Anatomía quirúrgica de las glándulas tiroides y paratiroides / Surgycal anatomy of the thyroid and parathyroid glands

Nuestro objetivo es lograr un relato de los detalles anatómicos que ayude al cirujano a conseguir intervenciones seguras, se elude el estilo de las anatomías descriptivas o topográficas tratando de producir una anatomía verdaderamente quirúrgica. Para ello se mencionan las fascias, estructuras capsulares y ligamentos que envuelven a la tiroides. Se hace hincapié en la vascularización, principalmente en lo referente a la arteria tiroidea inferior, fundamental para la localización del nervio recurrente. También en lo relacionado con el conjunto del drenaje venoso, que con su complicada distribución dificulta notablemente la disección. Relatamos minuciosamente las variantes anatómicas y las anomalías que afectan a la estructura de la región, su conocimiento es fundamental ante la posibilidad de que el cirujano encuentre en sus operaciones alguna de ellas. Describimos el aspecto, las relaciones y lo referente a la localización de las glándulas paratiroides, detalles necesarios para evitar su resección inopinada en las tiroidectomías y para el reconocimiento de la glándula patológica en el hiperparatiroidismo

The aim of this article is describe the anatomical details that helps the surgeon to achieve safe surgeries, the style of descriptive or topographic anatomies is avoided trying to produce a truly surgical anatomy. For this, fascias, capsular structures and ligaments that surround the thyroid gland are mentioned. Emphasis is placed on vascularization, mainly in relation to the inferior thyroid artery, essential for the location of the recurrent nerve. Also in relation to the whole of the venous drainage, which with its complicated distribution makes dissection remarkably difficult. We carefully describe the anatomical variants and the anomalies that affect the structures of the region, their knowledge is fundamental to the possibility that the surgeons finds in their surgeries. We describe the appearance, the relationships and the reference to the location of the parathyroid glans. Neccesary details to avoid their inopinate resection in thyroidectomies and for the recognition of the pathological gland in the hyperparathyroidism

Tubérculo de Zuckerkandl. Situación, forma y dimensiones / Zuckerkandl's tubercle. Location, shape and dimensions

Introducción y objetivo: Aunque no es conocido por buena parte de los cirujanos de cabeza y cuello, el tubérculo de Zuckerkandl es un detalle anatomoquirúrgico fundamental, descrito ya en el siglo XIX; su detección tiene gran importancia al servir de referencia en la búsqueda del nervio recurrente y de la glándula paratiroides superior. Material y método: Diseñamos un estudio descriptivo prospectivo para analizar el borde posterolateral de los lóbulos tiroideos buscando esta formación. Incluimos 107 tiroidectomías realizadas por un mismo cirujano, 88 son tiroidectomías totales (82,24%) y 19 hemitiroidectomías (17,75%); con lo que se disecaron 195 lóbulos tiroideos. El tubérculo de Zuckerkandl debe buscarse luxando hacia fuera el borde posterolateral de los lóbulos tiroideos. Resultados: Se detecta con seguridad en 155 lóbulos tiroideos (79,48%). El tubérculo tiene unas dimensiones medias de 11 mm de eje transversal, 9 mm de eje longitudinal. La forma del tubérculo de Zuckerkandl es sesil (70,96%) o pediculada (29,03%). En el 5,80% de los casos el extremo distal del tubérculo de Zuckerkandl es bífido. No encontramos un tubérculo de Zuckerkandl individualizado a modo de tiroides ectópico (0,00%). El tubérculo de Zuckerkandl es más frecuente en el lóbulo tiroideo derecho (p=0,06). Conclusión: El tubérculo de Zuckerkandl se reconoce por su situación, forma y dimensiones(AU)

Introduction and objective: Although Zuckerkandl's tubercle is not known by many head and neck surgeons, it is a fundamental surgical anatomical detail, already described in the nineteenth century. Its detection is of great importance as the reference in the search for the recurrent nerve and superior parathyroid gland. Material and method: We designed a prospective study to analyse the posterolateral border of thyroid lobes, looking for this tubercle. We included 107 thyroidectomies performed by the same surgeon; 88 were total thyroidectomies (82.24%) and 19 hemithyroidectomies (17.75%), with dissection of a total of 195 thyroid lobes. Zuckerkandl's tubercle should be sought by displacing the posterolateral margin of the thyroid lobes. Results: It was reliably detected in 155 thyroid lobes (79.48%). The mean tubercle dimensions were 11 mm transverse axis and 9 mm longitudinal axis. The shape of the Zuckerkandl's tubercle was sessile (70.96%) or pedunculated (29.03%). In the 5.80% of cases, the Zuckerkandl's tubercle distal end was bifid. We did not find a Zuckerkandl's tubercle individualised as an ectopic thyroid (0.00%). Zuckerkandl's tubercle was more frequent in the right thyroid lobe (P=.06). Conclusion: Zuckerkandl's tubercle is recognised by its location, shape and dimensions(AU)

[Zuckerkandl's tubercle. Location, shape and dimensions]. / Tubérculo de Zuckerkandl. Situación, forma y dimensiones.

INTRODUCTION AND OBJECTIVE: Although Zuckerkandl's tubercle is not known by many head and neck surgeons, it is a fundamental surgical anatomical detail, already described in the nineteenth century. Its detection is of great importance as the reference in the search for the recurrent nerve and superior parathyroid gland. MATERIAL AND METHOD: We designed a prospective study to analyse the posterolateral border of thyroid lobes, looking for this tubercle. We included 107 thyroidectomies performed by the same surgeon; 88 were total thyroidectomies (82.24%) and 19 hemithyroidectomies (17.75%), with dissection of a total of 195 thyroid lobes. Zuckerkandl's tubercle should be sought by displacing the posterolateral margin of the thyroid lobes. RESULTS: It was reliably detected in 155 thyroid lobes (79.48%). The mean tubercle dimensions were 11 mm transverse axis and 9 mm longitudinal axis. The shape of the Zuckerkandl's tubercle was sessile (70.96%) or pedunculated (29.03%). In the 5.80% of cases, the Zuckerkandl's tubercle distal end was bifid. We did not find a Zuckerkandl's tubercle individualised as an ectopic thyroid (0.00%). Zuckerkandl's tubercle was more frequent in the right thyroid lobe (P=.06). CONCLUSION: Zuckerkandl's tubercle is recognised by its location, shape and dimensions.

Agenesia de hueso vómer / Agenesis of the vomer bone

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