During thyroidectomy, the recurrent laryngeal nerve (RLN) is most at risk at which specific anatomical point in its course?
- A Where it loops around the subclavian artery on the right
- B At Berry's ligament (posterior suspensory ligament of thyroid) ✓
- C Where it enters the larynx deep to the inferior pharyngeal constrictor
- D In the tracheoesophageal groove
Explanation
While the RLN runs in the tracheoesophageal groove for most of its cervical course, it is most vulnerable at Berry's ligament — the posterior suspensory ligament of the thyroid gland — where the nerve may be closely adherent to or even embedded within the ligament as it enters the larynx. During ligation of the inferior thyroid artery and mobilization of the thyroid lobe, inadvertent traction on Berry's ligament can stretch or transect the RLN. The nerve is identified before this step to prevent injury. The non-recurrent variant (right side, ~0.5–1%) arises directly from the vagus and enters the larynx at higher risk if unidentified.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.