Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Embryological Remnants of the Thyroid Gland and their Significance in Thyroidectomy(Jaypee Journals, 2014) Fernando, R.; Rajapaksha, A.; Ranasinghe, N.; Gunawardhana, D.Embryological Remnants of the Thyroid and Their Significance in Thyroidectomy Prof Ranil Fernando The Thyroid gland develops from the floor of the primitive pharynx & parts of the ultimobranchial body and descends into the anterior triangles of the neck. It is functional around the 7th week of gestation. There are anomalies associated with the embryological development which give rise to recognizable clinical disease in patients. The Thyroid gland may be absent, fail to descend, remnants of descent left in the neck or the thyroid gland may descend too far. All these are well recognized clinical entities. In addition, there are three (3) significant embryological components which are well recognized and need to be identified and removed during Thyroidectomy. These are the Pyramidal lobe, Tubercle of Zuckerkandl, and the Thyrothymic remnants. It is important to carefully dissect and identify these embryological remnants not only to prevent recurrence, but also because these are in close proximity to important structures such as the recurrent laryngeal Nerve and parathyroid gland and they assist the surgeon in identifying these important anatomical structure that need preservation. Recurrent goitres are mainly due to the embryological remnants left behind especially in the subtotal thyroidectomy era. These recurrences can isolated or occur in combination. Commonly recurrence from all three remnants is found. In our experience the Pyramidal lobe recurrences and tubercle of Zuckerkandl are found in about 50- 60% of the patients and the Thyrothymic remnants are found in about 30- 40 % of the patients Surgery for recurrent disease is fraught with danger and a sound knowledge of embryological remnants will enable an experienced surgeon to undertake redo thyroid surgery safely.Item Does the position of external branch of superior laryngeal nerve change with the height of the patients and the length of the larynx(Jaypee Publisher, 2012) Senanayake, K. J.; Fernando, R.; Salgado, S.; Jayanthi, M.When the external branch of superior laryngeal nerve (EBSLN) crosses the superior thyroid artery closer to thyroid upper pole, the EBSLN has a higher risk of getting damaged. Its anatomical position in relation to thyroid upper pole may vary with changing the height of patient and the length of larynx. We intended to test this hypothesis and predict the risk. Thirty cadavers of both sexes are dissected (29-87 years, mean 69). One cadaver excluded due to a goiter and five nerves were damaged during dissection. Therefore, 53 nerves were studied. The distance from upper pole of thyroid to the point where the nerve crosses the superior thyroid artery (TS) was measured. Cadaver length (CL), cricothyroid length (CT) and the cricohyoid length (CH) measured to the closest millimeter. Correlation of TS with CL, CT and CH was measured. The mean distance from the upper pole of the thyroid to the point where EBSLN crosses superior thyroid artery was 6.24 mm (SD 5.94). On right side, the mean distance was 4.03 mm (SD 5.34) and, on the left, 8.37 mm (SD 5.7 mm). The difference between two means was significant at 0.05 (t = 2.82, p = 0.007). There was a strong correlation between distance from the upper pole of the thyroid to the point where the nerve crosses the superior thyroid artery with CL (r = 0.98). There was moderate correlation with the CT and CH lengths (r = 0.55, 0.58 respectively). The position of EBSLN in relation to thyroid upper pole is strongly correlated with the height of the patient. The EBSLN crosses superior thyroid artery more closely to thyroid upper pole in right side.