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Updated: May 27, 2026
05:25
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Recurrent laryngeal nerve landmarks revisited.
Elham Asgharpour1, Eva Maranillo, Jose Sañudo
1Department of Human Anatomy and Embriology I, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.
Head & Neck
|November 15, 2011
Summary
Reliability of surgical landmarks for locating the recurrent laryngeal nerve (RLN) was assessed. The study found significant variability, identifying Berry's ligament and the inferior constrictor muscle as the most dependable anatomical guides.
Area of Science:
- Anatomy
- Surgical Navigation
- Laryngeal Nerves
Background:
- Accurate identification of the recurrent laryngeal nerve (RLN) is crucial for preventing surgical complications.
- Previous studies proposed various anatomical landmarks for RLN localization, but their reliability remains debated.
Purpose of the Study:
- To evaluate and validate the reliability of established surgical landmarks for recurrent laryngeal nerve identification.
- To provide anatomical data supporting safer surgical procedures involving the neck.
Main Methods:
- Dissection of 143 adult human cadaver necks (68 male, 76 female).
- Recording of RLN origin, length, and spatial relationship to key anatomical landmarks.
- Comparison of findings with existing literature, employing chi-square statistical analysis (p ≤ .05).
Main Results:
- The recurrent laryngeal nerve's position relative to landmarks showed high variability.
- Consistent locations included: anterior to tracheoesophageal sulcus (41.6%), posterior to inferior thyroid artery (35.8%), lateral to Berry's ligament (88.1%), and below the inferior constrictor muscle (90.4%).
- The nerve typically entered the larynx before its terminal division (54.6%).
Conclusions:
- The anatomical relationships of the recurrent laryngeal nerve to commonly used surgical landmarks are highly variable.
- Berry's ligament and the inferior constrictor muscle represent the most reliable landmarks for recurrent laryngeal nerve identification during surgery.
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