The Functional Impact on Voice of Sternothyroid Muscle Division During Thyroidectomy

Department of Surgery, Division of Surgical Oncology, National Naval Medical Center, 8901 Wisconsin Avenue, Bathesda, MD, 20889, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 08/2008; 15(7):2027-33. DOI: 10.1245/s10434-008-9936-8
Source: PubMed


Post-thyroidectomy voice dysfunction may occur in the absence of laryngeal nerve injury. Strap muscle division has been hypothesized as one potential contributor to dysphonia.
Vocal-function data, prospectively recorded before and after thyroidectomy from two high-volume referral institutions, were utilized. Patient-reported symptoms, laryngoscopic, acoustic, and aerodynamic parameters were recorded at 2 weeks and 3 months postoperatively. Patients with and without sternothyroid muscle division during surgery were compared for voice changes. Patients with laryngeal nerve injury, sternohyoid muscle division, arytenoid subluxation or no early postoperative follow-up evaluation were excluded. Differences between study groups and outcomes were compared using t-tests and rank-sum tests as appropriate.
Of 84 patients included, 45 had sternothyroid division. Distribution of age, gender, extent of thyroidectomy, specimen size, and laryngeal nerve identification rates did not differ significantly between groups. There was a significant predilection for or against sternothyroid muscle division according to medical center. No significant difference in reported voice symptoms was observed between groups 2 weeks or 3 months after thyroidectomy. Likewise, acoustic and aerodynamic parameters did not differ significantly between groups at these postoperative study time points.
Sternothyroid muscle division is occasionally employed during thyroidectomy to gain superior pedicle exposure. Division of this muscle does not appear to be associated with adverse functional voice outcome, and should be utilized at surgeon discretion during thyroidectomy.

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    • "On the other hand, Jaffe and Young [7] showed that strap muscle division does not result in any subjective or objective functional sequelae. The functional impact of cutting ST muscle during thyroidectomy on postoperative voice was reported by Henry et al. [8] in 2008. They showed no significant difference in both voice symptoms and aerodynamic parameters. "
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    ABSTRACT: Voice and swallowing complaints are common after thyroidectomy, but their etiology is not completely understood. Manipulation of the endolaryngeal soft tissues, pharyngeal constrictor muscles, and recurrent laryngeal nerves may all result in symptoms. In addition, the external branch of the superior laryngeal nerve and cricothyroid muscle may play a role in postoperative dysphonia. We review the literature related to the scope of voice complaints after thyroidectomy. We also discuss several studies describing the surgical anatomy of the external branch of the superior laryngeal nerve as it relates to thyroidectomy. Our surgical technique, which includes routine visualization of the external branch of the superior laryngeal nerve, is then described.
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