الفهرس | Only 14 pages are availabe for public view |
Abstract - 29 - 1- Twenty-one cases of reoperation on the thyroid are discussed. Eight patients are desCribed in details. Technical difficulties encountered at reoperation and the danger of injuring thteruur-ecurrent laryngeal nerve are stressed. 2- Early/recurrence (~ - l~ years) 1s usually malignant; while late recurrence (more than 3 years) is usual~ benign. 3- The main reason for reaurrence is inadequacy of the first operation. 4- Recurrence following adequate excision of non toxic goitre is the result of continued growth of minute nodules which were small and unrecognized during the first operation. 5- Principles in the technique of primary operationson the thyroid are suggested which if submitted will reduce the incidence of recurrence to negligible proportions, these are: Total exposure of both thyroid lobes is essential even though a nodule is palpable clinically in one lobe, a lobe should only be left in situ if it feels completely normal. Always look for a pyramidal lobe, and when present, :remove it en toto, dissecting it up or even beyond the hyoid bone. A partial tby:roidectomy Leavi.ng behind t he pyramidal lobe undoubtedly results in its rapid enlargment. - 30- - The inferior thyroid arteries are always sought and ligated. Postero-medial projections of the thyroid are not uncommon and usually give rise to pressure on the trachea and oesophagus, these projections are only discovered when the gland has been dislocated anteromedially. These projections are a potent source of recurrence. 6- Thyroid sUppression based on excellent theoretical grounds, plays an important role as a pre and post-operative therap,y in non toxic goitre to prevent a recurrent goitre and eventual cancer development. |