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THYROID SURGERIES Hemithroidectomy Subtotal thyroidectomy Near total thyroidectomy Total thyroidectomy

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Page 1: Thyroid Surgeries

THYROID SURGERIES

HemithroidectomySubtotal thyroidectomyNear total thyroidectomyTotal thyroidectomy

Page 2: Thyroid Surgeries

HISTORY

Pioneers in thyroid surgeriesTHEODOR KOCHERTHEODOR BILROTHWILLIAM HALSTEDCHARLES MAYOGEORGE CRILE

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

Page 3: Thyroid Surgeries

INDICATIONS

CosmesisCompressionCancerToxicity

Page 4: Thyroid Surgeries

PREOPERATIVE INVESTIGATIONS

Basic investigations FNAC USG neck Thyroid profile X-ray neck AP,Lateral ENT opinion Investigate for other co-morbid conditions-

Diabetes,Hypertension,Heart disease,etc. Anaesthetic fitness for surgery

Page 5: Thyroid Surgeries

ANATOMY OF NECK

Page 6: Thyroid Surgeries

ANATOMY OF NECK

Page 7: Thyroid Surgeries

THYROID-ARTERIAL SUPPLY

Page 8: Thyroid Surgeries

THYROID-VENOUS DRAINAGE

Page 9: Thyroid Surgeries

RECURRENT LARYNGEAL NERVE

Page 10: Thyroid Surgeries

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

Page 11: Thyroid Surgeries

INCISION

Low collar skin crease incision 2 cm above the suprasternal notch

Page 12: Thyroid Surgeries

INCISION

Skin, subcutaneous tissue,platysma incised

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Sub platysmal flap raised

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Upper limit is thyroid cartilage

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Lower limit is medial ends of clavicle

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Deep fascia incised

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Strap muscles separated in the midline

Page 18: Thyroid Surgeries

PLANE OF DISSECTION

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FASCIAL DISSECTION

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FASCIAL DISSECTION

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GLAND SEPARATED FROM THE MUSCLES

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GLAND SEPARATED FROM THE MUSCLES

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SUPERIOR PEDICLE

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SUPERIOR PEDICLE IDENTIFICATION

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SUPERIOR PEDICLE LIGATION

Page 26: Thyroid Surgeries

SUPERIOR PEDICLE LIGATION

Page 27: Thyroid Surgeries

MIDDLE THYROID VEIN IDENTIFIED

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MIDDLE THYROID VEIN LIGATED

Page 29: Thyroid Surgeries

INFERIOR THYROID VESSELS LIGATED

Page 30: Thyroid Surgeries

POSTERIOR CAPSULAR DISSECTION SAFEGAURDING

RECCURRENT LARYNGEAL NERVE & PARATHYROIDS

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Page 32: Thyroid Surgeries

COMPLETION OF SUBTOTAL THYROIDECTOMY

Page 33: Thyroid Surgeries

CLOSURE

Page 34: Thyroid Surgeries

CLOSURE