Unusual problems in parathyroid surgery.

Although parathyroid surgery is difficult because of the smallness of the glands and the variability in their location and number, a surgeon who is well versed in the embryology, gross anatomy, pathology of the glands, and the fine points of gross identification of normal and abnormal tissue should be able to identify these glands in most instances. In a review of 122 cases during a two year period, pathologic change was found in 96 per cent, even though 11 per cent were secondary cervical explorations and the mediastinum was entered by a sternal split approach in only two cases. Although the abnormal glands were found in varying locations and ten were outside the usual areas of search, all were consistent with failure to descend or excessive descent and with a relationship to anatomic structures having similar embryologic origin. Sophisticated localizing procedures such as arteriography and selective venous sampling for parathormone are rarely necessary.