A redescription","volume":"100","author":"Steinberg","year":"1986","journal-title":"J. Laryngol. 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