Identification of recurrent laryngeal nerve: a dilemma in thyroid surgery


  • Atishkumar B. Gujrathi Department of ENT, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
  • Harshada S. Kurande Department of ENT, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
  • Nishikant Gadpayale Department of ENT, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
  • Yogesh Paikrao Department of ENT, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India



Recurrent laryngeal nerve, Thyroidectomy, Vocal cord palsy


Background: Surgery of the thyroid gland is one of the most common surgical procedures performed. Recurrent laryngeal nerve injury is the most dreaded complication of thyroid surgery. Hence reducing intraoperative injury is of utmost importance. Routine dissection and identification of the recurrent nerve remain controversial.

Methods: This study consists of 70 patients who underwent thyroid surgery. This study was conducted at our institute during the period of 2 years (2018-2020). Patients were evaluated and operated. Patients with thyroid diseases and normal vocal cords were allocated to two groups randomly; in group A the nerve was identified and in group B the nerve was not identified.

Results: Most of the patients participating in the study were in the age group of 33-42 years. Male to female disease ratio was 0.13:1. In our study out of 70 patients who underwent thyroid surgery, 18 (25.71%) patients suffered from recurrent laryngeal nerve palsy. Amongst those 18 patients, 2 palsies (5.71%) were in Group A and 16 palsies (45.71%) were in Group B. Recurrent laryngeal nerve most commonly lied posterior to the inferior thyroid artery on both right (65.38%) as well as left side (45.45%). Most commonly injured recurrent laryngeal nerve was the right sided recurrent laryngeal nerve (77.77%).

Conclusions: Careful dissection of nerve during thyroid surgery eliminates the risk of recurrent laryngeal nerve injury. A thorough knowledge of thyroid gland, recurrent laryngeal nerve and its anatomical relations and variations is of utmost importance in preserving the recurrent laryngeal nerve in thyroid surgery.


Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS et al. Thyroid anatomy and physiology. In: Scott Brown’s Otorhinolaryngology 7th Edition. Great Britain: Hodder Arnold 2008. Chapter 26, 2008;318.

Rosato L, Avenia N, Bernante P. Complications of thyroid surgery: analysis of a multicentric study on 14934 patients operated on in Italy over 5 years. World J Surg. 2004;28:271-6.

Lo CY, Kwok KF, Yuen PO. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Archives of Surgery 2000;135:204-7.

Rosato L, Carlevato MT, De Toma G, Avenia N. Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or predictable sequence? World Journal of Surgery. 2005;29:780-4.

Woodson GE. Pathophysiology of recurrent laryngeal nerve. In: Randolph GW (ed.). Surgery of the thyroid and parathyroid glands. Philadelphia, PA: Saunders. 2003;366-73.

Hartl DM, Travagli JP, Leboulleux S. Current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery. Journal of Clinical Endocrinology and Metabolism. 2005;90:3084-8.

Bou-Malhab F, Hans S, Perie S. Swallowing disorders in unilateral recurrent laryngeal nerve paralysis. Annales d’Otolaryngologie et de Chirurgie Cervicofaciale. 2000;117 26-33.

Kumar A, Ahmed Z, Naz N, Aftab A. Risk Factors for Injury to Recurrent Laryngeal Nerve in Thyroid Surgeries- A Tertiary Care Centre Experience. Journal of Rawalpindi Medical College. 2019;23(3):128-32.

Shao T, Qiu W, Yang W. Anatomical variations of the recurrent laryngeal nerve in Chinese patients: a prospective study of 2,404 patients. Sci Rep. 2016;6(1):25475.

Nyeki ARN. European Annals of Otorhinolaryngology. Head and Neck diseases. 2015;132:265-9.

Saldanha M, Jayaramaiah SK, Aroor R. Relationship of Recurrent Laryngeal Nerve with Inferior Thyroid Artery. Int J Otorhinolaryngol Clin. 2019;11(2):27-9.

Yagnik V, Mehta M. Incidence of Recurrent Laryngeal Nerve Palsy With And Without Nerve Identification During Thyroid Surgery. The Internet Journal of Surgery. 2008;20:1.

Shen C, Xiang M, Wu H, Ma Y, Chen L, Cheng L. Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury. Neural Regen Res. 2013;8(17):1568-75.






Original Research Articles