laryngeal nerves


Summary: Branches of the VAGUS NERVE. The superior laryngeal nerves originate near the nodose ganglion and separate into external branches, which supply motor fibers to the cricothyroid muscles, and internal branches, which carry sensory fibers. The RECURRENT LARYNGEAL NERVE originates more caudally and carries efferents to all muscles of the larynx except the cricothyroid. The laryngeal nerves and their various branches also carry sensory and autonomic fibers to the laryngeal, pharyngeal, tracheal, and cardiac regions.

Top Publications

  1. Lombardi C, Raffaelli M, D Alatri L, Marchese M, Rigante M, Paludetti G, et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006;140:1026-32; discussion 1032-4 pubmed
    ..5, respectively; P < .05). Physicians should inform patients that transient voice and swallowing symptoms may occur following total thyroidectomy, and our data suggest mild symptoms may occur in the majority of operated patients. ..
  2. Inabnet W, Murry T, Dhiman S, Aviv J, Lifante J. Neuromonitoring of the external branch of the superior laryngeal nerve during minimally invasive thyroid surgery under local anesthesia: a prospective study of 10 patients. Laryngoscope. 2009;119:597-601 pubmed publisher
    ..a general anesthesia and placement of a special endotracheal tube equipped with electrodes to evoke the laryngeal nerves. This study aims to assess feasibility and efficacy of a novel technique of neuromonitoring of the EBSLN ..
  3. Nagai H, Ota F, Connor N. Effect of deficits in laryngeal sensation on laryngeal muscle biochemistry. Ann Otol Rhinol Laryngol. 2005;114:352-60 pubmed
    ..We conclude that sensory changes may affect properties of laryngeal muscles, and may thus have an impact on motor control during critical functions, such as airway protection during swallowing...
  4. Roy N. Denervation of the external branch of the superior laryngeal nerve: laryngeal and phonatory features. Curr Opin Otolaryngol Head Neck Surg. 2011;19:182-7 pubmed publisher
    ..Research is necessary to assess the precision of epiglottic petiole deviation as a possible marker of unilateral ESLN denervation. ..
  5. Kurozumi C, Yamagata R, Himi N, Koga T. Emetic stimulation inhibits the swallowing reflex in decerebrate rats. Auton Neurosci. 2008;140:24-9 pubmed publisher
    ..Taken together, these results suggest that emetic stimulation inhibits the swallowing pattern generator via the nucleus of the solitary tract, which in turn facilitates the gag reflex. ..
  6. Morton R, Whitfield P, Al Ali S. Anatomical and surgical considerations of the external branch of the superior laryngeal nerve: a systematic review. Clin Otolaryngol. 2006;31:368-74 pubmed
    ..Consistent approaches to the post-operative detection of EBSLN injury are needed to build an accurate picture of the incidence of surgical nerve injury. Then a standardised approach to EBSLN preservation may emerge. ..
  7. Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R. Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case-control evaluation. Surg Endosc. 2009;23:996-1003 pubmed publisher
    ..In the control group (N = 36), the laryngeal nerves were identified by 30 degrees 5-mm endoscope magnification solely...
  8. Bellantone R, Boscherini M, Lombardi C, Bossola M, Rubino F, De Crea C, et al. Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery. 2001;130:1055-9 pubmed
    ..Even if the EBSLN often crosses the superior thyroid pedicle, especially in large goiters, this study demonstrated that accurate distal ligation of the branches of the superior thyroid artery is a safe technique to prevent EBSLN injury. ..
  9. O Leary D, Murphy A, Pickering M, Jones J. Arterial chemoreceptors in the superior laryngeal nerve of the rat. Respir Physiol Neurobiol. 2004;141:137-44 pubmed
    ..In addition, hypoxia (PO2 < 60 mmHg) triggered SLN firing. Therefore, we can conclude that the paraganglia of the SLN are not only morphologically similar to the carotid body but are also excited by similar stimuli. ..

