How to Preserve Laryngeal Nerve for Preventing Post-Thyroidectomy Voice Change

Ji Won Kim; Seung-Ho Choi

doi:10.11106/cet.2014.7.2.153

Journal List > J Korean Thyroid Assoc > v.7(2) > 1056558

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Kim and Choi: How to Preserve Laryngeal Nerve for Preventing Post-Thyroidectomy Voice Change

Review Article

Clin Exp Thyroidol 2014;7(2):153-158.

Published online: 7 November 2014

DOI: https://doi.org/10.11106/cet.2014.7.2.153

How to Preserve Laryngeal Nerve for Preventing Post-Thyroidectomy Voice Change

Ji Won Kim, Seung-Ho Choi

Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence: Seung-Ho Choi, MD, PhD, Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea Tel: 82-2-3010-3750, Fax: 82-2-489-2773, E-mail: shchoi@amc.seoul.kr

Received 2 May 2014 Accepted 24 June 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

After thyroid surgery, voice change occurs very frequently, in more than 30% of cases. In addition to injury to the recurrent laryngeal nerve (RLN) or the external branch of superior laryngeal nerve (EBSLN), vocal fold edema due to excessive tracheal traction or disrupted laryngeal venous drainage, and laryngotracheal fixation following injury to extralaryngeal musculature can cause post-thyroidectomy voice change. Although complete recovery can be expected mostly in 3 months, dysphonic patients should be evaluated pre and postoperatively by laryngoscopy or laryngeal stroboscopy. The present review discusses the evaluation of voice change, the anatomy of RLN and EBSLN and common cause of voice change after thyroid surgery. Furthermore, we represent how to preserve RLN, SLN including intraoperative nerve monitoring.

Keywords: Thyroidectomy, Recurrent laryngeal nerve, External branch of superior laryngeal nerve

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Fig. 1.

Relationship of recurrent laryngeal nerves (RLN) and superior laryngeal nerves (SLN) to thyroid lobe and tracheoesophageal groove. (Adapted from Randolph GW et al., 2012)

Fig. 2.

Variations of nonrecurrent recurrent laryngeal nerve. (A) Accompanying the inferior thyroid artery, and (B) passing directly to the larynx at the level of the superior pole of the thyroid gland. (Adapted from Stewart et al., 1972)

Table 1.

Surgical approach to recurrent laryngeal nerve

	Landmark	Indication
Superior approach	Point of laryngeal entry	Large cervical or substernal goiter, suspicious non
		recurrent laryngeal nerve
Lateral approach	Around the level of midpoint	Routine cases
Inferior approach	Below the Inferior pole in the TE groove	Revision case or large cervical goiter

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