Surgical anatomy of the external branch of the superior laryngeal nerve: a systematic review and meta-analysis

Cheruiyot, Isaac; Kipkorir, Vincent; Henry, Brandon Michael; Munguti, Jeremiah; Cirocchi, Roberto; Odula, Paul; Wong, L. T. K.; Olabu, Beda; Walocha, Jerzy

doi:10.1007/s00423-018-1723-9

Cited by 33 publications

(20 citation statements)

References 65 publications

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“…The ISL was identified as extending medially and ventrally, following the upper level of the thyroid cartilage, running parallel to the laryngeal artery. The ESL was identified as running parallel to the esophagus and terminating in the cricothyroid muscles (Bacchi, Miani, and Piemonte 1990;Cernea et al 1992;Cheruiyot et al 2018;Kierner, Aigner, and Burian 1998;Knight, McDonald, and Birchall 2005;Kochilas et al 2008;Orestes and Chhetri 2014;Ozlugedik et al 2007). The trunk of the vagus nerve was then exposed caudally from the nodose to the recurrent bifurcation by following the carotid artery and identifying the recurrent laryngeal (RL) nerve as passing under the aortic arch (left side) or subclavian artery (right side).…”

Section: Microdissection Methodsmentioning

confidence: 99%

Functional Vagotopy in the Cervical Vagus Nerve of the Domestic Pig: Implications for the Study of Vagus Nerve Stimulation

Settell

Knudsen

Dingle

et al. 2019

Preprint

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Given current clinical interest in vagus nerve stimulation, there are surprisingly few studies characterizing the anatomy of the vagus nerve in large animal models as it pertains to on-and off-target engagement of local fibers. We sought to address this gap by evaluating vagal anatomy in the domestic pig, whose vagus nerve organization and size approximates the human cervical vagus nerve. We provide data on key features across the cervical vagus nerve including diameter, number and diameter of fascicles, and distance of fascicles from the epineural surface where stimulating electrodes are placed. We also characterized the relative locations of the superior and recurrent laryngeal branches of the vagus nerve that have been implicated in therapy limiting side effects with common electrode placement. We identified key variants across the cohort that may be important for vagus nerve stimulation with respect to changing sympathetic/parasympathetic tone, such as cross-connections to the sympathetic trunk. We discovered that cell bodies of pseudo-unipolar cells aggregate together to form a very distinct grouping within the nodose ganglion. This distinct grouping gives rise to a larger number of smaller fascicles as one moves caudally down the cervical vagus nerve. This often leads to a distinct bimodal organization, or ‘vagotopy’ that may be advantageous to exploit in design of electrodes/stimulation paradigms. Finally, we placed our data in context of historic and recent histology spanning mouse, rat, canine, pig, non-human primate and human models, thus providing a comprehensive resource to understand similarities and differences across species.

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Section: Microdissection Methodsmentioning

confidence: 99%

Functional Vagotopy in the Cervical Vagus Nerve of the Domestic Pig: Implications for the Study of Vagus Nerve Stimulation

Settell

Knudsen

Dingle

et al. 2019

Preprint

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“…This is supported by the fact that the reported identification rates of the EBSLN using these landmarks are much less in clinical studies compared to cadaveric ones. 21 …”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, though many previous studies reported similar outcomes to ours with respect to Cernea's classification, some others have identified type 1 arrangement to be more frequent than type 2. 16 , 17 , 20 , 21 , 22 , 28 , 30 , 31 This disparity is not surprising as the relationship of the distal EBSLN and STA depends on many factors, including the race, ethnicity, and neck length of an individual. This relationship also varies quite often as per the size and weight of the thyroid gland itself.…”

Section: Discussionmentioning

confidence: 99%

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Unmapped landmarks around branches of the Superior Laryngeal Nerve: An exploratory cadaveric study