More Information


  1. Sasaki C, Jassin B, Kim Y, Hundal J, Rosenblatt W, Ross D. Central facilitation of the glottic closure reflex in humans. Ann Otol Rhinol Laryngol. 2003;112:293-7 pubmed
    ..A precise understanding of this effect may improve the prevention of aspiration in patients emerging from prolonged sedation or under heavy psychotropic control...
  2. Lifante J, McGill J, Murry T, Aviv J, Inabnet W. A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under local/regional anesthesia and IV sedation. Surgery. 2009;146:1167-73 pubmed publisher
    ..Nerve monitoring aids in the visualization of the EBSLN during mini-incision thyroidectomy under local/regional anesthesia and leads to an improvement in patient-assessed voice quality after surgery but does not impact swallowing. ..
  3. Arai T, Ohkuri T, Yasumatsu K, Kaga T, Ninomiya Y. The role of transient receptor potential vanilloid-1 on neural responses to acids by the chorda tympani, glossopharyngeal and superior laryngeal nerves in mice. Neuroscience. 2010;165:1476-89 pubmed publisher
    ..citric acid and HCl) and other taste stimuli from the mouse chorda tympani, glossopharyngeal and superior laryngeal nerves, and compared potential effects of iodo-resiniferatoxin (I-RTX), a potent TRPV1 antagonist, on chemical ..
  4. Kitagawa J, Shingai T, Takahashi Y, Yamada Y. Pharyngeal branch of the glossopharyngeal nerve plays a major role in reflex swallowing from the pharynx. Am J Physiol Regul Integr Comp Physiol. 2002;282:R1342-7 pubmed
    ..These results indicate that the GPN-ph plays a major role in the initiation of reflex swallowing from the pharynx in rats. ..
  5. Aluffi P, Policarpo M, Cherovac C, Olina M, Dosdegani R, Pia F. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol. 2001;258:451-4 pubmed
    Voice dysfunction after thyroidectomy may be caused by damage to laryngeal nerves or lesions to strap muscles with laryngo-tracheal movement impairment...
  6. Park H, Kim K, Kim Y, Hong W, Kim M, Kim D. Age dependence of laryngeal chemoreflex in puppies. Ann Otol Rhinol Laryngol. 2001;110:956-63 pubmed
    ..The important implication of this finding is that postnatal neural maturation may influence the laryngeal reflex in humans to some extent. ..
  7. Kitagawa J, Nakagawa K, Hasegawa M, Iwakami T, Shingai T, Yamada Y, et al. Facilitation of reflex swallowing from the pharynx and larynx. J Oral Sci. 2009;51:167-71 pubmed
    ..The present findings suggest that spatiotemporal summation of afferent signals from the GPN-ph and SLN results in an increase of motoneuronal activity in the medullary swallowing center, thus enhancing reflex swallowing...
  8. Kochilas X, Bibas A, Xenellis J, Anagnostopoulou S. Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery. Clin Anat. 2008;21:99-105 pubmed publisher
    ..Videostroboscopy, electromyography, voice analysis, and electroglottography can provide crucial information on the function of the EBSLN following neck surgery. ..
  9. Robinson J, Mandel S, Sataloff R. Objective voice measures in nonsinging patients with unilateral superior laryngeal nerve paresis. J Voice. 2005;19:665-7 pubmed
    ..Selected objective voice measures are abnormal in voice patients with superior laryngeal nerve paresis, which suggests that the measures may be useful as outcomes measures after therapy. More research is encouraged. ..
  10. Van Daele D, Cassell M. Multiple forebrain systems converge on motor neurons innervating the thyroarytenoid muscle. Neuroscience. 2009;162:501-24 pubmed publisher
    ..Hypothalamic innervation involved several functionally specific nuclei. Overall, the data imply complex CNS control over the multi-functional thyroarytenoid muscle. ..
