Background: Anatomic and functional preservation of the recurrent laryngeal nerve (RLN) is the gold standard in thyroid and various neck surgery.

Aim of the work: To assess incidence and risk factors for (RLN) injury which may be just palsy or permanent injury postoperative after thyroid surgery in patient with recurrent multiple nodular goiter (MNG) and observe the timing of recovery.

Methods: This prospective cross-sectional study was done on fifty patients with recurrent MNG. The study was done from December 2018 to October 2019. Patients with voice changes, RLN injury from previous operation and other type of cancer thyroid were excluded from the study.
Results: Identification of the RLN was succeeded in 45 patients and failed in 5, due to sever fibrosis from pervious surgery. Intra-operative identification of both RLN done in 34 patients, we identify Right RLN in 8 while left RLN identified in 3. During dissection, intra-operative injury of RLN happen in 4 patients on one side only. seven patients developed hoarseness of voice which was transient and voice returned after Speech therapy from three weeks to two months. Postoperative indirect laryngoscopy done, only four patients suffered from immobile vocal cord on one side.

Conclusion: Previous history of thyroid surgery is not significant and intraoperative RLN injury is significant so incidence of re-operation related transient vocal cord paresis was rare in our study four patients only. The median recovery time for transient RLN injuries was 8 weeks after operation.