; Romanchishen, Filipp1
; Karpatsky, Igor1
; Vabalayte, Kristina1
1 Department of hospital surgery of Saint-Petersburg Pediatric Medical University, Saint-Petersburg Center of Endocrine Surgery and Oncology, Russia
The aim of the research was an improvement of TC patients’ surgical treatment results.
The technique of thyroid gland (TG) resections were developed during 42 autopsies and surgical dissections of 587 TG ligaments, 1717 recurrent laryngeal nerves (RLN), 177 spinal accessory nerves (SAN).
Before entry into a larynx RLN could divided on 2 or more branches (26.7%), crossed by an artery and vein (95.3%). Preventive ligation of crossing vessels provided hemostasis. Zuckerkandl’s tubercle (ZT) was found in 60.0% of anatomical and 73.4% – clinical cases. ZT tumors were found in 12.5%. SAN descended from jugular aperture of skull in front and laterally – in 85.4%, behind – in 12.2% and medially – in 2.4% to internal jugular vein. Further SAN passed along back surface of sternocleidomastoid muscle (SCMM), penetrated (87.8%) or passed adjacent to it (12.2%). Connection of SAN and C3 was revealed in 73.2%. Surgical topography of SAN depend considerably of approaches chosen (by Romanchishen or MacFee). SAN lefts the SCMM at level of middle third in 24.4% and lower – in 61.0%. Clinical use of this knowledge during 6148 operations provided decrease of RLN palsy up to 0.31%, SAN – up to 0.41%.
Precise anatomical technique of RLN, SAN dissection during Thyroidectomy and neck lymphadenectomy ensured the safety of TC patients surgery.