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Done by: Ghaliah Bataineh

Thyroid Gland

Thyroid gland
:Today we will start talking about thyroid gland ..So

Thyroid Gland: it's a structure that located at the level of (C5-T1)*


and it consists of right and left lobes connected together by a narrow isthmus which is a vascular organ surrounded by a sheath and it's located .in the mid line at the level of 2nd and 3rd tracheal rings Important thing related to the thyroid such as muscles , artery , nerve :and you have to know them Anterolateral aspect: when you look to the thyroid gland from this :aspect then you can find .Sup.belly of omohyoid-1 .Inf.part there's the scm-2 You have to reflect these muscle in order to find thyroid gland, because .these muscle cover the thyroid from it's anterolateral aspect SO.. DURING THE SURGICAL PROCEDURE , AFTER YOU MAKE ACUT YOU HAVE TO REFLECT THESE MUSCLE IN ORDER TO REACH THE THYROID GLAND Posterior aspect: you can find Carotid sheath , so during any thyroid surgery you have ti pay attention to this structure Inf. Thyroid artery, which originate from Thyrocervical trunk from the first part of Subclavian artery.

This artery reaching the gland from post . However, if you look to sup. Thyroid artery usually reaching the gland from anterior, this mean that the sup. Thyroid a. come from external carotid a. then reflect down to reach the gland from anterior aspect the inf. Thyroid a. come from subclavian a. and reaches the gland from post. Aspect Para thyroid gland : four in number located behind the thyroid gland which secret parathyroid hormone that's important to keep the calcium level in the blood

Done by: Ghaliah Bataineh

Thyroid Gland

Recurrent laryngeal nerve:

Vagus nerve as it descend down giving a branch that lobes in the Rt. Side on the subclavian a. but on Lf.Side it make lobes on the arch of aorta then it return back all the way up to the larynx to provide .innervations to it , and for that reason we call it the recurrent laryngeal n NOTE: RECURRENT LARYNGEAL N.is very important: it attachesthyroid gland from post. Aspect so when you do a surgery to this gland .you have to pay attention not to cut this n If you cut it we will lose innervations to the larynx SO you will lose the.voice - Those are the most important structure ..please read them carefully

Vasculture of Thyroid Gland


-:We have two type of gland Exocrine gland: which drainage in to a cavity such as salivary gland,* goblet cell and so on Endocrine gland: which drainage directly in to blood during venous* .circulation such as Thyroid gland SO as we mention, thyroid gland is an endocrine one, that drainage .directly in to blood When you look at vasculature of thyroid gland you find two main :arteries Sup. Thyroid a. from external carotid a. reaching the gland from anterior. Inf. Thyroid from subclavian a.Reaching the gland from inferior aspect.

Done by: Ghaliah Bataineh

Thyroid Gland

:NOTEof individual have an extra artery that arising directly from 10% brachiocephalic a. or from arch of aorta and provide blood supply to the .Isthmus of thyroid gland, this small a. we call it thyroid ima artery Also you have to pay attention to this a. during thyroids removal surgery, because if you cut it, you will have an internal bleeding, and as you know if you close the fascia (pretracheal fascia) after the surgery then the blood will accumulate within pretracheal fascia pressuring in to the .trachea As we mention early, that thyroid gland contain two arteries, as well as :it has four main vein drains in to the internal jugular, these vein are

Two sup. Thyroid vein. Two middle thyroid vein.

ALSO we have two inf. Thyroid vein drain in to the brachial cephalic. Important Clinical Note for Thyroid Gland Pyramidal lope of thyroid gland: from it's name, it's an additional part .(of thyroid gland (HARAMY Previously, we have described the gland that it consists of two lobes .and there's a structure in the midline called isthmus of thyroid gland Some time additional thyroid tissue located in the midline and we call it the pyramidal lobe of thyroid gland . SO it's an accessory thyroid tissue sup. To the isthmus descending down all the way from the neck to .the root of the neck Usually present in 50 % of population. It's remnant of Thyroglossal duct : The cell that forming the thyroid gland during embryonic life , they usually present at the root of the tongue and they migrate descending down from the root of the tongue crossing the neck all the way down throw this duct in to the root of the neck , where they start to differentiate . to form thyroid gland

After that the thyroglossal duct starts to close down and become as .only renal facial part which is fibrous facial ligament

Done by: Ghaliah Bataineh

Thyroid Gland

However , some of the cell don't migrate completely , they remain stuck within this duct , and these type of cell start to form the thyroid tissue above the level of thyroid gland , forming what we refer to it the . pyramidal lobe of thyroid gland SO the pyramidal lope is an remnant of thyroglossal duct which is an internal tube that carrying thyroid forming cells from the root of the tongue ( post. 3rd of tongue )in the embryo down to the root of the . neck

Risk of Surgery on Thyroid Gland


It depend in the structure that found around the thyroid gland , so when you remove thyroid gland due to cancer or tumor you have to pay -: attention to those three main risk factors Recurrent laryngeal nerve: if you remove thyroid gland and not pay attention to this n. then you will cut it and as a result you will develop dysphonia (hoarseness).

Para thyroid gland : It's very small gland that attach to post. Surface of thyroid gland , some time without pay attention during surgical removal os thyroid gland they may remove this glands , and this will lead to lose of para thyroid . hormone that increasing the level of calcium in blood

BY this the level of Ca will decrease in blood, (bn3awi9' 3no ) by using Na , and as a result , this will lead to dermeability in nervr fiber's and this will produce a special case we call it Depolarization of the .nerve And this will lead to involuntary contraction in skeletal m. which is .voluntary m In this case the patient will enter the convulsion situation ( t$anoge ) we call it Tetany which is a generalized convulsive disorder . characterized by involuntary m. spasms Postoperative bleeding : -:In each side of thyroid gland, we have Two main a. Which is Sup. And inf. Thyroid a Three vein which is sup. , middle and inf.

