Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Jun;36(6):1340-7.
doi: 10.1007/s00268-012-1547-7.

Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy

Marcin Barczyński  1 , Aleksander Konturek, Małgorzata Stopa, Agnieszka Honowska, Wojciech Nowak
Affiliations
Randomized Controlled Trial

Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy

Marcin Barczyński et al. World J Surg. 2012 Jun.

Abstract

Background: Injury to the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy results in a lowered fundamental frequency of the voice and deteriorated voice performance in producing high-frequency sounds. It remains unclear if the use of intraoperative nerve monitoring (IONM) can improve the clinical outcome of thyroidectomy in terms of preserved individual voice performance. This study was designed to test that hypothesis.

Methods: A total of 210 consenting female patients planned for total thyroidectomy were randomly assigned to two groups equal in size (n = 105): visual inspection of the EBSLN and RLN vs. this plus additional EBSLN and RLN monitoring. The primary outcome was the identification rate of the EBSLN. The secondary outcomes included: anatomical variability of the EBSLN according to the Cernea classification and changes in postoperative voice performance. Voice assessment included pre- and postoperative videostrobolaryngoscopy and an analysis of maximum phonation time (MPT), voice level (VL), fundamental frequency (Fo), and voice quality rating on the GRBAS scale.

Results: The following differences were found for operations without vs. with IONM: identification rate of the EBSLN was 34.3 % vs. 83.8 % (p < 0.001), whereas a 10 % or higher decrease in phonation parameters was found in 10 % vs. 2 % patients for MPT (p = 0.018), 13 % vs. 2 % for VL (p = 0.003), and 9 % vs. 1 % for Fo (p = 0.03), a change in the GRBAS scale > 4 points in 7 % vs. 1 % (p = 0.03), and temporary RLN injury was found in 2 % vs. 1 % (p = 0.56), respectively.

Conclusions: The use of IONM significantly improved the identification rate of the EBSLN during thyroidectomy, as well as reduced the risk of early phonation changes after thyroidectomy.

Trial registration: ClinicalTrials.gov NCT01395134.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart of the study. EBSLN external branch of the superior laryngeal nerve, RLN recurrent laryngeal nerve, IONM intraoperative neuromonitoring
Fig. 2
Fig. 2
Surgical anatomy of the EBSLN according to Cernea classification. EBSLN external branch of the superior laryngeal nerve, STA superior thyroid artery, CTM cricothyroid muscle
See this image and copyright information in PMC

Comment in

References

    1. Steurer M, Passler C, Denk DM, et al. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope. 2002;112:124–133. doi: 10.1097/00005537-200201000-00022. - DOI - PubMed
    1. Lombardi CP, Raffaelli M, D’Alatri L, et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006;140:1026–1032. doi: 10.1016/j.surg.2006.08.008. - DOI - PubMed
    1. Stojadinovic A, Shaha A, Orlikoff RF, et al. Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg. 2002;236:823–832. doi: 10.1097/00000658-200212000-00015. - DOI - PMC - PubMed
    1. Ortega J, Cassinello N, Dorcaratto D, et al. Computerized acoustic voice analysis and subjective scaled evaluation of the voice can avoid the need for laryngoscopy after thyroid surgery. Surgery. 2009;145:265–271. doi: 10.1016/j.surg.2008.11.002. - DOI - PubMed
    1. Henry LR, Helou LB, Solomon NP, et al. Functional voice outcomes after thyroidectomy: an assessment of the Dysphonia Severity Index (DSI) after thyroidectomy. Surgery. 2010;147:861–870. doi: 10.1016/j.surg.2009.11.017. - DOI - PubMed

Publication types

Associated data