Retrograde Thyroidectomy: A Technique for Visualization and Preservation of the External Branch of Superior Laryngeal Nerve

INTRODUCTIONThe external branch of the superior laryngeal nerve (EBSLN) should be identified during thyroidectomy to prevent injury and post-operative voice change. Identification is rendered difficult during a standard thyroidectomy where there is a large gland with upper pole enlargement. We describe the retrograde thyroidectomy technique to facilitate nerve preservation.PRESENTATION OF CASEA retrograde thyroidectomy was performed in a 53-year old woman with a difficult goiter. Operative steps are described.DISCUSSIONThis technique allows the upper pole to be completely mobilized caudally providing unparalleled visualization of the upper pole vascular pedicle, thereby preserving the EBSLN.CONCLUSIONThere is better visualization of the superior thyroid pedicle and the EBSLN with retrograde thyroidectomy, potentially reducing the incidence of EBSLN injury during a difficult thyroidectomy.