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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, ...

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