Non-Recurrent Inferior Laryngeal Nerve: Anatomical Landmarks

Minimally invasive thyroid surgery requires a high level of surgical expertise, ensuring a safe procedure even in the presence of dangerous anatomical variants, such as a non-recurrent inferior laryngeal nerve. It is a rare anatomical variant (frequency of approximatively 1%), in which the nerve arises directly from the cervical portion of the Vagus nerve, bypassing its usual course around the right subclavian artery. Recognizing the presence of this variant is crucial, because its atypical course can make its detection difficult, increasing the risk iatrogenic injury. Iatrogenic damage to this nerve can cause dyspnea, dysphonia due to vocal cord paralysis and   dysphagia for injury to the esophageal branch of the recurrent laryngeal nerve. Therefore, thorough anatomical knowledge combined with careful intraoperative dissection is essential to identify and preserve this nerve.