SURGERY OF THE THYROID-PART1-SURGICAL ANATOMY

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SURGERY OF THE THYROIDPART-1----SURGICAL ANATOMY : 

SURGERY OF THE THYROIDPART-1----SURGICAL ANATOMY DR SANOOP K ZACHARIAH

EMBRYOLOGY & DEVELOPMENT : 

EMBRYOLOGY & DEVELOPMENT THYROID PRIMODIUM

EMBRYOLOGY & DEVELOPMENT : 

EMBRYOLOGY & DEVELOPMENT STAGES

Slide 4: 

1st ARCH 2nd 3rd 4th Tuberculum impar Foramen ceacum copula pouches Ultimobranchial body THYROGLOSSAL DUCT

Slide 5: 

C-cells Hyoid bone

EMBRYOLOGYSURGICAL SIGNIFICANCE : 

EMBRYOLOGYSURGICAL SIGNIFICANCE ECTOPIC THYROID LINGUAL THYROID THYROGLOSSAL CYST THYROGLOSSAL FISTULA LATERAL ABERRENT THYROID

ECTOPIC THYROID : 

ECTOPIC THYROID LINGUAL INTRA THORAXIC LATERAL ABERRENT THYROID CERVICAL

ECTOPIC THYROID : 

ECTOPIC THYROID Usually residual tissue Whole gland-very rare May be the only thyroid tissue present Diagnosis –biopsy, radio nucleotide study

LINGUAL THYROID : 

LINGUAL THYROID Mass of ectopic thyroid tissue-base of tongue Incidence-1/100,000 F:M=4:1 Appears as a raised pink mass-posterior tongue Onset of symptoms coincide with puberty, pregnancy, menopause.

DD –LINGUAL THYROID : 

DD –LINGUAL THYROID HAEMANGIOMAS CYSTIC HYGROMA FIBROMA LIPOMA PAPILOMA PLEOMORPHIC ADENOMA SQUAMOUS CELL CARCINOMA

ANATOMY : 

ANATOMY ISTHMUS LOBE LOBE PL

SURGICAL ANATOMY : 

SURGICAL ANATOMY WHAT IS The shape ? The plane ? The blood supply ? The assosciated nerves & their significance ? Berrys ligament ? Why does the thyroid move with deglutition ? In which stage of deglutition ? What is superior pedicle ? Lymphatic drainage ?

SHAPE : 

SHAPE BOW TIE BUTTERFLY

RULE OF 2 : 

RULE OF 2 BIPARTITE ORIGIN BILOBED-CONNECTED BY ISTHMUS ADDITIONAL PYRAMIDAL LOBE IN 1/3RD OF THE GLANDS AVERAGE DIMENSIONS ARE MULTIPLES OF 2 WEIGHT-20 GMS (15-25) 2 CAPSULES- TRUE CAPSULE SURGICAL CAPSULE

RULE OF 2 : 

RULE OF 2 2 ARTERIES & 3 VEINS LYMPHATIC DRAINAGE INTO 2 COMPARTMENTS- CENTRAL, LATERAL 2 IMPORTANT NERVES 2 IMPORTANT GLANDS(PARATHYROIDS)-EACH LOBE 2 IMPORTANT TRAINGLES-BHEARS , JOLLS. 2 HORMONES PRODUCED- T3, T4

RULE OF 2 : 

RULE OF 2 BIPARTITE ORIGIN BILOBED-CONNECTED BY ISTHMUS ADDITIONAL PYRAMIDAL LOBE IN 1/3RD OF THE GLANDS AVERAGE DIMENSIONS ARE MULTIPLES OF 2 WEIGHT-20 GMS (15-25) 2 CAPSULES- TRUE CAPSULE SURGICAL CAPSULE

RULE OF 2 : 

RULE OF 2 2 ARTERIES & 3 VEINS LYMPHATIC DRAINAGE INTO 2 COMPARTMENTS- CENTRAL, LATERAL 2 IMPORTANT NERVES 2 IMPORTANT GLANDS(PARATHYROIDS)-EACH LOBE 2 IMPORTANT TRAINGLES-BHEARS , JOLLS. 2 HORMONES PRODUCED- T3, T4

