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The Scientific World Journal
Volume 2014, Article ID 692365, 7 pages
Review Article

Intraoperative Neuromonitoring of the External Branch of the Superior Laryngeal Nerve during Thyroidectomy: The Need for Evidence-Based Data and Perioperative Technical/Technological Standardization

11st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology and Surgical Sciences Endocrine Surgery Research Center, Insubria University Varese-Como, 21100 Varese, Italy
2Department of General Surgery, Ioannina University Hospital and Centre for Biosystems and Genomic Network Medicine Ioannina University, 45110 Ioannina, Greece
3Department of Surgery, KUMC Thyroid Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

Received 28 July 2014; Revised 26 October 2014; Accepted 28 October 2014; Published 24 November 2014

Academic Editor: David A. Sherris

Copyright © 2014 Alberto Mangano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The external branch of the superior laryngeal nerve (EBSLN) is surgically relevant since its close anatomical proximity to the superior thyroid vessels. There is heterogeneity in the EBSLN anatomy and EBSLN damage produces changes in voice that are very heterogenous and difficult to diagnose. The reported prevalence of EBSLN injury widely ranges. EBSLN iatrogenic injury is considered the most commonly underestimated complication in endocrine surgery because vocal assessment underestimates such event and laryngoscopic postsurgical evaluation does not show standardized findings. In order to decrease the risk for EBSLN injury, multiple surgical approaches have been described so far. IONM provides multiple advantages in the EBSLN surgical approach. In this review, we discuss the current state of the art of the monitored approach to the EBSLN. In particular, we summarize, providing our additional remarks, the most relevant aspects of the standardized technique brilliantly described by the INMSG (International Neuromonitoring Study Group). In conclusion, in our opinion, there is currently the need for more prospective randomized trials investigating the electrophysiological and pathological aspects of the EBSLN for a better understanding of the role of IONM in the EBSLN surgery.