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Julio C. Furlan, MD, PhD; Lenine G. Brandão, MD, PhD; Alberto R. Ferraz, MD, PhD; Aldo J. Rodrigues, Jr, MD, PhD

Arch Otolaryngol Head Neck Surg. 2003;129:79-82.

Objectives  To describe the topography of the superior laryngeal nerve (SLN) and to evaluate the influence of gender, ethnicity, side of the neck, and individual height on the topography of the SLN.

Design  Anatomical study of human cadavers.

Subjects  Fifty fresh human cadavers (19 female subjects and 31 male subjects; age range, 22-89 years; mean age, 61 years) were randomly selected for this study. The subjects were divided into nonwhite (n = 18) and white (n = 32) ethnic groups. The t test and linear regression were used for statistical analysis of data.

Results  All SLNs emerged medially to the vagus nerve. The SLNs mostly divided into internal (ibSLN) and external (ebSLN) branches distally from their origin (94%). The mean ± SE length of the SLN trunk was 16.7 ± 0.9 mm and was affected by gender (P = .01) but not ethnicity (P = .57), side of the neck (P = .96), or individual height (R² = 0.01; P = .33). The length of the ibSLN reached 44.9 ± 1.0 mm and was unaffected by gender (P = .91), ethnicity (P = .24), side (P = .40), or height (R²<0.01; P = .71). The length of the ebSLN measured 62.6 ± 1.2 mm and was unaffected by gender (P = .69), ethnicity (P = .42), side (P = .26), or height (R²<0.01; P = .85). The mean ± SE angle between the ibSLN and the tracheoesophageal sulcus was 49° ± 1° and was unaffected by gender (P = .35), ethnicity (P = .11), side (P = .26), or height (R²<0.01; P = .96). Only 1 subject demonstrated a bilateral anatomical variation of the ibSLN close to its entrance into the thyrohyoid membrane.

Conclusions  The topography of the SLN has a few anatomical variations and is unaffected by gender, ethnicity, side of the neck, and individual height, except that the SLN is longer in males than in females. These findings are important in that they can help in the prevention of SLN injuries during operations such as laryngectomy and neck dissection, as well as in the planning of laryngeal reinnervation and transplantation.

From the Division of Head and Neck Surgery, Department of Surgery, Clinical Hospital of the Faculty of Medicine (Drs Furlan, Brandão, and Ferraz), and the Department of Anatomy, Faculty of Medicine (Dr Rodrigues), University of São Paulo, São Paulo, Brazil. Dr Furlan is now with the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario.