By Anthony J. Edis M.D., Luis A. Ayala M.D., Richard H. Egdahl M.D., Ph.D. (auth.)
ISBN-10: 147571159X
ISBN-13: 9781475711592
ISBN-10: 1475711611
ISBN-13: 9781475711615
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Example text
The traction and countertraction possible when the muscles are intact greatly facilitate dissection of the areolar planes of the neck. 33 Fig. 1-23 34 SURGERY OF THE PARATHYROIDS THE "EASY" CASE On occasion an adenoma is seen as soon as the right lobe of the thyroid gland is reflected forward. There is a somewhat greater statistical probability that an adenoma will be located on the right side of the neck. Fig. 1·24 An adenoma of the right superior parathyroid gland is exposed. It has a smooth glistening capsule and is not adherent to the surrounding tissues, making it possible for the surgeon to shell it out with relative ease.
37 Fig. 1·27 38 SURGERY OF THE PARATHYROIDS THE 'ROUTINE' CASE In the usual cervical exploration for primary HPT the adenoma is not immediately evident, and it is necessary to carry out a methodical dissection on both sides of the neck. Usually some dissection is necessary to uncover the adenoma. The recurrent laryngeal nerves are routinely exposed in these cases. Once seen, they are less likely to be damaged. The inferior thyroid artery is not ligated. Fig. 1·28 Palpating the Recurrent Laryngeal Nerve.
The tumor grows slowly and spreads by local invasion, becoming fixed to neighboring tissues. Often the first indication that one is dealing with a parathyroid carcinoma rather than a straight forward adenoma is the unusual difficulty encountered in separating the lesion from surrounding tissues. The adhesive reaction surrounding a parathyroid cancer involves the recurrent laryngeal nerve in this instance. Treatment of this particular lesion, therefore , will involve excision of the tumor together with the ipsilateral thyroid lobe and a segment of the recurrent nerve, en-bloc.
Manual of Endocrine Surgery by Anthony J. Edis M.D., Luis A. Ayala M.D., Richard H. Egdahl M.D., Ph.D. (auth.)
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