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Abstract
Background and Objectives
The inferior parathyroid glands receive their blood supply from the inferior thyroid artery. The anatomic relationship of this artery and the recurrent laryngeal nerve can assume three different patterns. To maintain the vascular supply of the inferior parathyroid glands during central neck dissection, we considered the anatomic relationship of these structures in our surgical approach.
Materials and Methods
Fibrofatty tissue in the central neck compartment was removed by dissection proceeding along the recurrent laryngeal nerve. During the dissection, care was taken not to injure the vascular supply of the inferior parathyroid gland.
Results
For an inferior parathyroid gland that receives its blood supply from the posterolateral vascular pedicle, preservation is achieved by performing the dissection along the recurrence laryngeal nerve on the gland's medial side. In patients in whom the inferior thyroid artery travels deep to the right recurrent laryngeal nerve, such that the right parathyroid gland receives its blood supply from the posteromedial vascular pedicle, central neck dissection should be performed carefully along the lateral side of the gland to preserve the pedicle.
Conclusion
Preservation of inferior parathyroid gland function requires a detailed understanding of the anatomic relationship between the inferior thyroid artery and recurrent laryngeal nerve. The direction of the dissection along the nerve should be adjusted according to its anatomic relationship to the inferior thyroid artery.
References
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Fig. 1.
(A-C) The inferior parathyroid glands receive their blood supply from the inferior thyroid artery. The anatomical relationship of the inferior thyroid artery and the recurrent laryngeal nerve can assume three different patterns.
Fig. 2.
A schematic drawing (A) and photograph (B) of a central neck dissection (CND) on the left side. To preserve the function of the inferior parathyroid gland, if the gland receives its blood supply from the posterolateral vascular pedicle, the dissection should proceed along the RLN on the medial side of the inferior parathyroid gland (dotted line: extent of CND, CCA: common carotid artery, RLN: recurrent laryngeal nerve, black arrow: inferior thyroid artery, white arrow: parathyroid gland).
Fig. 3.
A schematic drawing (A) and photograph (B) of a CND on the right side. If the inferior thyroid artery travels deep to the right RLN and the right parathyroid gland receives its blood supply from the posteromedial vascular pedicle, the CND should be performed carefully along the lateral side of the gland to preserve the posteromedial vascular pedicle (dotted line: extent of the CND, CCA: common carotid artery, RLN: recurrent laryngeal nerve, black arrow: inferior thyroid artery, white arrow: parathyroid gland).
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