Non recurrent laryngeal nerve with right aberrant subclavian artery in recurrent case of papillary carcinoma of thyroid: an interesting clinical entity.

Background/objectives: A nonrecurrent laryngeal nerve is a rare anatomical variant and a routine preoperative imaging studies are not indicated. NRLN is related with absence of the brachiocephalic trunk and aberrant (mainly retroesophageal) course of theright subclavian artery which is evident on contrast enhanced CT scan of the chest.Case report: The patient presented with a swelling in the neck for 4 months which is slowly increasing in size. Patient gives history of a surgery done in the neck with an old midlinesuprasternal scar which was done 40 years earlier.laryngoscopic mirror examinartion was normal with moving vocal cords. Rest of the oral and oropharyngeal examination along with completeblood picture and biochemical investigations were normal. The patient was not a known diabetic or hypertensive.Conclusion: Accurate knowledge of frequent variations of the nerve along with the non recurrent variant reduces the risk of intraoperative injury. A nonrecurrent laryngealnerve(NRLN) is a rare anatomical variant and a routine preoperative imaging studies are not indicated. NRLN is related with absence of the brachiocephalic trunk and aberrant(mainly retroesophageal) course of the right subclavian artery which is evident on contrast enhanced CT scan of the chest.

Supraclavicular Artery Flap for Head and Neck Oncologic Reconstruction: An Emerging Alternative

Aim. Head and Neck oncologic resections often leave complex defects which are challenging to reconstruct. The need of the hour is a versatile flap which has the advantages of both a regional flap (viz. reliable and easy to harvest) and a free flap (thin, pliable with good colour match). In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic defects. Materials and Method. The flap was used as a pedicled fasciocutanous and was based on the transverse supraclavicular artery. We assessed this reconstructive option for complications as well as its and functional out comes. Results. Eleven cases underwent supraclavicular artery flap between 20011-2012 of which 5 were males and 6 females. Mean defect size was 5 cm × 6 cm. Nine donor sites were closed primarily and 1 required split skin grafting. We encountered one complete flap loss which was attributed to a band of constricting skin bridge over the vascular pedicle in a defect involving lateral third of midface. Two patient developed pharyngeocutaneous fistula (without flap loss) out of 3 patients who underwent augmentation pharyngoplasty post Near total laryngectomy. Conclusion. Supra clavicular artery flap is a thin versatile, reliable, easy to harvest, with good cosmetic and functional outcome at both ends (recipient and donor) for reconstructing head and neck oncologic defects