Page 141 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Neck and
Thoracic Surger
V
eline Head,
y
BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery
A Manual of Canine and F
BSA
➜ OPERATIVE TECHNIQUE 10.1 CONTINUED
VetBooks.ir SURGICAL TECHNIQUE

Approach
Palpate the neck to confirm clinical findings of enlarged thyroid glands in the conscious patient. Make a midline skin
incision at about the level of the palpated glands extending from the caudal edge of the larynx down to the manubrium.
Surgical manipulations
1 Continue the dissection in the midline, separating the sternohyoid and sternothyroid muscles. Place retractors to
hold the muscles apart.
2 Expose the ventral trachea and identify the thyroid glands on the lateral
and ventral aspects of the trachea. Identify and avoid the caudal
laryngeal nerves. Inspect both glands carefully to identify disease as
well as to identify the parathyroid glands and the pattern of
vascularization in the individual patient. Note: If the contralateral gland
is normal, it should be atrophied; if the contralateral gland is a ‘normal’
size, then the cat probably has bilateral disease.
3 Ligate the caudal blood supply and gently lift the thyroid gland (by the
caudal pole) out of the tracheal fascia. Continue meticulous dissection
cranially up to the level of the parathyroid gland.
4 The parathyroid gland is to be preserved. Make an incision into the
capsule around the extrathyroid parathyroid gland. Some texts
describe using bipolar cautery to cut the capsule around the
parathyroid gland. Lift the parathyroid gland off the underlying thyroid
gland, retaining the cranial blood supply and its attachment to the
capsule.
Closure

The site is observed closely for haemostasis prior to closure. The sternohyoid
and sternothyroid muscles are reapposed using a simple continuous suture.
Most hyperthyroid cats are too thin to require subcutaneous tissue closure
and the skin is closed with a continuous subcuticular suture, or simple
interrupted skin sutures. odified e tracapsular thyroidectomy in
a cat.
POSTOPERATIVE CARE

Cats should be hospitalized to watch closely for clinical signs of hypocalcaemia, including weakness and muscle
tremors, often first recognized as twitching of the ears and face.

OPERATIVE TECHNIQUE 10.2

eline th roidecto odi ed intracapsular

PATIENT POSITIONING
Dorsal recumbency, with equal retraction of the forelimbs caudally to ensure that the neck is symmetrical.

PRACTICAL TIP

It is helpful to place the neck over a small sandbag or bandage roll to hyperextend the cervical vertebrae. This
exposes more of the thoracic inlet and brings the trachea (and thyroid glands) to a more superficial position

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