Precautions to avoid injuring the superior laryngeal nerve [SLN] and its external and internal branches during thyroidectomy

ABSTRACT

The aim of this study is to find out the best operative measures and precautions to be undertaken to avoid injury and to safeguard the superior laryngeal nerve and its branches particularly its external laryngeal branch which is near and intimate to vascular pedicle of the superior pole of the thyroid gland during the operation of Thyroidectomy. This is in order to minimize the incidence of the serious disabilities associated with their injury particularly those of voice changes after Thyroidectomy. 30 patients with definite indications for Thyroidectomy were included into this study. From the operative findings of this series, it has been found that [the best operative precautions to be taken in consideration are either to identify the external laryngeal nerve which is most desirable but not always easy and sometimes time consuming or to dissect carefully the individual branches and tributaries of the distal 1.5cm to 2 cm of the superior thyroid pedicle and to tie and divide them right on the surface of the upper pole, and to avoid altogether the traditional method of mass clamping and ligation whether high or low of the superior thyroid pedicle during thyroidectomy since according to the operative findings in this study mass ligature is not without danger to the external laryngeal nerve, and to the superior laryngeal nerve if high ligature is adopted]. Lekacos et al 1987 [20] reported three cases of superior laryngeal nerve injury after 54 classical high ligations of the superior thyroid artery [STA]