Which of the following is the MOST important anatomical landmark to identify during thyroidectomy to prevent inadvertent injury to the external branch of the superior laryngeal nerve (EBSLN)?

• A The inferior thyroid artery where it crosses behind the recurrent laryngeal nerve
• B The cricothyroid membrane at the midline
• C The Zuckerkandl tubercle of the thyroid gland
• D The superior thyroid vessels at the thyroid upper pole, identifying and preserving the EBSLN before ligating the superior thyroid artery close to the thyroid capsule ✓

Explanation

The EBSLN runs in close proximity to the superior thyroid vessels and is at risk of injury during ligation of the superior thyroid pedicle. Injury results in loss of the high-pitched voice (cricothyroid muscle denervation). The safe technique involves identifying and separating the EBSLN from the superior thyroid vessels, then ligating the superior thyroid artery as close to the thyroid capsule as possible. The inferior thyroid artery is the landmark for the recurrent laryngeal nerve, not the EBSLN. The Zuckerkandl tubercle guides identification of the RLN on the right side.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.