Page 143 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

eline Head,
Thoracic Surger
A Manual of Canine and F
V
y
Neck and
BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery
BSA
OPERATIVE TECHNIQUE 10.3
VetBooks.ir Canine parathyroidectomy

PATIENT POSITIONING
Dorsal recumbency with a small sandbag or bandage roll under the
neck to hyperextend the cervical vertebrae.
ASSISTANT

Not necessary if good self-retaining retractors are available.

ADDITIONAL INSTRUMENTS
Fine self-retaining retractors; fine scissors (e.g. Stevens tenotomy
scissors); sterile cotton-tipped applicators are useful. In-house serum
calcium measurement is essential; ionized calcium is preferred.
Ultrasound image of a parathyroid mass on the left thyroid.
SURGICAL TECHNIQUE (© Davina Anderson)

Approach
A standard midline cervical approach is used.
Surgical manipulations
1 Make an incision extending from just caudal to the larynx to about two-thirds of the distance to the manubrium.
Split the sternohyoid and sternothyroid muscles and expose the trachea. Cautiously expose the thyroid glands on
each side of the trachea, taking care not to damage the recurrent laryngeal nerves, and the carotid/jugular
bundle.
2 Examine the cranial poles of both thyroid glands closely and palpate them, if necessary. The parathyroid gland
should be of smooth texture, with a lighter colour, on the cranial aspect of the gland. Adenomas tend to be
variable in colour but have a definite nodular appearance and texture. Sometimes it is necessary to palpate both
parathyroid glands simultaneously to determine which has a more nodular texture. Preoperative high-definition
ultrasonography is useful to avoid doubt as to which gland is abnormal.
3 Examine the caudal pole of the thyroid gland carefully for involvement of the internal parathyroid gland.
4 Assess the blood supply to the thyroid gland carefully prior to removal of the nodule.

5 The affected gland/nodule can be sharply dissected off the cranial pole of the thyroid, disturbing adjacent
structures as little as possible. If the internal parathyroid gland is involved, a small portion of thyroid tissue may be
removed to ensure adequate margins are obtained.

Intraoperative vie of identified parathyroid mass in the left The parathyroid mass has been dissected free of the thyroid. Note
thyroid. the tevens tenotomy scissors hich are very useful for this
(© Davina Anderson) procedure.
(© Davina Anderson)

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