Injury of the external branch of the superior laryngeal nerve in thyroid surgery

Potenza, Andre; Filho, V J F Araujo; Cernea, Cláudio Roberto

doi:10.21037/gs.2017.06.15

Cited by 55 publications

(43 citation statements)

References 70 publications

(113 reference statements)

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“…High ligation of the superior thyroid artery during thyroidectomy places the external branch of the SLN at risk of inadvertent injury, which would produce dysphonia by altering pitch regulation [25]. The cricothyroid artery, a potentially troublesome branch of the superior thyroid artery, runs superior to the upper pole and runs toward the midline on the cricothyroid ligament [8].…”

Section: Vascular Anatomymentioning

confidence: 99%

Comprehensive Review of Thyroid Embryology, Anatomy, Histology, and Physiology for Surgeons

Arrangoiz¹,

Cordera²,

Caba³

et al. 2018

IJOHNS

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Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.

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Section: Vascular Anatomymentioning

confidence: 99%

Comprehensive Review of Thyroid Embryology, Anatomy, Histology, and Physiology for Surgeons

Arrangoiz¹,

Cordera²,

Caba³

et al. 2018

IJOHNS

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“…Thus, EBSLN injury may alter the ability to produce acute sounds and lead to dysphagia, especially with liquids[ 11 ]. Clinical symptoms may present as weakness, tightness, and increased effort to speak, increased throat clearing, and vocal fatigue [ 15 , 16 ]. The severity may vary depending on the voice demands of the person and it is felt that singer and professional voice users, such as lawyers, teachers and broadcasters, are more significantly affected by the subtle changes related to its injury[ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…The severity may vary depending on the voice demands of the person and it is felt that singer and professional voice users, such as lawyers, teachers and broadcasters, are more significantly affected by the subtle changes related to its injury[ 16 , 17 ]. Even for non-professionals, the perception of an abnormal voice impairs the quality of life and decreases the general health in many ways and affected patients may be unable to shout for help[ 15 ]. The incidence of EBSLN injury in patients undergoing thyroidectomy is reported to be up to 58%[ 13 , 15 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve

Dessie

2018

PLoS ONE

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IntroductionThe superior thyroid artery, the main atrial supply of neck region, is branched from the external carotid artery as a first branch, but it may also arise from the common carotid artery and its bifurcation. The external branch of superior laryngeal nerve runs parallel to it and later crossing the artery either above or below the upper pole of the thyroid gland.ObjectiveThis study aimed at evaluating the variations of the origin of superior thyroid artery and its relationship with the external branch of the superior laryngeal nerve.MethodsA descriptive study was conducted on 43 embalmed cadavers. The anterior triangle of the neck region was dissected bilaterally. The presence or absence of STA and its origin, branching pattern, relationship with the external branch of the superior laryngeal nerve, level of origin in relation to the lamina of the thyroid cartilage and level of carotid bifurcation were observed and recorded.ResultThe superior thyroid artery arises from the external carotid artery in 44.2%, common carotid bifurcation in 27.9% and common carotid artery in 26.7% of cadavers. In one of the cadaver, the superior thyroid artery arises from lingual artery. The origin of superior thyroid artery was significantly associated with its branching pattern and level of common carotid artery bifurcation. The mean distance from the upper pole of the thyroid gland to the level where an external branch of superior laryngeal nerve turns medially from superior thyroid artery was found to be 1.04cm.ConclusionThe wide range of variations of the superior thyroid artery on its origin and relationship with adjacent structures is a common phenomenon. The clinicians should be aware of those variations.

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“…Recurrent laryngeal nerve injury can be detected by simple diagnostic methods such as indirect laryngoscopy or fiberoptic examination, EBSLN injury requires the use of more advanced techniques such as laryngeal videostroboscopy, spectrographic analysis and laryngeal EMG. Among these techniques, the more invasive and time-consuming cricothyroid muscle EMG is the most accurate diagnostic method (9,20). The risk of iatrogenic partial or complete EBSLN injury varies between 0% and 6% after thyroidectomy and this rate increases up to 60% when EMG is performed (12,14,18,21).…”

