Avoiding injury to the recurrent laryngeal nerves is the major consideration in every thyroidectomy. Advocates of routine exposure are challenged by an equal number opposing exposure. Unquestionably, when these nerves are not identified the incidence of damage will be somewhat higher.
A recent experience of ours documents another of the many reasons for routine exposure. During the course of a parathyroid gland exploration on a 46-year-old woman, we sought in vain the right recurrent laryngeal nerve. The adenoma was easily identified in the left lower parathyroid gland, and the three other glands were found in their usual position. The left recurrent laryngeal nerve lay in the tracheoesophageal groove. The great vessels of the neck all appeared normal. At length, after releasing additional adipose tissue, we uncovered a nonrecurrent nerve, as shown in Fig 1. This was a rather large structure which originated from the cervical trunk of the vagus at