Done by: Ghaliah Bataineh

Thyroid Gland

SO YOU HAVE TO PAY ATTENTION NOT TO CUT ANY ONE OF THEM WHICH WILL LEAD TO AHEMORRHAGE AND .INTERNAL BLEEDING

Radiological anatomy of head and neck


First of all ,when you look to a radiograph , you have to know that it's a record of structures through which x- ray beam has passed.

The density of structure will determine how this structure will appear in .the radiograph If the structure was very thick or hard tissue, like abone, the x- ray beam.pass through it and all of the beam will absorbed by it Once it absorbe all x-ray , then there will be no x- ray on the film, so the film will not be burn , after that when we wash the film it will return back to it's origin state ( white ) and that's what we call it . Radioopac However , if the tissue is very soft or if there's no tissue ( space ) , this mean that all the x-ray will reach to the film and burn it , in this .case the film will look black Radiolucence SO that's why we see different shadow from white to black on x.ray film Bone (radio opacity ) > soft tissue ( between black and white ) > .( space air ( Radiolucence Very close EX.

Enamel > Dentin > Pulp

the radiograph is a 2 dimensional representation of 3dimensional objects , that's what we call superimposition ( layered ). EX. If you look to the slide: this area is maxillary sinus This is the orbit, when u looks to it, the lower half is very Radioopac, because when x-ray enter the orbit it faces the petrous part of temporal bone which is hard tissue

Done by: Ghaliah Bataineh

Thyroid Gland

that absorb all x-ray and don't lead it to burn the film .( so the film looks white ( Radioopac

magnification : x- ray beam spread depend on distance between the object and the film , so when u need to take an x-ray to head $ neck region ,u have always to touch the film to the .object to avoid the magnification

Head $ neck radiography


extra- oral :

post. Ant of skull : depending on direction of x-ray , we put the film ant..And the x-ray tube post. , then the x-ray pass from post. To ant lateral view of the skull ( oblique post. Ant. ( occipitomental panorama : it's acomprehensive view , we usually use it to prwdict about. fracture in the mandible region , also we use it in orthodontic intra oral : ( 'Bite wing ( 3a9peri apical : around the apex of the rootocclusal : put the film in occlusal direction

KNOW WE WANT TO DESCRIBE EACH ONE IN MORE DETAIL

Done by: Ghaliah Bataineh

Thyroid Gland

* -: Post. Ant. Of the skull Here u have to put forehead & nose against the film cassette X-ray tube perpendicular to the film at level of external audiatory meatus X-ray beam passes from post. To ant. , then the photo will appear from ant. To post. , and as we discussed previously that the upper part of orbit will appear radiolucence and the lower part appear . radioopac in an x-ray film : This type of examination is very beneficial for two main things for cranial vault examination ( fractures ). frontal air sinuses : which indicate an inflammation in this sinuses , because this inflammation will absorb some of xray beam.

-: lateral view of the skull * Here we put the sagittal plane parallel to the cassette , and the x-ray tube . is centered over the region of sella turscica THIS EXAMINATION IS VERY IMPORTANT FOR Cranial base $ vault examination : there's cristae gally , sella turscica, mastoid process . 2. Diplopic bone str : vault contain internal and external table , and by this view we can determine the fracture in these two table easily .
1.

Paranasal sinuses : frontal, maxillary , sphenoid , , ethnocide ( obscured ).


3.

mastoid

Done by: Ghaliah Bataineh

Thyroid Gland

: ( Occipitomental (oblique PA*


in this radioghraph you should touching the chin to the cassette , and the .( head should titled backwards (45 angle WE use this kind of radioghraph in order to . investigation of maxillary air sinus this examination is the same as ant. -Post. Of skull but in order to avoid superimposition by petrous part of temporal bone we develop this kind of view and as you see here , x-ray beam enter from occipital .bone and leave from mental ( chin ) area

:panoramic radiograph*
:This is very important one, and we use it to predict About 1- mandibular fractures: mandible is aring bone then if there's afracture in one side there's commonly another one on the other side, SO we need panoramic radioghraph to show these fracture. 2-Minor oral surgeries ( MOS ) : Extraction of impacted upper 3rd molar ( wisdom teeth ), As u see here .. 3-Orthodontics : to discover if there's any tooth Impacted or remenant .

Done by: Ghaliah Bataineh

Thyroid Gland

*bitewing radiographs :
*Taken in initial & routine dental examination. *We use it to disclose caries in post. Teeth Specially class II caries ( caries that occur in mesial or distal surface ). This radioghraph provide viis radioghraph provide view of the crowns and pulp chambers only. AS you see here , when bacteria destroy enamel which Is very hard tissue it destroies very small part (pit) But in dentin which is soft tissue it's easier to destroy it In a large way, so caries within dentin very large , AND you can't distinguish this kind of caries without Bitwing radiographs , specially for crown in post. Teeth .

*periapical radiographs :
In order to surrounding examine the roots and tissues.

Done by: Ghaliah Bataineh

Thyroid Gland

Fields of application : *Endodontics : by this we can determine any inflammation In the apex of the root *Perodontics *Crowns and bridges ( post & core ) *Extraction of curved or remnant roots

Arterial Pulses
*Carotid Pulse: opposite to anterior border of SCM (Common carotid artery) Facial Pulse: palpated on the inferior border of the mandible* (facial artery) Temporal Pulse: palpated anterior to the auricle of the ear,* .specifically opposite to the tragus (superficial temporal artery)

.Plz forgive me if there's any mistake , , ..... , ..... .

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