The RLN also supplies laryngeal sensation below the vocal cords, and the superior laryngeal nerve supplies sensation above the cords. The posterior cricoarytenoid (PCA) muscles open or abduct the vocal cords, whereas the lateral cricoarytenoid muscles (LCA) adduct or close the vocal cords. The vocal cords are made of an intrinsic muscle called thyroarytenoid (TA) wrapped inside a thin layer of mucosa.

The latter is supplied by the superior laryngeal nerve (SLN), a branch of the Vagus. The RLNs supply all the intrinsic muscles of the larynx (voice box), with the exception of the cricothyroid muscles (CT). Apart from the motor nerves to the larynx, the recurrent laryngeal nerves supply a plethora of autonomic and sensory nerves on its way up and these must have some value assigned to their sensory input and autonomic reflexes. But is the model defective? This remains debatable. This unnecessary stretch down to the chest, and the sudden change of direction to ascend to the larynx is considered by evolution scientists as ‘evidence of poor design’. That makes it seven times longer than it needs to be. The nerve avoids the direct route between brain and throat and instead descends into the chest, then makes a U-turn around the aorta, and returns to the larynx. The course of RLN in mammals is thought to be an extreme detour, about 4.6 meters (15 ft) in the case of the giraffe. It has to be said that the use of bipolar diathermy devices in video assisted thoracoscopic surgery (VATS) played a major role in safe dissection around the RLN. In the author’s unit, this approach has virtually eliminated the risk of injuring the nerves during mediastinal nodal dissection. It is the purpose of this publication to dissipate all the myth around the anatomy of RLN, and encourage its deliberate exposure as a first step towards safety. Unfortunately this adage has gained credit through long use and the lack of clear descriptive anatomy in the medical literature targeting the needs of the thoracic surgeon. It is not surprising, therefore, that thoracic surgeons can be timid and self-assuring in their reasoning that ‘the best way of avoiding injury to the RLN is not to look for it’. RLN palsy ranks among the leading reasons for medicolegal litigation of surgeons because of its attendant reduction in quality of life. The reason for this fear is the dreaded complication of damaging the nerve and causing loss of voice, among other serious complications. If the article or the existing discussions do not address a thought or question you have on the subject, please use the 'Comment' box at the bottom of this page.Many thoracic surgeons are terrified to come anywhere near the recurrent laryngeal nerve (RLN), especially on the left side. The noun declines.Īn Oxford comma walks into a bar, where it spends the evening watching the television getting drunk and smoking cigars.Ī simile walks into a bar, as parched as a desert.Ī gerund and an infinitive walk into a bar, drinking to forget.Ī hyphenated word and a non-hyphenated word walk into a bar and the bartender nearly chokes on the irony. It was tense.Ī verb walks into a bar, sees a beautiful noun, and suggests they conjugate. The past, present, and future walked into a bar. The conditional would have walked into a bar, had it only known.Ī misplaced modifier walks into a bar owned by a man with a glass eye named Ralph.

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Giraffe voice box