Identification of parathyroid glands: anatomical study and surgical implications

Abstract

While performing thyroid surgery, the unintentional lesion of parathyroid glands and laryngeal nerves results in a profound alteration in patient's quality of life. To minimize thyroid surgery morbidity, the surgeon must have an in-depth knowledge of the thyroid gland morphology and its anatomical relations in the anterior compartment of the neck. This work intended to simulate total thyroidectomies using cadaver parts and isolate fragments that may correspond to parathyroid glands. The thyroid glands and "eventual" parathyroid glands were then submitted to histological study. Ninety-two cadaver parts were used for macroscopic dissection. A total of 242 fragments were isolated, 154 of which were confirmed through histological study to be parathyroid glands. In 36 cases, all "eventual" parathyroid glands isolated during dissection were confirmed through histological verification. In 40 cases, some glands were confirmed. In 16 cases, none of the "eventual" parathyroid glands was confirmed. The 92 thyroid glands isolated during dissection were also submitted to histological study. In 21 thyroid glands, 16 parathyroid glands were identified in the histological cuts: 8 sub-capsular, 8 extra-capsular, 6 intra-thyroidal. There was no statistical difference between the dimensions of the parathyroid glands. Parathyroid gland identification and preservation are sometimes a challenge during thyroid surgery, difficulty that has been demonstrated during dissection of cadaver parts.

Preoperative injection of carbon nanoparticles is beneficial to the patients with thyroid papillary carcinoma

“…In thyroid surgery, hypoparathyroidism was a common and serious complication, having a serious effect on the patient's life quality especially on the patients with total thyroidectomy (TT) and bilateral central lymph node dissection (BCND). [ 1 – 4 ] The key point of preventing permanent hypoparathyroidism was the identification of PG during the operation, [ 5 , 6 ] it mainly depended on physical recognition of PG by the operator such as color, texture, and surface microvasculature of PG. Meanwhile the identification of PG was closely related to the operative experience of the surgeon.…”

Novel method to save the parathyroid gland during thyroidectomy: Subcapsular saline injection

“…Second, although the blood vessels that feed the parathyroid glands generally branch from the superior and inferior thyroid artery, 26 there can be numerous anatomic variations. 4 Finally, the location of the lower parathyroid glands is inconsistent 27 : they can be found anywhere from the inferior thyroid to the superior mediastinum because their precursor cells settle relatively randomly in this area during embryogenesis. 26 These features mean that it is difficult to identify the exact location of the parathyroid glands and the structure of the vessel.…”

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

“…The surgical procedure can be performed in general anesthesia: the ultimate focused minimal invasive procedure could also be performed with local anesthesia or with local control with anesthetic block in particular in high risk patients not suitable for intubation. 105,106 Curative rates in patients undergoing parathyroidectomy range from 95% to 98% when surgery is done in a high volume center headed by a high volume surgeon: the complication rates are unusual and literature reports percentage inferior to 3% for all injuries. Mini invasive procedure in experienced skilled hand may be associated with lower morbidity and general costs.…”