Volume 20 No 22 (2022)
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Microanatomy of central compartment of neck and prediction of hypocalcemia with serial values of serum calcium in patients undergoing total thyroidectomy
Dr. Vasanth Kumar Gunasekaran, Dr. Jagadeesh Marthandam
Abstract
Background: A thorough knowledge of the microanatomy of the central compartment is crucial in relating the structures to one another and identifying them. The aim of the study is to determine the potential role of intraopera¬tive identifi¬cation and preservation of parathyroid glands, by understanding its microanatomical relationship with the recurrent laryngeal nerve, and predicting the postoperative hypocalcaemia with serial values of serum calcium level. Methods: A total of 70 cases where total thyroidectomy done were included in the study. Central neck dissection was performed ipsilaterally when size >4cms and extrathyroidal invasion noted. The microanatomical relationship of parathyroids in relation to the plane of recurrent laryngeal nerve was observed. Three samples of Serum calcium at immediate postop period, 6 hours after and 12 hours later were graphically depicted in a time value graph to predict the development of hypocalcemia postoperatively. Results: A total of 70 patients over a span of two years from 2013 to 2015 were included in the study. Central compartment neck dissection was carried out in 43(61.4%) patients. The pathological types consisted of 57 (81.4%) papillary carcinomas, 04 (5.7%) medullary carcinomas, 02 (2.8%) follicular neoplasms and 07 (10.1%) benign diseases of thyroid. Left inferior parathyroids were found posterolateral in 68.5% and anterolateral in 27.1%. Right side parathyroids had variable positions with superior parathyroids in the anterior plane observed laterally in 71.4% and medially in 28.6% of cases. Right inferior parathyroids were found highly variable in all the planes, 47.1% anteromedially, 38.5% posterolaterally, 5.7% anterolaterally and 8.5% posteromedially. The graphical representation showed Upsloping curve in 34.2%, downsloping curve in 47.1% and 69.6% of them developed transient hypocalcemia. 18.7% of cases showed a plateau curve. Conclusion: A thorough understanding of microanatomical relationship of parathyroids in relation to plane of recurrent laryngeal nerve intraoperatively is advocated in preventing hypocalcemia and nerve injury. Left side parathyroids and right superior parathyroid gland are usually positioned lateral to the plane of nerve whereas right side inferior parathyroid gland showed varied positions. The downsloping curve in graphical representation of serial calcium values postoperatively predicts the patients vulnerable to develop hypocalcemia.
Keywords
A thorough knowledge of the microanatomy of the central compartment is crucial in relating the structures to one another and identifying them.
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