- Unilateral toxic nodule.
- Solitary adenoma or cyst.
- Thyroid carcinoma.
- Graves' disease.
- Hashimoto thyroiditis.
- Multinodular goiter.
- Substernal goiter.
- Locally advanced head and neck carcinoma demonstrated by presence of nodal disease clinically, by preoperative imaging, or by sentinel node biopsy.
- Few contraindications exist for thyroidectomy or neck dissection.
Absolute (Neck Dissection)
- Randomly scattered dermal metastases precluding a full-thickness dissection.
- Intracranial extension of tumor from the neck.
- Tumor fixation to the skull base or the cervical spine.
Relative (Neck Dissection)
- Tumor fixation to the internal carotid artery.
- Locally advanced disease in the root of the neck.
- Periosteal invasion of the skull base.
- Curative resection for actual or potential malignancy.
- Relief of symptoms caused by toxic or large multinodular goiters.
- Relief of symptoms resulting from benign thyroid disease.
- Bleeding that may cause airway compression and require reoperation.
- Recurrent laryngeal nerve paresis or transection causing hoarseness (temporary or permanent).
- Hypocalcemia requiring oral calcium or vitamin D.
- Need for additional medical or surgical treatment.
Modified Radical Neck Dissection
- Clearance of primary tumor and locally advanced carcinoma from the neck at all nodal levels.
- Damage to vital adjacent structures, including spinal accessory nerve, sternocleidomastoid (SCM) muscle, internal jugular vein, and vagus nerve.
- Lymphatic leak from thoracic duct trauma.
- No special equipment is required.
- A self-retaining retractor may be used to assist in the dissection.
- A handheld recurrent laryngeal nerve stimulator is often employed.
- A harmonic scalpel may also be used to aid in the dissection.
- Nothing by mouth the evening before surgery.
- Preoperative antibiotics if needed for valvular pathology, artificial heart valves, artificial joints, etc.
- Consultation with an anesthesiologist if necessary based on airway examination or comorbid disease, or both.
- Surgeon-directed ultrasound to identify thyroid lesion, size of thyroid, location of surrounding structures, etc.
- Additional preoperative imaging and studies to demonstrate presence of lesion and potential metastatic disease in malignancy.
- Anesthesiology consultation (see later discussion).
- The patient should be supine.
- Airway management is of particular concern. Preoperative anesthesiology consultation should alleviate positioning concerns while ensuring proper airway safety during the procedure.
- A towel roll can be placed beneath the shoulder blades to facilitate neck extension.
- Arms may be tucked.
- Figure 1–1: A curvilinear incision is made in the neck a fingerbreadth below the cricoid cartilage and approximately 2 fingerbreadths above the sternal notch.
- Additionally, a suitable skin crease in the lower neck may be used for ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessSurgery Full Site: One-Year Subscription
Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.
Pay Per View: Timed Access to all of AccessSurgery
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.