Relationship Between External Branch of Superior Laryngeal Nerve Injury and Surgical Approach_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QINJian , XUXiao-bo , ZHOUZhi-yuan , HELiu ,  LIUWen-yong

Department of General Surgery, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiaotong Univercity School of Medicine, Shanghai 200011, China;

Corresponding?author：

LIUWen-yong, Email: 13564590722@163.com

Keywords：

External branch of superior laryngeal nerve injury; Open thyroidectomy; Influence factor

DOI：

10.7507/1007-9424.20160186

Video：

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Objective To explore the relationship between external branch of superior laryngeal nerve (EBSLN) injury and the approachs of surgery in open thyroidectomy, and to summarize the preventive methods. Methods The clinical data of 985 patients who had consecutively underwent open thyroidectomy from January 2009 to June 2012 were retrospectively analyzed, to explore the relationship between EBSLN injury and the approachs of surgery in open thyroidectomy. Results The overall incidence of EBSLN injury was 2.6% (26/985), and 959 patients (97.4%) didn’t suffered from EBSLN injury. Results of logistic regression showed that the extent of surgery (OR=4.536, P=0.004) and identification of the EBSLN (OR=0.126, P=0.044) were influence factors of EBSLN injury after open thyroidectomy, but age (OR=1.108, P=0.823), gender (OR=0.604, P=0.260), benign or malignant tumor (OR=1.871, P=0.186), anesthesia methods (OR=0.659, P=0.372), and the application of ultrasonic scalpel (OR=0.473, P=0.248) were not associated with EBSLN injury. Conclusion In open thyroidectomy, the extent of surgery and identification of EBSLN are the independent factors of EBSLN injury, which are important to avoid EBSLN injury.

Citation： QINJian, XUXiao-bo, ZHOUZhi-yuan, HELiu, LIUWen-yong. Relationship Between External Branch of Superior Laryngeal Nerve Injury and Surgical Approach. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 702-705. doi: 10.7507/1007-9424.20160186 Copy

