The Anatomic Basis of Parathyroid Surgery

Abstract

A study of 645 normal adult parathyroid glands in 160 cadavers revealed that there is a definite pattern of anatomic distribution on the basis of the embryologic development of the parathyroid, thyroid, and thymic glands. The sites of predilection of the upper gland (Parathyroid IV) are, in order of frequency, the cricothyroid junction; the dorsum of the upper pole of the thyroid; and the retropharyngeal space. Those of the lower gland (Parathyroid III) are at the lower pole of the thyroid and the thymic tongue; rarely in the upper, the lateral neck, or the mediastinum. An understanding of the developmental relationship of the parathyroid glands to the thyroid and the thymus is fundamental in the delineation of the embryologic origin of the parathyroid glands. The parathyroid gland, located within the surgical capsule of the thyroid (subcapsular), when diseased, remains in place locally. A gland outside of the capsule (extracapsular) is often displaced into the posterior or anterior mediastinum. A collective assessment of the size, weight, color, shape, and consistency of the parathyroid gland is mandatory in the determination of its normalcy. Frozen section examination for stromal and intracellular fatty content is an added assurance of normalcy. That parathyroid glands sink in saline solution, and fat globules float, may aid in differentiating the two types of tissue. Supernumerary, fused, and intrathyroidal parathyroids, albeit rare, are of surgical importance.

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

“…Knowing the anatomical position and vascular supply of the parathyroid glands is essential to avoid hypoparathyroidism after thyroid surgery30, 31. According to a study of 100 cadaveric thyroid glands32, 38.2 per cent of the parathyroid vessels were considered at risk of damage during standard thyroidectomy; the authors reported that the four parathyroid glands were at risk in 5 per cent of the subjects.…”

Editorial: “Ten Commandments” of Safe and Optimum Thyroid Surgery

“…The missing inferior parathyroid glands are sometimes found in the thyro-thalamic ligament at the lower pole. In about 5% individuals five rather than four glands may be seen [4,[9][10][11]. The parathyroids are golden yellow in colour and author finds the attached "sentinel pad" of fat a very reliable pointer to the gland ( fig.).…”

“…Mass ligatures should be avoided as there can be accidental inclusion of RLN or damage to the inferior parathyroids (Fig. 10) [9][10][11].…”

New Aspects in Studying of Parathyroid Morphology as a Condition for Parathyroidectomy Technology Optimization Under Integrated Approach

“…Они тесно прилежат к щитовидной железе и покрыты общим с ней париетальным листком IV фасции шеи, вследствие чего нередко удаляются при тиреоидэктомии. Верхние ОЩЖ мо-гут также локализоваться ниже верхнего полюса щитовидной железы, ретротра-хеально на уровне средней или нижней трети доли щитовидной железы, над верхним полюсом щитовидной железы, в области бифуркации общей сонной артерии, интратиреоидно [2,7,18,19].…”

“…Ряд авторов утверждают, что ОЩЖ расположены ассиметрично [7,18,19], но вместе с тем J.-F. Henry и G. Akerstrum в 60-80% отметили симметричное расположение билатеральных ОЩЖ [16].…”