Clinical manifestations of injured tracheal and esophageal branches of the recurrent laryngeal nerve following thyroid surgery

Tracheal branch (TB) and esophageal branch (EB) injuries of the recurrent laryngeal nerve (RLN) during thyroid surgery are underexplored. In this study, we examined postoperative clinical manifestations in these injuries. Using a head-mounted 2.5× magnifying loupe, TBs and EBs were isolated to assess branching patterns and postoperative outcomes. TBs comprised 1–3 branches, most commonly two, whereas EBs comprised 1–2 branches, usually one. Clinical symptoms were more frequent after TB injury than in controls, with 81.6% of patients showing chest tightness or dyspnea at 1 month, but only 5.3% at 1 year (not significant vs. controls). After EB injury, symptoms were initially higher than in controls, but only 8% persisted at 1 year (not significant). Transient hypoparathyroidism occurred in 25.4% and 16.7% of TBs and EBs, respectively. Symptoms that may result from RLN branch injuries generally resolve over time, highlighting the importance of protecting TBs and EBs during thyroid surgery.