Autotransplantation of Parathyroid Tissue Into Sternocleidomastoid Muscle

Abstract

\s=b\Four cases of secondary hyperparathyroidism were treated by total parathyroidectomy with autotransplantation into the sternocleidomastoid muscle. These total parathyroidectomy patients are presented to demonstrate the reliability of parathyroid autotransplantation into the sternocleidomastoid muscle. Our technique is described in detail, and all procedures were successful. In one case, the patient was found, in retrospect, to have an adenoma in the transplanted parathyroid tissue. When the patient developed graft-dependent hypercalcemia, a portion of the graft was easily excised under local anesthesia and the patient became normocalcemic. Parathyroid tissue should be transplanted into the sternocleidomastoid muscle rather than other sites because of easy accessibility, one operative site, less graft ischemia, a low incidence of infection, and a high success rate due to excellent blood supply.

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

“…If the nondominant forearm is chosen, there should be a preoperative discussion about the patient’s handedness and current and future dialysis access plans; care should be taken to avoid injuring a dialysis graft or fistula intraoperatively 166. The sternocleidomastoid is the second most common graft site, with the benefit of requiring only one operative incision 132,281,286,288,289,299. Other implantation sites, including an intramuscular or subcutaneous presternal site, muscles of the thigh anterior tibialis or trapezius, subcutaneous tissues of the nondominant forearm, and the abdominal adipose tissue are less frequently used 24,132,290,300–306.…”

“…166 The sternocleidomastoid is the second most common graft site, with the benefit of requiring only one operative incision. 132,281,286,288,289,299 Other implantation sites, including an intramuscular or subcutaneous presternal site, muscles of the thigh anterior tibialis or trapezius, subcutaneous tissues of the nondominant forearm, and the abdominal adipose tissue are less frequently used. 24,132,290,[300][301][302][303][304][305][306] Importantly, the autograft site chosen does not impact the risk of postoperative bleeding or voice changes, and the duration of surgery is not significantly different from a total PTX alone.…”

Parathyroid adenoma arising within the sternocleidomastoid muscle: a rare complication of autotransplantation

“…Other complications are extremely rare. These include recurrent thyroid malignancy (arising within inadvertently transplanted malignant tissue),9 graft hyperfunction and parathyroid adenoma 10 11. The latter is rare and a recent case report and review of the literature highlighting the presence of an adenoma arising from autotransplanted parathyroid tissue in the setting of secondary hyperparathyroidism identified fewer than 20 previous cases in the literature 12.…”

Total Parathyroidectomy: A Surgical Management for Uncontrolled Secondary Hyperparathyroidism in a Patient with End Stage Renal Disease

“…It utilizes the same operative site, and is associated with less graft ischemia, low infection incidence, and high graft survival rates. 9 Elevated alkaline phosphatase levels are expected to normalize after 3 months. 10 Pruritis disappears, improving quality of life while residual soft tissue calcifications no longer progress to more severe calciphylaxis.…”