A novel way of identification of recurrent laryngeal nerve during thyroid surgeries


  • Joe Mathew Department of General Surgery, Pushpagiri Medical College, Tiruvalla, Kerala, India




Recurrent laryngeal nerve, Identification, Dissection, Location, A new method


Background: This was a report of a movement of the recurrent laryngeal nerve which can be demonstrated during thyroid surgeries which can be used for locating the nerve, or identifying it if already exposed and causing confusion with other nearby structures or when alone too.

Methods: The nerve is located by observing for a superior-inferior movement of the recurrent laryngeal nerve transmitted by the loose areolar tissue over it and dissecting over this site to locate the nerve right underneath it. This was by direct observation of the movement which will be there so long as the thyroid is held retracted to the opposite side and is not separated from the thyroid at the tissues that constitute the condensation of pre-tracheal fascia called the Berry’s ligament.

Results: The recurrent laryngeal nerve originates from the vagus and loops posteriorly and then upwards around the arch of aorta on the left side and the subclavian artery on the right side. When the thyroid gland is retracted away and thus the nerve put on slight stretch, a superior-inferior to and fro- movement of the nerve can be seen. This movement can be used for identification and dissection of the nerve along its course.

Conclusions: A review of literature has been done and it is clear that this movement has not been hitherto identified or published

Author Biography

Joe Mathew, Department of General Surgery, Pushpagiri Medical College, Tiruvalla, Kerala, India

Associate professor of surgery,

Department of General Surgery,

Pushpagiri Medical College,



Ardito G, Revelli L, Alatri L, Lerro V, Guidi ML, Ardito F. Revisited anatomy of the recurrent laryngeal nerves. Am J Surg. 2004;187(2):249-53.

Sunderland S, Swaney WE. The intraneural topography of the recurrent laryngeal nerve in man. Anat Rec. 1952;114(3):411-26.

Steinberg JL, Khane GJ, Fernandes CM, Nel JP. Anatomy of the recurrent laryngeal nerve: a redescription. J Laryngol Otol. 1986;100(8):919-27.

Lahey FH, Hoover WB. Injuries to recurrent laryngeal nerve in thyroid operations, their management and avoidance. Annals Surg. 1938;108(4):545-62.

Uen YH, Chen TH, Shyu JF, Shyr YM, Su CH, Chen JY, et al. Surgical anatomy of the recurrent laryngeal nerves and its clinical applications in chinese adults. Surg Today. 2006;36(4):312-5.

Gauger PG, Delbridge LW, Thompson NW, Crummer P, Reeve TS. Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery. Eur J Surg. 2001;167(4):249-54.

Gravante G, Delogu D, Rizzello A, Filingeri V. The Zuckerkandl tubercle. Am J Surg. 2007;193(4):484-5.

Yun JS, Lee YS, Jung JJ, Nam KH, Chung WY, Chang HS, et al. The Zuckerkandl's tubercle: a useful anatomical landmark for detecting both the recurrent laryngeal nerve and the superior parathyroid during thyroid surgery. Endocr J. 2008;55(5):925-30.

Veyseller B, Aksoy F, Yildirim YS, Karatas A, Ozturan O. Effect of recurrent laryngeal nerve identification technique in thyroidectomy on recurrent laryngeal nerve paralysis and hypoparathyroidism. Arch Otolaryngol Head Neck Surg. 2011;137(9):897-900.

Randolph GW, Kobler JB, Wilkins J. Recurrent Laryngeal nerve identification and identification during thyroid surgery: Laryngeal palpation. World J Surg. 2004;28:755-60.

Hepgul G, Kucukyilmaz M, Koc O, Duzkoylu Y, Sari YS, Erbil Y. The identification of recurrent laryngeal nerve by injection of blue dye into the inferior thyroid artery in elusive locations. J Thyroid Res. 2013;2013:539274.

Kaisha W, Wobenjo A, Saidi H. Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and Berry’s ligament in Kenyans. Clin Anat. 2011;24:853-7.

Miyauchi A, Masuoka H, Yabuta T, Fukushima M, Kihara M, Higashiyama T, et al. The ima approach for the quick identification of the right recurrent laryngeal nerve in thyroid cancer surgery. Surg Today. 2013;43(2):225-8.

Chen JY, Shen Q. A New Technique for Identifying the Recurrent Laryngeal Nerve: Our Experience in 71 Patients. Chin Med J. 2018;131(7):871-2.






Original Research Articles