During total thyroidectomy for a large multinodular goiter, the recurrent laryngeal nerve (RLN) is identified in the tracheoesophageal groove. The surgeon encounters a non-recurrent laryngeal nerve on the right side. What vascular anomaly is characteristically associated with a non-recurrent right laryngeal nerve?

• A Aberrant right subclavian artery (arteria lusoria) ✓
• B Right aortic arch with mirror-image branching
• C Persistent left superior vena cava
• D Bovine aortic arch

Explanation

A non-recurrent right laryngeal nerve occurs in approximately 0.5-1% of cases and is virtually always associated with an aberrant right subclavian artery (arteria lusoria) — the right subclavian arises directly from the descending aorta and crosses behind the oesophagus. Because the right subclavian no longer loops under the right side, the right vagus nerve does not recur but travels directly to the larynx. This occurs on the right side only (non-recurrent left RLN is exceedingly rare and occurs with situs inversus). Failing to recognize this anatomy risks RLN injury.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.