# Identification of non-recurrent right inferior laryngeal nerve during thyroidectomy

## TL;DR

A rare anatomical variation of the laryngeal nerve was identified during thyroid surgery, highlighting the need for careful dissection to avoid nerve injury.

## Contribution

The paper presents a case of a non-recurrent right inferior laryngeal nerve associated with Arteria Lusoria, emphasizing its surgical implications.

## Key findings

- The non-recurrent right inferior laryngeal nerve was identified during surgery, arising from the vagus nerve near the thyroid superior pole.
- The nerve's unusual course increases the risk of iatrogenic injury, but careful dissection allowed for its preservation.
- Preoperative imaging may hint at the nerve's presence, but intraoperative identification is crucial for safe surgical outcomes.

## Abstract

The non-recurrent right inferior laryngeal nerve is a rare anatomical variant of the recurrent laryngeal nerve, almost always associated with an aberrant right subclavian artery (Arteria Lusoria). Its unusual course increases the risk of iatrogenic injury during thyroid and neck surgery. A 45-year-old woman underwent right hemithyroidectomy for a solitary thyroid nodule suggestive of a follicular tumor. The recurrent laryngeal nerve was not found in its expected tracheoesophageal location. Careful dissection of the vagus nerve revealed a non-recurrent branch arising near the thyroid superior pole and coursing horizontally to the larynx. The nerve was preserved, and surgery was completed uneventfully without intraoperative neuromonitoring. The non-recurrent right inferior laryngeal nerve lies higher and more anterior than the recurrent pathway strongly linked to Arteria Lusoria. Failure to recognize it may cause permanent vocal cord paralysis. Preoperative imaging may suggest its presence, but intraoperative identification through meticulous vagus dissection remains essential for safe surgery.