  11. Simonyan K, Jürgens U. Efferent subcortical projections of the laryngeal motorcortex in the rhesus monkey. Brain Res. 2003;974:43-59 pubmed
  12. Friedman M, LoSavio P, Ibrahim H. Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg. 2002;128:296-303 pubmed
    ..The EBSLN should be explored during thyroid surgery and identification is possible in most cases. Preservation of the EBSLN maintains optimal function of the larynx. ..
  13. Yu J, Lin S, Zhang J, Otmishi P, Guardiola J. Airway nociceptors activated by pro-inflammatory cytokines. Respir Physiol Neurobiol. 2007;156:116-9 pubmed
    ..Our data demonstrate that nociceptors can be activated by pro-inflammatory cytokines and support the hypothesis that airway nociceptors transmit immune signals from the lung to the brain. ..
  14. Crookes P, Recabaren J. Injury to the superior laryngeal branch of the vagus during thyroidectomy: lesson or myth?. Ann Surg. 2001;233:588-93 pubmed
    ..The story should no longer be perpetuated in surgical textbooks and papers. ..
  15. Aina E, Hisham A. External laryngeal nerve in thyroid surgery: recognition and surgical implications. ANZ J Surg. 2001;71:212-4 pubmed
    ..Recognition of the potential avascular space aids the exposure and preservation of ELN. As such every attempt should be made to ensure safe dissection in order to reduce morbidity related to thyroid surgery. ..
  16. Baekey D, Morris K, Gestreau C, Li Z, Lindsey B, Shannon R. Medullary respiratory neurones and control of laryngeal motoneurones during fictive eupnoea and cough in the cat. J Physiol. 2001;534:565-81 pubmed
    ..Cough-like motor patterns (fictive cough) in phrenic, lumbar and recurrent laryngeal nerves were elicited by mechanical stimulation of the intrathoracic trachea...
  17. Bradford A, McKeogh D, O Regan R. Laryngeal-receptor responses to phasic CO2 in anesthetized cats. J Appl Physiol (1985). 1998;85:1135-41 pubmed
    ..Because laryngeal-receptor stimulation exerts reflex effects on ventilation and upper airway muscle activity, these results suggest that airway CO2 plays a role in reflex regulation of breathing and upper airway patency...
  18. Sasaki C, Ho S, Kim Y. Critical role of central facilitation in the glottic closure reflex. Ann Otol Rhinol Laryngol. 2001;110:401-5 pubmed
    ..A precise understanding of this effect may improve the prevention of aspiration in patients emerging from prolonged sedation or under heavy psychotropic control...
  19. Scerrino G, Tudisca C, Bonventre S, Raspanti C, Picone D, Porrello C, et al. Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review. Int J Surg. 2017;41 Suppl 1:S94-S102 pubmed publisher
    ..These complaints are usually related to superior and inferior laryngeal nerves dysfunction, but these can appear even after uncomplicated surgical procedure...
  20. Furlan J, Brandão L, Ferraz A, Rodrigues A. Surgical anatomy of the extralaryngeal aspect of the superior laryngeal nerve. Arch Otolaryngol Head Neck Surg. 2003;129:79-82 pubmed
    ..These findings are important in that they can help in the prevention of SLN injuries during operations such as laryngectomy and neck dissection, as well as in the planning of laryngeal reinnervation and transplantation. ..
  21. Mutoh T, Taki Y, Tsubone H. Desflurane but not sevoflurane augments laryngeal C-fiber inputs to nucleus tractus solitarii neurons by activating transient receptor potential-A1. Life Sci. 2013;92:821-8 pubmed publisher
    ..The findings may help to explain local deleterious effects of irritant volatile general anesthetics on the airways during inhaled induction or bronchodilator therapy for status asthmatics. ..
