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Strap muscles, also known as infrahyoid muscles, are a group of long, flat muscles located in the front of the neck. They include the sternohyoid, sternothyroid, omohyoid, and thyrohyoid muscles. During surgery, doctors may need to cut through the connective tissue between these muscles to access the thyroid gland. Cutting the sternothyroid muscle, in particular, can be useful during a thyroidectomy to expose the superior pole of the thyroid gland. However, there is some debate about the impact of cutting strap muscles on postoperative vocal outcomes, with potential effects on pitch and vocal frequency. The use of stretching straps can help improve flexibility and range of motion, but it is important to warm up the muscles before stretching and to stop if there is any pain.
| Characteristics | Values |
|---|---|
| Definition | Strap muscles refer to muscles with a long and flat shape, similar to a belt or strap. |
| Types | Sternohyoid, sternothyroid, omohyoid, and thyrohyoid. |
| Location | Infrahyoid muscles are located in the ventral aspect of the neck. |
| Function | The sternothyroid helps depress the hyoid bone and larynx, aiding in swallowing, speaking, and chewing. |
| Conditions | Muscle tension dysphonia, hypothyroidism, hyperthyroidism, and goiter. |
| Surgery | Cutting the sternothyroid muscle can be useful during thyroidectomy to expose the superior pole of the thyroid gland, but it may impact postoperative vocal outcomes. |
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What You'll Learn
Sternothyroid (ST) muscle cutting during thyroidectomy
The sternothyroid (ST) muscle is one of the infrahyoid muscles, a group of strap-like muscles located in the front of the neck. The infrahyoid muscles are innervated by nerves originating from the ansa cervicalis and the hypoglossal nerve. The sternothyroid muscle specifically helps depress the hyoid bone and larynx, which aids functions such as swallowing, speaking, and chewing.
During a thyroidectomy, the ST muscle can be partially cut to expose the superior pole of the thyroid gland. This technique is useful when the surgical exposure of the upper end of the superior pole is insufficient. The ST muscle is cut using Harmonic Curved Shears at the laryngeal head where the muscle inserts along the thyroid cartilage. After the thyroid gland is removed, the strap muscles are reapproximated at the midline, and meticulous skin closure is conducted.
Studies have evaluated the impact of partial cutting of the ST muscle on postoperative vocal outcomes after total thyroidectomy. One study reviewed 57 patients who underwent total thyroidectomy with central neck dissection for micropapillary thyroid carcinoma. The patients were divided into two groups: Group A without cutting the ST muscle and Group B with partial cutting of the muscle at the superior pole. All patients underwent voice analysis before the operation and 2 weeks and 1 month after the surgery. The results showed no differences between the two groups at each time point of voice analysis. Group A showed a decrease in maximum frequency 2 weeks after surgery but no difference after 1 month. Group B showed a mild decrease in maximum frequency 2 weeks after surgery, but the difference was not significant.
Overall, the partial cutting of the ST muscle during thyroidectomy is useful for exposing the superior pole of the thyroid gland without causing significant negative impacts on postoperative vocal outcomes. However, additional studies considering more clinical variables and parameters are needed to validate the safety of the procedure fully.
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Impact on postoperative vocal outcomes
The sternothyroid (ST) muscle is a strap muscle that can be cut during a thyroidectomy to expose the superior pole of the thyroid gland. The ST muscle is one of the infrahyoid muscles, which are a group of strap-like muscles located in the ventral aspect of the neck. These muscles are involved in depressing the hyoid bone and larynx, which aids functions such as swallowing, speaking, and chewing.
There is some controversy regarding the impact of ST muscle division on postoperative vocal outcomes. Some studies have shown that bilateral division of the strap muscles during thyroidectomy resulted in decreased pitch that could not be recovered. However, other studies have found no significant difference in voice symptoms, aerodynamic parameters, or objective postoperative outcomes between patients who underwent partial cutting of the ST muscle and those who did not.
One study evaluated the impact of partial cutting of the ST muscle on postoperative vocal outcomes by conducting a retrospective review of 57 patients who underwent total thyroidectomy with central neck dissection for micropapillary thyroid carcinoma. The patients were divided into two groups: Group A, which did not involve cutting the ST muscle, and Group B, which involved partial cutting of the muscle at the superior pole. Voice analysis was conducted before the operation and 2 weeks and 1 month after the surgery, with no differences found between the two groups at any time point.
Another study reported that the vocal outcomes after partial cutting of the ST muscle during total thyroidectomy showed no difference in postoperative progress compared to studies on voice outcomes after thyroidectomy without neural injury. However, it was noted that the patient group in this study was enrolled from two different institutes with opposing preferences for cutting the ST muscle, which may have led to selection bias.
While the impact of partial cutting of the ST muscle on postoperative vocal outcomes remains a subject of ongoing research, the available evidence suggests that it does not result in significant negative consequences. However, further studies with larger patient groups and evaluations of subjective symptoms are needed to comprehensively understand the safety profile of this procedure.
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Goitre exposure and nerve supply preservation
The sternothyroid is a strap muscle present at the front of the neck. It is one of the muscles that form the infrahyoid muscle group. The infrahyoid muscles are a group of strap-like muscles located in the ventral aspect of the neck. They are innervated by nerves originating from the ansa cervicalis and the hypoglossal nerve. The sternothyroid helps depress the hyoid bone and larynx, meaning it aids functions such as swallowing, speaking, and chewing.
