NON-RECURRENT RECURRENT LARYNGEAL NERVE

We do so many thyroid operations that we occasionally see unusual anatomy such as the non-recurrent recurrent laryngeal nerve. In the case illustrated here, there is a right non-recurrent recurrent laryngeal nerve that we astutely (or luckily) identified. The recurrent nerve branches directly off the vagus nerve rather than taking the recurrent route.The biggest problem with this anomaly is that the nerve can be injured during thyroid surgery.

Right non-recurrent recurrent laryngeal nerve. (Note that the retraction is
pulling the vagus nerve to the patient's right and pulling the trachea to the
patient's left)

Normal course of the recurrent laryngeal nerves

Right non-recurrent recurrent laryngeal nerve

PICTURE

I came across this picture, painted by a medical missionary, Kuhn Hong. It depicts a scene at the Mbingo Hospital in Cameroon. When I saw it it reminded me of the Nigerian Christian Hospital and Dr. Farrar, its founder.

DESPAIR

Not all cases end happily. These two children came in very late-one with an encephalocoele and one with hydrocephalus. We referred them to a neurosurgeon.

LITHOPEDION-SMALL BOWEL OBSTRUCTION

This specimen came from a woman with a SBO. We operated and found a hard calcified mass in the omentum with a loop of attached small bowel. If you look carefully you can see an eye (one eye is covered by omental fat), mouth and the femurs. This woman had an intraabdominal pregnancy that died and calcified!

CHECKUP

This lady came for a checkup. Last trip she had a hemimandibulectomy for fibrous dysplasia. She is eating and speaking normally.

FUNGATING BREAST CANCER

This lady is sweet and tough. She always had a smile. She underwent 3 courses of chemo for her breast cancer and then we did a mastectomy. She never complained and was raising her hands up to praise the Lord on day one. We all hope she does well.

THYROGLOSSAL DUCT CYST

This your girl came with a neck cyst that was slowly growing for years. It was a thyroglossal duct cyst. This is not uncommon in Nigeria. I was proud of this case since we were able to remove it without rupturing the cyst. We performed a Sistrunk procedure.