Identification of external branch of superior laryngeal nerve during thyroid surgery: a prospective study

Background: Identification of external branch of superior laryngeal nerve (EBSLN) according to Cernea et al classification and to describe a surgical technique of superior pole dissection to preserve EBSLN during thyroid surgeries.Methods: The study was done over 2 years period in a tertiary care hospital. 105 nerves were studied among the 90 patients who underwent thyroid surgeries. Avascular dissection over the JOLL’S triangle was carried out and identified EBSLN were classified according to Cernea et al classification. Individual ligation of superior pole vessels was carried out after identifying the nerve. Outcome was studied relating the identified nerve with sides of thyroidectomy performed, size of thyroid gland and nerves at risk according to Cernea et al classification. Results: Of the 105 nerves studied, in 81.90% of patients the nerve was identified. There were 34.88% of Type 1 nerves, 52.33% of Type 2A nerve and 12.79% of Type 2B nerves identified. Less number of nerves could be identified on the left side. Type 2B nerves were more common on left side inspite of less number of dissections carried out on left. Type 2 variation was more common in large goiters.Conclusions: Careful dissection should be done in superior pole in avascular cricothyroid space, with lateralization of superior pole and individual identification of superior pole vessels once the nerve is identified. Identification of the nerve is mandatory in all patients who undergo thyroid surgery for optimal functions of the larynx. These results showed a better identification of nerves by proper surgical techniques without use of any sophisticated equipments.

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Neuromonitoring of the external branch of the superior laryngeal nerve during minimally invasive thyroid surgery under local anesthesia: A prospective study of 10 patients

The Laryngoscope ◽

10.1002/lary.20071 ◽

2009 ◽

Vol 119 (3) ◽

pp. 597-601 ◽

Cited By ~ 28

Author(s):

William B. Inabnet ◽

Thomas Murry ◽

Shamly Dhiman ◽

Jonathan Aviv ◽

Jean-Christophe Lifante

Keyword(s):

Minimally Invasive ◽

Prospective Study ◽

Local Anesthesia ◽

Thyroid Surgery ◽

Superior Laryngeal Nerve ◽

Laryngeal Nerve ◽

External Branch ◽

Minimally Invasive Thyroid Surgery ◽

A Prospective Study

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Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy

International Journal of Phonosurgery & Laryngology ◽

10.5005/jp-journals-10023-1059 ◽

2013 ◽

Vol 3 (2) ◽

pp. 39-41 ◽

Cited By ~ 2

Author(s):

Bhagyashree D Bokare ◽

Poorva K Athavale ◽

Vipin R Ekhar ◽

Devendra Meghraj Mahore

Keyword(s):

Thyroid Gland ◽

Total Thyroidectomy ◽

Superior Laryngeal Nerve ◽

Vocal Folds ◽

Laryngeal Nerve ◽

Superior Thyroid Artery ◽

Type I ◽

Care Hospital ◽

External Branch ◽

Superior Pole

ABSTRACT The basic principle of head and neck surgery is based on the identification and preservation of important structures, rather than avoidance. This principle is also applicable to identification and preservation of external branch of the superior laryngeal nerve (EBSLN) as a standard routine in all thyroid surgeries. During thyroid surgery, the EBSLN is clearly at risk due to its close proximity to the superior thyroid artery (STA) and its branches that need to be ligated during dissection of the superior pole of the thyroid gland. Injury is detrimental to the patient by causing paralysis of the cricothyroid muscle which is the main tensor and pitch controlling mechanism of the vocal folds. Injury to the EBSLN during surgery can result in the voice changes, loss of upper range and easy fatigability of voice, the severity of which varies according to the vocal demand of the patient. Total 45 cases of thyroid swellings were treated with surgery, in the Department of ENT at a tertiary care hospital during the period from 1st October 2009 to 30th October 2010. Hemithyroidectomy was the most common operative procedure implemented in 24 patients (53.33%) in which right sided was common. Next common procedure performed was that of total thyroidectomy in 14 patients (31.11%). Four patients underwent total thyroidectomy with neck dissection. The position of EBSLN was classified according the Cernea et al classification. In our study we found the EBSLN to be type I in 46.66%, type IIa in 73.33% and type IIb in 02.22%. The anatomical landmark taken into consideration to identify EBSLN was the Joll's triangle with its relation to the superior pole of the thyroid gland and STA. How to cite this article Athavale PK, Bokare BD, Ekhar VR, Mahore DM. Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy. Int J Phonosurg Laryngol 2013;3(2):39-41.

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