Special Points in the Technic of Thyroid Surgery
A review of the literature on the technique of thyroid surgery brings one to the conclusion that many variations of technique exist and that all fulfill the requisites for the satisfactory removal of the thyroid gland. After all, a satisfactory technique 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 nerves or to the parathyroid bodies; one in which satisfactory results are obtained from a cosmetic standpoint; and above all, one which brings about the cure of the patient.
The infiltration of novocain is carried out in three steps. The skin and subcutaneous tissue is first well blocked over a wide area. In this step, no attempt is made to infiltrate beneath the cervical fascia or in the preglandular muscles.
For several years I have used a transverse incision, (Richter1) which is usually at a point about midway between the suprasternal notch and the cricoid cartilage. In my experience, this incision has produced the most satisfactory type of scar. Often, in making an elliptical incision, one is surprised to find after the operation, that the ellipse is exaggerated because, at the time of operation the head was in extension and when the head drops down, the curve of the incision is increased. Also, in the elliptical incision, occasionally one is surprised to find that one end. . .