Preoperative neck CT scan of this patient with primary hyperparathyroidism was interpreted as showing an enlarged left inferior parathyroid gland (see parathyroid embryology and anatomy). No other preoperative studies (sestamibi scan, angiogram, venous sampling) were done since 80% of individuals with primary hyperparathyroidism have a single adenomatous gland (the remainder have hyperplasia of all four glands or two adenomas), and the success of a first surgical exploration in the hands of an experienced surgeon is 95-98%.
The subcutaneous platysma muscle layer (see neck anatomy) separates cleanly from the underlying deep investing fascia of the neck, allowing easy blunt creation of superior and inferior flaps from a collar incision. Gelpie self-retaining retractors provide exposure. Other forms of self-retaining neck flap retractors are available.
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