OBJECTIVE Selective reinnervation for bilateral vocal fold paralysis has been successful in animal models and shows promise in humans, but detailed, surgically relevant measurements for performing this in the human larynx are not readily available. METHODS Anatomical study describing the anatomy and gender differences of the recurrent laryngeal nerve, with specific attention to the distance between the posterior cricoarytenoid (PCA) branch and the interarytenoid (IA) branch. METHODS Dissection of 20 human cadaveric larynges. RESULTS The mean distance between PCA and IA branches on the left side in male specimens was 4.9 +/- 2.7 mm; on the right side 5.4 +/- 2.5 mm. The mean distance between PCA and IA branches on the left side in female specimens was 4.9 +/- 2.0 mm; on the right side 5.5 +/- 2.6 mm. A thyroid cartilage notch was required to be able to achieve sufficient access for neurorrhaphy in 57.1% of male specimens on either side and in 69.2% of female specimens on either side. The mean size of the thyroid cartilage notch required in male specimens was 39.55 +/- 19.67 mm(2), and in female specimens 47.61 +/- 12.98 mm(2). CONCLUSIONS This study provides new insight into laryngeal anatomy and further data for developing a reliable surgical approach.