Retrograde Thyroidectomy for preservation of the External Branch of the Superior Laryngeal Nerve: A case series

Naraynsingh, Vijay; Cawich, Shamir; Hassranah, Dale; Maharaj, Ravi; Islam, Shariful; Singh, Yudhvir

doi:10.1016/j.ijscr.2017.04.030

Cited by 3 publications

(1 citation statement)

References 20 publications

(28 reference statements)

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“…Through this method, he demonstrated a low incidence of EBSLN injury (0.1%), which was confirmed by laryngoscopy ( 23 ). He stated that his retrograde technique provides the advantage of proper traction and capsular dissection of the upper pole, which should reduce the risk of EBSLN injury ( 24 , 25 ). Loré’s technique is clearly distinguished from CT, which is performed in the lateral-to-medial aspect.…”

Section: Discussionmentioning

confidence: 99%

Revisiting Loré’s retrograde thyroidectomy from the perspective of preserving the external branch of the superior laryngeal nerve

Huh¹,

Chang²,

Lee³

et al. 2023

Gland Surg

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Background Injury to the external branches of the superior laryngeal nerve (EBSLN) is the main reported cause of inexplicable post-thyroidectomy dysphonia (PTD) without recurrent laryngeal nerve (RLN) injury. Loré proposed a retrograde thyroidectomy (RT) technique in which the superior pole is dissected as a final step after the Berry ligament division, making this approach advantageous for protecting the EBSLN. However, evidence of this protective effect remains insufficient. We aimed to evaluate EBSLN function following RT and conventional thyroidectomy (CT) using postoperative electromyography (EMG). Methods This is a retrospective cohort study conducted at a single tertiary center. Consecutive patients who had undergone CT or RT were included. Bilateral EMG of the cricothyroid muscle was performed 2–3 months postoperatively in all patients. Patient characteristics, postoperative findings of bleeding events, drain amount, hypocalcemia, calcium replacement, RLN function, and EBSLN function were thoroughly reviewed and compared between the two surgical approaches. Abnormalities in the EMG findings were reported based on the wave configuration, and the results were graded into four categories. Results Seven hundred and thirty-one consecutive patients who underwent CT (n=341), or RT (n=390) were included, and a total of 1,179 RLNs and EBSLNs were at risk in CT (n=601) and RT (n=578). The CT and RT groups had similar clinical characteristics and surgical data. Two groups presented similar postoperative results for bleeding incidence, drain amount, and hypocalcemia. All RLNs were identified in both groups and their permanent function was preserved. EBSLN was significantly less frequently identified in the surgical field during RT than it was during CT (0.3% vs. 4.2%, respectively; P<0.001). Abnormal rates of postoperative EMG on the EBSLN were significantly lower in the RT group than in the CT group (1.7% vs. 7.8%, respectively; P<0.001), while the CT group presented with a higher grade of abnormal EMG (P<0.001). Conclusions The RT technique may be beneficial for preserving EBSLN function. Meticulous capsular dissection and appropriate traction of the upper pole facilitated by RT are crucial for decreasing the risk of EBSLN injury, which can be achieved without directly identifying the nerve.

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Section: Discussionmentioning

confidence: 99%

Revisiting Loré’s retrograde thyroidectomy from the perspective of preserving the external branch of the superior laryngeal nerve

Huh¹,

Chang²,

Lee³

et al. 2023

Gland Surg

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Endoscopic thyroidectomy versus traditional open thyroidectomy for identification of the external branch of the superior laryngeal nerve

Zhang

Lin

et al. 2020

Surg Endosc

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Variations in the course of the externalbranch of the superior laryngeal nerveand their importance in surgicalprocedures: an experimental cadaveric study

et al. 2023

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Introduction: Injury of the external branch of the superior laryngeal nerve can cause a hoarse or weak voice due to the functional loss (dysergia) of the cricothyroid muscle. Defining the anatomical variations of the external branch of the superior laryngeal nerve and estimating the frequency of it, it makes crucial for surgical interventions. Aim: To reveal the topography of the external branch in the Anatolian population, to prevent injury of it during the surgical intervention in the anterior neck region.Materials and Methods: Twenty-six bilateral hemilarynges (4 females, 22 males) were dissected. The morphometric and morphological features of the external branch were examined. The obtained results were compared statistically left and right. Results: Landmarks such as the thyroid gland and laryngeal prominence were determined for the detection of the external branch. The variations of the course of the external branch and the points of piercing the cricothyroid muscle or inferior constrictor pharyngeal muscle were evaluated. Discussion: Although safe approaches have been described for nerve protection during neck surgeries, it can expose injuries during preliminary surgery approaches as the nerve is thinner and more superficial than other branches of the vagus nerve. However, it can be detected more easily and safely during the surgical approach by knowing the defined anatomical landmarks and morphological variations of the external branch.Conclusion: The anatomical variations described can be a safe and important guide in surgical approaches to be applied in the anterior neck region.

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Retrograde Thyroidectomy for preservation of the External Branch of the Superior Laryngeal Nerve: A case series

Abstract: Retrograde thyroidectomy is recommended for large MNG where the EBSLN lies well below the upper pole; it minimizes risk to the nerve.

Cited by 3 publications

References 20 publications

Revisiting Loré’s retrograde thyroidectomy from the perspective of preserving the external branch of the superior laryngeal nerve

Revisiting Loré’s retrograde thyroidectomy from the perspective of preserving the external branch of the superior laryngeal nerve

Endoscopic thyroidectomy versus traditional open thyroidectomy for identification of the external branch of the superior laryngeal nerve

Variations in the course of the externalbranch of the superior laryngeal nerveand their importance in surgicalprocedures: an experimental cadaveric study

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