RULE OF 2 : 

RULE OF 2 2 cm *2cm 2cm 2cm 2cm

DEEP CERVICAL FASCIA : 

DEEP CERVICAL FASCIA HAS 4 COMPONENTS INVESTING LAYER PREVERTBRAL FASCIA PRETRACHEAL FASCIA CAROTID SHEATH

DEEP FASCIA-DIVISIONS : 

DEEP FASCIA-DIVISIONS PT PV CS IL STRAP MUSCLES

Slide 21: 

PRETRACHEAL FASCIA SURGICAL CAPSULE SUSPENSORY LIGAMENT OF BERRY TRUE CAPSULE ANTERIOR

STRAP MUSCLES : 

STRAP MUSCLES OF THE FOLLOWING WHICH ARE THE STRAP MUSCLES ? Stlylohyoid Geniohyoid Mylohyoid Sternohyoid Omohyoid Sternothyroid Thyrohyoid HYOID BONE Suprahyoid muscles Infrahyoid muscles or STRAP MUSCLES

HOW TO REMEMBER NAMES OF STRAPS ? : 

HOW TO REMEMBER NAMES OF STRAPS ?

STRAP MUSCLES : 

STRAP MUSCLES OF THE FOLLOWING WHICH ARE THE STRAP MUSCLES ? Stlylohyoid Geniohyoid Mylohyoid Sternohyoid Omohyoid Sternothyroid Thyrohyoid HYOID BONE Suprahyoid muscles Infrahyoid muscles or STRAP MUSCLES

HOW TO REMEMBER NAMES OF STRAPS ? : 

HOW TO REMEMBER NAMES OF STRAPS ?

WHY DOES THYROID MOVE WITH DEGLUTITION ? : 

WHY DOES THYROID MOVE WITH DEGLUTITION ? DURING FIRST STAGE OF DEGLUTITION HYOID MOVES UP PULLS PRETRACHEAL FASCIA UP THIS PULLS LIGAMENT OF BERRY UP THIS PULLS THYROID UP

WHAT ARE OTHER STRUCTURES THAT MOVE WITH DEGLUTITION ? : 

WHAT ARE OTHER STRUCTURES THAT MOVE WITH DEGLUTITION ? THYROGLOSSAL CYST PRE & PARATRACHEAL NODES SUB-HYOID BURSA ALL STRUCTURES ENCLOSED IN THE PRETRACHEAL FASCIA WILL MOVE ON DEGLUTITION

BLOOD SUPPLY : 

BLOOD SUPPLY Each lobe supplied by superior and inferior thyroid arteries and drained by 3 veins

SUPERIOR VASCULAR PEDICLE : 

SUPERIOR VASCULAR PEDICLE Components- Superior thyroid artery=1st branch of external carotid artery Superior thyroid vein-drains into IJV External laryngeal nerve-leaves the pedicle at 1cm above the upper pole to enter the cricothyroid muscle So,the sup.pedicle should be ligated close to the gland

INFERIOR THYROID ARTERY : 

INFERIOR THYROID ARTERY Directly arises from thyrocervical trunk Passes behind carotid sheath Runs transversely to enter post aspect of lobe Terminally divides into numerous branches close to RLN & inferior parathyroid gland So, the artery should be ligated just medial to the carotid sheath i.e away from the gland

RECURRENT LARYNGEAL NERVE : 

RECURRENT LARYNGEAL NERVE Branch of vagus Lies in tracheo-oesophageal groove 2% -non recurrent-only on the right Damage –stridor,hoarseness

Slide 33: 

SUPERIOR PEDICLE INFERIOR THY VEIN INFERIOR THY ROID ARTERY RLN SLN MTV

DAMAGE TO EXTERNAL LARYNGEAL N : 

DAMAGE TO EXTERNAL LARYNGEAL N ELN-supplies cricothyroid muscle Cricothyroid muscle is a tensor of vocal cord Controlling pitch Hence pitch is affected

THANK YOUEND OF VOLUME 1 : 

THANK YOUEND OF VOLUME 1