  22. Cunningham J, Halum S, Butler S, Postma G. Intraobserver and interobserver reliability in laryngopharyngeal sensory discrimination thresholds: a pilot study. Ann Otol Rhinol Laryngol. 2007;116:582-8 pubmed
    ..1) Intraobserver reliability was good for experienced endoscopists. 2) Interobserver LPSDT agreement between endoscopists was poor. 3) Eighteen percent of the subjects demonstrated elevated LPSDT thresholds of more than 4 mm Hg. ..
  23. Selvan B, Babu S, Paul M, Abraham D, Samuel P, Nair A. Mapping the compound muscle action potentials of cricothyroid muscle using electromyography in thyroid operations: a novel method to clinically type the external branch of the superior laryngeal nerve. Ann Surg. 2009;250:293-300 pubmed publisher
    ..A total of 70 external laryngeal nerves were dissected and confirmed by the CMAPs in 35 total thyroidectomy patients...
  24. Yelmen N, Sahin G, Oruc T, Guner I. The reflex effects on the respiratory regulation of the CO2 at the different flow rate and concentration. Yonsei Med J. 2007;48:856-64 pubmed
    ..In conclusion, the results of this study purpose that the stimulation of the laryngeal mechanoreceptors by the effect of hypercapnia decreases the activation of the respiratory center. ..
  25. Lee K, Koo D, Kim S, Lee J, Park K, Oh S, et al. Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery. 2010;148:1207-13 pubmed publisher
    ..0 ng/mL. Robotic BABA total thyroidectomy with CND yields good postoperative outcomes. Given the excellent cosmetic outcomes, this technique may be a suitable operative alternative for low-risk patients with PTC. ..
  26. Manikandan S, Neema P, Rathod R. Ultrasound-guided bilateral superior laryngeal nerve block to aid awake endotracheal intubation in a patient with cervical spine disease for emergency surgery. Anaesth Intensive Care. 2010;38:946-8 pubmed
    ..We describe the successful performance of ultrasound-guided bilateral superior laryngeal nerve block to facilitate awake fibreoptic intubation in a patient presenting for emergency surgery on the cervical spine. ..
  27. Kaczynska K, Szereda Przestaszewska M. Superior laryngeal nerve section abolishes capsaicin evoked chemoreflex in anaesthetized rats. Acta Neurobiol Exp (Wars). 2002;62:19-24 pubmed
    ..05) in all nine rats treated by vagotomy. Section of the superior laryngeal nerves (SLNs) precluded the occurrence of apnoea...
  28. Tsujimura T, Tsuji K, Magara J, Sakai S, Suzuki T, Nakamura Y, et al. Differential response properties of peripherally and cortically evoked swallows by electrical stimulation in anesthetized rats. Brain Res Bull. 2016;122:12-8 pubmed publisher
    ..These findings suggest that peripherally and cortically evoked swallows have different response properties and are affected differently by the mastication network. ..
  29. Polizopoulou Z, Koutinas A, Papadopoulos G, Saridomichelakis M. Juvenile laryngeal paralysis in three Siberian husky x Alaskan malamute puppies. Vet Rec. 2003;153:624-7 pubmed
    ..In the nucleus ambiguus of the dogs there was a depletion of motor neurons, neuronal degeneration and mild gliosis, but there were no lesions in the root and peripheral segments of the recurrent laryngeal nerves.
  30. Grocott H, Clark J, Homi H, Sharma A. "Other" neurologic complications after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004;8:213-26 pubmed
    ..An overview of the current concepts of injury mechanisms/etiology, diagnosis, prognosis, and when possible, prevention of these injuries is presented. ..
  31. Lang I, Medda B, Jadcherla S, Shaker R. The role of the superior laryngeal nerve in esophageal reflexes. Am J Physiol Gastrointest Liver Physiol. 2012;302:G1445-57 pubmed publisher
    ..Transection of SLN or proximal recurrent laryngeal nerves (RLN) blocked EUCR and ELIR generated from the cervical esophagus...
