Özet:

The motor inervation of the vocal cord abductor and adductor muscles is provided by the recurren laryngeal nerve (RLS), while the motor inervation of the cryothyroid muscle, called the vocal cord reactive muscle, is provided by the external branch of the superior laryngeal nerve (SLSE). During thyroidectomy, both RLS and SLSE are at risk of injury (regeneration) due to their anatomically close neighbors during thyroidectomy. In order to prevent the vocal cord function from being deteriorated, both RLS and SLSE should be strictly preserved during surgery. Today, the accuracy of RLS in the area of thyroidectomy during thyroidectomy is considered the gold standard method for the preservation of RLS. A sufficient knowledge of surgical anatomy, clinical experience and rigorous surgical technical factors in the discovery and safe disection of RLS are key factors. During thyroidectomy, RLS can be found by 4 different approaches depending on the form of thyroid growth and the choice of the surgeon. These are lateral, inferior, superior and medial approaches. The lateral approach is the most commonly used method in primary thyroid surgery. RLS is usually found by disection around the inferior thyroid artery at the middle polar level of the thyroid. In the inferior approach, secondary surgery is generally found in the area where the RLS enters the neck area and there is no sharp tissue. The superior approach is also recommended in advanced large guatars or guatars with large substernal components. After the thyroid upper poles are released, the poles are pulled forward and laterally and the RLS is placed in the area where the larynx enters the lower border of the krikofaringeal muscle. Medial approach is a preferred approach in substernal or retropharyngeal grown guatars. In this method first is the istmus separated and the istmus and the lobun medial are disked through the trakea and the anterolateral of the trakea is revealed. The second or third trakeal circle lateral face with the thyroid fibers and the Berry ligament fibers are opened to the stage craniale in the thyroid medial, the lateral of the trakeal, ensuring that the RLS enters the vision area. The preservation of the anatomical integrity of the RLS does not indicate that its function is also preserved. Intraoperative nerve monitoring (IONM) is a method that allows functional assessment in addition to the observation of the nerve, which is the golden standard for the preservation of RLS. IONM contributes significantly to the appearance of RLS, to the determination of its anatomical diversity, to the intraoperative recognition of RLS injury, to the prevention of bilateral vocal cord paralysis, to the preservation of the presence of electrical activity of the nerve in patients with preoperative vocal cord paralysis. While it is not a standardized method for the protection of SLSE, three methods have been defined for the protection of SLSE during the release of the thyroid upper poles. These are the separate release of the capsule of the superior thyroid vessels without SLSE, the investigation and observation of the SLSE before the upper polar vessels are separated, or the presence of the SLSE accompanied by the IONM and the disque of the upper pollen. The discovery, verification, upper polar disection and protection of IONM SLSE also make significant contributions.

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