1.	王深明, 黃勇. 甲狀腺手術與喉上神經損傷. 中國實用外科雜志, 2004, 24(10): 625-627.
2.	Jonas J, B?hr R. Neuromonitoring of the external branch of the superior laryngeal nerve during thyroid surgery. Am J Surg, 2000, 179(3): 234-236.
3.	孫輝, 劉曉莉. 甲狀腺手術中喉返神經和喉上神經的保護. 中國實用外科雜志, 2012, 32(5): 356-359.
4.	Erbil Y, Barbaros U, I?sever H, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol, 2007, 32(1): 32-37.
5.	張雪松, 方登華, 高瑞崗. 腔鏡甲狀腺切除術中喉上神經損傷的預防. 中國內鏡雜志, 2012, 18(12): 1336-1337.
6.	Friedman M, Losavio P, Ibrahim H. Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg, 2002, 128(3): 296-303.
7.	Monfared A, Gorti G, Kim D. Microsurgical anatomy of the laryngeal nerves as related to thyroid surgery. Laryngoscope, 2002, 112(2): 386-392.
8.	Orestes MI, Chhetri DK. Superior laryngeal nerve injury: effects, clinical findings, prognosis, and management options. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(6): 439-443.
9.	曾志成, 楊科球, 王淼, 等. 喉上神經的應用解剖. 中國臨床解剖學雜志, 1996, 14(1): 38-40.
10.	Jansson S, Tisell LE, Hagne I, et al. Partial superior laryngeal nerve (SLN) lesions before and after thyroid surgery. World J Surg, 1988, 12(4): 522-527.
11.	el-Guindy A, Abdel-Aziz M. Superior laryngeal nerve preservation in peri-apical surgery by mobilization of the viscerovertebral angle. J Laryngol Otol, 2000, 114(4): 268-273.
12.	Dener C. Complication rates after operations for benign thyroid disease. Acta Otolaryngol, 2002, 122(6): 679-683.
13.	Lennquist S, Cahlin C, Smeds S. The superior laryngeal nerve in thyroid surgery. Surgery, 1987, 102(6): 999-1008.
14.	Kark AE, Kissin MW, Auerbach R, et al. Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J (Clin Res Ed), 1984, 289(6456): 1412-1415.
15.	Aluffi P, Policarpo M, Cherovac C, et al. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol, 2001, 258(9): 451-454.
16.	Vellar ID. Thomas peel dunhill: pioneer thyroid surgeon. Aust N Z J Surg, 1999, 69(5): 375-387.
17.	Spanknebel K, Chabot JA, Digiorgi M, et al. Thyroidectomy using local anesthesia: a report of 1 025 cases over 16 years. J Am Coll Surg, 2005, 201(3): 375-385.
18.	Akhtar N, Abbas SA. Regional anaesthesia in thyroid surgery. J Coll Physicians Surg Pak, 2013, 23(12): 885-887.
19.	Arora N, Dhar P, Fahey TJ 3rd. Seminars: local and regional anesthesia for thyroid surgery. J Surg Oncol, 2006, 94(8): 708-713.
20.	Banasiewicz T, Meissner W, Pyda P, et al. Local anesthesia in thyroid surgery—own experience and literature review. Pol Przegl Chir, 2011, 83(5): 264-270.
21.	魏濤, 李志輝, 朱精強. 超聲刀與傳統方法在開放甲狀腺手術的臨床對比研究. 中國普外基礎與臨床雜志, 2008, 15(5): 323-326.
22.	Maeda S, Shimizu K, Minami S, et al. Video-assisted neck surgery for thyroid and parathyroid diseases. Biomed Pharmacother, 2002, 56 Suppl 1: 92s-95s.
23.	李小軍, 王小強, 張瑞鵬, 等. 甲狀腺術中喉返神經熱損傷的前瞻性對照研究. 中國普通外科雜志, 2013, 22(11): 1435-1440.
24.	Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Chirurg, 2003, 74(5): 437-443.
25.	Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg, 2000, 24(11): 1335-1341.
26.	Bellantone R, Boscherini M, Lombardi CP, et al. Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery, 2001, 130(6): 1055-1059.
27.	梁興忠, 張興海, 任梅, 等. 甲狀腺手術過程中喉上神經損傷原因分析. 淮海醫藥, 2015, 33(1): 73-74.
28.	金濤, 朱旬, 邢春根, 等. 喉上神經外支監測在咽下縮肌入路甲狀腺手術中的應用. 中國普通外科雜志, 2013, 22(5): 655-657.
29.	Pagedar NA, Freeman JL. Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Arch Otolaryngol Head Neck Surg, 2009, 135(4): 360-362.
30.	楊瑞民. 顯露喉上神經在甲狀腺切除術中的應用. 中國實用醫藥, 2012, 7(3): 82-83.
31.	Hurtado-Lopez LM, Pacheco-Alvarez MI, Montes-Castillo Mde L, et al. Importance of the intraoperative identification of the external branch of the superior laryngeal nerve during thyroidectomy: electromyographic evaluation. Thyroid, 2005, 15(5): 449-454.
32.	Naraynsingh V, Cawich SO, Maharaj R, et al. Retrograde thyroidectomy: a technique for visualization and preservation of the external branch of superior laryngeal nerve. Int J Surg Case Rep, 2014, 5(3): 122-125.
33.	Darr EA, Tufano RP, Ozdemir S, et al. Superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries. Laryngoscope, 2014, 124(4): 1035-1041.
34.	Glover AR, Norlén O, Gundara JS, et al. Use of the nerve integrity monitor during thyroid surgery aids identification of the external branch of the superior laryngeal nerve. Ann Surg Oncol, 2015, 22(6): 1768-1773.
35.	Kandil E, Mohamed SE, Deniwar A, et al. Electrophysiologic identification and monitoring of the external branch of superior laryngeal nerve during thyroidectomy. Laryngoscope, 2015, 125(8): 1996- 2000.
36.	Barczyński M, Konturek A, Stopa M, et al. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg, 2012, 36(6): 1340-1347.

