Right Non-Recurrent Laryngeal Nerve: Case Report

Abstract Background: The non-recurrent laryngeal nerve (NRLN) is a rare anatomical variant, with a prevalence of 0.3–0.8%. Its recognition during thyroid surgery is crucial to avoid nerve injury, which may cause permanent vocal cord paralysis and related complications. Case Report: A 36-year-old woman presented with a progressively enlarging midline neck swelling for 20 years and recent-onset dysphagia. Clinical and ultrasound examination revealed a large multinodular goitre with tracheal deviation. FNAC confirmed a benign colloid goitre (Bethesda II). During elective total thyroidectomy, capsular dissection revealed an anomalous nerve arising directly from the right vagus and entering the larynx transversely—diagnosed intraoperatively as a right non-recurrent laryngeal nerve (Type 2A). Meticulous dissection preserved the nerve, and both superior and inferior pedicles were managed carefully to avoid neural injury. Postoperative recovery was uneventful, with normal vocal cord mobility. Histopathology confirmed multinodular colloid goitre without malignancy. This rare intraoperative finding was managed successfully due to careful surgical technique and anatomical awareness. Conclusion: Right NRLN, though rare, poses a significant risk for thyroidectomy. Detailed preoperative imaging, careful dissection, and intraoperative vigilance are essential to prevent iatrogenic injury, ensuring optimal surgical outcomes and preserving laryngeal nerve function.