Abstract
Levator glandulae thyroideae, an embryological remnant found in association with pyramidal lobe in the thyroid gland is often encountered during thyroidectomy. Complete removal of these structures will prevent the incidence of recurrence. In this context, we studied the use of a surgical loupe in increasing the identification rate of levator glandulae thyroideae. This cross-sectional study was conducted in the department of surgery in a tertiary care centre from February 2015 to July 2015 with data collected from randomly selected patients posted for thyroidectomy. Age, sex, presence of the pyramidal lobes and levator glandulae thyroideae were studied. Statistical analysis was done with R statistical programming software version 3.2.0. There were 45 patients in the study. The median age was 41 years (range 22-57). There were 9(20%) males and 36 (80%) females. Levator glandulae thyroideae was dissected out in 33(73.3%) of the patients. This was attached to pyramidal lobe in 31(93.94%)and only in 2(6.06)cases it arose from the isthmus. In patients with pyramidal lobe present,31(83.8%) 31(83.8% )patients had levator glandulae thyroideae and there was a statistically significant association between pyramidal lobe and levator glandulae thyroideae. This study showed that with the help of a surgical loupe, more than 73 percent of the levator glandulae thyroideae can be dissected out. Inclusion of a magnifying surgical loupe in the surgical armamentarium during routine thyroidectomy could potentially reduce the recurrence of goiter.
Keywords: Loupe magnification, Levator glandulae thryoideae,Pyramidal lobe, Thyroidectomy, Cross-sectional study, Embryological remnant.
References
1. TW Sadler. Langman's medical embryology: Lippincott Williams & Wilkins; 2011.
2. AV Ranade, R Rai, MM Pai, SR Nayak, Prakash, A Krisnamurthy, S Narayana. Anatomical variations of the thyroid gland: possible surgical implications. Singapore medical journal 2008;49(10):831-4.
3. SZ Sultana, M Khalil, MK Khan, R Shamim, S Parveen, ZG Ara. Morphological study of levator glandulae thyroidea in Bangladeshi cadaver. Mymensingh medical journal : MMJ 2009;18(2):179-83.
4. R Cirocchi, S Trastulli, J Randolph, S Guarino, G Di Rocco, A Arezzo, V D'Andrea, A Santoro, M Barczynski, N Avenia. Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults. The Cochrane database of systematic reviews 2015;8:Cd010370.
5. X Meng, S Wen, B Wang, Y Feng, L Yang, L Kong. [Surgical treatment for primary papillary thyroid cancer: a Meta-analysis]. Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery 2015;29(9):835-40.
6. L Delbridge. Total thyroidectomy: the evolution of surgical technique. ANZ journal of surgery 2003;73(9):761-8.
7. G Pata, C Casella, F Mittempergher, ... Loupe Magnification Reduces Postoperative Hypocalcemia after Total Thyroidectomy. The American … 2010.
8. A Saber, M Rifaat, GM Ellabban, MA Gad. Total thyroidectomy by loupe magnification: a comparative study. Totale Schilddrüsenresektion mit Lupenvergrößerung: eine Vergleichsstudie 2011;43(1):49.
9. M Testini, M Nacchiero, G Piccinni, P Portincasa, B Di Venere, G Lissidini, GM Bonomo. Total thyroidectomy is improved by loupe magnification. Microsurgery 2004;24(1):39-42.
10. S Lemeshow, DW Hosmer, J Klar, SK Lwanga. Adequacy of sample size in health studies. 1990.
11. L Delbridge, TS Reeve, M Khadra, AG Poole. Total thyroidectomy: the technique of capsular dissection. The Australian and New Zealand journal of surgery 1992;62(2):96-9.
12. RC Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, 2012. ISBN 3-900051-07-0; 2014.
13. R Lehr Jr. Musculus levator glandulae thyroideae: an observation. Anatomischer Anzeiger 1978;146(5):494-6.
14. T Rajini, A Ramachandran, GB Savalgi, SP Venkata, V Mokhasi. Variations in the anatomy of the thyroid gland: clinical implications of a cadaver study. Anatomical science international 2012;87(1):45-9.
15. S Joshi, S Joshi, S Daimi, S Athavale. The thyroid gland and its variations: a cadaveric study. Folia morphologica 2010;69(1):47-50.