Identification of the External Branch of the Superior Laryngeal Nerve during Thyroid Surgery

Aleksova, Lyubka; Ali, Metin M.; Chakarov, D.; Yozgyur, Zeynep M.

doi:10.1515/folmed-2017-0083

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…Friedman et al [17] reported an EBSLN visualization rate of 85.1%, and they found that the remaining branches run deep into the inferior constrictor muscle fibers. Recent studies have reported that the EBSLN can be visually identified in up to 93% of thyroidectomy cases [131819202122]. Despite anatomical integrity, adequate motor function of the nerve branch may not always be confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, on the basis of our results in primary thyroid surgery, functional identification rates of the EBSLN could exceed 95% due to appropriate anatomical dissection and proper use of electrophysiological monitoring. Previous studies have reported the successful identification of the EBSLN with the assistance of IONM [118192021222627]. After significant advances and improvements in anatomical knowledge, surgical technique, and electrophysiological monitoring, the EBSLN identification rate has been reported to reach more than 90% in recent studies [34222328].…”

Section: Discussionmentioning

confidence: 99%

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Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

et al. 2019

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Purpose Thyroid reoperations are surgically challenging because of significant anatomical variance. Visual and functional identification of the external branch of the superior laryngeal nerve (EBSLN) were studied in 2 groups of patients who underwent primary and redo thyroid surgery. Methods This study was conducted on 200 patients: 100 patients with redo and 100 patients with primary thyroid surgery. In addition to visual identification, nerve branches were functionally identified by intraoperative nerve monitoring (IONM). Visual, functional, and total identification rates of the EBSLN in both primary and redo surgery were determined and compared between the 2 groups. Results We attempted to identify 138 and 170 EBSLNs at risk in redo and primary surgery, respectively. Visual identification rates were 65.3% and 30.4% (P < 0.001) in primary and redo surgery groups, respectively. In total, 164 (96.5%) and 97 EBSLNs (70.3%) were identified in primary and redo surgery, respectively (P < 0.001), including the use of IONM. In primary surgery group, 53 nonvisualized EBSLNs of 164 identified nerves (32.3%) were determined by IONM alone. In redo surgery group, 55 of 97 identified nerves (56.7%) were determined by IONM alone (P < 0.001). Conclusion Both visual and total identification rates of the EBSLN are significantly decreased in reoperative thyroidectomy. IONM increases the total identification rate of the EBSLN in primary and redo thyroid surgery. Electrophysiological monitoring makes a substantial contribution to the identification of the EBSLN both in primary and especially in redo thyroid surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

et al. 2019

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“…Employing IONM routinely would allow identification of these unexpected circumstances. This ability to identify motor nerves also applies to improving EBSLN identification rates from 79.1% to 97.5% …”

Section: Discussionmentioning

confidence: 94%

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Leong

Ryan

et al. 2019

ANZ Journal of Surgery

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Background: Intraoperative nerve monitoring (IONM) has increasingly been used in thyroid surgery by general, endocrine and head and neck surgeons. The purpose of this paper was to explore the prevalence and reasons for the usage of IONM in endocrine surgery in Australia and New Zealand. Methods: A survey was sent to general surgeons registered with the Royal Australasian College of Surgeons involved in endocrine surgery and members of the Australian and New Zealand Endocrine Surgeons. Users were divided into surgeon type, area of work, hospital type and volume of surgery. These data were analysed with univariate and multivariate logistic regression models. Results: Significant differences in IONM usage levels were observed between endocrine and general surgeons, area of work and volume of surgery performed. Endocrine surgeons are significantly more likely to use IONM than general surgeons. Surgeons who work in tertiary hospitals are more likely to use IONM as compared to those working in district hospitals. Surgeons who perform less than 100 thyroidectomies were more likely to be users of IONM. Conclusion: IONM is not routinely used in thyroid surgery in Australia and New Zealand. The main reasons for the use of IONM given in our study by routine users were to establish familiarity of equipment and medicolegal reasons. Selective users chose as the most common reasons, a documented pre-existing unilateral nerve paresis or a hostile surgical field. Non-users stated that there was conflicting evidence that it improves outcomes and increased costs. © 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 867-871ANZJSurg.com

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“…Before the end of the operation, while anatomical integrity is confirmed, neural monitoring is required to exclude the elimination of thermal damage and strain injury and verify neural function. Electrostimulation causes simultaneous contraction of the cricothyroid muscle in both the straight and oblique abdomen as the standard of neurological integrity (3,14,29). Nevertheless, IONM does not completely eliminate the risk of nerve injury caused by unintentional injuries (30,31), and the surgeon's experience and full understanding of anatomy and possible variations are more important than the aid of high-tech instruments during thyroid surgery (32).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utility of video-assisted method for identifying and preserving the external branch of the superior laryngeal nerve during thyroidectomy

et al. 2023

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BackgroundThe EBSLN is vulnerable to damage during thyroidectomy, results in voice related complications, negatively affect patient quality of life, routine identification of the EBSLN prior to surgical manipulation is necessary for a complication-free thyroidectomy. We aimed to validate a video-assisted procedure for identifying and preserving the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy and analyze the EBSLN Cernea classification and the localization of the nerve entry point (NEP) from the insertion of the sternothyroid muscle.MethodsA prospective descriptive study was performed; 134 patients, who scheduled for lobectomy with an intraglandular tumor max diameter ≤ 4 cm and without extrathyroidal extension, were randomly divided into the video-assisted surgery (VAS) and conventional open surgery (COS) groups. We used the video-assisted surgical procedure for visually identifying the EBSLN directly, and compared the differences in the visual identification rate and total identification rate of the two groups. We also measured the localization of the NEP using the insertion of the sternothyroid muscle as a reference.ResultsThere was no statistically significant difference in clinical characteristics between the two groups. The visual identification rate and total identification rate were significantly higher in the VAS group than the COS group (91.04% vs. 77.61%, 100% vs. 89.6%). The EBSLN injury rate was 0 in both groups. The mean vertical distance (VD) of the NEP from the sternal thyroid insertion was 1.18 mm (SD 1.12 mm, range, 0–5 mm), with approximately 88.97% of the results occurring within the 0–2 mm range. The mean horizontal distance (HD) was 9.33 mm (SD 5.03 mm, range, 0–30 mm), with over 92.13% of the results occurring within the 5–15 mm range.ConclusionBoth the visual and total identification rates of the EBSLN were significantly higher in the VAS group. This method provided a good visual exposure rate of the EBSLN, aiding in identifying and protecting the EBSLN during thyroidectomy.

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Identification of the External Branch of the Superior Laryngeal Nerve during Thyroid Surgery

Cited by 9 publications

References 11 publications

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Utility of video-assisted method for identifying and preserving the external branch of the superior laryngeal nerve during thyroidectomy

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