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Updated: Feb 11, 2026
05:25
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
589
External laryngeal nerve landmarks revisited.
Consuelo Ortega1, Eva Maranillo2, Steve McHanwell3
1Otorhinolaryngology Service, Infanta Sofía University Hospital, Madrid, Spain.
Head & Neck
|April 24, 2018
Summary
Precise localization of the external laryngeal nerve (ELN) is crucial in neck surgery to prevent iatrogenic damage. The study found the ascending pharyngeal vein and superior thyroid artery to be the most reliable landmarks for ELN identification.
Area of Science:
- Anatomy
- Surgical Anatomy
- Neck Surgery
Background:
- Iatrogenic damage to the external laryngeal nerve (ELN) is a common complication during neck surgeries.
- Accurate localization of the ELN is essential for preventing surgical injury.
Purpose of the Study:
- To analyze proposed surgical landmarks for the external laryngeal nerve (ELN).
- To investigate the anatomy of the ELN's collateral and terminal branches.
Main Methods:
- Examination of 157 adult human embalmed cadavers (77 male, 80 female).
- Recording of ELN origin, length, and relationship to anatomical landmarks.
- Statistical comparison of findings with existing literature.
Main Results:
- The external laryngeal nerve (ELN) is consistently located deep to the ascending pharyngeal vein.
- The ELN crosses the carotid axis at the superior thyroid artery origin in 47% of cases.
- An intramuscular trajectory through the inferior constrictor of the pharynx is observed in 80% of cases.
Conclusions:
- The position of the external laryngeal nerve (ELN) relative to classical landmarks is highly variable.
- The ascending pharyngeal vein and superior thyroid artery represent the most reliable anatomical relationships for ELN identification.
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