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Thyroid surgery
Published in Pallavi Iyer, Herbert Chen, Thyroid and Parathyroid Disorders in Children, 2020
Jessica Fazendin, Brenessa Lindeman
A surgical endocrinologist’s approach to thyroid surgery must start with a thorough understanding of the gland’s anatomy. The thyroid lies anterolateral to the trachea and is attached to it by the short, fibrous ligament of Berry. Typical thyroids are bi-lobed, their shape often likened to a butterfly, with a normal gland weighing between 15 and 20 g. As with other endocrine organs, the thyroid has a robust and intercalated system for arterial supply and venous drainage. The thyroid is supplied by two main arteries, and their subsequent branches. The superior thyroid artery, the first branch of the external carotid artery, supplies the superior poles of the gland, with the inferior thyroid artery, arising from the thyrocervical trunk, supplying the inferior poles. The inferior thyroid artery also supplies both upper and lower parathyroid glands. The venous drainage is three-fold via the superior, middle, and inferior thyroid veins, of which the first two drain into the internal jugular vein and the inferior vein drains into the brachiocephalic vein. The gland has a rich lymphatic drainage system via the Delphian (pretracheal), laryngeal, paratracheal, and lateral cervical nodes. The most common site of lymphatic drainage is to the paratracheal nodes within the central compartment of the neck (2).
Thyroid disease
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
The blood supply of the thyroid is symmetric bilaterally. The superior thyroid artery is a branch of the external carotid artery, whilst the inferior thyroid artery is a branch of the thyrocervical trunk (a branch from the first part of the subclavian artery).
Surgical Anatomy of the Thyroid
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Ashutosh Mangalgiri, Deven Mahore
The blood supply of the thyroid gland comes from the superior thyroid artery, the branch of the external carotid artery. This artery contributes in a major way to supply the thyroid gland. Another vessel supplying the thyroid gland is the inferior thyroid artery. The inferior thyroid artery provides a major contribution to the parathyroid gland.
Anatomy and motor function of extra-laryngeal branching patterns of the recurrent laryngeal nerve; an electrophysiological study of 1001 nerves at risk
Published in Acta Chirurgica Belgica, 2023
A comprehensive anatomic and functional knowledge of the recurrent laryngeal nerve (RLN) has paramount importance in the safety of thyroid surgery. Many branches of the RLN have been established by anatomical studies under direct or microscopic observation [1,2]. Extra-laryngeal terminal branching (ETB) is a macroscopic variation that is visible along its cervical course of the RLN [3,4]. The thyroid surgeon must preserve both anatomic and functional integrity of all terminal branches if present. RLNs with terminal branches have division points along their cervical course at variable locations, creating different combinations. Therefore, in the case of bifid RLN, the location of division points should be established in order to identify and expose all neural branches. The RLN always intersects the inferior thyroid artery (ITA) along its course [5,6]. Branched RLNs are tabulated into subgroups of various types so that the crossing of the ITA and nerve branches should be identified separately [6]. Intraoperative nerve monitoring (IONM) is widely accepted method to assess the motor function of the RLN. In case of bifid nerve, electrophysiological activity of nerve branches may establish functional variations of the RLN. Thus, the importance of this study is both to expose all anatomic aspects of ETB pattern of the RLN, and to detect functional variations of nerve branches through IONM. This study aims to evaluate the variations in anatomy and electrophysiological activity of the cervical segment of the RLN in a prospective, consecutive surgery cohort.
Ultrasound-guided thermal ablation for hyperparathyroidism: current status and prospects
Published in International Journal of Hyperthermia, 2022
Zhiguang Chen, Linggang Cheng, Wei Zhang, Wen He
The average dimensions of each gland are 5 mm × 3 mm × 1 mm (length × width × thickness), and each gland weighs approximately 60 mg [18,19]. The superior gland is relatively fixed and is located in the middle third of the posterior thyroid gland. The final position of the inferior gland changes considerably because of the relatively long descending process, with >50% located at the lower pole of the thyroid gland [20–22]. There are abundant vascular network anastomoses between the parathyroid gland and the pharynx, larynx, trachea, and esophagus. The blood supply to the parathyroid gland mainly comes from the inferior thyroid artery and, in a few cases, from the superior thyroid artery. The venous system of the parathyroid gland is accompanied by the corresponding artery, which flows into the internal jugular vein. Furthermore, the lymphatic drainage of the parathyroid gland is similar to that of the thyroid gland, leading to the deep neck and anterior trachea [23].
Intra-operative vagal neuromonitoring predicts non-recurrent laryngeal nerves: technical notes and review of the recent literature
Published in Acta Chirurgica Belgica, 2021
S. Van Slycke, K. Van Den Heede, K. Magamadov, J.-P. Gillardin, H. Vermeersch, N. Brusselaers
A non-recurrent course of the laryngeal nerve is reported in few surgical cases and, as in the two presented cases, is found mostly on the right side (0.3–1.6% of all thyroid surgery cases) [3]. On the left side it is even more unique, thought to be found in less than 0.04%; and it has also been described in combination with a co-existing situs inversus and dextrocardia [1]. In our centre, we performed 590 thyroid surgery procedures from January 2010 to April 2013. We encountered three patients with a right non-recurrent laryngeal nerve (0.5%), of which two are presented here. Stedman was the first to report an anatomical variant of the inferior recurrent laryngeal nerve [4]. During autopsy he identified a branch of the vagal nerve which coursed directly to the laryngotracheal junction without turning around the subclavian artery. In that particular case the anatomical variant of the normal inferior laryngeal nerve was associated with an aberrant right subclavian artery and an extra-anatomical lusorian artery, which branched directly of the main aortic arch, distally of the left subclavian artery. This branch ran behind the esophagus to reach the right axillary area. After this first report, several other authors described this NRLN during autopsies [4,5]. Due to this anomaly, the nerve has been more frequently damaged during thyroid surgery, since it was often thought to be a branch of the inferior thyroid artery, leading to permanent hoarseness as iatrogenic consequence [6]. As seen in Figure 1, a type A NRLN can be mistaken for a branch of the inferior thyroid artery, a type B for a branch of the superior thyroid artery.