The external branch of the superior laryngeal nerve (EBSLN) provides motor supply to the cricothyroid muscle (CTM). This muscle approximates the thyroid and cricoid cartilages, stretching the vocal fold, thus being essential for the production of high-frequency sounds. The EBSLN may be at risk during dissection of the superior thyroid vessels particularly in patients with a large thyroid volume (above 100 ml), a short neck, or a big (above 4 cm in size) nodule in the upper pole of the thyroid. The surgeon must keep the integrity of the EBSLN to preserve normal phonation, particularly among female individuals and voice professionals. Intraoperative stimulation of the EBSLN with or without nerve monitoring can improve the visual identification rate and functional preservation of the nerve and the voice following thyroidectomy. The objective of this chapter is to present the anatomic variation of the EBSLN and the standardized approach to neural monitoring technique in order to minimize the risk of its intraoperative injury during thyroid surgery.