This chapter offers an in-depth guide to the surgical anatomy and intraoperative nerve monitoring of the recurrent laryngeal nerve (RLN), which is critical in thyroid and parathyroid surgery. It discusses the risks and complications of RLN injury, including vocal cord paralysis, and emphasizes the importance of routine preoperative and postoperative laryngeal examinations to detect nerve damage. The chapter explores RLN and superior laryngeal nerve (SLN) anatomy, their variations, and the surgical techniques used to identify and preserve them during procedures. It also covers the role of intraoperative electromyography (EMG) in preventing nerve injury, as well as unique challenges such as nonrecurrent RLNs and nerve displacement due to goiters or thyroid cancer. By combining detailed anatomical knowledge with modern monitoring technologies, this chapter provides essential insights for safe and effective thyroid surgery, reducing the risk of complications and improving patient voice outcomes.
