Impact of Intraoperative Spraying methylene blue In thyroidectomy
General anaesthesia ,supine position with hyperextension to the neck Low collar incision to the neck , incision to the skin and platysma muscle and fascia ,upper and lower flaps are developed ,separation of strap muscles and identification of the thyroid gland after freeing of investing fascia Ligation of the middle thyroid vein and ligation and separation of the superior pedicle away from the external laryngeal nerve At this point of operation and before ligation of inferior pedicle, methylene blue 0.05% spraying is applied to the field the amount varies according to size of the thyroid lobe and variation in population and neck size Thyroid gland stained by bluish color , recurrent laryngeal nerve not stained or minimally stained so we can avoid injury to it parathyroid glands get red of the stain after about 3 minutes so we can avoid injury to it thyroid gland lose its stain in about 15 minutes so we can remove any residual and decrease residual tissue or recurrence
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
40
General anaesthesia ,supine position with hyperextension to the neck Low collar incision to the neck , incision to the skin and platysma muscle and fascia ,upper and lower flaps are developed ,separation of strap muscles and identification of the thyroid gland after freeing of investing fascia Ligation of the middle thyroid vein and ligation and separation of the superior pedicle away from the external laryngeal nerve At this point of operation and before ligation of inferior pedicle methylene blue 0.05% spraying is applied to the field the amount varies according to size of the thyroid lobe and variation in population and neck size Thyroid gland stained by bluish color , recurrent laryngeal nerve not stained or minimally stained so we can avoid injury to it parathyroid glands get red of the stain after about 3 minutes so we can avoid injury to it thyroid gland lose its stain in about 15 minutes so we can remove any residual and decrease residual tissue or recurrence
Recurrent laryngeal nerve injury
Time frame: 2 weeks
Parathyroid gland Injuries
Time frame: 3 months
Intraoperative injury to trachea
Time frame: 2 weeks
Operative time
Time frame: 1 day
Presence of residual or recurrence
Time frame: 3 months
Hoarseness of voice
temporary or permanent (by clinical evaluation and vocal cord examination)
Time frame: 3 months
Stridor
temporary or permanent (by clinical evaluation and vocal cord examination)
Time frame: 3 months
Hypoparathyroidism
temporary or permanent (level of para thormone hormone )
Time frame: 3 months
Hypocalcaemia
temporary or permanent ( level of total and free serum calcium )
Time frame: 3 months
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