Reoperative Pearls

• Reconfirm the diagnosis of HPT

• The surgeon must review prior operative notes

• Assess patient risk factors

• Pathologist must re-review prior pathology slides

• Missed gland usually is in the neck

• Judicious, cost-effective parathyroid gland localization

• Consider lateral cervical approach

• Remember that if the inferior gland is missing, look superior to the superior gland for the inferior gland and, similarly, if the superior gland is the missing one, look inferior to the inferior for the superior gland.

FIGURE 58-3. Radionuclide scintiscan demonstrating a suspicious uptake in the anterior mediastinum near the left main bronchus (see Case 2).
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