Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Thyroid Lobectomy ++ Unilateral toxic nodule.Solitary adenoma or cyst. +++ Total Thyroidectomy ++ Thyroid carcinoma.Graves' disease.Hashimoto thyroiditis.Multinodular goiter.Substernal goiter. +++ Neck Dissection ++ 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. +++ Thyroid Surgery +++ Expected Benefits ++ 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. +++ Potential Risks ++ 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.Scarring.Infection.Need for additional medical or surgical treatment. +++ Modified Radical Neck Dissection +++ Expected Benefits ++ Clearance of primary tumor and locally advanced carcinoma from the neck at all nodal levels. +++ Potential Risks ++ 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. +++ Thyroid Procedures ++ 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, ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.