External laryngeal nerve in thyroid surgery: Recognition and surgical implications

Aina, E. N.; Hisham, A. N.

doi:10.1046/j.1440-1622.2001.02078.x

Cited by 81 publications

(87 citation statements)

References 9 publications

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“…It is clearly evident from the studies of Cernea et al that the ELNs are in greater danger in cases of large goiters (type 2: 69%), in comparison to those in cases of small goiters (type 2: 25%) (Cernea et al, 1992a). To support this evidence, Aina and Hisham also found that with large goiters weighing more than 100 g, approximately 92.3% were type 2 nerves, whereas in goiters weighing less than 100 g, approximately 66.6% were type 2 nerves (Aina and Hisham, 2001b). Seven et al (2003) dissected the thyroid gland and ELN in 30 fresh cadavers (18 females, 12 males; age range 20-50 years) with a normal thyroid size and no signs of abnormality in the neck, and applied the classification system propesed by Cernea et al (1992b).…”

Section: Discussionmentioning

confidence: 92%

“…The ELN is intimately associated with the STA in close relation to the superior pole of the thyroid gland, thus rendering it vulnerable to injury during ligation of this vessel during thyroid gland surgery (Chosky and Nicholson, 1996;Aina and Hisham, 2001b). It can be stretched by a retractor or transected when the superior thyroid vessels are divided (Chosky and Nicholson, 1996).…”

Section: Discussionmentioning

confidence: 99%

“…Type 2a and 2b nerves are considered to be the ''nerves at an increased risk'' of iatrogenic lesion during a thyroidectomy, owing to their low-lying course (Cernea et al, 1992a,b;Aina and Hisham, 2001b). It is clearly evident from the studies of Cernea et al that the ELNs are in greater danger in cases of large goiters (type 2: 69%), in comparison to those in cases of small goiters (type 2: 25%) (Cernea et al, 1992a).…”

Section: Discussionmentioning

confidence: 99%

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Relation of the external branch of the superior laryngeal nerve to the superior pole of the thyroid gland: An anatomical study

et al. 2007

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The external branch of the superior laryngeal nerve (ELN) is intimately associated with the superior thyroid artery (STA) in relation to the superior pole of the thyroid gland, rendering it vulnerable to injury during the ligation of this vessel during thyroidectomy. Although most texts acknowledge the fact that the nerve is in close relation to the STA, there has not been an anatomical study to relate the position of the ELN to the superior pole of the thyroid gland. The aim of this study was to determine the shortest distance, from the most superior point of the thyroid gland, to the ELN. Bilateral micro-dissection on 43 adult cadavers, excluding those with thyroid pathology and previous thyroidectomies, was undertaken. The most superior point of the superior pole of the thyroid gland was identified and the shortest distance to the ELN was measured with a digital calliper (accuracy 0.01 mm). The metric study indicated a mean distance from the ELN to the superior pole of a normal sized thyroid gland of 5.76 mm (range: 2.00-11.26) on the right, and 6.17 mm (range: 2.78-13.48) on the left. From the literature, it is clear that the ELN may even be closer to the superior pole of an enlarged thyroid gland. The recommendation to stay on the substance of the superior pole of the thyroid gland when ligating the STA remains valid, as the nerve is extremely close in relation to the superior pole of the normal thyroid gland.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Relation of the external branch of the superior laryngeal nerve to the superior pole of the thyroid gland: An anatomical study

et al. 2007

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“…The type I variant of EBSLN (which crosses STA > 1 cm above upper pole of thyroid gland) was seen in 22 (25%) patients unlike the findings of Aina et al [1] and Hwang et al [6], who reported lower prevalence of type I variant i.e 17.8% and 16.3% respectively. However, type II a variant of EBSLN (which crosses STA < 1cm above upper pole) was seen in 52 (59%) patients.…”

Section: Discussionmentioning

confidence: 54%

“…Refinement in surgical techniques, recognition of the importance of parathyroid, recurrent laryngeal nerve, external branch of superior laryngeal nerve, need to protect them result in lesser morbidity. [1] Iatrogenic injuries to EBSLN are not infrequent due to anatomical variation of relationship of this nerve with superior thyroid vessels. The reported risk of EBSLN injury in the literature varies from 0.3 to 13% [2].…”

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of external branch of superior laryngeal nerve (EBSLN) in thyroid surgery

Mustafa

Bokare

2016

Int J of Biomed & Adv Res

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Aim and objective: To study the anatomic variations of the external branch of superior laryngeal nerve & to propose a systemic approach to identification and preservation of this nerve during thyroid surgery. Methods: In the present study total 90 cases of thyroid diseases were treated with surgery, in the department of ENT at a tertiary care hospital, over a period of 2 years. Hemithyroidectomy was the most common operative procedure implemented in 63 patients (70%) among which right sided was more common (58.7%). Next common procedure performed was that of total thyroidectomy in 27 patients (30%). The position of EBSLN was classified according to the Cernea's classification. Results: A total number of 88 EBSLN were identified and majority of EBSLN were found to be type II a variant i.e. 59% followed by type I variant (25%) and type II b variant (16%). In about 18 patients, EBSLN was not identified. Conclusion: In our study the surgeons can be sensitized about EBSLN anatomic variations, anatomic variation taken into consideration to identify EBSLN during thyroid surgery. Preservation of the EBSLN maintains optimal function of the larynx.

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Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery

et al. 2008

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Injury of the external branch of the superior laryngeal nerve (EBSLN) increases the morbidity following a variety of neck procedures and can have catastrophic consequences in people who use their voice professionally. Identification and preservation of the EBSLN are thus important in thyroidectomy, parathyroidectomy, carotid endarterectomy, and anterior cervical spine procedures, where the nerve is at risk. There are large variations in the anatomical course of the EBSLN, which makes the intraoperative identification of the nerve challenging. The topographic relationship of the EBSLN to the superior thyroid artery and the upper pole of the thyroid gland are considered by many authors to be the key point for identifying the nerve during surgery of the neck. The classifications by Cernea et al. ([1992a] Head Neck 14:380-383; [1992b] Am. J. Surg. 164:634-639) and by Kierner et al. ([1998] Arch. Otolaryngol. Head Neck Surg. 124:301-303), as well as clinically important connections are discussed in detail. Along with sound anatomical knowledge, neuromonitoring is helpful in identifying the EBSLN during neck procedures. The clinical signs of EBSLN injury include hoarseness, decreased voice projection, decreased pitch range, and fatigue after extensive voice use. Videostroboscopy, electromyography, voice analysis, and electroglottography can provide crucial information on the function of the EBSLN following neck surgery.

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External laryngeal nerve in thyroid surgery: Recognition and surgical implications

Abstract: The various technical problems in preserving the ELN need to be considered. Recognition of the potential avascular space aids the exposure and preservation of ELN. As such every attempt should be made to ensure safe dissection in order to reduce morbidity related to thyroid surgery.

Cited by 81 publications

References 9 publications

Relation of the external branch of the superior laryngeal nerve to the superior pole of the thyroid gland: An anatomical study

Relation of the external branch of the superior laryngeal nerve to the superior pole of the thyroid gland: An anatomical study

Surgical anatomy of external branch of superior laryngeal nerve (EBSLN) in thyroid surgery

Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery

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