Preventing Laryngeal Nerve Palsy During Thyroidectomies: A Non-systematic Review of the Surgical Anatomy Literature

This non-systematic review explored recurrent laryngeal nerve (RLN) injury mechanisms, anatomical landmarks, and extralaryngeal branching (ELB) variations during thyroidectomy. A PubMed and Medline search identified relevant studies, including systematic reviews and meta-analyses. Key risk factors for RLN palsy include repeat surgeries, extent of resection, and malignancy. Injury mechanisms involve traction, compression, and thermal damage. The Zuckerkandl tubercle and Berry's ligament show consistent RLN relationships with greater clinical utility than the inferior thyroid artery. ELB, especially bifurcation, increases RLN injury risk. Understanding RLN anatomy and variations is crucial to minimizing injury. Further studies are needed to assess the clinical significance of these anatomical landmarks and variations to guide safer surgeries.