Identification of the External Branch of the Superior Laryngeal Nerve During Thyroidectomy
Bibliographic record
Abstract
Introduction: The external branch of the superior laryngeal nerve (EBSLN) is vulnerable to injury in thyroidectomy during dissection of the superior pole. EBSLN innervates the cricothyroid muscle, which acts as a tensor of the vocal cords assisting in high-pitched phonation. Subjective voice disturbance is common after thyroidectomy in cases where vocal cord mobility is normal.1 Unilateral EBSLN injury may adversely affect the voice in nonsingers as well as singers.2 The position of EBSLN in relation to the superior pole was classified by Cernea as follows: type 1 nerves cross the superior pole greater than 1 cm above the upper border of the thyroid, type 2a nerves cross within 1 cm of the thyroid, and type 2b nerves cross below the upper border of the thyroid.3 In a study from our institution, 175 of 178 EBSLNs were identified at operation, 7% were type 1, 45% were type 2a, and 48% type 2b.4 Consequently, we identify the EBSLN during thyroidectomy. The objective of this video presentation is to demonstrate our method for the routine identification of EBSLN. Materials and Methods: Informed consent for videography was obtained. Surgeon point-of-view video was shot using a head-mounted GoPro camera set to 1080p 60fps in narrow mode. Video and audio were edited using Adobe Premiere Pro CC. Under loupe magnification, the sternothyroid strap muscle was reflected from the superior pole, Jolls triangle was bluntly dissected, and the lateral surface of the cricothyroid muscle was exposed. The EBSLN was bluntly dissected with a pledget and traced laterally. An Allis clamp was placed on the superior pole and the superior thyroid vascular pedicle was ligated. Results: The EBSLN is routinely identifiable with negligible added operating time. Conclusions: The EBSLN can be identified routinely during dissection of the superior pole of the thyroid using loupe magnification. The EBSLN frequently overlies the superior pole and if not identified is at increased risk of injury. No competing financial interests exist. Runtime of video: 2 mins 6 secs
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".