During thyroidectomy, the recurrent laryngeal nerve is most vulnerable at which location in its course?
- A At the inferior thyroid artery crossing, within 2 cm of the posterolateral aspect of the thyroid lobe ✓
- B At the level of the cricoid cartilage entering the larynx
- C As it enters the thorax beside the subclavian artery on the right
- D At the tracheoesophageal groove, where it is invariably located in the midline
Correct answer: A. At the inferior thyroid artery crossing, within 2 cm of the posterolateral aspect of the thyroid lobe
Explanation
The recurrent laryngeal nerve (RLN) is most vulnerable during thyroid surgery where it crosses the inferior thyroid artery in a variable relationship (nerve may be anterior, posterior, or between branches of the artery) within 2 cm of the posterolateral thyroid lobe near the ligament of Berry. The RLN can also be non-recurrent on the right (directly from vagus, ~0.5–1% of cases), making it susceptible if unexpected. Damage causes ipsilateral vocal cord paralysis (hoarseness/respiratory distress if bilateral).
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.