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KMID : 1202020140070020149
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Journal of Korean Thyroid Association
2014 Volume.7 No. 2 p.149 ~ p.152
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Preservation of Parathyroid Glands during Thyroid Surgery
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Park Jin-Woo
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Abstract
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Hypoparathyroidism after thyroidectomy occurs as a result of devascularization or unintentional resection ofthe parathyroid glands. To preserve parathyroid glands, surgeons have to know well about their embryologyand anatomy. The parathyroid glands vary in number, size, shape, and color. Because of more variablemigration path in the neck, the inferior parathyroid glands are more widely distributed than the superior glands.The upper parathyroid glands are dorsal and the lower parathyroid glands are ventral to the coronal planeof recurrent laryngeal nerve path. Positional symmetry of superior or inferior parathyroid glands is found inapproximately 70-80%. Each parathyroid gland has its own end-artery. Both the superior and inferior parathyroidglands most frequently receive blood supply from the inferior thyroid artery. Parathyroid exploration requiresa meticulous and bloodless dissection with help of surgical loupes. During the superior pole dissection, everyattempt should be made to dissect the gland posteriorly off the thyroid with preserving the posterior branchof the superior thyroid artery. Dissection of the lateral lobe is best achieved by capsular dissection. The tertiarybranches of the inferior thyroid artery lying on the thyroid capsule are individually ligated and divided. Thesurgeon can also utilize positional symmetry of the parathyroid glands. If the parathyroid gland is clearlydevascularized or turns deep black, it should be biopsied, confirmed as normal parathyroid tissue, andreimplanted. It is useful to search for unintentionally resected parathyroid tissue in the surgical specimen forautotransplantation at the end of the operation.
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KEYWORD
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Parathyroid, Hypoparathyroidism, Capsular dissection, Autotransplantation
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