thyroid gland

Thyroid, Parathyroid and Head & Neck Surgery

Thyroid, Parathyroid and Head & Neck Surgery2018-04-23T19:57:34+00:00

Thyroid, Parathyroid, and Head & Neck Procedures that We Provide:

  • Thyroid lobectomy (partial thyroidectomy)
  • Total thyroidectomy
  • Parathyroidectomy
  • Parotidectomy
  • Excision of the submandibular gland
  • Excision of congenital masses of the head and neck

Thyroid Lobectomy (Partial Thyroidectomy)

A partial thyroidectomy, also known as a thyroid lobectomy, is removal of one of the two lobes of the thyroid gland.  This procedure is performed in the operating room and requires general anesthesia.  During the procedure, a 2-3 inch incision is made in a natural horizontal skin crease in the lower center of the neck.  The deeper tissues of the neck are gently retracted to provide exposure to the thyroid gland, and the lobe that contains the nodule is removed.  At the end of the procedure, the skin incision is closed in a cosmetic fashion to be as inconspicuous as possible.  Most patients are able to go home the same day, care for themselves the next morning, resume desk work in a week, and return to normal activities in two weeks.

Total Thyroidectomy

A total thyroidectomy is complete removal of all thyroid tissue.  This procedure is performed in the operating room and requires general anesthesia.  During the procedure, a 2-3 inch incision is made in a natural horizontal skin crease in the lower center of the neck.  The deeper tissues of the neck are gently retracted to provide exposure to the thyroid gland, and the entire gland is removed.  At the end of the procedure, the skin incision is closed in a cosmetic fashion to be as inconspicuous as possible.  Because the delicate parathyroid glands must be separated from the back of the thyroid gland on both sides, about 20% of patients will have a temporary drop in the calcium level in their blood that will require calcium supplementation.  For this reason, patients undergoing a total thyroidectomy will need to stay overnight in the hospital, during which time their blood calcium levels are monitored, and calcium supplementation is started if necessary. Most patients are able to go home the next morning after surgery and care for themselves, resume desk work in a week, and return to normal activities in two weeks.

Parathyroidectomy

Parathyroidectomy is removal of one or more of the 4 parathyroid glands that reside on the back of the thyroid gland.  When hyperparathyroidism exists, 85% of cases are due to a parathyroid adenoma–a benign growth of a parathyroid gland that produces more parathyroid hormone (PTH) than the body requires.  The remaining 15% of cases are due to two parathyroid adenomas, an anomalous fifth parathyroid gland that forms an adenoma, or hyperplasia of all four glands (usually seen in patients with longstanding chronic kidney disease).  Prior to surgery, an ultrasound of the neck and at least one other imaging study (Sestamibi scan, SPECT, or MRI) is obtained to determine the precise location of the parathyroid adenoma. The parathyroidectomy is performed in the operating room and requires general anesthesia.  During the procedure, a 1-2 inch incision is made in a natural horizontal skin crease in the lower center of the neck.  The deeper tissues of the neck are gently retracted to provide exposure to the parathyroid glands, and the parathyroid adenoma is removed.  While the patient is still in surgery, a blood test for PTH is performed after the suspected adenoma is removed; if the PTH level drops and is normal, it is confirmation that the adenoma was the sole source of the problem, and the surgery is finished.  However, if the PTH level does not drop, surgical exploration of the parathyroid glands and removal of enlarged glands is continued until the PTH level drops into the normal range.  At the end of the procedure, the skin incision is closed in a cosmetic fashion to be as inconspicuous as possible. Most patients are able to go home the same day, care for themselves the next morning, resume desk work in a week, and return to normal activities in two weeks.

Parotidectomy

The parotid gland is the largest of the salivary glands, all of which produce saliva to help lubricate the oral cavity during meals. It is located just anterior to the ear, with extensions behind the ear and inferiorly into the upper neck. The most common indication for parotidectomy is tumors in the gland; the operation is rarely performed for severe, recurrent infections within the gland. Fortunately, most parotid tumors (>85%) are benign. Parotid gland malignancies vary widely in their aggressiveness and prognosis; many low grade parotid cancers are highly curable with surgery. The most common parotid tumor is a pleomorphic adenoma, also called a benign mixed tumor. Pleomorphic adenomas have been known to degenerate into cancers if they are neglected for many years, hence the standard treatment for most parotid tumors is a parotidecomy to remove part or all of the parotid gland along with the tumor.  The surgery is performed in the operating room under general anesthesia.  Depending on the tumor type, the incisions can frequently be made just like the incisions for a facelift, which are well-hidden.  After surgery, most patients will stay overnight in the hospital and be able to go home the next morning.  A drain will be placed at the time of surgery and will be removed 3 – 7 days later.

Excision of the Submandibular Gland

The submandibular glands are two salivary glands that reside underneath the tongue and just below the border of the jaw.  They produce saliva to help lubricate the oral cavity between and during meals.  Tumors, chronic infections, and large salivary stones obstructing a duct are the most common indications for removal of one of the glands.  The surgery is performed in the operating room under general anesthesia.  A 2-3 inch incision is made in a natural skin crease in the neck, 2 inches below the lower border of the jaw.  The gland is removed through this incision, which is then closed in a cosmetic fashion.  A drain is placed at the end of the surgery and remains for 3 days on average. Most patients are able to go home the same day, care for themselves the next morning, resume desk work in a week, and return to normal activities in two weeks.

Excision of Congenital Neck Masses

The two most common congenital neck masses are thyroglossal duct cysts and branchial cleft cysts.  Although these masses are present from birth, they can become a problem any time from early childhood to well into adulthood.

Thyroglossal duct cysts form from anomalies that occur during development of the thyroid gland.  The thyroid gland actually forms during fetal development at the bottom of the tongue, and then it descends down in the neck to its normal position in the low anterior neck.  If the tract that forms as the thyroid gland descends fails to resorb before birth, a thyroglossal duct cyst can form.   These cysts are usually surgically removed because there is a small risk of cancer developing in the cyst, and because the cysts can become infected and/or cause an unnatural appearing lump in the middle of the neck.  The procedure for a thyroglossal duct cyst removal is called a Sistrunk procedure, and is performed under general anesthesia in the operating room.  A 1-2 inch skin incision is made in the middle of the neck, and the cyst is removed in its entirety, along with all of the tract that leads from the cyst up to the bottom of the tongue, and includes removal of the central portion of hyoid bone in the neck.  The skin incision is closed in a cosmetic fashion.  A drain is placed at the end of the surgery and remains in place for 3-4 days.  After surgery, most patients will stay overnight in the hospital for observation and be able to go home the next morning.

Branchial cleft cysts form from incomplete closure of clefts or pouches in the branchial apparatus, which is a transient structure that is present during early fetal development.  There are many variation of branchial cleft cysts that can occur in children and adults.  One variant includes a cyst in front of the ear with a tract that opens into the ear canal.  Another variant includes a cyst in the side of the neck with a tract that opens into the throat.  Some cysts drain through the skin.  Cysts are surgically removed when a patient has recurrent infections in the cyst, chronic drainage from the cyst, or to improve the cosmetic appearance.  Surgery is performed in the operating room under general anesthesia.  Some cysts can be removed through a single small incision in the neck; others that have a long tract leading to the throat require more than one incision to provide the necessary exposure to remove all of the tract.  The skin incision (or incisions) is closed in a cosmetic fashion.  A drain is placed at the end of the surgery and remains in place for 3-4 days.  After surgery most patients will stay overnight in the hospital for observation and be able to go home the next morning.

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