Aside from the classic description of a normal parathyroid gland being “London tan” in color and about the size of a grain of rice, there are a number of other subtle and less frequently described morphological features that aid in their identification:
Bloodless field:
A bloodless surgical field is of high importance when attempting to identify parathyroid glands:
As any blood staining impairs the ability toidentify and assess the morphological features of thegland
Parathyroid glands are not palpable unless abnormal:
A normal parathyroid gland is soft and quite compressible on digital palpation:
This important feature can help to differentiate a normal gland from a small lymph node,which is normally rubbery and palpable
Fat pads (Figure 1):
The parathyroid glands are often encased in a “fat pad”:
Located in a region where the thymus “points” to the inferior pole of the thyroid gland (inferior gland)
Cranial to the ITA and generally posterior to the RLN (superior gland)
Vascular pedicle:
A small vascular pedicle can often beseen entering the parathyroid gland
Cope’s sign (Figure 2):
Bruising of the parathyroid glandthat can occur with mobilization or dissection
“Kissing glands” (Figure 3):
This term is used to describetwo parathyroid glands that are so close in position thatthey appear to a single, bilobed gland
Althoughuncommon,this possible configuration should be bornein mind when searching for a missing gland
Kissingglands can be differentiated from a true bilobar gland byidentifying a cleavage plane between the capsules of thetwo glands
Slides under fascia:
The parathyroid glands are usuallyfound within the thyroids pretracheal fascial capsule, butnot adherent to it
This feature allows the gland to be gentlyslid or rolled under the fascia by a fine instrument such as aCrile
Fat pads. Visualinspection can yield manyclues to aid in theidentification of theparathyroid glands. Inspectionshould begin by looking for afat pad located where thethymus points to the inferior pole of the thyroid gland forthe inferior gland, and 1 to 2 cmcranial to the inferior thyroidartery on the posterior surfaceof the thyroid gland andanterior to the recurrentlaryngeal nerve (as shown)
Cope’s sign. Mobilization in the area of the parathyroid glandcan cause bruising and discoloration of the parathyroid gland. This signis often subtle, but it can be an important visual cue to direct furtherdissection. This image shows a red-purple discoloration at the top of thethymus in the region of the inferior parathyroid gland. Further dissectionallowed morphologic identification of a normal inferior gland
“Kissing” left upper and lower parathyroid glands. Parathyroidtissue was identified in a fat pad at the level of the inferior thyroidartery, which initially appeared to be a single, bilobed gland. Closer inspection revealed a cleavage plane between the lobes, which wascarefully dissected, and separate upper and lower glands were able to bemorphologically identified
My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida.
I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016.
Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida.
Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.
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Rodrigo Arrangoiz MS, MD, FACS, FSSO 