Head & Neck Surgery

A clearly and unequivocally positive sestamibi scan showing a single focus of radioisotope uptake in the neck (Figure 1) is selection criteria for minimally invasive radio guided parathyroidectomy (Algorithm 1).If the sestamibi scan is negative, inconclusive or equivocal, these individuals are not candidates for minimally invasive radio guided parathyroidectomy (Figure 2).When the sestamibi scan is not clearly positive, these patients are advised that a more extensive neck exploration would be necessary. The extent of exploration under these circumstances is determined by results of an Intraoperative Parathormone assay which is available at Norton Hospital. At the time of surgical exploration, if an abnormal parathyroid gland is identified and removed, blood samples at five and ten minutes following removal of this gland are obtained to determine the parathormone level. If the parathormone levels fall an appropriate amount compared to the preoperative levels, no further necessary as this indicates that the abnormally functioning gland has been removed with a 90% degree of accuracy. If the parathormone level does not fall after removal of an abnormal parathyroid gland this indicates that additional abnormally functioning glands are present and the exploration needs to continue.Under the current circumstances using the sophisticated scanning techniques at University of Louisville Hospital, approximately 65% of patients have a clearly positive scan and are candidates for minimally invasive radio guided parathyroidectomy. The other 35% with negative scans or equivocal scans may, undergo a more extensive exploration.