Segregated ligation of the superior thyroid artery minimize postthyroidectomy injury to the external branch of superior laryngeal nerve, a novel practical approach

2020 ◽  
Vol 13 (7) ◽  
pp. 3419
Author(s):  
Adel Mosa Ahmed Al-Rekabi
Keyword(s):  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Practical Approach ◽  
Superior Thyroid Artery ◽  
External Branch

scholarly journals Assessment of Relation between External Branch of Superior Laryngeal Nerve & Thyroid Gland- A Cadaveric Study

2020 ◽  
Vol 6 (2) ◽  
pp. 73-76
Author(s):  
Anurag ◽  
Vishnu Gupta
Keyword(s):  
Thyroid Gland ◽  
Cricoid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
The Body ◽  
Superior Thyroid Artery ◽  
Group I ◽  
External Branch ◽  
The Mean ◽  
Group Ii

Background: The thyroid gland is essential for normal growth of the body. This study assessed relation of external branch of superior laryngeal nerve to the superior pole of the thyroid gland. Subjects and Methods: This study was conducted on 25 human cadavers having 50 superior thyroid poles of both genders. Cadavers were classified based on age groups, group I was those with age less than 39 years and group II cadavers were those with age more than 40 years of age. Various measurements were performed on cadavers. Results: 14 cadavers were I group I and 11 were in group II. The mean mass was 67.2 Kgs in group I and 59.5 Kgs in group II, time elapsed after death was 481.5 minutes in group I and 476.4 minutes in group II, mean height was 1.74 meters in group I and 1.69 meters in group II, mean BMI found to be 22.3 kg/m2in group I and 20.1 kg/m2in group II. Height found to be significant between both groups (P< 0.05). The mean distance from EBSLN to cranial point of the thyroid gland was 6.66 mm in group I and 8.96 mm in group II. The mean transverse distance from superior thyroid artery to EBSLN was 3.55 mm in group I and 5.12 mm side in group II. The mean distance of the crossing point between the most cranial point of the thyroid lobe was 6.40 mm in group I and 11.47 mm in group II. The mean distance from the EBSLN to the midline of the neck was 19.80 mm in group I and 18.58 mm in group II. The mean distance from the EBSLN to the midline of the neck on the most cranial point of the cricoid cartilage was 18.77 mm in group I and 17.80 mm in group II. Conclusion: Authors found variation in measurements in left and right side in both group I and group II.

scholarly journals Does the Position of External Branch of Superior Laryngeal Nerve change with the Height of the Patients and the Length of the Larynx

2012 ◽  
Vol 4 (1) ◽  
pp. 1-2
Author(s):  
Kithsiri J Senanayake ◽  
Ranil Fernando ◽  
Sujatha Salgado ◽  
Manjula Jayanthi
Keyword(s):  
Strong Correlation ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Superior Thyroid Artery ◽  
Strongly Correlated ◽  
Moderate Correlation ◽  
Anatomical Position ◽  
External Branch ◽  
The Mean ◽  
The Difference

ABSTRACT When the external branch of superior laryngeal nerve (EBSLN) crosses the superior thyroid artery closer to thyroid upper pole, the EBSLN has a higher risk of getting damaged. Its anatomical position in relation to thyroid upper pole may vary with changing the height of patient and the length of larynx. We intended to test this hypothesis and predict the risk. Thirty cadavers of both sexes are dissected (29-87 years, mean 69). One cadaver excluded due to a goiter and five nerves were damaged during dissection. Therefore, 53 nerves were studied. The distance from upper pole of thyroid to the point where the nerve crosses the superior thyroid artery (TS) was measured. Cadaver length (CL), cricothyroid length (CT) and the cricohyoid length (CH) measured to the closest millimeter. Correlation of TS with CL, CT and CH was measured. The mean distance from the upper pole of the thyroid to the point where EBSLN crosses superior thyroid artery was 6.24 mm (SD 5.94). On right side, the mean distance was 4.03 mm (SD 5.34) and, on the left, 8.37 mm (SD 5.7 mm). The difference between two means was significant at 0.05 (t = 2.82, p = 0.007). There was a strong correlation between distance from the upper pole of the thyroid to the point where the nerve crosses the superior thyroid artery with CL (r = 0.98). There was moderate correlation with the CT and CH lengths (r = 0.55, 0.58 respectively). The position of EBSLN in relation to thyroid upper pole is strongly correlated with the height of the patient. The EBSLN crosses superior thyroid artery more closely to thyroid upper pole in right side. How to cite this article Senanayake KJ, Fernando R, Salgado S, Jayanthi M. Does the Position of External Branch of Superior Laryngeal Nerve change with the Height of the Patients and the Length of the Larynx. World J Endocr Surg 2012;4(1):1-2.

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

2013 ◽  
Vol 3 (2) ◽  
pp. 39-41 ◽  
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.

scholarly journals Comparative analysis of voice changes after thyroidectomy; mass versus individual ligation of superior thyroid artery with reference to identification of external branch of superior laryngeal nerve

2020 ◽  
Vol 6 (6) ◽  
pp. 1155
Author(s):  
Sunil Samdani ◽  
Shweta Dudi ◽  
Veena Mobarsa
Keyword(s):  
Superior Laryngeal Nerve ◽  
Close Relation ◽  
Laryngeal Nerve ◽  
Controlled Study ◽  
Superior Thyroid Artery ◽  
Cricothyroid Muscle ◽  
External Branch ◽  
Group B ◽  
The Impact ◽  
Superior Pole

<p class="abstract"><strong>Background:</strong> The external branch of the superior laryngeal nerve innervates the cricothyroid muscle to promote lengthening and thinning of the vocal fold, thus increasing voice pitch. The close relation with the superior thyroid vessels puts the external branch of the superior laryngeal nerve in risk every time the superior pole of the thyroid is dissected.</p><p class="abstract"><strong>Methods:</strong> : This randomized  controlled  study was undertaken at SMS Medical College, Jaipur between  February  2013 to November 2014  to  evaluate  the  impact  of  isolating  and  ligating  the  superior  thyroid  vessels  near  the  upper pole of the gland as compared  to conventional mass  ligation  of  the  superior  pole  regarding  external branch of superior laryngeal nerve injury in hemi or  subtotal  thyroidectomy. Total 120 patients were taken and divided into two groups A and B. Group A including mass ligation of superior pole of thyroid and group B includes individual ligation of superior thyroid vessels.  </p><p class="abstract"><strong>Results:</strong> Our study observed normal voice in 51 cases (85%) in individual ligation of superior thyroid vessel group and 27 cases (45%) in mass ligation group on auditory perceptual test by GRBAS scale one month postoperatively. Normal electromyography findings after 1 month post-operatively was observed in 57 cases (95%) in individual ligation group as compared to 40 cases (66.67%) in mass ligation group.</p><p class="abstract"><strong>Conclusions:</strong> Our study conclude that careful ligation of superior thyroid vessels is a safe technique to preserve the external branch of superior laryngeal nerve than mass ligation of superior pole of thyroid.</p>

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