Surgical aspects of topographic and anatomical changes in the neck after hemithyroidectomy

Abstract

Objective. To develop the optimal surgical techniques for repeated interventions on the thyroid gland, taking into account topographic and anatomical changes in the neck after a previous hemithyroidectomy. Materials and methods. The results of repeated surgical treatment of 69 patients (divided into two groups) with various pathologies of the thyroid gland were analyzed. Patients of the main group (39 person) underwent magnetic resonance imaging of the soft tissues of the neck before the surgery. In the comparison group (30 person), reintervention in the volume of thyroidectomy was performed in the classical way without tomography. Results. Based on magnetic resonance imaging of the soft tissues of the neck, the topographic anatomy of its anterior section in patients after hemithyroidectomy was studied. Two types of disposition of organs and structures were revealed: anterior lateral and posterior medial. The first type is characterized by an anterior displacement of the esophagus to the posterior surface of the lateral lobe of the thyroid gland and the neurovascular bundle. In the second type, a tight contact between the thyroid gland and the short muscles of the neck and displacement of the carotid artery and jugular vein posteriorly and medially was detected. Surgical techniques for repeated surgical intervention have been adjusted for each type of disposition. Conclusions. The proposed techniques made it possible to minimize the length of surgical access, the duration of intervention, the severity of pain syndrome, as well as the number of intra- and postoperative complications.