During thyroidectomy the surgeon identifies the recurrent laryngeal nerve running anterior to the inferior thyroid artery, just lateral to Berry's ligament. Which anatomical variant is this, and what is its clinical significance?

• A Normal anatomy — the RLN always runs anterior to the inferior thyroid artery
• B Berry's ligament variation — no clinical significance
• C Non-recurrent laryngeal nerve — highest risk of injury during right-sided thyroidectomy ✓
• D Bilateral recurrent nerve — occurs when right subclavian arises normally

Explanation

A non-recurrent laryngeal nerve (NRLN) occurs almost exclusively on the right (associated with an aberrant right subclavian artery — arteria lusoria) and travels directly from the vagus to the larynx without looping around the subclavian artery. It is at highest risk of inadvertent division during right thyroidectomy because the surgeon expects a recurrent rather than a direct nerve course.

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

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Written and medically reviewed by the StethoPrep medical team.