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A D V E R T I S E M E N T
A D V E R T I S E M E N T
The inferior thyroid artery is now dissected and elevated and the recurrent laryngeal nerve is identified, usually posterior to the vessel and within or anterior to the tracheo-eosphageal groove (see discussion of nerve location under thyroid anatomy).
A D V E R T I S E M E N T
The lower parathyroid is usually found in close association with the inferior thyroid artery and below it. It is often possible to preserve its blood supply as it is dissected off the thyroid capsule, ligating the inferior thyroid vessel distal to the takeoff of the parathyroid branch. In the case of an isolated gland, the safest survival strategy is to cut the gland into thin slices and implant it into the adjacent sternocleidomastoid muscle. The site of implantation should be marked with a metal clip in the event of future problems, especially when operating for parathyroid disease. In the latter case, it is best to implant the questionable gland into a forearm muscle so that it is easily accessible without reopening the neck.
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A D V E R T I S E M E N T
The lobe is then retracted to the right, exposing the suspensory ligament (of Berry) attaching it to the trachea. The ligament is sharply divided close to the gland to avoid entering the pretracheal fascia which can cause significant postoperative pain. The isthmus is then easily mobilized from the trachea and divided at its junction with the opposite lobe.
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This page was last modified on 3/28/1999.
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