A 34-year-old patient with primary hyperparathyroidism and repeated renal stones underwent a parathyroidectomy. During operation, a right superior parathyroid adenoma was found which measured 3.5 × 1.5 × 1.0 cm in size. The right nonrecurrent laryngeal nerve passed over the middle of the adenoma, and deformed the parathyroid into a dumbbell shape. Magnetic resonance angiography revealed an absence of the right innominate artery and an independent origin of the right retro-esophageal subclavian and common carotid artery. The combination of the parathyroid tumor and nonrecurrent laryngeal nerve is extremely rare, especially in Asia. To avoid surgical complications, it is important to understand the possibility of a nonrecurrent laryngeal nerve developing in such patients.
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