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Superior laryngeal nerve identification and preservation in thyroidectomy
Michael Friedman1, Phillip LoSavio, Hani Ibrahim
1Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St Luke's Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612-3833, USA. khender213@aol.com
Archives of Otolaryngology--Head & Neck Surgery
|March 12, 2002
Summary
Thyroid surgeons can achieve high identification rates of the external branch of the superior laryngeal nerve (EBSLN) by understanding its anatomic variations. Routine identification and preservation of the EBSLN during thyroidectomy are crucial for maintaining optimal voice function.
Area of Science:
- Otolaryngology
- Surgical Anatomy
- Thyroid Surgery
Background:
- Injury to the external branch of the superior laryngeal nerve (EBSLN) can cause significant voice changes.
- Variations in EBSLN anatomy and inconsistent identification rates discourage surgeons from routine exploration.
- Current thyroidectomy practices often avoid identifying the EBSLN, contradicting surgical preservation principles.
Purpose of the Study:
- To detail the anatomical variations of the EBSLN, especially near the cricothyroid junction.
- To propose a systematic method for identifying and preserving the EBSLN.
- To determine the nerve identification rate during thyroidectomy procedures.
Main Methods:
- A retrospective analysis of 1057 EBSLNs from 884 thyroid lobectomies and total thyroidectomies (1978-1997).
- Intraoperative EBSLN identification findings were recorded and compared annually for benign and malignant conditions.
- Results were benchmarked against a 50-year literature review of EBSLN identification rates.
Main Results:
- Three distinct anatomical variations of the distal EBSLN were identified.
- An overall EBSLN identification rate of 85.1% (900/1057) was achieved over the 20-year study period.
- Identification rates were higher for benign disease (86.1%) versus malignant disease (83.4%), with recent years showing over 90% identification.
Conclusions:
- Knowledge of EBSLN's three distal anatomical variations and its relationship with the inferior constrictor muscle facilitates high identification rates.
- The EBSLN should be routinely explored during thyroid surgery, as identification is feasible in the majority of cases.
- Preserving the EBSLN is essential for maintaining optimal laryngeal function and voice quality.