Recurrent Laryngeal Nerve
What is the Recurrent Laryngeal Nerve?
The recurrent laryngeal nerve is a branch of the vagus nerve, which is one of the main nerves that connects the brain to many parts of the body. This nerve travels down into the chest and then loops back up toward the neck—on the right side it loops under the subclavian artery, and on the left side it loops under the aortic arch near the heart. After looping, it goes back up to the voice box (larynx). Because of this long and winding path, it’s called “recurrent,” meaning it loops back.
The main job of the recurrent laryngeal nerve is to control the muscles of the voice box, which help us speak, breathe, and swallow. It also carries sensory information from part of the throat. If this nerve is damaged—for example, during neck or chest surgery—it can lead to hoarseness, voice loss, or trouble breathing or swallowing.
The main job of the recurrent laryngeal nerve is to control the muscles of the voice box, which help us speak, breathe, and swallow. It also carries sensory information from part of the throat. If this nerve is damaged—for example, during neck or chest surgery—it can lead to hoarseness, voice loss, or trouble breathing or swallowing.
Dr. Spector describes the anatomy and function of the recurrent laryngeal nerve.
That’s why doctors are very careful to protect it during operations near the thyroid or heart.
Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2013). Clinically Oriented Anatomy (7th ed.). Wolters Kluwer.
Standring, S. (2020). Gray’s Anatomy: The Anatomical Basis of Clinical Practice (42nd ed.). Elsevier.
Standring, S. (2020). Gray’s Anatomy: The Anatomical Basis of Clinical Practice (42nd ed.). Elsevier.
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How can the recurrent laryngeal nerve be damaged?
Injuries to the recurrent laryngeal nerve often happen during surgeries in the neck or chest, especially when operating on the thyroid gland, parathyroid glands, or heart. Because this nerve travels close to important structures like the thyroid and aorta, it’s at risk of being stretched, cut, or damaged by swelling or scar tissue. If the nerve is injured, it can cause hoarseness, a weak or breathy voice, difficulty speaking, or even trouble breathing, especially if both sides are affected.
Sometimes, nerve damage can be temporary and will heal over time. But in more serious cases, the voice problems may last longer or even be permanent. Doctors may use special monitoring equipment during surgery to protect the nerve, and if it is injured, treatments like voice therapy, medications, or even surgery to improve vocal cord movement may be needed. Protecting the recurrent laryngeal nerve is very important because of the key role it plays in speaking, swallowing, and breathing.
Randolph, G. W. (2016). Surgical anatomy of the recurrent laryngeal nerve: Revisited. Laryngoscope Investigative Otolaryngology, 1(1), 45–52.
Rosenthal, L. H., Benninger, M. S., & Deeb, R. H. (2007). Vocal fold immobility: A longitudinal analysis of etiology over 20 years. The Laryngoscope, 117(10), 1864–1870.
Rosenthal, L. H., Benninger, M. S., & Deeb, R. H. (2007). Vocal fold immobility: A longitudinal analysis of etiology over 20 years. The Laryngoscope, 117(10), 1864–1870.
If you are suffering from compression symptoms, be sure to consult a nerve specialist
How can injuries to the recurrent laryngeal nerve be treated?
Treatments for injuries to the recurrent laryngeal nerve depend on how badly the nerve is hurt and whether one or both sides are affected. If only one side is injured and the nerve isn’t completely damaged, doctors may recommend voice therapy with a speech-language pathologist. This therapy can help strengthen the vocal cords and improve speaking and breathing. In many cases, the nerve can heal over time, and the voice may return to normal within a few months.
If the nerve damage is more serious or doesn’t improve, other treatments may be needed. These can include injections to make the vocal cord thicker so it can close better during speech, or even surgery to reposition or support the vocal cords. If both sides of the nerve are injured—though rare—it can cause trouble breathing and may require a tracheostomy, which is a small breathing tube placed in the neck.
If the nerve damage is more serious or doesn’t improve, other treatments may be needed. These can include injections to make the vocal cord thicker so it can close better during speech, or even surgery to reposition or support the vocal cords. If both sides of the nerve are injured—though rare—it can cause trouble breathing and may require a tracheostomy, which is a small breathing tube placed in the neck.
Dr. Spector describes how injuries of the recurrent laryngeal nerve can be treated.
The goal of treatment is always to help the person speak clearly, breathe comfortably, and prevent choking while eating or drinking.
References:
Rosenthal, L. H., Benninger, M. S., & Deeb, R. H. (2007). Vocal fold immobility: A longitudinal analysis of etiology over 20 years. The Laryngoscope, 117(10), 1864–1870.
Randolph, G. W., Dralle, H., Abdullah, H., et al. (2011). Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. The Laryngoscope, 121(S1), S1–S16.
Rosenthal, L. H., Benninger, M. S., & Deeb, R. H. (2007). Vocal fold immobility: A longitudinal analysis of etiology over 20 years. The Laryngoscope, 117(10), 1864–1870.
Randolph, G. W., Dralle, H., Abdullah, H., et al. (2011). Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. The Laryngoscope, 121(S1), S1–S16.
PAGE CONTRIBUTORS
PAGE CONTRIBUTORS
Matthew Spector, MD
Head and Neck Surgeon
University of Pittsburgh
Medical Center
Christina Yver, MD
Facial Plastic & Reconstructive Surgery
University of Pittsburgh Medical Center
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