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The Modern Thyroid Operation

The Modern Thyroid Operation. Department of Otolaryngology Kaohsiung Medical University, Taiwan. Feng-Yu Chiang, MD. E-mail: fychiang@kmu.edu.tw. The modern thyroid operation. Eradicate thyroid disease A safe thyroid operation Intra-operative evidence.

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The Modern Thyroid Operation

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  1. The Modern Thyroid Operation Department of Otolaryngology Kaohsiung Medical University, Taiwan Feng-Yu Chiang, MD E-mail: fychiang@kmu.edu.tw

  2. The modern thyroid operation • Eradicate thyroid disease • A safe thyroid operation • Intra-operative evidence

  3. Eradicate thyroid disease • Total lobectomy • Total thyroidectomy • Neck dissection (Central or Lateral) • Resection of upper aerodigestive tract • I-131 therapy

  4. A safe thyroid operation • Preserve RLN and EBSLN • Preserve parathyroid function

  5. Intra-operative evidence • Anatomic integrity - High-resolution photographs • Functional integrity - IONM of RLN - Intact blood supply to parathyroid

  6. Preservation of RLN

  7. Recurrent laryngeal nerve palsy • Most common and serious complication • The leading reason for medicolegal litigation

  8. Routine identification of RLN • Lower rates of RLN palsy • Gold standard of RLN treatment

  9. Intra-Operative NeuroMonitoring(IONM)

  10. Applications of IONM • Prevent RLN injury • Localize and identify RLN • Predict vocal function • Elucidate mechanism of RLN injury • Help preserve parathyroid

  11. ET tube KMU ENT

  12. 17

  13. Video of RLN approach

  14. IONM is useful and helpful for • Anatomic variants of RLN • Difficult thyroid operation

  15. Anatomic variants of RLN (Extralaryngeal branches, Non-RLN, Distorted RLN…etc) - important factors: • RLN injury • False results of IONM

  16. Extralaryngeal branches of RLN • Branch to trachea • Branch to esophagus • Branch to inferior constrictor muscle • Anterior branch • Posterior branch

  17. Bifurcated RLN

  18. Non-recurrent RLN

  19. Video of detecting Non-RLN

  20. Video of mapping Non-RLN

  21. Video of Non-RLN

  22. Difficult thyroid operation (Recurrent, substernal or large goiter , Thyroid cancer) Early localization & Definite identification An important step to prevent RLN injury

  23. Localization

  24. Reoperation

  25. Substernal or large goiter

  26. Palsy rates in 3 operation periods

  27. Preservation of EB-SLN

  28. Video of EB-SLN

  29. Preservation of parathyroid function • Preserve parathyroid with intact blood supply • Auto-transplantation for devascularized parathyroid

  30. Parathyroid with intact blood supply (1)

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