en جراحی دست / آرنج Hand surgery / Elbow گزارش مورد Case Report <div style="text-align: justify;"><strong>Background</strong>: The bifid median nerve (BMN) is a common anatomical variation that, when encountered unexpectedly during carpal tunnel release (CTR), can increase the risk of iatrogenic injury and complicate the surgical approach. This report discusses the intraoperative management and outcomes of two such cases.<br> <strong>Case Presentation</strong>: We present two cases of severe carpal tunnel syndrome in which a BMN (lanz type IIIA) was discovered incidentally during open CTR performed under wide awake local anesthesia no tourniquet (WALANT). In the first case, the discovery led to an extended proximal release to ensure complete decompression of the bifurcated nerve. In the second case, a conventional open approach was considered sufficient. Both patients experienced complete resolution of symptoms at the 12-month follow-up.<br> <strong>Conclusion</strong>: The incidental discovery of a BMN during CTR requires a thorough anatomical examination to ensure complete decompression and prevent iatrogenic injury. As demonstrated by our two cases, the surgical approach, whether extended or conventional, can be successfully adapted to the intraoperative findings. The crucial factor is visual confirmation that all nerve components are fully decompressed.</div> <span style="font-size:11pt"><span style="line-height:200%"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="line-height:200%"><span style="font-family:"Times New Roman",serif"></span></span></span></span></span></span> Bifid median nerve (BMN), Carpal tunnel syndrome (CTS), Wide awake local anesthesia no tourniquet (WALANT), Extended carpal tunnel release (CTR), Anatomical variation, Intraoperative discovery 97 102 http://jros.iums.ac.ir/browse.php?a_code=A-10-2725-1&slc_lang=en&sid=1 Farid Najd Mazhar fnajdmazhar@yahoo.com 10031947532846008547 10031947532846008547 No Reza Mohammadi Rezamohamdi1753@gmail.com 10031947532846008548 10031947532846008548 No Bushra Zareie shafabushra@gmail.com 10031947532846008549 10031947532846008549 No Omid mahmoudi nasab O.mahmoodinasab@gmail.com 10031947532846008550 10031947532846008550 No Meisam Jafari Kafiabadi meisamjafarikafiabadi@gmail.com 10031947532846008551 10031947532846008551 Yes Hooman Shariatzade Shariatzadeh.h@hotmail.com 10031947532846008552 10031947532846008552 No