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124

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Anatomy

Head and Neck

Question 171 of 190

Regarding the recurrent laryngeal nerve, which of the following statements is CORRECT:

Answer:

The right recurrent laryngeal nerve originates in the root of the neck, as a branch of the right vagus nerve as it reaches the lower edge of the first part of the subclavian artery. It passes around the subclavian artery and travels upwards and medially in a groove between the trachea and the oesophagus as it heads to the larynx.

Recurrent Laryngeal Nerve

Anatomy / Head and Neck / Neck

Last Updated: 11th April 2019

Right Recurrent Laryngeal Nerve

The right recurrent laryngeal nerve originates in the root of the neck, as a branch of the right vagus nerve as it reaches the lower edge of the first part of the subclavian artery. It passes around the subclavian artery and travels upwards and medially in a groove between the trachea and the oesophagus as it heads to the larynx.

Right Recurrent Laryngeal Nerve. (Image by Henry Vandyke Carter [Public domain])

Left Recurrent Laryngeal Nerve

The left recurrent laryngeal nerve originates more inferiorly, from the left vagus nerve as it crosses the arch of the aorta in the superior mediastinum. It passes below and behind the arch of the aorta and then ascends beside the trachea to the larynx.

By Jkwchui (Based on drawing by Truth-seeker2004) [CC BY-SA 3.0 , via Wikimedia Commons

Left Recurrent Laryngeal Nerve. (Image by Jkwchui (Based on drawing by Truth-seeker2004) [CC BY-SA 3.0 , via Wikimedia Commons)

Clinical Implications

Damage to the recurrent laryngeal nerves may result in hoarseness, respiratory obstruction, inability to speak and loss of sensation below the vocal cord.

Causes of damage include:

  • thyroid/parathyroid surgery
  • mediastinal lymphadenopathy
  • cricothyroidotomy
  • aneurysm of the aortic arch
  • lung cancer in the apex of the right lung
  • malignancy infiltrating into the 'aortopulmonary window'

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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