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<p>During thyroid surgery, anatomical changes in the recurrent laryngeal nerve (RLN) can take many different forms and have clear clinical consequences. About 0.3–1% of the right and 0.004% of the left have non-recurrent RLN variants, and branching patterns are prevalent, with up to 37.6% of cases showing bifurcation and 1% showing trifurcation. The surgical field is made much more complex by differences in the superior laryngeal nerve’s external branch (such as Cernea IIa at 44%). Numerous studies have connected these abnormalities in nerve structure to a higher risk of harm: rates of temporary vocal cord paralysis have been reported to range from 1.1 to 12.5%, with permanent paralysis occurring in as many as 3.8% of cases. Measures such as meticulous intraoperative dissection, nerve monitoring, and advanced mapping (including artificial intelligence segmentation and carbon nanoparticle mapping) serve to identify these variations and avoid injury during surgery.</p>

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Prevalence and Clinical Significance of Anatomical Variations in Laryngeal Nerves During Thyroid Surgery in Adult Patients

  • 期刊论文

  • 发表日期：

    2025年8月30日

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  • G. Deepa,
  • B. H. Shrikrishna

摘要

During thyroid surgery, anatomical changes in the recurrent laryngeal nerve (RLN) can take many different forms and have clear clinical consequences. About 0.3–1% of the right and 0.004% of the left have non-recurrent RLN variants, and branching patterns are prevalent, with up to 37.6% of cases showing bifurcation and 1% showing trifurcation. The surgical field is made much more complex by differences in the superior laryngeal nerve’s external branch (such as Cernea IIa at 44%). Numerous studies have connected these abnormalities in nerve structure to a higher risk of harm: rates of temporary vocal cord paralysis have been reported to range from 1.1 to 12.5%, with permanent paralysis occurring in as many as 3.8% of cases. Measures such as meticulous intraoperative dissection, nerve monitoring, and advanced mapping (including artificial intelligence segmentation and carbon nanoparticle mapping) serve to identify these variations and avoid injury during surgery.