🇵🇹 João Carvas, MD, PhD on LinkedIn: #worldthyroidday #thyroidhealth #nutritionmatters #hypothyroidism #tfi… (2024)

** Identification through US **🛠 NON-RECURRENT LARINGEAL NERVE (NRLN)The NRLN is an rare anomaly on the right side, and is associated with the absence of the brachiocephalic artery (BCA) and the presence of arteria lusoria. It is even rarer on the lef side, and is usually associated with situs inversus.🦇 On the right side normal ultrasound will show common carotid artery (CCA) and subclavian artery (SCA) originating from the BCA - this pattern gives a characteristic Y image. So, NRLN can be easily identified in pre-operative US, as an ABSENT Y SIGN. In this case a CT-angiogram should follow to confirm the vascular variation.🙈 It is important for surgeons to perform US to all their patients before surgery and actively search for a negative Y sign.João Capela Costa, MD MSc FICS FEBS(ED)Sociedade Portuguesa Cirurgia Endócrina#ultrasound#surgery #POCUS #safesurgery #thyroid #thyroidsurgery #endocrinesurgery

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📐 JOLL'S TRIANGLE (aka sternothyroid-laryngeal triangle)🦋 Joll’s triangle is concerned with identification and preservation of External branch of superior laryngeal nerve (EBSLN) in thyroid surgery. 🔺 Superior: superior attachment of strap muscles. 🔺 Medial: midline. 🔺 Lateral : upper pole of thyroid gland and superior thyroid vessels.--> EBSLN lies in the floor of the triangle formed by the cricothyroid muscle.The triangle is also named as sternothyroid-laryngeal triangle.Sociedade Portuguesa Cirurgia Endócrina#thyroidanatomy #trianglesoftheneck #endocrinesurgery #necksurgery

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📐 BEAHRS or RIDDLE TRIANGLE 🦋 Thyroid surgery is all about meticulous dissection and preserving the two nerves (RLN, EBSLN) and bilateral parathyroidglands. This is one of the most important triangle in relation with thyroid as it indicates the position of the recurrent laryngeal nerve (RLN).It is named after O. H. Beahrs (synonymous as Riddle’s triangle).Plane: Posterior to thyroid gland, in the traqueo-esophageal groove.Boundaries of Baehr’s triangle can be identified after retracting the ipsilateral thyroid lobe medially. 🔺 Base: Common Carotid Artery 🔺 Superior: Inferior Thyroid Artery 🔺 Medial: Recurrent Laringeal Nerve Sociedade Portuguesa Cirurgia Endócrina#thyroidanatomy #trianglesoftheneck #endocrinesurgery #necksurgery

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📐TRIANGLES OF THE NECK 📐A better understanding of these triangles make surgery more efficient and avoid intraoperative complications.✔ ANTERIOR TRIANGLE🔺 Submandibular (aka digastric) triangle > Lesser's triangle (aka lingual triangle) > Pirogov's triangle (aka Pinaud's triangle) > Béclard's triangle🔺 Submental triangle (unpaired)🔺 Carotid triangle > Farabeuf's triangle🔺 Muscular triangle✔ POSTERIOR TRIANGLE🔺 Occipital triangle🔺 Supraclavicular triangle🔺 Suboccipital triangle🔺 Triangle of the vertebral artery🔺 Scalene triangleJoão Capela Costa, MD MSc FICS FEBS(ED)Sociedade Portuguesa Cirurgia Endócrina#neckanatomy #trianglesoftheneck #endocrinesurgery #necksurgery

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💥 The following 11 nerves, ranked in order with their associated surgical procedures, were found to be the most commonly injured: ☠ intercostobrachial nerve in axillary lymph node dissections and transaxillary breast augmentations, ☠ vestibulocochlear nerve in cerebellopontine tumor resections and vestibular schwannoma removals, ☠ facial nerve in surgeries of the inner ear and cheek region, ☠ long thoracic nerve in axillary lymph node dissections, ☠ spinal accessory nerve in surgeries of the posterior triangle of the neck and cervical lymph node biopsies, ☠ recurrent laryngeal nerve in thyroid surgeries, ☠ genitofemoral nerve in inguinal hernia and varicocele surgeries, ☠ sciatic nerve in acetabular fracture repairs and osteotomies, ☠ median nerve in carpal tunnel release surgeries, ☠ common fibular nerve in varicose vein and short saphenous vein surgeries,☠ ulnar nerve in supracondylar fracture surgeries.#Surgery #Complications #nerveinjury #RLNinjury #endocrinesurgery

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Pure surgery wisdom.

🍀 Parathyroid gland preservation is key in successfull thyroid surgery. Damage to all glands (usually 4) leads to transient/permanent hipocalcemia, that may need life-long medication.💡 Knowledge of their location is key.👆 UPPER PARATHYROIDS (4th pharyngeal pouch):✔ travel short distance during embriogenesis- less tendency to ectopy.✔ location: 1cm superior to the junction of the RLN, and the ITA - 85%. Deep to the RLN plane. ✔ Intrathyroidal parathyroids are more likely to be superior glands👇 LOWER PARATHYROIDS (3rd pharyngeal pouch): ✔ travel longer distances - travels with thymus - ECTOPY more likely. ✔ location: 1cm of the insertion of the ITA into the inferior pole (inferior/lateral/posterior) - 50%. Superficial to the RLN plane.🍪 ECTOPY IS RARE (15-20%): ++ mediastinum, the thymus, and the thyroid gland.#parathyroid #anatomy #headandneck #endocrinesurgery #Rhinocerosunicornis # SirRichardOwen

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❓ Question:In children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings, is continuation of postoperative antibiotics associated with a reduction in surgical site infection risk and resource use ❓Short answer: NO 🚫 👉 Antibiotics did not shown any reduction in SSI or other complication metrics, in children with AA.👉 Another paper that excludes gangrenous appendicitis from the "complicated appendicitis" group. #antimicrobialstewardship #pediatricappendicitis #emergencysurgery #evidencebasemedicine

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