External laryngeal nerve to identify or not during thyroidectomy: a single-institute experience

Abstract

Background Iatrogenic injury to the external branch of the superior laryngeal nerve (ESLN) may occur during thyroidectomy because of its close proximity to the upper pole of the thyroid gland. Injury to the ESLN results in postoperative voice changes, which may be severe, especially in professional voice users. Although the main principle in neck surgery is proper dissection and identification rather than avoidance of important structures for their preservation, many surgeons do not routinely identify the ESLN during thyroidectomy because the nerve has variable anatomical courses. This encouraged us to conduct this study to evaluate the incidence of ESLN injury during thyroidectomy when superior thyroid vessels were ligated individually close to thyroid capsule without prior identification of the nerve. Patients and methods The present study included 200 patients with goiters who underwent either total or hemithyroidectomy at the Department of Surgery, Medical Research Institute Hospital, Alexandria University. In all patients, superior thyroid vessels were ligated in branches very close to thyroid capsule without prior positive search for the ESLN. Results In the present study, 185 (92.5%) patients underwent total thyroidectomy, whereas the remaining 15 (7.5%) patients underwent hemithyroidectomy. Transient ESLN injury occurred in 3% of patients, whereas 2% suffered from permanent nerve injury. Conclusion Preservation of the ESLN is necessary during thyroidectomy, especially in professional voice users. Ligation of superior thyroid vessels in branches close to thyroid capsule without prior identification of the ESLN is a safe procedure and does not increase the incidence of nerve injury.