Anatomy of the Recurrent Laryngeal Nerve and Its Protection During Thyroid Surgery: Audit at Federal Medical Centre Owerri

The recurrent laryngeal nerve innervates the intrinsic muscles of the larynx with the exception of the cricothyroid and is responsible for vocal cord abduction and adduction. Injury to this nerve during thyroid surgery results in hoarseness, aspiration, and in bilateral cases, life-threatening airway compromise. The nerve is subject to considerable anatomical variation in its course and its relationship to the inferior thyroid artery, the tubercle of Zuckerkandl, and the Berry's ligament, which increases the risk of intraoperative damage. This study aims to audit the intraoperative identification and protection of the recurrent laryngeal nerve during thyroid surgeries performed at the Federal Medical Centre Owerri, South East Nigeria, and correlate surgical approach with rates of postoperative vocal cord palsy. Data will be obtained from operative notes, anaesthetic records, and postoperative laryngoscopy findings over a five-year period. The frequency of anatomical variations encountered will be recorded. The study anticipates generating an evidence-based audit report that will support protocol revision for recurrent laryngeal nerve identification during thyroid surgery in South East Nigeria, contributing to reduced rates of this preventable complication.

Keywords: recurrent laryngeal nerve, thyroid surgery, nerve injury, anatomical variation, Federal Medical Centre Owerri