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Related Experiment Videos

The superior laryngeal nerve in thyroid surgery.

S Lennquist1, C Cahlin, S Smeds

  • 1Department of Surgery, University Hospital, Linköping, Sweden.

Surgery
|December 1, 1987
PubMed
Summary

Thyroid surgery risks external branch of the superior laryngeal nerve (ESLN) injury. Careful perioperative identification of ESLN, avoiding intramuscular dissection, is crucial for preserving nerve function and preventing complications.

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Area of Science:

  • Otolaryngology
  • Surgical Anatomy
  • Endocrinology

Background:

  • Injury to the external branch of the superior laryngeal nerve (ESLN) during thyroid surgery can lead to significant vocal dysfunction.
  • Anatomic variations in ESLN course necessitate refined surgical strategies for its preservation.

Purpose of the Study:

  • To clinically evaluate a strategy for perioperative identification and preservation of the ESLN during thyroid surgery.
  • To assess the vulnerability of the ESLN during surgical division of superior thyroid vessels.

Main Methods:

  • Postmortem anatomic observations were used to inform a clinical evaluation strategy.
  • Perioperative identification and dissection techniques were employed in a clinical series of thyroidectomies.
  • Assessment of ESLN course relative to the superior thyroid artery and pharyngeal constrictor muscle.

Main Results:

  • 72% of ESLNs were identifiable without intramuscular dissection.
  • 19% of identifiable ESLNs (14% of total) coursed partly lateral to the superior thyroid artery, posing a risk during vessel division.
  • Only one patient experienced signs of ESLN injury, likely due to diathermy to an adjacent vessel.

Conclusions:

  • Perioperative identification of ESLN is feasible and important for preventing injury.
  • Intramuscular dissection into the pharyngeal constrictor muscle for ESLN identification is generally inadvisable.
  • ESLNs with specific courses are highly vulnerable during superior thyroid artery division, highlighting the need for meticulous surgical technique.

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