- 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 ...
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