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HeadNeckPA

ENT Picture of the Day 3-29-11

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This is an anatomy question.

 

The patient below underwent a partial thyroidectomy (lobe is missing in pic) for a suspicious nodule.

 

What is the white squiggly structure between the retractors and the forceps?

 

Identification and preservation of this structure is one of the most important aspects of thyroid surgery....

 

Thyroid.jpg

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I would guess recurrent laryngeal nerve also, but the most commonly injured is the external branch of the superficial laryngeal nerve.

Edited by acozadd
typo

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I would guess recurrent laryngeal nerve also, but the most commonly injured is the external branch of the superficial laryngeal nerve.

 

 

This is indeed the recurrent laryngeal nerve.

 

While the external branch of the superior laryngeal nerve is the most common injury during thyroid surgery, it is not routinely identified. By taking the superior pole vessels close to the thyrod capsule you remain far enough away from the SLN. Most patient's with a post-operative SLN injury would not know the difference unless they were a professional speaker or singer. The SLN only gives muscle innervation to the cricothyroid muscle (elongation of the vocal folds). Mild hoarseness and decreased vocal stamina are the most common symtoms of SLN injury, as compared to significant hoarseness and a "breathy" quality to the voice in the patient with an injury to the recurrent laryngeal nerve.

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This is indeed the recurrent laryngeal nerve.

 

While the external branch of the superior laryngeal nerve is the most common injury during thyroid surgery, it is not routinely identified. By taking the superior pole vessels close to the thyrod capsule you remain far enough away from the SLN. Most patient's with a post-operative SLN injury would not know the difference unless they were a professional speaker or singer. The SLN only gives muscle innervation to the cricothyroid muscle (elongation of the vocal folds). Mild hoarseness and decreased vocal stamina are the most common symtoms of SLN injury, as compared to significant hoarseness and a "breathy" quality to the voice in the patient with an injury to the recurrent laryngeal nerve.

 

Woops. Tried to pull that from memory and endocrine was several months ago... points for being close?

 

PS I'm really enjoying these pictures, interesting and educational! Keep it up.

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