Surgical landmarks for the recurrent laryngeal nerve
THE CONTEXT
The recurrent laryngeal nerve can be located using defined landmarks during mobilisation of the thyroid.
Berry’s ligament and injury risk
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Berry’s ligament is a condensation of pretracheal fascia binding the thyroid to the trachea.
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The recurrent laryngeal nerve’s entry into the larynx at the cricothyroid joint lies at the level of Berry’s ligament, where the nerve is at greatest risk of surgical injury.
Landmarks for identifying the nerve
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The nerve can be located in the tracheo-oesophageal groove or at the cricothyroid joint.
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Within the groove, the nerve forms one side of Beahrs’ triangle; the carotid artery and inferior thyroid artery form the other two sides.
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As the thyroid lobe is mobilised laterally, the nerve normally lies beneath the tubercle of Zuckerkandl, the most posterolateral portion of the gland.