CBL-I

R O L L # 7 7 - 9 6

S L I D E S B Y: M U H A M M A D H A M M A D A K R A M

R O L L # 8 7
CBL 1

• A 40 year old obese woman with previous history of Type 1 diabetes

presented in the OPD with enlarged mass at the front of her neck.
She complains of increased appetite, tremors and sweating. On
examination her heart rate was 120 beats per min. She was
diagnosed as a case of goitre. Doctors advised thyroidectomy.
Q1- Why the inferior thyroid artery is
ligated lateral to the gland?
• Because of extreme variability of the inferior thyroid artery and the
Recurrent Laryngeal Nerve, it is suggested that the artery be ligated
either proximally or at its tertiary branches on thyroid capsule.i.e:
away from the gland, to save the recurrent laryngeal nerve.
 Inferior Thyroid
Artery and
Recurrent
Laryngeal Nerve
 • Two capsules completely cover the thyroid
gland:

1. The true capsule is made up of fibro-

elastic connective tissue. It consists of

Q2- Capsules a dense capillary plexus deep to it. To

avoid hemorrhage during operations,
of Thyroid thyroid is removed along with the true

Gland capsule

2. The false capsule is made up of the pre-

tracheal layer of deep cervical fascia. It
makes the suspensory ligament of Berry.
 • It consists of two lobes (left and right), which are connected
by a central isthmus anteriorly.

• The thyroid gland is closely associated with numerous other

structures in the anterior neck:

• Anteriorly – infrahyoid muscles, namely the sternothyroid,

Anatomical superior belly of the omohyoid and sternohyoid

• Laterally – carotid sheath, containing the common carotid

Relations artery, internal jugular vein and vagus nerve

• Medially –
Organs – larynx, pharynx, trachea and esophagus
Nerves – external laryngeal and recurrent laryngeal
 Q3- Posterior Triangle - Borders
• Its boundaries are as follows:

• Anterior – posterior border of the sternocleidomastoid.

• Posterior – anterior border of the trapezius muscle.

• Inferior – middle 1/3 of the clavicle.

• Apex – superior nuchal line where the trapezius and SCM meet
• Roof: Skin, superficial fascia, investing layer
of deep cervical fascia
Floor: Prevertebral layer of deep cervical
fascia covering Semispinalis
capitis, Splenius capitis, Levator scapulae,
Scalenus posterior and medius
 • Occipital Triangle
Nerves: Spinal Accessory Nerve
Cutaneous branches of cervical plexus: Lesser
Occipital Nerve, Transverse Cervical nerve, Great
Auricular and Supraclavicular nerves
Contents Muscular: branches to trapezius, levator scapulae
and rhomboids
Vessels: Transverse cervical artery and vein,
Occipital artery
Lymph nodes: Supraclavicular and Occipital nodes
Contents of Subclavian/ Supraclavicular Triangle

• Nerves: Roots and trunks of Brachial Plexus

Nerve to serratus anterior, nerve to subclavius and
Suprascapular nerve
Vessels: Third part of Subclavian artery and subclavian
vein
Suprascapular artery and vein, Lower part of external
jugular vein
Lymph nodes: Few members of supraclavicular chain
Q4- Vasculature

• The thyroid gland secretes hormones directly into the

circulation and is highly vascularized.
Arterial Supply
The arterial supply to the thyroid gland is via two main arteries:
• Superior thyroid artery – arises as the first branch of the external carotid artery. It lies in
close proximity to the external branch of the superior laryngeal nerve (innervates the
larynx).

• Inferior thyroid artery – arises from the thyrocervical trunk (a branch of the
subclavian artery). It lies in close proximity to the recurrent laryngeal nerve (innervates
the larynx).

• In a small proportion of people (around 10%) there is an additional artery present –

the thyroid ima artery. It arises from the brachiocephalic trunk and supplies the
anterior surface and isthmus of the thyroid gland.
Venous Drainage

• Venous drainage is carried by the superior, middle, and inferior

thyroid veins, which form a venous plexus around the thyroid gland.

• The superior and middle veins drain into the internal jugular vein and
the inferior empties into the brachiocephalic vein.
Q5- Hypocalcemia after
Thyroidectomy
• Hypoparathyroidism may occur spontaneously or
from accidental removal of the parathyroid glands
during thyroidectomy. This results in hypocalcemia
leading to increased neuromuscular irritability
causing muscular spasm and convulsions (tetany).