Injury to the Superior Laryngeal Branch of the Vagus During Thyroidectomy: Lesson or Myth?

Crookes, Peter F.; Recabaren, James

doi:10.1097/00000658-200104000-00016

Cited by 30 publications

(16 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The opera singer Amelita Galla Curci is said to have sustained injury to her EBSLN during thyroidectomy, despite having had her surgery performed under local anesthesia specifically to protect her recurrent laryngeal nerves. Her marvelous voice never fully recovered and she never performed on stage again …”

Section: Methods For Diagnosis and Treatment Of The Ebsln Injurymentioning

confidence: 99%

External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement

Randolph²,

et al. 2013

View full text Add to dashboard Cite

show abstract

Section: Methods For Diagnosis and Treatment Of The Ebsln Injurymentioning

confidence: 99%

External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement

Randolph²,

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Her voice became coarse and the critics wrote that the ''amazing voice is gone forever; instead of cream velvet there is a sad quivering ghost'' (Kark et al, 1984). There is still controversy, however, as to whether her voice quality changed as a result of a possible SLN injury or progressing presbyphonia (Crookes and Recabaren, 2001;Gough, 2002).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

View full text Add to dashboard Cite

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.

show abstract

“…This event has been considered related to the lesion of this tiny motor branch (that for this reason was named after the singer) until recently, when it was clarified that Galli-Curci suffered from a physiological decline of her performances due to the normal aging process. The nerve has nevertheless maintained its name in several textbooks and papers, although the true story should be remarked, to preserve the integrity of the surgeon who performed the thyroidectomy (2, 3). …”

Section: The Superior Laryngeal Nervementioning

confidence: 99%

Neurological Complications in Thyroid Surgery: A Surgical Point of View on Laryngeal Nerves

et al. 2014

View full text Add to dashboard Cite

The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB) is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle) varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified, the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN) runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction, and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve, which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a low range.

show abstract

Injury to the Superior Laryngeal Branch of the Vagus During Thyroidectomy: Lesson or Myth?

Cited by 30 publications

References 8 publications

External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement

External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement

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

Neurological Complications in Thyroid Surgery: A Surgical Point of View on Laryngeal Nerves

Contact Info

Product

Resources

About