Section: Table 1 the Distribution Of Demographic Characteristics Andmentioning

confidence: 99%

“…However, a disadvantage of these systems is that they can damage adjacent anatomical structures by direct or lateral thermal spread (5)(6)(7). These adjacent structures include the external branch of the superior laryngeal nerve (EBSLN), and in particular, injury to the nerve occurs during the dissection of the upper pole of the thyroid gland (8,9). EBSLN is the only nerve that innervates the cricothyroid muscle, which is the tensor of the vocal cords, and its injury may lead to hoarseness, loss of strength of the voice, vocal fatigue and inability to achieve high pitch tasks (10,11).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Different Hemostatic Systems on the Injury of the External Branch of the Superior Laryngeal Nerve in Thyroidectomy

Özben¹,

Özgültekin²,

Adatepe³

et al. 2019

Istanbul Med J

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Amaç: Hızlı ve etkin bir şekilde hemostaz sağlayan damar mühürleyici ve ultrasonik koagülasyon sistemleri tiroid cerrahisinde yaygın bir şekilde kullanılmaktadır. Bu sistemlerin bir dezavantajı termal hasar yolu ile komşu anatomik yapılara zarar verebilmesidir. Ancak süperior laringeal sinirin eksternal dalının yaralanması ile ilgili veriler sınırlıdır. Bu çalışmanın amacı tiroidektomi ameliyatında kullanılan farklı damar kapama sistemlerinin bu sinir yaralanması üzerine olan etkisini değerlendirmektir. Yöntemler: Çalışmaya Ekim 2008 ile Şubat 2009 tarihleri arasında selim tiroid hastalığı nedeni ile tiroidektomi ameliyatı yapılan toplam 45 hasta dahil edildi. Hastalar randomize edilerek her biri 15'er hastadan oluşan toplam üç gruba ayrıldı. Ameliyatta ilk grupta damar mühürleyici, ikinci grupta harmonik kesici ve üçüncü grupta klasik sütür ile bağlama tekniği kullanıldı. Hastaların laringeal elektromiyografi bulguları ve ses şikayetleri karşılaştırıldı. Bulgular: Hastaların 37'si kadın (%82), 8'i erkek ve yaş ortalaması 47,9±11,1 yıl idi. Demografik özellikler ve cerrahi işlemler tüm gruplarda istatistiksel olarak benzer bulundu (p>0,05). Ameliyat öncesi elektromiyografi bulguları normal olan 84 adet sinirin kontrol incelemesinde damar mühürleyici grubunda 28 sinirin 3'ünde (%10,7), harmonik kesici grubunda 28 sinirin 2'sinde (%7,1) ve klasik sütür ile bağlama grubunda 28 sinirin 2'sinde (%7,1) tam veya parsiyel sinir yaralanması mevcuttu (p>0,05). Ses şikayetleri açısından gruplar arasında anlamlı fark saptanmadı (p>0,05). Sonuç: Damar kapama cihazlarının kullanımı klasik sütür bağlama tekniği ile karşılaştırıldığında, süperior laringeal sinirin eksternal dalı yaralanması riskini artırmadığı görülmektedir. Anahtar Kelimeler: Elektromiyografi, süperior laringeal sinirin eksternal dalı, sinir yaralanması, tiroidektomi, damar kapama sistemleri Introduction: Vessel-sealing and ultrasonic coagulation systems that provide rapid and effective hemostasis are widely used in thyroid surgery. An important disadvantage of these systems is injury to the neighboring anatomical structures by thermal damage. However, data on injury to the external branch of the superior laryngeal nerve is limited. The aim of this study was to evaluate the effect of different vascular closure systems on this nerve injury in thyroidectomy. Methods: A total of 45 patients who underwent thyroidectomy for benign thyroid disease between October 2008 and February 2009 were included in the study. Patients were randomized and divided into three groups, each consisting of 15 patients. Systems used were vessel-sealer in the first group, harmonic scalpel in the second group and conventional suture ligation technique in the third group. Laryngeal electromyography findings and voice complaints were compared. Results: There were 37 female (82%) and 8 male patients. The mean age was 47.9±11.1 years. Demographic features and surgical procedures were statistically similar in all groups (p>0.05). The control electromyography of 84 nerves with preoperatively con...

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Injury of the external branch of the superior laryngeal nerve in thyroid surgery

Cited by 55 publications

References 70 publications

Comprehensive Review of Thyroid Embryology, Anatomy, Histology, and Physiology for Surgeons

Comprehensive Review of Thyroid Embryology, Anatomy, Histology, and Physiology for Surgeons

Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve

The Effect of Different Hemostatic Systems on the Injury of the External Branch of the Superior Laryngeal Nerve in Thyroidectomy

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