Surgery of Thyroid Gland
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Total thyroidectomy is the treatment of choice for cases with confirmed diagnosis of thyroid malignancy. During the procedure, a frozen section biopsy of the regional node is necessary. Neck dissection is done in case of positive neck node. A complete hemithyroidectomy (unilateral lobectomy) is indicated in case a frozen section diagnosis is not confirmative. Depending upon postoperative histopathology, a second operation is necessary to remove the non-operated side. Total extracapsular thyroid lobectomy is very commonly performed. The de Quervain’s points are located, inferior thyroid arteries identified, and recurrent laryngeal nerves are preserved. The superior thyroid vessels are identified, divided, and ligated separately. The external laryngeal nerve is identified and followed to the cricothyroid muscle. The tracheoesophageal groove lymph nodes must be dissected carefully in malignant cases to preserve the recurrent laryngeal nerve and blood supply of the parathyroid glands.