The rising incidence and detection rate of thyroid cancer have led to a concomitant increase in the number of thyroidectomy procedures performed annually. Among the postoperative complications, recurrent laryngeal nerve injury (RLNI) remains a major factor affecting patients’ quality of life. In pursuit of precision therapeutic strategies and reduced nerve injury rates,clinicians have shown growing interest in the recurrent laryngeal nerve(RLN). In recent years, high-frequency ultrasound (HFUS) has been increasingly incorporated into the perioperative management of thyroidectomy. This study is the first to address RLN management during the perioperative period for thyroid cancer. The ultrasonographic characteristics of the RLN are systematically reviewed, with particular emphasis on the clinical utility of HFUS in preoperative screening, intraoperative monitoring, and postoperative follow-up. We also discuss the inherent limitations of this technique and outline future directions. Despite these promising advances, significant challenges persist in ensuring the accuracy and standardization of ultrasonographic examinations across diverse patient populations. In conclusion, this review highlights the transformative potential of HFUS in optimizing perioperative neural monitoring and functional evaluation for thyroid cancer. However, it also notes that ultrasound cannot currently replace laryngoscopy or intraoperative nerve monitoring (IONM), though it serves as a valuable complementary tool with clear clinical utility.
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