During total thyroidectomy, the recurrent laryngeal nerve is at risk of injury near the ligament of Berry. Which ligament is this, and what is the specific surgical importance of the RLN's relationship to it?

• A Anterior suspensory ligament connecting thyroid to hyoid; RLN crosses it superficially
• B Posterior suspensory ligament of thyroid that tethers the gland to the trachea; RLN passes deep to it in a groove ✓
• C Cricothyroid ligament; RLN enters the larynx via a notch in it
• D Prelaryngeal fascia; RLN pierces it to enter the thyroid lobe

Explanation

Berry's ligament (posterior suspensory or Galen's ligament) anchors the posterior medial surface of the thyroid lobe to the cricoid cartilage and upper tracheal rings. The RLN commonly passes deep to this ligament in a groove between the ligament and the trachea, or may branch here. The nerve can be trapped when dividing the ligament during thyroidectomy. This is the most vulnerable point for RLN injury, responsible for most post-thyroidectomy hoarseness.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.