An alternative approach, especially in benign disease is to do a partial
lobectomy, leaving the posterior rim of thyroid undisturbed to preserve parathyroids. In this case, the main trunk of the inferior thyroid artery is not divided and the recurrent laryngeal nerve is not routinely explored and visualized. There is good historical precedent for not exploring the nerve, including documented incidents of late neurapraxia. After careful hemostasis, the strap muscles are reapproximated, the platysma layer is closed and the skin is closed without drains. Instructions are left to watch for respiratory distress and a tracheostomy set should be easily accessible in the event the wound needs to be opened to evacuate hematoma compressing the trachea or to perform an emergency tracheostomy if necessary.
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