Neuroanatomy and Monitoring of the External Branch of the Superior Laryngeal Nerve

Purpose of Review The external branch of the superior laryngeal nerve (EBSLN) is often overlooked, and intraoperative damage to this nerve is likely under-reported despite significant consequences. This article reviews the anatomy and identification of the EBSLN, its role in voice physiology, and the updated literature describing the role for intraoperative neuromonitoring (IONM). Recent Findings With the widespread acceptance of IONM, particularly in the identification of recurrent laryngeal nerve damage, recent studies have demonstrated a role for this technology in the surgical identification of the EBSLN. However, the ability of IONM to improve clinical outcomes with regard to the EBSLN has not been fully elucidated in the current literature. The intraoperative identification and preservation of the EBSLN require a perspicacious endocrine surgeon. While IONM can play an important role in identification, further studies are required to demonstrate its role in long-term clinical outcomes.