Anatomical variations of the recurrent laryngeal nerve increase risk of vocal cord paralysis in thyroidectomy

Anatomical variations of the recurrent laryngeal nerve (RLN) during thyroidectomy, such as extralaryngeal branching and relation to the inferior thyroid artery (ITA), significantly increase the risk of vocal cord paralysis (VCP). This retrospective study on 1070 neck sides found that extralaryngeal branching nerves had higher VCP rates compared to nonbranching nerves. RLN crossing anteriorly or posteriorly to the ITA also elevated VCP risk. These findings highlight the impact of RLN anatomical variations on post-thyroidectomy complications, emphasizing the importance of intraoperative vigilance to prevent VCP.