[Management of primary hyperparathyroidism in case of negative cervicotomy]

Negative initial cervicotomy for primary hyperparathyroidism can be due to one of two reasons: first, one gland has not been found: it was an missing adenoma on an ectopic gland. Secondly, four normal glands were found: a missing adenoma arising in a supernumerary and ectopic gland. Successful parathyroid surgery depends the on surgeon's experience, his knowledge of parathyroid gland embryology, and his perseverance to find the pathologic gland. After an unsuccessful cervicotomy, the necessity for reoperation must be discussed. Before reexploration, diagnosis of hyperparathyroidism must be reviewed, the operative notes and pathologic report of the previous operation must be studied, and localization studies must be performed in order to define the cervical or mediastinal surgical approach.