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Updated: Jul 2, 2026

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Navigating Unanticipated Non-recurrent Laryngeal Nerves in Thyroid Surgery: Strategies for Preservation and
Zoltán Farsang1,2, Zsófia Pánczél1, Róbert Jaskó1
1Department of Surgery, St. George University Teaching Hospital, Székesfehérvár, Hungary.
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:
Vascular anomalies of the aortic arch were described only by the unblinded radiologist. Among the 17 NRLN cases, three (16.7%) exhibited normal vascular anatomy. According to Toniato et al.'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.
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