The Technic of Thyroid Surgery
A discussion of the technic of thyroid surgery obviously precludes any description of preoperative treatment, but it is taken for granted that a careful preoperative regimen has been followed.
A satisfactory technic is one which can be carried out within a reasonable length of time, under some form of light anesthesia or analgesia augmented by local anesthesia, one in which the proper amount of the thyroid gland is removed without injury to the recurrent laryngeal nerve or parathyroid bodies, one in which the result is satisfactory from a cosmetic standpoint, and above all, one which brings about the cure of the patient.
In reviewing the literature on the technic of thyroid surgery, we must conclude that there are many variations of technic all of which fulfill the requisites mentioned above, and that the principles are the same in all, the method varying more or less with the individual operator.
The anesthetic which we use is light analgesia supplemented by local infiltration with three-fourths per cent novocain. The infiltration is carried out in three steps, a small wheal being made intra-dermally with a fine needle placed at the mid-point of the projected incision line. From this point the novocain is introduced, the skin and subcutaneous tissue being infiltrated over a wide area. No attempt is made to infiltrate beneath the cervical fascia or pre-glandular muscles. It is important that the neck be placed in extension without any rotation of the head.
A transverse incision is made, no attempt being made to. . .