Thyroidectomy-total

Thyroidectomy is a procedure that is commonly done with the patient under general anaesthesia.

The doctor will administer the general anaesthesia through a tube into the patient's airways. Following this, a horizontal incision is made sharply on the middle of the neck [Figure 3]. The doctor will then slowly cut through the underlying fat and through a thin sheet-like muscle called the platysma. This creates flaps which are raised superiorly and inferiorly. This exposes two long strand of muscles which run up the neck called the sternohyoid muscles. These sternohyoid muscles are then pulled apart from each other [ Figure4]. Deep to the sternohyoid muscle is a type of loose connective tissue called areolar tissue. This areolar tissue is then cut through using electrocautery to expose the thyroid gland.

The middle thyroid vein is then divided between clamps and cauterised to stop blood from leaking out. The side of the thyroid gland is then pushed towards the midline of the neck [Figure5], which exposes the vessels on the superior side of the thyroid gland [Figure 6]. The superior pole vessels are then divided and cauterised. This is done in a direction from the middle to the neck to the outside of the neck. This prevents damage to an important nerve branch called the external branch of the superior laryngeal nerve which is involved in speech production.

After division of the superior pole vessels, the gland is moved further to the middle of the neck. An important nerve, the recurrent laryngeal nerve, which is also involved in speech production is identified [Figure 7].

The lower pole of the thyroid is then made mobile. Force is now applied to the side thyroid towards the necks midline until it is sharply cut off from the trachea (windpipe), which should divide the ligament of berry [Figure 5,7].

The other side of the thyroid is removed in a similar way.

The muscles of the neck are then placed back into their correct positions and the wound is closed.

Figure 3: Incision for thyroidectomy Figure 4: Seperation of Sternohyoid muscles.

Figure 5: Medial traction of thyroid gland Figure 6: Superior thyroid vessels

Figure 7: Ligament of Berry