  32. Ono K, Shiba K, Nakazawa K, Shimoyama I. Synaptic origin of the respiratory-modulated activity of laryngeal motoneurons. Neuroscience. 2006;140:1079-88 pubmed
    ..We conclude that various synaptic inputs from respiratory neurons contribute to shaping the respiratory-related trajectory of membrane potential of laryngeal motoneurons. ..
  33. Rubin F, Villeneuve A, Alciato L, Slaïm L, Bonfils P, Laccourreye O. Idiopathic unilateral vocal-fold paralysis in the adult. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135:171-174 pubmed publisher
    ..and 11 patients in whom a malignant tumor occurred along the path of the ipsilateral vagus and inferior laryngeal nerves or in the ipsilateral paralyzed larynx...
  34. Yu J. Airway mechanosensors. Respir Physiol Neurobiol. 2005;148:217-43 pubmed
  35. Kiray A, Naderi S, Ergur I, Korman E. Surgical anatomy of the internal branch of the superior laryngeal nerve. Eur Spine J. 2006;15:1320-5 pubmed
    ..The morphometric data regarding the ibSLN, information regarding the distances between the nerve, and the other consistent structures may help us identify this nerve, and to avoid the nerve injury. ..
  36. Kodama S, Oribe K, Suzuki M. Superior laryngeal neuralgia associated with deviation of the hyoid bone. Auris Nasus Larynx. 2008;35:429-31 pubmed
    ..Superior laryngeal neuralgia was diagnosed, and the condition was treated with carbamazepine. Superior laryngeal neuralgia is rare but should be considered, particularly if no other pathologic findings are identified...
  37. Hurtado Lopez L, Zaldivar Ramirez F. Risk of injury to the external branch of the superior laryngeal nerve in thyroidectomy. Laryngoscope. 2002;112:626-9 pubmed
    ..The frequency of high-risk position for EBSLN lesion in our milieu was higher than that reported in series from other countries and races. ..
  38. Ngo Nyeki A, Njock L, Miloundja J, Evehe Vokwely J, Bengono G. Recurrent laryngeal nerve landmarks during thyroidectomy. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132:265-9 pubmed publisher
    ..A total of 62 recurrent laryngeal nerves were identified: 32 on the right and 30 on the left...
  39. Islam A, Rahman M, Ali M. Ortner syndrome with recurrent pericardial effusion: a diagnostic and therapeutic dilemma. J Coll Physicians Surg Pak. 2013;23:660-2 pubmed publisher
    ..The patient responded to some extent to systemic and intrapericardial chemotherapy. Immunocompromised state associated with malignancy may predispose to infection including tuberculosis. ..
  40. De Biase N, Korn G, Guglielmino G, Pontes P. Laryngeal electromyography in dysphonic patients with incomplete glottic closure. Braz J Otorhinolaryngol. 2012;78:7-14 pubmed
    ..This study aims to assess the electrophysiological function of the superior and inferior laryngeal nerves by measuring the electrical activity of the muscles they innervate in dysphonic patients with incomplete ..
  41. Björck G, Margolin G, Måbäck G, Persson J, Mattsson P, Hydman J. New animal model for assessment of functional laryngeal motor innervation. Ann Otol Rhinol Laryngol. 2012;121:695-9 pubmed
    ..and posterior cricoarytenoid muscles receive dual innervation from both the superior and recurrent laryngeal nerves, whereas the cricothyroid muscle is innervated only by the superior laryngeal nerve...
  42. Gleich S, Nicholson W, Jacobs T, Hofer R, Sprung J. Inability to ventilate while using a silicone-based endotracheal tube. J Clin Anesth. 2008;20:389-392 pubmed publisher
  43. Teymoortash A, Berger R, Lichtenberger G, Werner J. [Function and dysfunction of the superior laryngeal nerve]. HNO. 2008;56:889-94 pubmed
    ..Diagnosis of this disease is clinically challenging because the clinical symptoms are frequently not pronounced. Besides laryngoscopy, stroboscopy and electromyography are required for exact diagnosis. ..
