c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Thyroidectomy: 10

A D V E R T I S E M E N T

   
 

The superior pole vessels must now be carefully separated from the peritracheal fascia containing the superior laryngeal nerve. The nerve usually lies posteromedial to the vessels.

 While delicately retracting the superior pole laterally, a small hemostat is insinuated just medial to the fascia containing the vessels, hugging the contour of the top of the lobe. Opening the clamps separates the vessels from the nerve.      

Notes:

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Thyroidectomy: 11

A D V E R T I S E M E N T

   
 

Some surgeons encircle the vascular pedicle at this point. The safer option is to place a small curved clamp on a small portion of the vascular pedicle and slide it down onto the thyroid substance to clamp the tissue. A clamp is placed in parallel on the tissue above and it is divided between clamps. The tissue in the upper clamp is ligated. The lower clamp is used for traction as the next set of clamps is placed. The process is repeated two or three times until the upper pole is completely freed.     

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Thyroidectomy: 12

A D V E R T I S E M E N T

   
 

Once the upper pole is free, the traction suture is used to gently pull the lobe medially. The posterior surface of the upper pole is examined for the delicate brown upper parathyroid gland. The upper glands are more variable in position than the lower. If the gland is identified, it is carefully dissected out of the thyroid capsule and left on the carotid sheath posteriorly. It is usually not possible to identify a discrete feeding vessel with the upper gland. If the gland turns dark in color it is devascularized and may need to be implanted in muscle (see below).     

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This page was last modified on 3/28/1999.