MANAGEMENT OF NEGATIVE CERVICOTOMY FOR PR IMARY HYPERPARATHYROIDISM

Negative initial cervictomoy for primary hyperparathyroidism can be du e to one of two reasons: first, one gland has not been found: it was a n missing adenoma on an ectopic gland. Secondly, four normal glands we re found: a missing adenoma arising in a supernumerary and ectopic gla nd. 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 n ecessity for reoperation must be discussed. Before reexploration, diag nosis of hyperparathyroidism must be reviewed, the operative notes and pathologic report of the previous operation must be studied, and loca lization studies must be performed in order to define the cervical or mediastinal surgical approach.