Abstract Background: The recurrent laryngeal nerve (RLN), a branch of the vagus nerve (cranial nerve X), provides motor innervation to all intrinsic muscles of the larynx except the cricothyroid muscle. Owing to its long and complex anatomical course through the neck and thoracic region, the RLN is particularly susceptible to injury during thyroid and parathyroid surgeries. Damage to this nerve can result in significant postoperative morbidity, including vocal fold palsy. Therefore, precise knowledge of its anatomical relationship with adjacent structures—especially the inferior thyroid artery (ITA)—is of paramount importance in thyroid surgery. Aims and Objectives: To assess the anatomical variations in the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in patients undergoing thyroidectomy. Materials and Methods: A prospective, non-randomized, interventional study was conducted involving 50 patients undergoing thyroidectomy at Tezpur Medical College and Hospital. Intraoperative identification of the RLN was performed, and its anatomical relationship to the inferior thyroid artery was documented and analyzed. Results: The recurrent laryngeal nerve was found to be: Deep to the ITA (bilaterally): 78.2% of cases; Superficial to the ITA: 16.3% of cases. Passing between branches of the ITA: 5.5% of cases. These findings demonstrate that although the nerve most commonly lies deep to the artery, significant anatomical variations exist. Conclusion: A thorough understanding of the anatomical relationship between the recurrent laryngeal nerve and the inferior thyroid artery is crucial for safe thyroid surgery. Accurate intraoperative identification and careful dissection of the nerve can substantially reduce the risk of inadvertent injury and prevent complications such as postoperative vocal fold palsy.
Kathar et al. (Mon,) studied this question.