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

Aygün, Nurcihan; Demircioglu, Mahmut Kaan; Demircioglu, Zeynep Gul; Akgün, İsmail; İşgör, Adnan; Uludağ, Mehmet

doi:10.14744/semb.2020.27448

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…[ 19 ] Especially in large goiters, the risk of EBSLN crossing the upper pole vessels from the more inferior level (Cernea type 2B) increases. [ 21 ] In addition, identification of EBSLN is more difficult than visual identification of RLN due to its relationship with inferior pharyngeal constrictor muscle and its thinner structure. It is not uncommon for this structure not to be an EBSLN unless the fibrillar structure that is visually assessed as an EBSLN is confirmed by IONM.…”

Section: Dissection Of Upper Pole and Ionm Of Ebslnmentioning

confidence: 99%

Surgical treatment of substernal goiter part 2: cervical and extracervical approaches, complications

Uludağ¹

2022

Sisli Etfal

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The most appropriate treatment of substernal goiter (SG) is surgery. These patients should be evaluated carefully and multidisciplinary in pre-operative period and surgical management should be planned preoperatively. Although most of the SGs can be resected by the cervical approach, an extracervical approach may be required in a small proportion of patients. Surgical complications of SG related to thyroidectomy are higher than other thyroidectomies. In addition to the complications related to thyroidectomy, complications related to the type of surgical intervention may also occur in SG. The patients who may be needed extracervical approaches should be consulted with thorax surgeons, cardiovascular surgeons, and anesthesiologists preoperatively; the surgical management should be planned together. In this part, we aimed to evaluate the cervical approach methods, extracervical approach methods, technical details, and complications in detail.

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Section: Dissection Of Upper Pole and Ionm Of Ebslnmentioning

confidence: 99%

Surgical treatment of substernal goiter part 2: cervical and extracervical approaches, complications

Uludağ¹

2022

Sisli Etfal

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“…Practically, during the upper pole dissection, approximately 75% of EBSLNs are close to upper pole <1 cm (Cernea type 2a+2b) and under potential risk of injury. [ 39 , 78 , 80 ]…”

Section: Monitorization Of External Branch Of the Superior Laryngeal Nervementioning

confidence: 99%

Anatomical, functional and dynamic evidences obtained by intraoperative neuromonitoring improving the standards of thyroidectomy

et al. 2021

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The use of intraoperative neuromonitoring (IONM) is getting more common in thyroidectomy. The data obtained by the usage of IONM regarding the laryngeal nerves’ anatomy and function have provided important contributions for improving the standards of the thyroidectomy. These evidences obtained through IONM increase the rate of detection and visual identification of recurrent laryngeal nerve (RLN) as well as the detection rate of extralaryngeal branches which are the most common anatomic variations of RLN. IONM helps early identification and preservation of the non-recurrent laryngeal nerve. Crucial knowledge has been acquired regarding the complex innervation pattern of the larynx. Extralaryngeal branches of the RLN may contribute to the motor innervation of the cricothyroid muscle (CTM). Anterior branch of the extralaryngeal branching RLN has always motor function and gives motor branches both to the abductor and adductor muscles. In addition, up to 18% of posterior branches may have adductor and/or abductor motor fibers. In 70–80% of cases, external branch of superior laryngeal nerve (EBSLN) provides motor innervation to the anterior 1/3 of the thyroarytenoid muscle which is the main adductor of the vocal cord through the human communicating nerve. Furthermore, approximately 1/3 of the cases, EBSLN may contribute to the innervation of posterior cricoarytenoid muscle which is the main abductor of ipsilateral vocal cord. RLN and/or EBSLN together with pharyngeal plexus usually contribute to the motor innervation of cricopharyngeal muscle that is the main component of upper esophageal sphincter. Traction trauma is the most common reason of RLN injuries and constitutes of 67–93% of cases. More than 50% of EBSLN injuries are caused by nerve transection. A specific point of injury on RLN can be detected in Type 1 (segmental) injury, however, Type 2 (global) injury is the loss of signal (LOS) throughout ipsilateral vagus-RLN axis and there is no electrophysiologically detectable point of injury. Vocal cord paralysis (VCP) develops in 70–80% of cases when LOS persists or incomplete recovery of signal occurs after waiting for 20 min. In case of complete recovery of signal, VCP is not expected. VCP is temporary in patients with incomplete recovery of signal and permanent VCP is not anticipated. Visual changes may be seen in only 15% of RLN injuries, on the other hand, IONM detects 100% of RLN injuries. IONM can prevent bilateral VCP. Continuous IONM (C-IONM) is a method in which functional integrity of vagus-RLN axis is evaluated in real time and C-IONM is superior to intermittent IONM (I-IONM). During upper pole dissection, IONM makes significant contributions to the visual and functional identification of EBSLN. Routine use of IONM may minimalize the risk of nerve injury. Reduction of amplitude more than 50% on CTM is related with poor voice outcome.

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

Cited by 2 publications

References 22 publications

Surgical treatment of substernal goiter part 2: cervical and extracervical approaches, complications

Surgical treatment of substernal goiter part 2: cervical and extracervical approaches, complications

Anatomical, functional and dynamic evidences obtained by intraoperative neuromonitoring improving the standards of thyroidectomy

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