Welcome to this presentation on the neck part
During this presentation, we're going to
cover three subject areas, we're going to
begin by looking at the thyroid gland.
Secondly, we'll visit the stellate ganglion
and then lastly, we'll
visit the thoracic outlet.
And as we move through each of these three
topical areas, we'll discuss
So here we begin with the thyroid and what I
want you to understand here at
the beginning is some really basic anatomy.
The thyroid gland is located anteriorly to
the trachea, in the lower neck, at the level
of the fifth cervical to the first thoracic
It has a brownish-red color and a nodular
First, the thyroid is made up of lobes.
Here we see the right lobe.
Next, we have the left lobe.
And lastly, both lobes are connected by an
The apices of the lobes diverge laterally on
the laminae of the thyroid cartilage, and
their bases are at the level of the fourth
or fifth tracheal cartilages.
The lobes are attached on their posterormedial
aspects to the cricoid cartilage by
Berry's ligament. On their lateral aspect,
the lobes are in close relationship with the
great vessels of the neck.
This particular slide shows a very important
relationship or anatomic relationship, and
this is the relationship
of the thyroid gland to the recurrent
Each laryngeal nerve here is the right
It's lying within the trachea, esophageal
groove, and we see that grew
between the trachea and the esophagus, which
We also see the same relationship, however,
it's unlabeled on the
opposite side, so here is your left
recurrent laryngeal nerve
and again, it travels in the
on that particular slide.
Clinically, these are important during a thyroidectomy.
The surgeon has to carefully identify these
nerves and preserve them so they are
not injured during the removal of the
thyroid gland will
also demonstrate another clinical
correlation of the recurrence.
When we talk about thyroid goiter.
The thyroid gland is supplied by the
superior and inferior thyroid arteries,
and in some instances by the thyroid artery
of Neubauer, a branch from the
brachiocephalic trunk or aortic arch.
Here are some important aspects about the
nerves, both recurrent laryngeal nerves are
branches of the vagus
nerve, and they will supply all the
laryngeal muscles with the exception of the
They are called recurrent as they come off
the vagus nerve
and then travel back upwards to either side
trachea and ultimately to their destination
larynx. The left and right
recurrent laryngeal nerves do have some
relationship differences, the left recurrent
loops around the aortic arch in the vicinity
of the ligamentum arteriosum,
whereas the right recurrent
loops more superiorly on the right side and
loops under the right
Here is an important clinical correlation
looking at goiter in this particular
has a very enlarged thyroid gland, very
that's very visible.
In this particular individual, there are
enlarged nodules, so this particular form of
Some of the symptoms that are associated
with a goiter
are as follows.
One is coughing.
And this has a mass effect on the
passageways and the larynx, a second symptom
hoarseness. Very large goiters can
involve the recurrent laryngeal nerves, and
if they become
involved, then they're unable to effectively
the muscles of the larynx and can then
hoarseness. Another symptom that can be
with goiter is the difficulty swallowing
dysphagia, and this would be
due to a mass effect.
So the mass is compressing the structures
the bolus of food.
And then lastly, again, due to a mass
effect, you can have compression
of your respiratory passageways in the area,
and making that a problem for some patients.
A very common procedure to demonstrate
whether or not
nodules are functional nodules or
nodules is to utilize a technician.
Ninety nine M protectant eight Skåne.
And we see here in the image the
results of such a scan.
Hot nodules are going to show up.
In this kind of cooperation that we see
here, this is due to the
presence of functional thyroid nodules and
taking up the technician.
Ninety nine. So this these areas light up
when you have a hot
nodule out region.
A cold cold nodule is not a functional
So these types of nodules will not pick up
technician. And this area here
represents a cold nodule in this scan.
So here we are demonstrating more
specifically some of
the aspects of a cold nodule.
And again, it's this area here.
nonfunctional. These are
And then lastly, the odds of being malignant
are going to be greater than
the hot nodules.
Here we're looking at the thyroid gland with
respect to a
clinical procedure, its removal, a
thyroidectomy, some of the
indications for a thyroidectomy are what we
just went through.
For example, a goiter cancer of the thyroid
also be another indication for its removal.
And then lastly, persistent hyper thyroid
Some complications associated with a
From the vasculature, either arterial
bleeding or venous bleeding.
Infection is always a concern in any
As we discussed not too long ago, hoarseness
voice can occur if there is surgical injury
one of the recurrent laryngeal nerve.
So, again, it's very important to isolate
them and protect them during a
thyroidectomy. The last
complication to highlight.
For your information, is that some patients
hypoparathyroidism, this is due
to not being able to adequately identify the
before the removal of the thyroid, and as a
result, the thorough are
also removed. And then you do not have
enough functional parathyroid tissue
remaining for them to carry out their