Impact of Sternothyroid Muscle Division on Patient-Reported Swallowing Outcomes Following Thyroid Surgery: A Prospective Study

Objective: Division of the sternothyroid muscle during thyroidectomy is a widely accepted surgical technique to provide improved exposure of the thyroid gland, superior pole vessels, and the external branch of the superior laryngeal nerve (EBSLN). Our group had previously shown no decrement in postoperative voice outcomes with this technique. However, given the known role of the strap muscles in swallowing function, this study aims to assess the impact of sternothyroid muscle division on patient-reported dysphagia. Study Design: Prospective, consecutive cohort study. Setting: Single institution urban tertiary health care system. Methods: Adult patients who underwent total thyroidectomy or lobectomy with a single surgeon between November 2022 and July 2023 were enrolled. Patients with clinical evidence of significant preoperative dysphagia were excluded. Complete sternothyroid muscle division was performed in all cases. The integrity of the recurrent laryngeal nerve and EBSLN (when visualized) was confirmed through intraoperative nerve monitoring and postoperative flexible laryngoscopy. Differences between preoperative and postoperative patient-reported swallowing outcomes were assessed using the Eating Assessment Tool-10 (EAT-10). Results: A total of 114 patients were included in the study. No statistically significant difference was found between mean preoperative and postoperative EAT-10 scores (0.63 vs 0.75, P =.677). These results remained consistent regardless of sex, history of reflux, unilateral or bilateral sternothyroid muscle division, performance of substernal resection of goiter, or final histologic diagnosis. Conclusion: Division of the sternothyroid muscle during thyroidectomy can be useful in the exposure of the thyroid gland without impact on patient-perceived swallowing disturbance.