Exploration of the neck for hyperparathyroidism.

A step-by-step plan for exploration of the neck for hyperparathyroidism has evolved during a 15-year experience with 148 patients at the Toronto General Hospital. Selective catheterization of the veins of the neck with parathormone immunoassay has been a valuable aid in preoperative localization and is particularly helpful in those patients who have had a previous neck dissection. The success of the exploration is based on a practical knowledge of the embryology and anatomy of the parathyroid glands, meticulous dissection and the identification of all glands. The "angle of identification", as described, has been helpful in operative localization. The parathyroid gland or glands that are grossly abnormal are excised, and the remaining glands biopsied and examined by an experienced pathologist, expert in quick-section techniques.