The functional impact on voice of sternothyroid muscle division during thyroidectomy

Abstract
Background  Post-thyroidectomy voice dysfunction may occur in the absence of laryngeal nerve injury. Strap muscle division has been hypothesized
as one potential contributor to dysphonia.

Methods  Vocal-function data, prospectively recorded before and after thyroidectomy from two high-volume referral institutions, were
utilized. Patient-reported symptoms, laryngoscopic, acoustic, and aerodynamic parameters were recorded at 2 weeks and 3 months
postoperatively. Patients with and without sternothyroid muscle division during surgery were compared for voice changes. Patients
with laryngeal nerve injury, sternohyoid muscle division, arytenoid subluxation or no early postoperative follow-up evaluation
were excluded. Differences between study groups and outcomes were compared using t-tests and rank-sum tests as appropriate.

Results  Of 84 patients included, 45 had sternothyroid division. Distribution of age, gender, extent of thyroidectomy, specimen size,
and laryngeal nerve identification rates did not differ significantly between groups. There was a significant predilection
for or against sternothyroid muscle division according to medical center. No significant difference in reported voice symptoms
was observed between groups 2 weeks or 3 months after thyroidectomy. Likewise, acoustic and aerodynamic parameters did not
differ significantly between groups at these postoperative study time points.

Conclusion  Sternothyroid muscle division is occasionally employed during thyroidectomy to gain superior pedicle exposure. Division of
this muscle does not appear to be associated with adverse functional voice outcome, and should be utilized at surgeon discretion
during thyroidectomy.

Content Type Journal ArticleCategory Endocrine TumorsDOI 10.1245/s10434-008-9936-8Authors
Leonard R. Henry, National Naval Medical Center Department of Surgery, Division of Surgical Oncology 8901 Wisconsin Avenue Bathesda MD 20889 USANancy Pearl Solomon, Walter Reed Army Medical Center Department of Surgery, Army Audiology & Speech Center Washington DC 20307 USARobin Howard, Walter Reed Army Medical Center Department of Clinical Investigation, Division of Biostatistics Washington DC USAJoyce Gurevich-Uvena, Walter Reed Army Medical Center Department of Surgery, Army Audiology & Speech Center Washington DC 20307 USALeah B. Horst, Walter Reed Army Medical Center Department of Surgery, Division of Anesthesia Washington DC USAGeorge Coppit, Walter Reed Army Medical Center Department of Surgery, Division of Otolaryngology- Head and Neck Surgery Washington DC USARobert Orlikoff, Seton Hall University Department of Speech-Language Pathology South Orange NJ 07079 USASteven K. Libutti, National Cancer Institute Surgery Branch Bethesda MD 20889 USAAshok R. Shaha, Memorial Sloan Kettering Cancer Center Department of Surgical Oncology, Head and Neck Service New York NY 10021 USAAlexander Stojadinovic, Walter Reed Army Medical Center and The United States Military Cancer Institute Department of Surgery, Division of Surgical Oncology 6900 Georgia Avenue Washington DC 20307 USA

Journal Annals of Surgical OncologyOnline ISSN 1534-4681Print ISSN 1068-9265 (Source: Annals of Surgical Oncology)