Recurrent Laryngeal Nerve — FRCA Primary MCQ

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ModerateAnatomyRecurrent Laryngeal NerveFRCA Primary

During right thyroid surgery, the recurrent laryngeal nerve is identified and traced caudally. In normal adult anatomy, it hooks beneath which structure before ascending towards the larynx?

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Correct answer: E — The right subclavian artery

The correct answer is **A: the right subclavian artery**. In normal anatomy, the right recurrent laryngeal nerve branches from the vagus near the thoracic inlet, hooks beneath the right subclavian artery and then ascends towards the larynx in or close to the tracheo-oesophageal groove. The left recurrent laryngeal nerve has a longer intrathoracic course: it passes beneath the aortic arch and posterior to the ligamentum arteriosum. Therefore, the aortic arch and ligamentum arteriosum are left-sided relationships. The right common carotid artery and brachiocephalic trunk are nearby arterial structures, but the right recurrent laryngeal nerve does not normally loop around either.

Reference: Haller JM, Iwanik M, Shen FH. Clinically relevant anatomy of recurrent laryngeal nerve. Spine. 2012;37(2):97–100. https://pubmed.ncbi.nlm.nih.gov/21540775/