  44. Arch Tirado E, Verduzco Mendoza A, Taboada Picazo V, Mota Rojas D, Alonso Spilsbury M, Alfaro Rodriguez A. Analysis of normal and denerved laryngeal vocalization in guinea pigs (Cavia porcellus). J Voice. 2009;23:34-9 pubmed
    ..With regard to the unilateral paralysis, the motility was frequently compensated by the healthy vocal chord, improving voice emission, and loss of air inhalation. ..
  45. Leon X, Pujol A, Lopez M, Garcia J, Pons G, Sanudo J, et al. [Larynx transplant: a therapeutic option for the 21st century? Literature review]. Acta Otorrinolaringol Esp. 2008;59:127-38 pubmed
    ..This review of the literature aims to update the compendium of knowledge about this procedure and to explore the prospects of larynx transplantation as a viable therapeutic option. ..
  46. Nakano C, Massarollo L, Volpi E, Barbosa Junior J, Arias V, Ueda R. Ancient schwannoma of the vagus nerve, resection with continuous monitoring of the inferior laryngeal nerve. Braz J Otorhinolaryngol. 2008;74:316 pubmed
  47. Ohkuri T, Horio N, Stratford J, Finger T, Ninomiya Y. Residual chemoresponsiveness to acids in the superior laryngeal nerve in "taste-blind" (P2X2/P2X3 double-KO) mice. Chem Senses. 2012;37:523-32 pubmed publisher
    ..These results are consistent with the hypothesis that the residual avoidance of acidic solutions by P2X-dblKO mice may be attributable to the direct chemosensitivity of nerve fibers innervating the laryngeal epithelium and not to taste...
  48. Cavalcanti D, Garcia Gonzalez U, Agrawal A, Tavares P, Spetzler R, Preul M. A clear map of the lower cranial nerves at the superior carotid triangle. World Neurosurg. 2010;74:188-94 pubmed publisher
    ..The most superficial segments of the glossopharyngeal, vagus and its superior laryngeal nerves, accessory, and hypoglossal nerves were exposed and designated into smaller anatomic triangles...
  49. Jürgens U, Ehrenreich L. The descending motorcortical pathway to the laryngeal motoneurons in the squirrel monkey. Brain Res. 2007;1148:90-5 pubmed
  50. Suzuki T, Nakazawa K, Shiba K. Swallow-related inhibition in laryngeal motoneurons. Neurosci Res. 2010;67:327-33 pubmed publisher
    ..It is concluded that the swallow-related inhibition of both adductor and abductor LMs is chloride-dependent IPSPs mediated through GABA(A) receptors, not through glycine receptors. ..
  51. Hurtado López L, Díaz Hernández P, Basurto Kuba E, Zaldívar Ramírez F, Pulido Cejudo A. Efficacy of Intraoperative Neuro-Monitoring to Localize the External Branch of the Superior Laryngeal Nerve. Thyroid. 2016;26:174-8 pubmed publisher
    ..0467 [CI 0.2686-0.4554], indicating a fair agreement between the visual and IONM classification. IONM identified 97.5% of EBSLN cases. It was higher than the visual identification. There were no injuries to EBSLN identified through IONM. ..
  52. Hassanain M, Wexler M. Conservative management of well-differentiated thyroid cancer. Can J Surg. 2010;53:109-18 pubmed
    ..Conservative surgical management reduces the risk of complications and maintains an overall survival rate equivalent to the more extensive approach...
  53. Ptok M, Strack D. Electrical stimulation-supported voice exercises are superior to voice exercise therapy alone in patients with unilateral recurrent laryngeal nerve paresis: results from a prospective, randomized clinical trial. Muscle Nerve. 2008;38:1005-11 pubmed publisher
    ..Because no further data exist, it can be assumed that improvement following VE only reflects spontaneous recovery. However ES appears to be an effective non-surgical therapeutic procedure. ..