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This chapter will examine the data regarding this rare but serious complication of thyroid surgery. We evaluated the available literature for recommendations regarding immediate primary repair versus no repair in patients with an identified transected RLN during thyroid surgery.

The first description of paraganglia of the temporal bone was by Stacy R. Guild, an anatomist from Johns Hopkins School of Medicine (Fig. 1.1). In a brief presentation at the American Association of Anatomists at the University of Chicago in April of 1941 entitled “A hitherto unrecognized structure, the Glomus Jugularis, in man,” Guild wrote: “Human temporal bone sections reveal structures in several respects like the carotid body, for which the name glomus jugularis is proposed. Usually they are in the adventitia of the dome of the jugular bulb, immediately below the bony floor of the middle ear and near the ramus tympanicus of the glossopharyngeal nerve…. Each glomus, wherever located, consists of blood vessels of capillary or precapillary caliber with numerous epithelioid cells between vessels. Usually, but not always, the vessels are the more prominent feature. Innervation and blood come from the same trunks that supply the carotid body; namely, glossopharyngeal nerve and ascending pharyngeal artery (through its inferior tympanic branch). Presumably it has functions like the carotid body, perhaps limited to a smaller circulatory region. Suggestion: similar structures may be present along other parts of the peripheral circulatory system” [1].

Jugular paragangliomas (JPs) arise from the paraganglion cells located within the adventitia of the jugular bulb [1]. Although typically slow growing and histologically benign, JPs commonly invade the middle ear, mastoid, and neural compartment of the jugular foramen, thereby causing facial nerve and lower cranial nerve (IX, X, XI, XII) deficits. Furthermore, operative intervention and radiotherapy may also result in cranial nerve deficits, and it is important to be aware of and manage cranial nerve injury to minimize their clinical impact on the patient.