THYROID SURGERIES

HemithroidectomySubtotal thyroidectomyNear total thyroidectomyTotal thyroidectomy

HISTORY

Pioneers in thyroid surgeriesTHEODOR KOCHERTHEODOR BILROTHWILLIAM HALSTEDCHARLES MAYOGEORGE CRILE

In 1909 Kocher received the nobel prize for medicine for his contributions to thyroid physiology,pathology & surgery.

INDICATIONS

CosmesisCompressionCancerToxicity

PREOPERATIVE INVESTIGATIONS

Basic investigations FNAC USG neck Thyroid profile X-ray neck AP,Lateral ENT opinion Investigate for other co-morbid conditions-

Diabetes,Hypertension,Heart disease,etc. Anaesthetic fitness for surgery

ANATOMY OF NECK

ANATOMY OF NECK

THYROID-ARTERIAL SUPPLY

THYROID-VENOUS DRAINAGE

RECURRENT LARYNGEAL NERVE

POSITION

Supine Neck extended Sandbag under the

shoulders Head up tilt with head

ring Both arms tucked to the

patient’s sides Skin prepared from the

level of mandible to the nipples

INCISION

Low collar skin crease incision 2 cm above the suprasternal notch

INCISION

Skin, subcutaneous tissue,platysma incised

Sub platysmal flap raised

Upper limit is thyroid cartilage

Lower limit is medial ends of clavicle

Deep fascia incised

Strap muscles separated in the midline

PLANE OF DISSECTION

FASCIAL DISSECTION

FASCIAL DISSECTION

GLAND SEPARATED FROM THE MUSCLES

GLAND SEPARATED FROM THE MUSCLES

SUPERIOR PEDICLE

SUPERIOR PEDICLE IDENTIFICATION

SUPERIOR PEDICLE LIGATION

SUPERIOR PEDICLE LIGATION

MIDDLE THYROID VEIN IDENTIFIED

MIDDLE THYROID VEIN LIGATED

INFERIOR THYROID VESSELS LIGATED

POSTERIOR CAPSULAR DISSECTION SAFEGAURDING

RECCURRENT LARYNGEAL NERVE & PARATHYROIDS

COMPLETION OF SUBTOTAL THYROIDECTOMY

CLOSURE

CLOSURE