Navigating Unanticipated Non-recurrent Laryngeal Nerves in Thyroid Surgery: Strategies for Preservation and Anticipation

BACKGROUND/AIM: This study aimed to investigate the incidence, anatomical characteristics, and clinical implications of non-recurrent laryngeal nerves (NRLNs) discovered during thyroid surgeries and autopsies. PATIENTS AND METHODS: A total of 2,215 thyroid surgeries and 194 autopsies were reviewed, identifying 17 and 1 case of NRLN, respectively. Data regarding nerve anatomy, associated vascular anomalies, and patient medical history were collected and analyzed. Neck ultrasound examinations were subsequently performed on the 17 living patients, 5 months to 19 years post-surgery, by three radiologists specializing in head and neck soft-tissue imaging. Two radiologists were blinded to the specific nerve anatomy, while one was unblinded. RESULTS: 's classification, one case each was categorized as 2a, 2b, and one case involved a coexisting right NRLN and right RLN. No definitive recurrent paresis was observed, with only one patient experiencing transient palsy lasting 5 weeks. Histological evaluation revealed no structural differences between NRLN and RLN variants, although their epineurium and adventitia were notably thinner than those of the vagal nerve. CONCLUSION: Achieving blood-free conditions for meticulous dissection and preserving sympathetic nerve branches are essential for optimal functional outcomes in thyroid surgeries involving NRLNs.