Critical structures in thyroidectomy

During a thyroidectomy, the focus is on preserving the recurrent laryngeal nerves and the parathyroid glands. Injury to them has immediate and serious consequences such as hoarseness, stridor, hypocalcemia, tetany etc. So, most surgeons concentrate on preserving them. What is often overlooked is the preservation of EBSLN (external branch of superior laryngeal nerve).

The external branch of superior laryngeal nerve is a branch of the vagus nerve that innervates the muscles of the larynx (voice box) that are responsible for controlling the pitch and volume of the voice. For example, teachers and other professionals who need to speak loudly. It also provides sensory innervation to the larynx.

The EBSLN is typically located near the superior pole of the thyroid gland, just superior to the thyroid cartilage. This needs careful dissection during the ligation of the superior pole vessels.

Here is a recent surgery picture depicting the EBSLNs, RLNs and parathyroids.

A 12 year old boy with papillary thyroid cancer with multiple nodes along the upper, middle, lower jugular regions and pre and para tracheal regions. The below picture depicts bedpost thyroidectomy and node dissection.

All surgeons should try to demonstrate this “critical view of safety” by the end of a thyroidectomy.

Contributors

Dr Karthik Chandra Vallam

Oncologists