J Korean Thyroid Assoc.  2014 Nov;7(2):153-158. 10.11106/cet.2014.7.2.153.

How to Preserve Laryngeal Nerve for Preventing Post-Thyroidectomy Voice Change

  • 1Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shchoi@amc.seoul.kr


After thyroid surgery, voice change occurs very frequently, in more than 30% of cases. In addition to injury to the recurrent laryngeal nerve (RLN) or the external branch of superior laryngeal nerve (EBSLN), vocal fold edema due to excessive tracheal traction or disrupted laryngeal venous drainage, and laryngotracheal fixation following injury to extralaryngeal musculature can cause post-thyroidectomy voice change. Although complete recovery can be expected mostly in 3 months, dysphonic patients should be evaluated pre and postoperatively by laryngoscopy or laryngeal stroboscopy. The present review discusses the evaluation of voice change, the anatomy of RLN and EBSLN and common cause of voice change after thyroid surgery. Furthermore, we represent how to preserve RLN, SLN including intraoperative nerve monitoring.


Thyroidectomy; Recurrent laryngeal nerve; External branch of superior laryngeal nerve

MeSH Terms

Laryngeal Nerves*
Recurrent Laryngeal Nerve
Thyroid Gland
Vocal Cords


  • Fig. 1. Relationship of recurrent laryngeal nerves (RLN) and superior laryngeal nerves (SLN) to thyroid lobe and tracheoesophageal groove. (Adapted from Randolph GW et al., 2012)

  • Fig. 2. Variations of nonrecurrent recurrent laryngeal nerve. (A) Accompanying the inferior thyroid artery, and (B) passing directly to the larynx at the level of the superior pole of the thyroid gland. (Adapted from Stewart et al., 1972)



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