Reoperative parathyroidectomy: location of missed glands based on a contemporary nomenclature system. Arch Surg 2010 Nov;145(11):1065-8
Date
11/17/2010Pubmed ID
21079094DOI
10.1001/archsurg.2010.230Scopus ID
2-s2.0-78449264157 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
OBJECTIVES: To evaluate and categorize the locations of missed parathyroid glands found during reoperative parathyroidectomy and to determine any factors associated with these locations.
DESIGN: Retrospective cohort study.
SETTING: Tertiary referral center.
PATIENTS: Fifty-four patients who underwent reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism from January 1, 2005, through January 1, 2009.
MAIN OUTCOME MEASURES: Location of missed parathyroid glands and their association with continuous variables were analyzed using a Kruskal-Wallis test, and associations between gland location and categorical variables were evaluated using the Fisher exact test.
RESULTS: Among 54 patients, 50 abnormal parathyroid glands were identified, resected, and classified as follows: 5 (10%) were type A (adherent to the posterior thyroid capsule); 11 (22%), type B (behind the thyroid in the tracheoesophageal groove); 7 (14%), type C (close to the clavicle in the prevertebral space); 3 (6%), type D (directly over the recurrent laryngeal nerve); 9 (18%), type E (easy to identify; near the inferior thyroid pole); 13 (26%), type F (fallen into the thymus); and 2 (4%), type G (gauche, within the thyroid gland). No demographic, biochemical, or pathological factors were significantly associated with gland location. Among the 43 patients followed up for 6 months, 40 (93%) had documented cures.
CONCLUSIONS: Missed glands after parathyroidectomy for hyperparathyroidism can be found in standard locations in most cases. A standardized nomenclature system based on the regional anatomy and the embryology of the parathyroid glands can guide a systematic exploration for parathyroid adenomas that are not easily identified and facilitate communication about gland locations.
Author List
Silberfein EJ, Bao R, Lopez A, Grubbs EG, Lee JE, Evans DB, Perrier NDAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Female
Humans
Hyperparathyroidism
Male
Middle Aged
Parathyroid Glands
Parathyroidectomy
Recurrence
Reoperation
Retrospective Studies
Statistics, Nonparametric
Terminology as Topic
Treatment Outcome