- 期刊
- OpenAccess
Objective Voice Outcomes in Patients Undergoing Total Thyroidectomy With Different Mechanisms of Unilateral Superior Laryngeal Nerve Injury
摘要
Background: In total thyroidectomy (TT), injury in external branch of superior laryngeal nerve (EBSLN) results in cricothyroid muscle (CTM) dysfunction and high-pitched voice impairment. There is no research on the correlation between unilateral EBSLN injury mechanisms and voice outcome. This study aimed to investigate objective voice parameter changes in TT patients with unilateral EBSLN injury. Method: In the study, 557 patients who underwent intraoperative neuromonitoring (IONM)-assisted TT were enrolled. CTM twitch of EBSLN stimulation before (S1) and after (S2) superior pole dissection were routinely evaluated, and loss of S2 CTM twitch is defined as the EBSLN injury. The mechanisms of EBSLN injury were elucidated and divided into mechanical (M) and thermal (T) injury groups. The clinical characteristics and objective voice parameter changes were compared between groups. Result: Unilateral EBSLN injury were identified in 14 patients, and all the injured nerves were associated with Cernea EBSLN anatomic classification Type 2A or 2B. Compared with Group M (n = 7), Group T (n = 7) patients had a significantly larger total specimen weight (p = 0.027) and a relatively higher number of Type 2B EBSLN (83.3% vs. 28.6%, p = 0.103). There were no significant differences in obvious (≥ 30%) objective voice parameter changes between groups. However, pre-/post-operative changes in Fmax were significantly higher in Group M (54.9%) than in Group T (36.3%) (p = 0.037). Conclusions: IONM and CTM twitch could be a diagnostic and preventive tool for EBSLN injury and elucidate the mechanisms. Mechanical and thermal EBSLN injuries are associated with different degrees of worsening objective voice outcome, and perioperative voice analysis is essential to identifying the voice changes that facilitate early speech therapy referral.
延伸閱讀
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