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ANZ J Surg. 2015 Dec;85(12):957-61. doi: 10.1111/ans.12017. Epub 2012 Dec 10.

Adenomas of cervical maldescended parathyroid glands: pearls and pitfalls.

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Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Endocrine Surgical Unit, Department of Surgery, Monash University, Melbourne, Victoria, Australia.

Erratum in



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).


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.


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.


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.


adenoma; ectopic; high cervical; hyperparathyroidism; parathyroid; parathyroidectomy; undescended

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