Anatomical Basis of Recurrent Laryngeal Nerve Injury

Introduction

The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve that plays a critical role in voice production and airway protection. Due to its anatomical course, it is highly susceptible to injury during thyroid surgeries and other neck procedures.

Relationship to the Thyroid and Neck Structures

The RLN loops around major vascular structures before ascending towards the larynx. On the right side, it encircles the subclavian artery, while on the left, it courses around the aortic arch. This anatomical positioning increases its vulnerability during surgical interventions.

Common Causes of Injury

Thyroidectomy: Unintentional damage during thyroid removal procedures.
Neck Trauma: Blunt force injury or penetration.
Intubation Complications: Excessive pressure on the nerve due to prolonged intubation.
Tumor Infiltration: Compression or infiltration by thyroid or esophageal tumors.

Clinical Manifestations

RLN injury can lead to unilateral or bilateral vocal cord paralysis, resulting in symptoms such as hoarseness, dysphonia, and airway obstruction in severe cases.

Prevention and Management

Preventive strategies include meticulous surgical techniques, intraoperative nerve monitoring, and preoperative imaging. Management options range from voice therapy to surgical interventions such as vocal cord medialization.