Correlation between the cernea classification of external branch of superior laryngeal nerve in relation to the ultrasound-based volume of thyroid gland

Ramachandran, Riju; Murali, Sreedutt; Nair, C. Gopalakrishnan; Babu, Merin; Jacob, Pradeep

doi:10.4103/ijem.ijem_230_17

Cited by 11 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…The EBSLN comes into play at frequencies above 150 Hz, thus it is particularly involved in producing the high tones. This can be predominantly significant for individuals using their voice professionally[ 13 ]. In case of thyroidectomy STA must be ligated and is highly essential to ensure proper hemostasis[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…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 ]. One of the earlies reported case goes back to 1935 when the famous opera singer Amelita Galli- Curci suffered from damage to the EBSLN after thyroid surgery.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…In the studies conducted by Ravikuvar et al,[ 20 ] a significant relationship between the incidence of Cernea type 2b and goiter with a volume greater than 50 cc (Odd ratio: 438.5 (95% CI: 194.63-988.28) and the presence of hyperthyroidism (Odd ratio: 6.425 (95% CI: 2.835-14.562)) was detected, while there was no significant relationship concerning age and sex. 180 of 912 thyroid lobes evaluated in this study were larger than 50 cc in volume (19.7%) and 82.2% of large lobes were toxic.…”

Section: Discussionmentioning

confidence: 93%

Factors influencing the relationship of the external branch of the superior laryngeal nerve with the superior pole vessels of the thyroid gland

Aygün

Demircioglu

et al. 2020

Sisli Etfal

View full text Add to dashboard Cite

Objectives: In a thyroidectomy, the external branch of the superior laryngeal nerve (EBSLN) is a potential risk during the superior pole dissection due to its close anatomical relationship with the superior thyroid artery and its highly variable anatomy. In this study, we aimed to evaluate the relationship of EBSLN with the superior pole considering Cernea classification and the factors affecting this relationship. Methods: The data of thyroidectomized 126 patients (95 female, 31 male) with 200 neck sides (mean age of 45.6±12.1 years) using intraoperative neuromonitoring (IONM) for the EBSLN exploration were evaluated retrospectively. During the superior pole dissection, the EBSLN course was classified according to Cernea classification after being confirmed with IONM. It was defined as a large goiter in the case of the thyroid lobe volume being >50 cc. The factors influencing the presence of type 2b, which has the highest risk of injury, were evaluated using logistic regression analysis. Results: Of the 200 EBSLNs evaluated, 52 (26%) were type 1, 134 (68%) were type 2a, and 14 (7%) were type 2b. The mean volumes of the resected thyroid lobes were 22±25 cc (min-max: 2-136), 23±20 cc (3-163), and 39±24 cc (3-65) in type 1, 2a and 2b, respectively, which was significantly higher in type 2b (p=0.035). Presence of large goiter rates were 5.8% (n=3), 8.2% (n=11), 64.3% (n=9) in type 1, 2a, and 2b, respectively, and was significantly higher in type 2b (p=0.0001). There was no significant difference between EBSLN Cernea types concerning age, sex, nerve side, presence of cancer and hyperthyroidism. In logistic regression analysis, large goiter was the only independent factor associated with Cernea type 2b. In case of a lobe volume greater than 50 cc, the probability of type 2b presence was approximately 25 times higher (p<0.001, odds ratio: 25.262). Conclusion: Type 2b course of EBSLN is more common in large goiters, and it is 25 times more likely to be seen in the presence of a lobe volume over 50 cc. Thus, it should be considered that the probability of this high-risk course is significantly higher in large goiters.

show abstract

Correlation between the cernea classification of external branch of superior laryngeal nerve in relation to the ultrasound-based volume of thyroid gland

Cited by 11 publications

References 20 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

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

Factors influencing the relationship of the external branch of the superior laryngeal nerve with the superior pole vessels of the thyroid gland

Contact Info

Product

Resources

About