Identification of the external branch of the superior laryngeal nerve during thyroidectomy

Cernea, Cláudio Roberto; Ferraz, Alberto Rossetti; Furlani, José; Monteiro, Sonia; Nishio, Sunao; Hojaij, Flávio; Dutra, Augusto; Marques, Lourdes A.; Pontes, Paulo; Bevilacqua, Ruy Geraldo

doi:10.1016/s0002-9610(05)80723-8

Cited by 174 publications

(157 citation statements)

References 11 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).…”

Section: Discussionmentioning

confidence: 96%

“…Various methods have been described to avoid injury to the ELN. To ensure safety of the ELN, the technique of individual ligation of the superior thyroid vessels close to the medial border of the superior pole, without identifying the nerve was proposed, and even then studies revealed that the risk of injury exceeds 10% (Lekacos et al, 1987;Cernea et al, 1992a). Hurtado-Lopez et al (2005) demonstrated the importance of intraoperative identification of the ELN during thyroidectomies when the showed that the rate of ELN injury increases when not exploring and identifying the nerve expressly.…”

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: 96%

Section: Discussionmentioning

confidence: 99%

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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“…Different identification rates of the EBSLN have been quoted by authors with few not performing routine identifications [13]. The techniques used for the identification of the EBSLN mentioned in literature include the use of nerve stimulator, the inspection of the distal part of the inferior constrictor muscle and individual ligation of the superior thyroid vessels [7,[14][15][16][17] The principle of any surgery is the identification of any structure in order to preserve it. This applies to identification of the EBSLN as well.…”

Section: Discussionmentioning

confidence: 99%

“…The Friedman classification system describes three anatomic variants of the nerve [4] which have been studied by cadaveric dissection [5]. The other classification systems for the EBSLN are the Cernea classification and the Kierner classification [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Identification of External Branch of the Superior Laryngeal Nerve in Thyroid Surgery: Is it Always Possible?

Nilakantan¹

2013

Thyroid Disorders Ther

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“…22,23 A study of patients who underwent BABA RT combined with ligation of the superior thyroid poles after intraoperative monitoring confirmed the location of the EBSLN found that the phonation-efficient index was significantly lower 1 month after surgery than before treatment. 24 EBSLN were identified in 73% through neuromonitoring.…”

Section: Expansion Of Applications Of Oncoplastic Thyroid Surgerymentioning

confidence: 98%

Oncoplastic Thyroid Surgery Using A Bilateral Axillo-Breast Approach

Seong

Chai

et al. 2017

J Minim Invasive Surg

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Since the first use of the robot da Vinci system for thyroid surgery in 2007, robotic thyroidectomy (RT) via a bilateral axillo-breast approach (BABA) has become a popular surgical alternative for patients who wish to avoid scars on the neck. BABA RT provides excellent cosmetic satisfaction with surgical safety and oncologic completeness. Recently, the use of BABA RT has expanded beyond benign thyroid nodules and small-sized papillary thyroid carcinoma (PTC) to Graves' disease, relatively large PTCs, and PTC with lateral neck metastasis. Unfortunately, there are concerns about the use of this procedure for these additional indications. This review article summarizes postoperative outcomes of BABA RT for thyroid carcinoma, including quality of life, as well as expanding indications for BABA RT.

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Identification of the external branch of the superior laryngeal nerve during thyroidectomy

Cited by 174 publications

References 11 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

Identification of External Branch of the Superior Laryngeal Nerve in Thyroid Surgery: Is it Always Possible?

Oncoplastic Thyroid Surgery Using A Bilateral Axillo-Breast Approach

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