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Objectives We report two cases of a non-recurrent right inferior laryngeal nerve; per operative discovery during a thyroidectomy. Through these cases, we highlight the clinical and surgical implications by first analyzing the most appropriate technique. Results The frequency of the recurrent non recurrent nerve was 1.3% with confidence interval between 0.2 and 4.6% in our center. We identified two patients who underwent a thyroidectomy, during which the discovery of the recurrent non-recurrent right nerve was made intraoperatively. The nerve approach was performed by the superior approach in front of a bulky and plunging goiter. The outcome was simple. Conclusion The thyroid surgeon must keep in mind the probability of finding this nerve variation. For indirect signs, the superior approach would be the most suitable technique to avoid recurrent morbidity.

The identification and dissection of the recurrent laryngeal nerve is essential to guarantee its anatomical and functional integrity. The superior approach of the recurrent nerve is a reliable surgical alternative. Various indications are recognized with a reliable landmark. This is the entry point into the larynx under the inferior horn of the thyroid cartilage. The limits of this technique, namely, the extralaryngeal divisions and the hemorrhages encountered at the point of entry of the larynx are a source of morbidity of the recurrent laryngeal nerve. A careful dissection, respect for the surgical steps, and the surgeon's experience are guarantees of a good result. We wanted through a review of the literature and our experience in the superior approach to discuss surgical indications, to identify landmarks at the point of entry of the larynx, to determine the limits of this approach, and to take precautions to mitigate the risk of recurrent laryngeal nerve injury.

Multiple myeloma or Kahler's disease is a malignant hemopathy characterized by a clonal proliferation of tumor plasma cells that invade the hematopoietic bone marrow. It is often discovered preferentially during spine, pelvis and ribs pain. Kahler's disease are rarely discovered during ENT infections. We report a case of a 58-year-old female patient that we exanimated in our ENT service for acute suppurative otitis media. The remainder of the examination revealed a swelling in the breast and functional impairment of the right upper limb. The maxillofacial CT- scan revealed lytic lacunar images of maxilla and cranial vault. Conventional X-ray displayed a fracture of the right humeral shaft. The positive diagnosis of multiple myeloma was made using bone marrow biopsy that has shown the presence of pathological plasmatic cells proliferation. Furthermore examination such as the plasma protein electrophoresis found hypo-gamma-globulinemia. Analysis of urinary sediment found κ -like Bence-Jones proteinuria. We provided Biphosphonates and analgesics treatment in addition to that of acute otitis media. Unfortunately, the death occurred six months later before he was able to benefit from a more invasive treatment protocol. This observation shows us that acute otitis media should not be trivialized, as it required a rigorous clinical examination and may surprise us.