Background: Thyroidectomy is one of the most commonly performed procedure for both benign and malignant diseases of the thyroid. By  developing  a  thorough   understanding  of  anatomical landmarks and  by making use of  them,  the  surgeon   can  minimise  the  risk  associated  with  the  procedure.  Experience  of  the  surgeon  is  a significant  factor  in  minimising  or  dealing  with  the  complications. During each thyroidectomy, recurrent laryngeal, external branch of superior laryngeal nerves, and  parathyroids  should  be routinely  preserved. For this, various approaches like inferior, superior or lateral, tubercle of Zuckercandl, or landmarks like inferior thyroid artery, space of reeves may be used. The  unidentified  nerves are   most  likely  to  be  damaged  leading  to  high  morbidity  and  rarely  mortality. Transient or permanent hypoparathyroidism is due to inadvertent gland  removal or  injury  to  its  vascular  pedicle.

Aim: To analyse the cardinal anatomical structures to be preserved during each thyroidectomy and the tips for safeguarding them. Material and methods: This is an observational study of 75 thyroidectomies   performed for various indications from 2016 December to 2018 December. Surgical details from case sheets and surgical register were perused for it. Patients on medical treatment for thyroid diseases were excluded.

Conclusions: The recurrent laryngeal nerve, external branch of superior laryngeal nerve and parathyroids  are the cardinal structures  to be preserved during each thyroidectomy. Inferior, superior or lateral  approaches, tubercle  of  Zuckercandl, superior or inferior thyroid arteries, space of reeves may  be  used.

Keywords: External branch of superior laryngeal nerve, Parathyroids, Recurrent laryngeal nerve, Thyroidectomy, Tubercle  of  Zuckercandl.

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Arun.S

Assistant Professor Dept of General Surgery, Government Medical College Manjeri, Kerala, India, 676121