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A D V E R T I S E M E N T

 

Parathyroid Embryology and Anatomy: 7

A D V E R T I S E M E N T

   
 

A small percentage of parathyroid glands will be found in ectopic locations, most commonly in the region of the thymus.       

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Parathyroid Embryology and Anatomy: 8

A D V E R T I S E M E N T

   
 

In patients with primary hyperparathyroidism, 80% of individuals have one adenomatous gland. 10-12% have hyperplasia involving all four glands, and 8-10% have two adenomatous glands. The normal parathyroid gland is tan to brown in color and measures about 3x4 mm. It is usually lies flat against the posterior surface of the thyroid lobe. The superior glands are normally slightly smaller than the inferior. Adenomas tend to be larger and more spherical and can often be identified visually. If only normal glands are found near the thyroid, the adenoma is most likely to be found in the thyrothymic ligament or in the cervical extension of the thymus gland. In a first exploration for primary hyperparathyroidism, an experienced surgeon is successful 95-98% of the time in locating the offending gland or glands. Preliminary localizing studies (US, angiogram, MRI, Sestamibi scan, CT) are not required. For secondary exploration, they are very beneficial.   

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Parathyroid Embryology and Anatomy: 9

A D V E R T I S E M E N T

   
 

A parathyroid gland can be easily devasuclarized in mobilization. The color of a devascularized gland becomes darker. After biopsy confirmation, such a gland may be sliced into 1-mm pieces and reimplanted. A pocket in the adjacent sternocleisomastoid muscle is usually used and the site is marked with a clip in case the gland must be relocated in the future. A forearm muscle is an alternate site.      

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This page was last modified on 1/13/2000.