Superior laryngeal nerve preservation in peri-apical surgery by mobilization of the viscerovertebral angle

Iatrogenic lesions of the superior laryngeal nerve (SLN) are much more comm on than is generally recognized. Since injury to this nerve may cause trans ient or even persistent changes either in quality of voice or in deglutitio n, an attempt should be made to localize and identify the nerve during surg ery. This study included 74 patients who underwent surgical dissection near the thyroid apex in the neck. Effective prevention of SLN injury during su rgery was achieved by anatomical localization of the nerve in the viscerove rtebral angle and its functional identification with the nerve stimulator. post-operative analysis consisted of subjective interview, rigid laryngosco py, acoustic analysis, laryngeal videostroboscopy and cricothyroid electrom yography. Four patients complained of post-operative voice changes; two wer e diagnosed as SLN injury (2.4 per cent), one as reflux laryngitis and the fourth as intubation granuloma. Surgical access to the SLN in the periapica l area may be achieved through mobilization of the viscerovertebral angle. The use of a nerve stimulator during difficult situations should keep SLN i njury at a minimum.