title: Adenomas of cervical maldescended parathyroid glands: pearls and pitfalls.
abstract: BACKGROUND
  Missed parathyroid adenoma (PTA) is the commonest cause of persistent hyperparathyroidism. Although many are subsequently found in well-described locations, some are found in unusual regions of the neck. This paper presents the combined experience of three large tertiary endocrine surgery centres with maldescended PTA (MD-PTA).
  
  
  METHODS
  Patients were recruited from the endocrine surgical databases of three tertiary endocrine surgery units. Patients with PTA found >1 cm above the superior thyroid pole or other cervical locations as a result of abnormal or incomplete descent were included for analysis.
  
  
  RESULTS
  MD-PTA was identified in 16 patients out of a total of 5241 patients who had undergone parathyroidectomies in the 7-year study period (incidence 0.3%). Seven (44%) patients had minimally invasive parathyroidectomy, while nine (56%) had bilateral neck exploration. The mean excised gland weight was 750 + 170 mg. Cure was achieved in all patients with a minimum follow-up of 6 months. The locations of MD-PTA in this study included submandibular triangle, retropharyngeal space, carotid sheath (at carotid bifurcation and intravagal), parapharyngeal space (superior to thyroid cartilage or superior thyroid pole) and cricothyroid space.
  
  
  CONCLUSIONS
  Despite their rare occurrence, incompletely or abnormally descended PTAs can be encountered by any surgeon who performs parathyroidectomies. It is important to develop a strategy to systematically locate these glands. High cure rates can still be achieved with minimally invasive parathyroidectomy if confident preoperative localization is available. A sound knowledge of embryology and a thorough exploration also facilitate an overall high success rate with open exploration.
authors.affiliation: Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: James C
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
authors.affiliation: Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Delbridge
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.affiliation: Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Stanley
authors.initials: S
authors.lastname: Sidhu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology / Q000601:surgery; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010280:Parathyroid Glands / Q000002:abnormalities* / Q000033:anatomy & histology / Q000473:pathology*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D002118:Calcium