Devaraja

Punja

Kalthur

et al. 2021

Journal of Taibah University Medical Sciences

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Objectives Preserving the External Branch of Superior Laryngeal Nerve (EBSLN) and Internal Branch of Superior Laryngeal Nerve (IBSLN) is essential during thyroidectomy. However, due to potential distortions caused by large goitres, the present anatomical landmarks used to identify these nerves are flawed. Although under such circumstances, bony landmarks may offer more stable reference points, not much has been explored in this regard. This study measures the distance between the most vulnerable points of the EBSLN and IBSLN and their relatively unexplored bony landmarks, such as the hyoid bone and thyroid notch as well as soft-tissue landmarks like the origin of the Superior Thyroid Artery (STA) and carotid bifurcation. Methods An exploratory cadaveric study was conducted in a medical school affiliated with a tertiary care hospital. The detailed analysis included 13 sides from 8 cadavers. Results The average distance from the EBSLN piercing site to the greater cornua of the hyoid bone, thyroid cartilage prominence, origin of the STA, and carotid bifurcation was 35.1(±7.2) mm, 33.3(±3.8) mm, 25.7(±6.3) mm, and 31.5(±5.0) mm, respectively and from the IBSLN piercing site was 15.9(±5.9) mm, 32.9(±4.7) mm, 16.3(±4.2) mm, and 20.7(±5.9) mm, respectively. For most cadavers, the distal EBSLN had Cernea type 2a-like relationship with the STA. Certain variations were also observed in the way these nerves branched with respect to the origin of the STA. Conclusions This study provides metric information (linear measurements) regarding the distance between the branches of SLN and certain unique landmarks. This could potentially aid in minimising intraoperative trauma to these branches.

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“…Reportedly, the incidence of injury to EBSLN is as high as 58% ( 41), which might be related to various underlying criteria (42). The anatomical correlation between EBSLN and blood vessels of the superior thyroid pole (Cernea classification) can be categorized into three types: (I) the EBSLN crosses the superior thyroidal vessels at least 1 cm above a plane horizontal to the upper edge of the superior thyroid pole (type I); (II) the distance is <1 cm and is not below the plane (type II a); (III) the EBSLN is below the plane (type II b) (43). During handling of the superior pole vessels, type I poses the lowest risk of injury, while type II b poses the highest risk of injury.…”

Section: Ebsln Injurymentioning

confidence: 99%

Narrative review of management of thyroid surgery complications

Jin¹,

Sugitani²

2021

Gland Surg

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Currently, thyroid surgery is the most common and safe operation worldwide. However, thyroidectomy is still not free from the risks of complications and death due to the anatomical structure and physiological function particularity of the thyroid gland. Postoperative complications affect the life quality and life safety of patients after surgery. The common complications include hypoparathyroidism (HP), recurrent laryngeal nerve (RLN) injury, injury to the external branch of the superior laryngeal nerve (EBSLN), postoperative bleeding (PB), thoracic duct injury, laryngeal edema, tracheospasm, tracheal injury, and esophageal injury. A severe complication, such as dyspnea, asphyxia, or thyroid crisis, might cause the death of the patient. Therefore, every thyroid surgeon's responsibility is to remain alert and aware of the occurrence of various intraoperative and postoperative complications and exercise effective prevention and treatment. This is closely related to the advancement in thyroid disease research, the increase in local anatomy knowledge, the standardization of surgical approaches, the improvement in operating skills, the application of new technologies, and the emphasis on specialty training. In addition, many complications that effect patients are much better tolerated if the patient has appropriate expectations of what the complications are and how to treat them. Open communication between surgeon and patient optimizes the potential negative effects that complications may have on patients' quality of life. This paper discusses the prevention, recognition and therapy of intraoperative and postoperative complications in thyroid surgery.

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Surgical anatomy of the external branch of the superior laryngeal nerve: a systematic review and meta-analysis

Cited by 33 publications

References 65 publications

Functional Vagotopy in the Cervical Vagus Nerve of the Domestic Pig: Implications for the Study of Vagus Nerve Stimulation

Functional Vagotopy in the Cervical Vagus Nerve of the Domestic Pig: Implications for the Study of Vagus Nerve Stimulation

Unmapped landmarks around branches of the Superior Laryngeal Nerve: An exploratory cadaveric study

Narrative review of management of thyroid surgery complications

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