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See all Premium member Presentation Transcript 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 You do not have the permission to view this presentation. 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SURGERY OF THE THYROID-PART1-SURGICAL ANATOMY SANOOPKZ Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1114 Category: Science & Tech.. License: All Rights Reserved Like it (14) Dislike it (0) Added: December 08, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: goor (12 month(s) ago) great animation,,Thank U Saving..... Post Reply Close Saving..... Edit Comment Close By: Doc.ARD (12 month(s) ago) Thank you veryyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy much Saving..... Post Reply Close Saving..... Edit Comment Close By: Doc.ARD (12 month(s) ago) Thnx Saving..... Post Reply Close Saving..... Edit Comment Close By: sherifaboubakr (12 month(s) ago) thx uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu Saving..... Post Reply Close Saving..... Edit Comment Close By: haitham112002 (12 month(s) ago) thanks for this lecture . i hope you allow me to download this lecture and other lectures about same subject. thanks Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript 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