The presence of a nonrecurrent inferior laryngeal nerve is a rare anatomical variant of the right side of the laryngeal nerve in 0.3 to 0.5% of patients. The clinical significance of the nonrecurrent inferior laryngeal nerve is that due to its unusual anatomical location it may lead to its untimely recognition during surgery, resulting in its injury, vocal cord paresis and hoarseness.
In our clinical surgical practice, we utilize the possibilities offered by neuromonitoring/neurostimulation of the vagus nerve and optical magnification with surgical loupes for the safe preparation and protection of the nerve even in these difficult cases.
In a recent patient of ours (April 2025) ( total thyroidectomy Surgery in Ioannina), after the localization and neurostimulation of the vagus nerve, we found the inability to stimulate the vagus in its lower part. This led to the suspicion of the existence of a non-recurrent inferior laryngeal nerve, which we searched for, located and prepared safely. (Type I, non-recurrent inferior laryngeal nerve, see image)
In the same patient, we also identified a nerve anastomosis of Galen (anastomosis of Galen Latin: ansa galeni) that connects the inferior laryngeal nerve with the internal laryngeal nerve.
See Surgical Video on YouTube.
