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Surgical Approaches to Mediastinal Parathyroid Glands

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Surgery of the Thyroid and Parathyroid Glands

Abstract

The mediastinal parathyroid gland typically results from the failure of the parathyroid glands to cease at their normal position adjacent to the thyroid gland during their descent from the third and fourth pharyngeal pouches. An understanding of the possible anatomic locations of the aberrant parathyroid glands as well as the anatomy of the mediastinum itself is important to developing an effective diagnostic and management strategy. Combining this knowledge with one or several of the preoperative localization techniques that exist can contribute to the successful localization and subsequent resection of an anomalous mediastinal parthyroid gland. The hyperfunctioning ectopic, mediastinal parathyroid gland can usually be addressed operatively through a neck approach. Occasionally though, a thoracic approach is needed and selecting the optimal thoracic approach is dependent upon accurate preoperative localization of the aberrant gland as well as the expertise of the surgeon. The objectives of this chapter are to provide an overview of the ectopic mediastinal parathyroid gland, discuss the associated localization techniques, and describe the open and minimally invasive approaches that can be used when performing a mediastinal parathyroidectomy.

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Correspondence to Anthony W. Kim M.D. .

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Kim, A.W., Detterbeck, F.C. (2012). Surgical Approaches to Mediastinal Parathyroid Glands. In: Oertli, D., Udelsman, R. (eds) Surgery of the Thyroid and Parathyroid Glands. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23459-0_35

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  • DOI: https://doi.org/10.1007/978-3-642-23459-0_35

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