Comment on: Rare anomaly of the recurrent laryngeal nerve

Dear Editor,

I congratulate the author of the photo essay, where the clinical picture of a 24-year-old patient with a non-recurrent laryngeal nerve (NRLN), noticed during thyroidectomy for papillary thyroid cancer, was highlighted.¹ A significant risk factor for recurrent laryngeal nerve (RLN) injury is the non-recurrent path of the laryngeal nerve (LN). Hence, NRLN must be appropriately identified to assist surgeons in making appropriate intraoperative decisions to reduce morbidity during thyroidectomy. However, there are concerns regarding this study.

While the author used only the superior thyroid artery as the reference landmark to classify NRLN, Soustelle et al. (1976) classified the NRLN relative to both the superior and inferior thyroid vessels, using both the superior and inferior thyroid vessels as landmarks to classify NRLN.^2,3 In that classification, Type 1 nonrecurrent nerves run together with the superior thyroid vascular pedicle, and Type 2A nonrecurrent nerves traverse parallel to and over the trunks of the inferior thyroid artery. The Type 2B nonrecurrent nerve follows a path under the trunk or between the branches of the inferior thyroid artery.

The classification used by Dr. Kumar was not referenced, and it appears to be a proposal for a new classification of NRLN. Furthermore, the author did not state the type of NRLN in the photo essay, which could have assisted readers in comprehending the classification of NRLN.

Nonetheless, this photo essay draws attention to the rare but clinically important occurrence of NRLN during thyroidectomy. However, it would have been more informative if the specific NRLN type in the picture had been identified and referenced to an established classification system. Using standardized classifications in future reports may improve communication among surgeons and reduce the risk of postoperative complications in thyroidectomy patients with RLN anomalies.