Abstract
INTRODUCTION: The external branch of the superior laryngeal nerve (EBSLN) should be identified during thyroidectomy to prevent injury and post-operative voice change. Identification is rendered difficult during a standard thyroidectomy where there is a large gland with upper pole enlargement. We describe the retrograde thyroidectomy technique to facilitate nerve preservation. PRESENTATION OF CASE: A retrograde thyroidectomy was performed in a 53-year old woman with a difficult goiter. Operative steps are described. DISCUSSION: This technique allows the upper pole to be completely mobilized caudally providing unparalleled visualization of the upper pole vascular pedicle, thereby preserving the EBSLN. CONCLUSION: There is better visualization of the superior thyroid pedicle and the EBSLN with retrograde thyroidectomy, potentially reducing the incidence of EBSLN injury during a difficult thyroidectomy.