[Parathyroid glands and their anatomical positional variations : Preoperative diagnostics and surgical planning]

The identification of the parathyroid glands during neck surgery can be challenging due to their variable anatomical location. Knowledge of embryonic migration, typical positions and vascular supply is therefore essential for successful surgery of the parathyroid glands. This narrative review article, supported by a systematic literature search, addresses these aspects in detail. Anatomical orientation along the recurrent laryngeal nerve and the inferior thyroid artery as key landmarks, followed by systematic cervical exploration, improves intraoperative detection rates of parathyroid glands. The anatomical variability is higher for the inferior than for the superior parathyroid glands. In cases of primary hyperparathyroidism, preoperative localization using high-resolution ultrasound and functional imaging techniques (e.g., choline positron emission tomography/computed tomography, PET/CT) enables focused parathyroidectomy, leading to a significant reduction of operation times and complication rates.