Cervical Segment of RLN

The axons which comprise the RLN are situated anteriorly in the vagus as this nerve exits the brain stem. The vagus nerve courses in-feriorly in the neck after passing through the jugular foramen. During the cervical segment the RLN axons congregate at the ventromedial aspect of the vagus nerve 40 mm prior to branching from the main trunk [25]. The vagus travels in the carotid sheath posterior to the internal and common carotid arteries. On the right side of the neck the vagus passes over the subclavian artery. In this region the recurrent laryngeal nerve branches from the main trunk of the vagus and loops around the subclavian artery from anterior to posterior and travels cephalad in the neck towards the larynx [26]. In less than 1% of cases the right inferior laryngeal nerve branches directly from the vagus to the larynx at approximately the level of the cricoid cartilage. The so-called non-recurrent anomaly present with a right non-recurrent nerve [25,30].

In the majority of necks the RLN courses from the mediastinum as a single nerve trunk on each side until it approaches the cricoid cartilage. Rarely is there more than one main trunk on a side of the neck. Ardito et al. found 4 cases out of 2626 RLNs which had two ipsilater-al, parallel trunks ascending from the mediastinum, and 4 cases with a fan-shaped arrangement in the nerve's proximal course through the neck [29]. Sun et al. examined 100 cadaver RLNs and found two double RLNs ascending from the mediastinum [31].

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