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Related Concept Videos

The Parathyroid Glands00:59

The Parathyroid Glands

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
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The cranial part of the parasympathetic division plays a crucial role in regulating the visceral functions of the head and specific structures in the neck, thoracic, and abdominopelvic cavities. Preganglionic fibers of the parasympathetic division exit the brain through cranial nerves III (oculomotor), VII (facial), IX (glossopharyngeal), and X (vagus), delivering parasympathetic output to the respective visceral structures.
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The sympathetic chain ganglia, also known as the sympathetic trunk ganglia or paravertebral ganglia, are a series of ganglia located bilaterally on either side of the spinal column. These ganglia serve as relay stations for the sympathetic nervous system. Preganglionic neurons originating in the spinal cord project their axons to the sympathetic chain ganglia. Within the ganglia, these preganglionic fibers synapse with postganglionic neurons.
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The Pituitary Gland

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The pituitary is a small endocrine organ in the sphenoid bone under the hypothalamus. Primarily, the pituitary in adults has two distinct anatomical and functional regions— the anterior and posterior lobes. During human fetal development, a third pituitary gland region called the pars intermedia atrophies and disappears. However, some of its cells migrate and exist adjacent to the anterior pituitary in adults.
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Superior Parathyroid Masquerading as Retropharyngeal Lymph Node.

Smriti Panda1, Alok Thakar1, Aanchal Kakkar2

  • 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India
|August 12, 2024
PubMed
Summary

A rare case of an undescended parathyroid gland was incidentally found in the retropharyngeal space during cancer surgery. This ectopic gland highlights challenges in diagnosing recurrent parathyroid issues.

Keywords:
Ectopic parathyroidParathyroid glandRetropharyngeal parathyroidRetropharyngeal spaceUndescended parathyroid

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Area of Science:

  • Endocrinology
  • Surgical Anatomy
  • Oncology

Background:

  • Ectopic parathyroid glands occur in 2-22% of individuals.
  • Undescended parathyroid glands, located above the carotid bifurcation, represent 2-7% of ectopic glands.
  • These glands pose diagnostic challenges due to their unusual locations.

Purpose of the Study:

  • To report a unique case of an incidentally discovered parathyroid gland in the retropharyngeal space.
  • To discuss the implications of high, undescended parathyroid glands in recurrent hyperparathyroidism.
  • To emphasize the importance of including the skull base in preoperative imaging for suspected parathyroid disease.

Main Methods:

  • A 60-year-old female patient with tonsil cancer underwent tonsillectomy and retropharyngeal lymph node dissection.
  • Preoperative MRI identified a hyperintense structure in the retropharyngeal space.
  • Postoperative histopathology confirmed the structure as a normal parathyroid gland.

Main Results:

  • An ectopic parathyroid gland was incidentally discovered in the retropharyngeal space.
  • The gland was located medial to the carotids at the oropharyngeal level.
  • This finding underscores the potential for parathyroid tissue in unusual extracervical locations.

Conclusions:

  • High, undescended parathyroid glands, including those in the retropharyngeal space, can be a source of missed or recurrent parathyroid adenomas.
  • Extracervical parathyroid glands may be overlooked during standard preoperative assessments and surgical explorations.
  • Comprehensive preoperative imaging, including the skull base, and thorough surgical exploration are crucial for identifying such ectopic glands.