REVISED ANATOMY OF THE RECURRENT LARYNGEAL NERVES: SURGICAL IMPORTANCE, BASED ON THE DISSECTION OF 100 CADAVERS*

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Abstract
The recurrent laryngeal nerves (200 in number) in 100 cadavers were dissected and their branching patterns studied, analyzed and recorded. It was found that out of 200 nerves, 114 or 57% had a single nerve trunk while 86, or 43% had a divided nerve trunk. Recurrent laryngeal nerves with divided trunks were found to occur bilaterally in 24% of the subjects examined. The division of this nerve may occur at any point peripheral to its point of origin from the parent vagus nerve. Secondary and tertiary branches of the recurrent nerves may occur extra-laryngeally. Injury to these secondary and tertiary divisions offers an adequate explanation for the more complex and heretofore controversial types of laryngeal paralyses, since it is felt that injury to 1 branch of a nerve with a divided trunk will produce paralysis only in the area supplied by that branch. In some instances only a single muscle or a portion of a muscle may be supplied by this injured branch. The point at which the re current laryngeal nerve is most vulnerable to injury is on the postero-lateral surface of the thyroid gland at the level of the junction of middle and lower third, where the chief branches of the inferior thyroid artery usually enter the gland. An avoidance of damage to these nerves is probably most readily achieved through a knowledge of the possibilities of their branching pattern, complimented by nerve dissection with fine instruments, together with an educated watchfulness.