BACKGROUND: To evaluate surgical identification of nonrecurrence of the inferior laryngeal nerve (NRILN) during thyroidectomy in patients with an aberrant subclavian artery (a. lusoria) as seen on CT. MATERIAL AND METHODS: The medical files of patients treated by thyroidectomy between January 1998-December 2000 (n = 583) were retrospectively reviewed for preoperative and postoperative mobility of the vocal cords and perioperative identification of NRILN. The available preoperative CT studies (n = 163) were reviewed for presence of a. lusoria. RESULTS: In five patients, the CT study revealed an a. lusoria (3.16%). In one of five of these patients, an NRILN was surgically detected; the overall detection rate of NRILN was 0.21%. In one of four patients with nonidentification of this nerve during surgery, immediate unilateral and permanent vocal cord paralysis were present after surgery. No permanent vocal cord paralysis occurred in any of the other patients. CONCLUSION: The identification of a. lusoria should alert the radiologist and surgeon that a NRILN is present, allowing an anticipating surgical technique, reducing the risk of neural injury.