During a right thyroid lobectomy, the recurrent laryngeal nerve is traced upward from the thorax. Around which structure does the RIGHT recurrent laryngeal nerve loop before ascending in the tracheo-oesophageal groove?

• A Ligamentum arteriosum
• B Right brachiocephalic vein
• C Arch of the aorta
• D Right subclavian artery ✓

Explanation

The right recurrent laryngeal nerve branches from the vagus at the root of the neck and hooks around the right subclavian artery before ascending in the tracheo-oesophageal groove. The left nerve, arising lower in the thorax, loops under the arch of the aorta posterior to the ligamentum arteriosum. This asymmetry explains why the left nerve has a longer thoracic course and why the right nerve is more vulnerable during cervical exposure.

Reference: Gray's Anatomy, 42nd ed.

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Written and medically reviewed by the StethoPrep medical team.