THYROID SURGERIES

Hemithroidectomy Subtotal thyroidectomy Near total thyroidectomy Total thyroidectomy

HISTORY 
Pioneers 

in thyroid surgeries

THEODOR KOCHER  THEODOR BILROTH  WILLIAM HALSTED  CHARLES MAYO  GEORGE CRILE 
In

1909 Kocher received the nobel prize for medicine for his contributions to thyroid physiology,pathology & surgery.

INDICATIONS 
Cosmesis  Compression  Cancer  Toxicity

PREOPERATIVE INVESTIGATIONS 
      

Basic investigations FNAC USG neck Thyroid profile X-ray neck AP,Lateral ENT opinion Investigate for other co-morbid conditionsDiabetes,Hypertension,Heart disease,etc. Anaesthetic fitness for surgery

ANATOMY OF NECK

ANATOMY OF NECK

THYROID-ARTERIAL SUPPLY

THYROID-VENOUS DRAINAGE

RECURRENT LARYNGEAL NERVE

POSITION 
    

Supine Neck extended Sandbag under the shoulders Head up tilt with head ring Both arms tucked to the patient¶s sides Skin prepared from the level of mandible to the nipples

INCISION 

Low collar skin crease incision 2 cm above the suprasternal notch

INCISION 

Skin, subcutaneous tissue,platysma incised 

Sub platysmal flap raised

Upper limit is thyroid cartilage

Lower limit is medial ends of clavicle 

Deep fascia incised 

Strap muscles separated in the midline

PLANE OF DISSECTION

FASCIAL DISSECTION

FASCIAL DISSECTION

GLAND SEPARATED FROM THE MUSCLES

GLAND SEPARATED FROM THE MUSCLES

SUPERIOR PEDICLE

SUPERIOR PEDICLE IDENTIFICATION

SUPERIOR PEDICLE LIGATION

SUPERIOR PEDICLE LIGATION

MIDDLE THYROID VEIN IDENTIFIED

MIDDLE THYROID VEIN LIGATED

INFERIOR THYROID VESSELS LIGATED

POSTERIOR CAPSULAR DISSECTION SAFEGAURDING RECCURRENT LARYNGEAL NERVE & PARATHYROIDS

COMPLETION OF SUBTOTAL THYROIDECTOMY

CLOSURE

CLOSURE

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