this is a patient i have at the moment. i plan on operating as soon as the consultant anaesthetist sees his way clear to dope her. this is not too unusual in south africa. it shows a tendency to wait a long time before seeking help. this next photo will show something that south african doctors will immediately recognise, but may need a note to explain to our international audience. roughly in the middle of the mass are two small parallell scars. these are markings made by a sangoma. they are meant to be therapeutic. as you can see they were not. i have already posted about that (here and here) so i will not labour the point any more.
but, if there is any sage advice from surgeons out there for when i do attack this lady with my blade, i'm open to any suggestions. after all, two heads are better than one (except of course in the case above)
Have you an anesthetist who's comfortable with awake intubation? Or with doing intubation over a fiberoptic scope?
Is there any chance this is something other than goiter? Hygroma? The marked asymmetry is unusual.
I guess I'd attack from the patient's left first, figuring I'd have half a chance of avoiding parathyroids over there. In the couple of really huge thyroids I've done, I've been surprised that it wasn't as hard as I'd anticipated, meaning it's possible to peel it clear anteriorly and rotate it. However I admit I've never had such a large and asymmetrical one. I'd love to be there to watch! Let us know.
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