Faculty Collaboration Database

The fallen one: the inferior parathyroid gland that descends into the mediastinum. J Am Coll Surg 2009 May;208(5):887-93; discussion 893-5

Date

05/30/2009

Pubmed ID

19476855

DOI

10.1016/j.jamcollsurg.2009.01.032

Scopus ID

2-s2.0-64949159015 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: Inferior parathyroid glands are located along the embryologic migration path of the thymus and can rest in the thyrothymic ligament or anterior mediastinum. Our nomenclature system designates these glands as "fallen" (type F) glands. This study reviews our experience with type F parathyroid glands to determine which can be retrieved successfully through a cervical incision.

STUDY DESIGN: A retrospective review of patients who underwent parathyroidectomy between June 1998 and May 2008 was performed. Patient demographics, localization studies, and operative and pathologic reports were analyzed. Distance from the superior aspect of the clavicle to the target parathyroid gland was measured.

RESULTS: Sixty (9.2%) patients had a type F parathyroid gland. Parathyroidectomy was performed through cervical incision in 54 (90%) patients and 6 (10%) required a thoracic approach. Preoperative imaging identified parathyroid glands located >or=6 cm below the superior aspect of the clavicle in eight patients. Of these, six (75%) required a thoracic approach and two (25%) were resected through a cervical incision with concomitant thymectomy. Parathyroidectomy was successfully performed through a cervical incision in all 52 (100%) patients in whom the target parathyroid gland was <6 cm below the superior aspect of the clavicle (Fisher's exact test, p < 0.001).

CONCLUSIONS: A cervical approach allows successful retrieval of type F parathyroid glands located <6 cm below the superior aspect of the head of the clavicle in the anterior mediastinum. Parathyroidectomy for glands located >or=6 cm below the superior aspect of the clavicle can be attempted from the neck with concomitant thymectomy, but the majority will require a thoracic approach.

Author List

Callender GG, Grubbs EG, Vu T, Hofstetter WL, Fleming JB, Woodburn KL, Lee JE, Evans DB, Perrier ND

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenoma
Female
Humans
Hyperparathyroidism
Male
Middle Aged
Minimally Invasive Surgical Procedures
Parathyroid Glands
Parathyroid Neoplasms
Parathyroidectomy
Reoperation
Retrospective Studies