The Nerve to the Vocal Cords

The nerve that is mentioned most in reference to thyroid surgery is called the recurrent laryngeal nerve.

It gets this name from the fact that it exits the brain as part of the Vagus nerve, passes through the neck, and then returns into the neck. Thus the name “recurrent”. Ironically, there are rare occasions when the nerve is not recurrent, and these are logically called “non-recurrent recurrent laryngeal nerves”. As far as I can tell, this happens only on the right side. I have seen 17 such cases.

As a young surgeon in the 70’s, it occurred to me that if I didn’t cut anything during a thyroidectomy until I found and protected the nerve, it would be very difficult to cut the nerve by accident. That has proven to be a very good surgical principle to follow.

Below are some photos to help you get a feel for the nerve and how it is preserved during thyroidectomy. Some photos are shown with the thyroid lobe already out, others with the thyroid lobe being elevated, showing the nerve in the groove between the windpipe and the esophagus.