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, 黄勇. 甲状腺手术与喉上神经损伤. 中国实用外科杂志, 2004, 24(10): 625-627.
2.	Jonas J, Bähr R. Neuromonitoring of the external branch of the superior laryngeal nerve during thyroid surgery. Am J Surg, 2000, 179(3): 234-236.
3.	孙辉, 刘晓莉. 甲状腺手术中喉返神经和喉上神经的保护. 中国实用外科杂志, 2012, 32(5): 356-359.
4.	Erbil Y, Barbaros U, IŞsever H, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol, 2007, 32(1): 32-37.
5.	张雪松, 方登华, 高瑞岗. 腔镜甲状腺切除术中喉上神经损伤的预防. 中国内镜杂志, 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, 杨科球, 王淼, 等. 喉上神经的应用解剖. 中国临床解剖学杂志, 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.	魏涛, 李志辉, 朱精强. 超声刀与传统方法在开放甲状腺手术的临床对比研究. 中国普外基础与临床杂志, 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.	李小军, 王小强, 张瑞鹏, 等. 甲状腺术中喉返神经热损伤的前瞻性对照研究. 中国普通外科杂志, 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.	梁兴忠, 张兴海, 任梅, 等. 甲状腺手术过程中喉上神经损伤原因分析. 淮海医药, 2015, 33(1): 73-74.
28.	金涛, 朱旬, 邢春根, 等. 喉上神经外支监测在咽下缩肌入路甲状腺手术中的应用. 中国普通外科杂志, 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.	杨瑞民. 显露喉上神经在甲状腺切除术中的应用. 中国实用医药, 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, 黄勇. 甲状腺手术与喉上神经损伤. 中国实用外科杂志, 2004, 24(10): 625-627.
2. Jonas J, Bähr R. Neuromonitoring of the external branch of the superior laryngeal nerve during thyroid surgery. Am J Surg, 2000, 179(3): 234-236.
3. 孙辉, 刘晓莉. 甲状腺手术中喉返神经和喉上神经的保护. 中国实用外科杂志, 2012, 32(5): 356-359.
4. Erbil Y, Barbaros U, IŞsever H, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol, 2007, 32(1): 32-37.
5. 张雪松, 方登华, 高瑞岗. 腔镜甲状腺切除术中喉上神经损伤的预防. 中国内镜杂志, 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, 杨科球, 王淼, 等. 喉上神经的应用解剖. 中国临床解剖学杂志, 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. 魏涛, 李志辉, 朱精强. 超声刀与传统方法在开放甲状腺手术的临床对比研究. 中国普外基础与临床杂志, 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. 李小军, 王小强, 张瑞鹏, 等. 甲状腺术中喉返神经热损伤的前瞻性对照研究. 中国普通外科杂志, 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. 梁兴忠, 张兴海, 任梅, 等. 甲状腺手术过程中喉上神经损伤原因分析. 淮海医药, 2015, 33(1): 73-74.
28. 金涛, 朱旬, 邢春根, 等. 喉上神经外支监测在咽下缩肌入路甲状腺手术中的应用. 中国普通外科杂志, 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. 杨瑞民. 显露喉上神经在甲状腺切除术中的应用. 中国实用医药, 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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