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The Functional Impact on Voice of Sternothyroid Muscle Division During Thyroidectomy

¹ Department of Surgery, Division of Surgical Oncology, National Naval Medical Center, 8901 Wisconsin Avenue, Bathesda MD 20889, USA
² The United States Military Cancer Institute, 6900 Georgia Avenue, Washington, DC 20307, USA
³ Department of Surgery, Army Audiology & Speech Center, Walter Reed Army Medical Center, Washington, DC 20307, USA
⁴ Department of Clinical Investigation, Division of Biostatistics, Walter Reed Army Medical Center, Washington, DC, USA
⁵ Department of Surgery, Division of Anesthesia, Walter Reed Army Medical Center, Washington, DC, USA
⁶ Department of Surgery, Division of Otolaryngology- Head and Neck Surgery, Walter Reed Army Medical Center, Washington, DC, USA
⁷ Department of Speech-Language Pathology, Seton Hall University, South Orange, NJ 07079, USA
⁸ Surgery Branch, National Cancer Institute, Bethesda, MD 20889, USA
⁹ Department of Surgical Oncology, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
¹⁰ Department of Surgery, Division of Surgical Oncology, Walter Reed Army Medical Center and The United States Military Cancer Institute, 6900 Georgia Avenue, Washington, DC 20307, USA

Correspondence: Address correspondence and reprint requests to: Alexander Stojadinovic, MD; E-mail: Alexander.stojadinovic{at}na.amedd.army.mil

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.

Key Words: Sternothyroid • Voice • Thyroidectomy