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CERNEA CLASSIFICATION

*Lecture on Cernea Classification of Thyroidectomy* *1. Introduction to Thyroidectomy* Surgical removal of the thyroid gland, often for conditions like goiter, cancer, or hyperthyroidism. Critical structures at risk: Recurrent Laryngeal Nerve (RLN) and External Branch of the Superior Laryngeal Nerve (EBSLN). *2. Anatomy of the EBSLN* **Function**: Innervates the cricothyroid muscle, responsible for vocal cord tension and high-pitched phonation. **Clinical Impact of Injury**: Voice fatigue, loss of vocal range, and impaired projection—critical for singers and speakers. *3. Cernea Classification of the EBSLN* Developed to categorize anatomical variations of the EBSLN relative to the superior thyroid artery (STA) and thyroid cartilage, aiding surgical preservation. **Type 1**: EBSLN crosses the STA more than1 cm *above* the upper border of the thyroid cartilage. *Lowest risk* during surgery. **Type 2a**: Crosses the STA *within 1 cm above* the thyroid cartilage border. Moderate risk; requires careful dissection. **Type 2b**: Crosses the STA *within 1 cm below* the thyroid cartilage border but above the thyroid upper pole. **High risk**; most common type in some populations (20–25%). **Type 3**: Crosses the STA *more 1 cm below* the thyroid cartilage, near the thyroid upper pole. **Highest risk**; necessitates meticulous technique. *4. Clinical Implications* **Prevalence**: Type 2b and 3 are more prone to injury due to proximity to ligation sites. **Surgical Techniques**: *Ligation of STA branches* individually (vs. en masse) in Type 2b/3. *Capsular dissection* to stay close to the thyroid gland. **Intraoperative Strategies**: Visual identification, nerve monitoring (IONM), and magnification aids. *5. Outcomes and Studies* **Injury Rates**: Range from 0% to 58%, reduced significantly with Cernea-guided dissection. **Key Study**: Cernea et al. (1992) highlighted Type 2b as a common risk category, advocating tailored approaches. *6. Limitations and Considerations* **Anatomical Variability**: Classification may not cover all variations; surgeon experience is crucial. **Debates**: Routine nerve exposure vs. risk of iatrogenic injury; complementary use of IONM. *7. Conclusion* The Cernea classification enhances surgical planning, reducing EBSLN injury and improving voice outcomes. Emphasizes preoperative knowledge, intraoperative vigilance, and adaptation to anatomical