Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 889 - файл

Throughout the history of thyroid surgery, most focus was placed on the RLN. The importance of the exterior branch of the superior laryngeal nerve (EBSLN) for voice modulation was not recognized until much later [3]. The case of the loss of the magic voice of the opera singer Amelita Galli Curci illustrates the dramatic consequences of loss of function of the EBSLN [4]. The EBSLN, referred to as the “neglected nerve” [5], has often been overlooked in thyroid surgery [6]. This nerve innervates the cricothyroid muscle (CTM), which is involved in produc­ing sounds of higher pitch, in projecting the voice, and hence important for shout­ing, calling, and singing high-pitched notes. The EBSLN is a small nerve, and it runs along the superior thyroid vessels, after which it penetrates between the two heads of the cricothyroid muscle. The EBSLN is therefore at risk when dissecting the upper pole. Several anatomic variations of its relation to the upper pole of the thyroid and to the superior thyroid vessels have been observed. Well-recognized anatomical classications of the relation between the EBSLN and the upper pole of the thyroid include Cernea’s [7] and Friedman’s [8]. Diagnosis of pre- and postop­erative CTM function is difcult to ascertain, since it cannot be evaluated reliably with laryngoscopy. Instead, registration of CTM movement depends on electromy­ography, which requires needles to be placed in the CTM [9]. This is technically difcult and invasive, and not without risk and pain to the patient [9]. Evaluation of CTM function using acoustic analysis has been investigated but is too unreliable to be used in clinical practice [10].