. Manual of operative surgery. uent presence of these extra masses ofthyroid is not surprising, the thyroid itself beingdeveloped from the thyroglossal duct; surgicallythey are of importance, as their presence is cal-culated to confuse the operator, ignorant of theirexistence. The thyroid is surrounded by a strongcovering of fascia—fibrous capsule. When agoitre is present in the gland (adenoma or cyst), it is, of course, surrounded by more or less altered Fig. 2,1 a—De Quervain, Deutscheglandular tissue—glandular capsule. The wordcapsule, being applied both to the outer fibrous covering and to
. Manual of operative surgery. uent presence of these extra masses ofthyroid is not surprising, the thyroid itself beingdeveloped from the thyroglossal duct; surgicallythey are of importance, as their presence is cal-culated to confuse the operator, ignorant of theirexistence. The thyroid is surrounded by a strongcovering of fascia—fibrous capsule. When agoitre is present in the gland (adenoma or cyst), it is, of course, surrounded by more or less altered Fig. 2,1 a—De Quervain, Deutscheglandular tissue—glandular capsule. The wordcapsule, being applied both to the outer fibrous covering and to the glandular tissue inside which (chTef liTdacces^soo^^°^^* ™* ^^^the tumor lies, leads to confusion when methods of operating are described. In the succeeding pages the outer or surgicalcapsule will be called the fibrous; the inner, the glandular capsule. The arteries of the thyroid are: (a) The superior thyroid, entering the upperpole of the lateral lobe; (b) the inferior thyroid, entering the posterior surface of. Leitschf. chir., cxvi, Superior thyroid artery and Superior thyroid vein. 3. Acces-sory inferior thyroid vein. 4. Inferior 254 goitre; bronchocele; struma the lower pole and in close and, surgically, dangerous relation to the recurrentlaryngeal nerve (Fig. 372); (c) the thyroidea ima, entering the isthmus frombelow. The veins of the thyroid are of very great importance; a study of Kochersschemata (Figs. 373 and 374) will give a fair idea of their location and im-portance. Operations for the cure of goitre may be divided into three groups: ; II. Intraglandular enucleation; III. Incision and evacuation. I. EXCISION Complete excision of the thyroid gland is an unjustifiable operation, as itis followed by fatal consequences. As in the case of other organs, nature hasbeen lavish in her provision of functional material in the thyroid, and it is safeto say that one-fourth of the gland is sufficient for the maintenance of health. De Quer
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