Thyroid Gland- Surgical Anatomy - AIIMS, Rishikesh

Thyroid Gland- Surgical Anatomy

March 2019 1VARSHNEY UG Lecture

March 2019 VARSHNEY UG Lecture 2

Bi-lobed gland over 2nd & 3rdtracheal ring

Weight : 20 – 30 gr


Samuel D. Gross – 1866 , Philadelphia

A System of Surgery

Thyroid surgery: ‘Horrid butchery’

“No honest and sensible surgeon would ever engage inthyroid surgery”

1909 Nobel Prize

Theodur Kocher (1841-1917)

• Mortality:

• 1889 – 2.4%

• 1900 – 0.18%

• Emphasis on meticulous technique

• Performed 5000 cases by death in 1917March 2019 4VARSHNEY UG Lecture

Thyroidectomy

Neck Release

Moraitis, Shaha. JSO 2006

•Open the “gift wrap”

•Separate fascia from the muscles

•Separate strap muscles

•Separate sternomastoid muscle


Thyroid Gland moves with deglutition

Ligament of Berry

(Condensation of Pretracheal fascia)

Inferior constrictor- 2 parts

Thyropharyngeus {Thyroid cartilage}

Cricopharyngeus {Cricoid cartilage}

[Contraction – Thyroid and cricoid move up]


The thyroid gland is a very vascular structure.

Superior thyroid artery (ECA),

Inferior thyroid artery

( Thyrocervical trunk)

Arteria thyroideaima artery (2-12% ) (innominate, subclavian, right common carotid, internal mammary, or the aortic arch.


The superior thyroid vein follows the pathway of the superior thyroid artery.

The middle thyroid veins directly flow into the internal jugular vein.

The inferior thyroid veins can be found just anterior to the trachea and often anastomose with each other


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Nerve supply


SLN

Dissection of thesuperior thyroidvessels parallel tothe vessels onsurface of thyroid &exposure of SLN.


Laryngeal Nerves


Beahr`s Triangle


Goitre



THYROIDECTOMY

Skin Incision


Superficial Dissection

Platysma

Anterior Jugular Veins

Jugular Venous Arch


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077200/figure/Fig3/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077200/figure/Fig3/

Exposure of Strap Muscles

• Investing Layer of Deep Cervical Fascia

• Sternohyoid Muscle

•Sternothyroid•Superior belly of Omohyoid


Separating the Strap Muscles and Exposing the Anterior Surface of the Thyroid


March 2019 22VARSHNEY UG Lecture


QUESTIONS ???

Thyroid Gland- Surgical Anatomy - AIIMS, Rishikesh

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