Leiomyoma, or fibroid, is a type of smooth muscle tumour that presents more commonly in premenoid females. It can occur in the sternothyroid muscle, where it may manifest as a neck mass. However, leiomyomas in the sternothyroid are extremely rare.
A goitre is a swelling of the thyroid gland, which can be caused by hypothyroidism or hyperthyroidism. During the exposure of a large goitre, the strap muscles are cut in their upper half to preserve nerve supply from the ansa cervicalis. This nerve loop supplies the infrahyoid muscles, which include the sternothyroid.
Surgery for goitre is rarely indicated unless there are significant compressive symptoms despite medical treatment. The high risk of complications means that surgery should only be performed if the patient cannot be treated in any other way. One such complication is nerve injury, which can be minimised through intraoperative nerve monitoring. For example, in the case of phrenic nerve palsy due to a large retrosternal goitre, the nerve can be preserved by performing a lobectomy with isthmusectomy on the contralateral side first, followed by the slow mediastinal dissection.
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Infrahyoid muscle group anatomy
The infrahyoid muscle group, also known as the strap muscles, are a group of four pairs of muscles located in the anterior (frontal) part of the neck. They are found underneath the hyoid bone and can be divided into two groups: the superficial plane and the deep plane. The superficial plane includes the omohyoid and sternohyoid muscles, while the deep plane comprises the sternothyroid and thyrohyoid muscles. These muscles connect the hyoid bone to the sternum, larynx, and scapula.
The sternohyoid muscle is the most superficial of the infrahyoid muscles. It originates from the posterior surface of the manubrium of the sternum and the posterior surface of the medial end of the clavicle. It inserts onto the inferior border of the hyoid bone and functions to depress the hyoid bone from an elevated position. The omohyoid muscle is also part of the superficial plane and is comprised of two muscle bellies connected by a muscular tendon. The superior belly arises from the hyoid bone, while the inferior belly arises from the scapula.
The sternothyroid muscle is a wide muscle located underneath the sternohyoid in the deep plane of the neck. It arises from the manubrium of the sternum and attaches to the thyroid cartilage. It functions to depress the thyroid cartilage. The thyrohyoid muscle is a short band of muscle thought to be a continuation of the sternothyroid. It originates at the oblique line of thyroid cartilage and inserts onto the inferior border of the hyoid bone.
The infrahyoid muscles are important for several functions related to speech, swallowing, and the movement of the larynx, as they control the positioning of the hyoid bone. They receive their nerve supply from the ansa cervicalis, which can be damaged by trauma to the cervical spine or incorrect positioning during surgery. This may result in swallowing difficulties, a hoarse voice, and throat tightness. In some cases, such as neck dissection for malignant head and neck tumours, the ansa cervicalis may be deliberately sacrificed to remove cancerous tissues, with only the most important structures being preserved.
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Sternothyroid muscle function
The sternothyroid is a paired strap muscle located in the muscular triangle of the neck. It is part of the infrahyoid muscle group, which also includes the sternohyoid, omohyoid, and thyrohyoid muscles. These muscles are located inferior to the hyoid bone and are responsible for depressing it during speech, swallowing, and chewing. The sternothyroid is comparatively wider and shorter than the other infrahyoid muscles. It originates from the posterior edge of the costal cartilage of the first rib and the posterior surface of the manubrium of the sternum. From here, the muscle fibres travel superiorly and insert on the oblique line of the thyroid cartilage.
The sternothyroid has important anatomical relationships with the neurovascular and glandular structures of the neck. It helps to stabilise the hyoid bone and larynx, aiding functions such as swallowing, speaking, and chewing. The muscle also plays a role in protecting the trachea, oesophagus, blood vessels, and thyroid gland. During thyroidectomy (removal of the diseased thyroid gland), the sternothyroid muscle may be divided to allow the surgeon access to the superior pedicle of the gland. This procedure does not appear to have any adverse functional outcomes postoperatively.
The sternothyroid muscle is supplied by the ansa cervicalis (C1, C2, C3), which is a nerve loop on the internal jugular vein. The branches to the muscle enter in their lower half. In the case of a large goitre, the upper half of the strap muscles may be cut to preserve nerve supply from the ansa cervicalis. Muscle tension dysphonia, a condition causing changes in voice and difficulty in understanding speech, can result from excessive tension in the sternothyroid and other infrahyoid muscles. Leiomyoma, or fibroids, are rare in the sternothyroid muscle but can present as a mass in the neck.
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Frequently asked questions
Strap muscles are a group of flat, strap-like muscles located in the front of the neck. They are also known as infrahyroid muscles and include the sternohyoid, sternothyroid, omohyoid, and thyrohyoid muscles.
Cutting the sternothyroid muscle can be useful during thyroid surgery, specifically during a thyroidectomy. This technique can help expose the superior pole of the thyroid gland. However, it is controversial due to its potential impact on vocal outcomes.
Cutting the strap muscles may affect vocal outcomes, particularly the pitch and frequency of the voice. In some cases, it can result in decreased pitch that may not recover. Additionally, there may be risks associated with the nearby nerves and other structures in the neck.
