الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
During thyroidectomy, the parathyroid gland as well as the recurrent laryngeal nerve iatrogenic injuries are the most serious complications in goiter surgery. However, recurrent laryngeal nerve injury has been reduced to minimum as a result of meticulous surgical techniques and intraoperative nerve monitoring.
The optimum approach for thyroid cancer treatment is Thyroidectomy and neck dissection. Thyroidectomy is one of the most frequent operations performed in iodine deficient regions and one of the most important surgical interventions in endocrine surgery
The main postoperative complications of thyroidectomy are recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism, and post-operative hypoparathyroidism is the most frequently encountered complication after thyroidectomy which leads to hypocalcemia.
Hypoparathyroidism after thyroidectomy is caused by direct injury to the parathyroid gland or injury to its blood supplies, which leads to post-operative hypocalcemia that affects the physical and psychological health of the patient and lengthens hospital stay. The patients also bear additional financial burdens when they experience this complication, including hospital charges for investigations, laboratory testing, and increased length of hospital stay.
Hypocalcemia can be present with peri-oral numbness, numbness of the fingertips and positive of Chvostek’s sign. There may be muscle spasms, cramping, seizures, or cardiac arrhythmia in severe cases. Treatment of hypocalcemia consists of giving patients calcium supplements and vitamin D, So avoiding parathyroid gland injury during thyroidectomy is important to care about it.
Nanocarbon suspension is the only lymph tracer approved for clinical application. Nanocarbon particles provide the surgeon with direct information about the identification and location of parathyroid glands without staining, while thyroid glands and lymph nodes developed black color.
Carbon nanoparticles applied in the form of a standard carbon nanoparticles suspension injection. This product, which size is a 150 nm in diameter, does not enter the blood circulation and has no toxic side effects on the human body.
We did a prospective cohort study with comparative between two groups of patients, one group established with the conventional technique of thyroidectomy while the other group established using CN injection to see which group with less post-operative hypocalcemia. A hundred patients with benign and malignant goiter disorders underwent thyroidectomy assigned into two groups: group 1 (control group) included 50 cases established with the conventional technique and group 2 (interventional group) included 50 cases operated upon with CN injection technique.
All patients did pre-operative investigations and consented to participate. Also, post-operative investigations and follow up were offered to all patients particularly those who developed hypoparathyroidism and monitoring of calcium level was done until serum calcium level returned to normal.
The results showed that in group 2; 47 patients had normal Ca++ level (94%) while 3 cases had low Ca++ level (hypocalcemia) (6%). But in group 1; 37 patients had normal Ca++ level (74%) while 13 cases had low Ca++ level (hypocalcemia) (26%). The three patients in group 2 and the 13 patients in group 1 who developed hypocalcemia were managed with IV and oral supplementation of calcium and vitamin D and recovery occurred within a period of 1 week to 1 month.
Both groups thyroid final pathology was variation of benign goiter and malignant and the small well estimated histopathological samples taken in group 2 showed; 30 of the cases (60%) confirmed as parathyroid tissue while 20 of the cases (40%) not confirmed. Those 20 cases which not confirmed as parathyroid tissue shows; 17 cases were fatty tissue (85%) while 3 cases were lymph nodes (LN) (15%).
So, the current study helped us to identify the parathyroid gland easily and readily during the surgery, this technique can identify the undeveloped parathyroid glands and their blood supplies within 3 - 5 minutes which will the decrease the incidence of postoperative hypocalcemia and the hospital stay of the patient.