Surgical anatomy of parathyroid glands with emphasis on parathyroidectomy.

Number, location and surrounding structures of parathyroid glands with emphasis on parathyroidectomy were studied on 101 cadaverous bodies. Number of collected samples from all known locations of parathyroid glands varied from three to five in one individual, with mean 3.71 +/- 0.62. We identified 80% of samples as parathyroid glands. Mean number of correctly identified parathyroid glands in one individual was 2.77 +/- 1.06. The rest 20% of collected samples were lymph nodes, fat particles and thyroid or lipothymic tissue. Almost 30% more of inferior parathyroid glands were found in abnormal position in lipothymic tissue in comparison with their superior counterparts. We found several abnormities of vessels and cervical extensions of thymus. We also present case of brachiocephalic trunk, reaching the inferior pole of thyroid gland. We recommend beginning of parathyroidectomy in circumscribed area 2 cm in diameter, 1 cm cranially to the intersection of the inferior thyroid artery and recurrent laryngeal nerve followed by preparation on dorsal surface of thyroid gland, along the course of inferior thyroid artery and recurrent laryngeal nerve, in cervical extensions of thymus and in paraoesophageal and retropharyngeal region. Success of parathyroidectomy is based on the knowledge and experience of surgeon.