1. 王深明, 黃勇. 甲狀腺手術與喉上神經損傷. 中國實用外科雜志, 2004, 24(10): 625-627.
2. Jonas J, B?hr R. Neuromonitoring of the external branch of the superior laryngeal nerve during thyroid surgery. Am J Surg, 2000, 179(3): 234-236.
3. 孫輝, 劉曉莉. 甲狀腺手術中喉返神經和喉上神經的保護. 中國實用外科雜志, 2012, 32(5): 356-359.
4. Erbil Y, Barbaros U, I?sever H, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol, 2007, 32(1): 32-37.
5. 張雪松, 方登華, 高瑞崗. 腔鏡甲狀腺切除術中喉上神經損傷的預防. 中國內鏡雜志, 2012, 18(12): 1336-1337.
6. Friedman M, Losavio P, Ibrahim H. Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg, 2002, 128(3): 296-303.
7. Monfared A, Gorti G, Kim D. Microsurgical anatomy of the laryngeal nerves as related to thyroid surgery. Laryngoscope, 2002, 112(2): 386-392.
8. Orestes MI, Chhetri DK. Superior laryngeal nerve injury: effects, clinical findings, prognosis, and management options. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(6): 439-443.
9. 曾志成, 楊科球, 王淼, 等. 喉上神經的應用解剖. 中國臨床解剖學雜志, 1996, 14(1): 38-40.
10. Jansson S, Tisell LE, Hagne I, et al. Partial superior laryngeal nerve (SLN) lesions before and after thyroid surgery. World J Surg, 1988, 12(4): 522-527.
11. el-Guindy A, Abdel-Aziz M. Superior laryngeal nerve preservation in peri-apical surgery by mobilization of the viscerovertebral angle. J Laryngol Otol, 2000, 114(4): 268-273.
12. Dener C. Complication rates after operations for benign thyroid disease. Acta Otolaryngol, 2002, 122(6): 679-683.
13. Lennquist S, Cahlin C, Smeds S. The superior laryngeal nerve in thyroid surgery. Surgery, 1987, 102(6): 999-1008.
14. Kark AE, Kissin MW, Auerbach R, et al. Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J (Clin Res Ed), 1984, 289(6456): 1412-1415.
15. Aluffi P, Policarpo M, Cherovac C, et al. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol, 2001, 258(9): 451-454.
16. Vellar ID. Thomas peel dunhill: pioneer thyroid surgeon. Aust N Z J Surg, 1999, 69(5): 375-387.
17. Spanknebel K, Chabot JA, Digiorgi M, et al. Thyroidectomy using local anesthesia: a report of 1 025 cases over 16 years. J Am Coll Surg, 2005, 201(3): 375-385.
18. Akhtar N, Abbas SA. Regional anaesthesia in thyroid surgery. J Coll Physicians Surg Pak, 2013, 23(12): 885-887.
19. Arora N, Dhar P, Fahey TJ 3rd. Seminars: local and regional anesthesia for thyroid surgery. J Surg Oncol, 2006, 94(8): 708-713.
20. Banasiewicz T, Meissner W, Pyda P, et al. Local anesthesia in thyroid surgery—own experience and literature review. Pol Przegl Chir, 2011, 83(5): 264-270.
21. 魏濤, 李志輝, 朱精強. 超聲刀與傳統方法在開放甲狀腺手術的臨床對比研究. 中國普外基礎與臨床雜志, 2008, 15(5): 323-326.
22. Maeda S, Shimizu K, Minami S, et al. Video-assisted neck surgery for thyroid and parathyroid diseases. Biomed Pharmacother, 2002, 56 Suppl 1: 92s-95s.
23. 李小軍, 王小強, 張瑞鵬, 等. 甲狀腺術中喉返神經熱損傷的前瞻性對照研究. 中國普通外科雜志, 2013, 22(11): 1435-1440.
24. Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Chirurg, 2003, 74(5): 437-443.
25. Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg, 2000, 24(11): 1335-1341.
26. Bellantone R, Boscherini M, Lombardi CP, et al. Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery, 2001, 130(6): 1055-1059.
27. 梁興忠, 張興海, 任梅, 等. 甲狀腺手術過程中喉上神經損傷原因分析. 淮海醫藥, 2015, 33(1): 73-74.
28. 金濤, 朱旬, 邢春根, 等. 喉上神經外支監測在咽下縮肌入路甲狀腺手術中的應用. 中國普通外科雜志, 2013, 22(5): 655-657.
29. Pagedar NA, Freeman JL. Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Arch Otolaryngol Head Neck Surg, 2009, 135(4): 360-362.
30. 楊瑞民. 顯露喉上神經在甲狀腺切除術中的應用. 中國實用醫藥, 2012, 7(3): 82-83.
31. Hurtado-Lopez LM, Pacheco-Alvarez MI, Montes-Castillo Mde L, et al. Importance of the intraoperative identification of the external branch of the superior laryngeal nerve during thyroidectomy: electromyographic evaluation. Thyroid, 2005, 15(5): 449-454.
32. Naraynsingh V, Cawich SO, Maharaj R, et al. Retrograde thyroidectomy: a technique for visualization and preservation of the external branch of superior laryngeal nerve. Int J Surg Case Rep, 2014, 5(3): 122-125.
33. Darr EA, Tufano RP, Ozdemir S, et al. Superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries. Laryngoscope, 2014, 124(4): 1035-1041.
34. Glover AR, Norlén O, Gundara JS, et al. Use of the nerve integrity monitor during thyroid surgery aids identification of the external branch of the superior laryngeal nerve. Ann Surg Oncol, 2015, 22(6): 1768-1773.
35. Kandil E, Mohamed SE, Deniwar A, et al. Electrophysiologic identification and monitoring of the external branch of superior laryngeal nerve during thyroidectomy. Laryngoscope, 2015, 125(8): 1996- 2000.
36. Barczyński M, Konturek A, Stopa M, et al. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg, 2012, 36(6): 1340-1347.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Relationship Between External Branch of Superior Laryngeal Nerve Injury and Surgical Approach

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