SURGICAL ANATOMY OF THE THYROID CAPSULE AND FASCIAL SHEATH

Abstract

The article is based on the anatomical (60 observations) and clinical material (160 patients with various thyroid diseases), controversial issues of anatomy and nomenclature of the capsule and fascial sheath of the thyroid gland, as well as their derivatives, are discussed. The topography of the connective tissue fixation apparatus of the thyroid gland has been specified, its classification has been proposed, the relationships with surrounding structures have been described. The article substantiates the sequence of mobilization of the thyroid lobes from the position of convenience and safety of dissection. It was established that in order to mobilize the upper pole of the thyroid lobe and gain access to the cricothyroid space, it is necessary to dissect the upper suspending ligament in the avascular zone located medial to the inner edge of the sternum-thyroid muscle. When dissecting the posterior fascial leaf, it is necessary to apply hemostatic clamps as closely as possible and parallel to the posterior edge of the superior pole of the thyroid, since there is a probability (8.3% by anatomical data) of interference of the external branch of the superior laryngeal nerve and posterior branches of the superior thyroid vessels. The dissection of the Berry ligament and the transverse connective tissue plates adjacent to it is recommended to be performed in the final stages of thyroidectomy after the final visualization of the recurrent laryngeal nerve.