Transoral Endoscopic Parathyroid Cyst Removal

Introduction:

Remote access approaches to the central neck have become increasingly popular in some parts of the world.¹ Recently, the transoral vestibular approach has been employed effectively in North America with the assistance of international colleagues.² The transoral approach offers direct access to the central neck, and can be used effectively and safely in a Western population.

Materials and Methods:

The aim of this video is to demonstrate the utility of the transoral vestibular approach for central neck lesions. A 30-year-old female with left-sided otalgia was noted to have an ipsilateral central neck mass. Ultrasonography showed a cystic 2.7 × 4.0 × 2.5 cm level VI mass extending into the mediastinum. Aspiration noted a parathyroid hormone level of 140 pg/mL, consistent with a parathyroid cyst. Three vestibular incisions were made in the oral vestibule, and insufflation was used to maintain a working space.

Results:

The left parathyroid cyst was removed endoscopically while preserving the adjacent normal parathyroid gland. There were no injuries noted to the mental or recurrent laryngeal nerves. Operative time was 110 minutes, and the patient was discharged within 23 hours. Final pathology analysis was consistent with a parathyroid cyst. The patient had an excellent outcome without a cervical incision or complications.

Conclusions:

Transoral endoscopic approaches can be safely used for central neck lesions. This approach provides optimal observation and avoids a cervical incision.

No competing financial interests exist.

Runtime of video: 8 mins 1 sec