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Consideration of Submandibular (Undescended) Ectopic Parathyroid Glands in Surgery and Localization Studies

Suhyla Alam, MD1; Peter G. Volsky, MD2; J. Trad Wadsworth, MD3; Daniel W. Karakla, MD4
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Virginia, Commonwealth University, Richmond
2Pittsburgh Ear Associates, Pittsburgh, Pennsylvania
3Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
4Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, Norfolk
JAMA Otolaryngol Head Neck Surg. 2015;141(10):943-944. doi:10.1001/jamaoto.2015.2069.
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Extract

This case series describes 3 patients with undescended symptomatic parathyroid adenomas that required reoperation or advanced imaging to localize.

Anatomy of the parathyroid glands varies. During embryogenesis, precursor glands descend from the third and fourth pharyngeal pouches into the neck, but up to 20% end up in “ectopic” locations.1 Adenomas that develop from undescended glands in the submandibular region are difficult to identify on standard imaging and account for 7% of cases of persistent hyperparathyroidism following parathyroidectomy.2 Undescended adenomas are well described in endocrine surgery literature but nearly absent from otolaryngology literature. With approval from Eastern Virginia Medical School’s institutional review board to use patient cases in a deidentified format, we identified the senior authors’ (J.T.W. and D.W.K.) patients with undescended parathyroid adenomas.

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Figure 1.
Case 1: Sestamibi Single Photon Emission Computed Tomographic (SPECT) (Second Study)

An image from the second sestamibi SPECT series obtained after the patient’s initial surgery demonstrating asymmetric tracer uptake in the left submandibular gland.

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Figure 2.
Case 1: Computed Tomographic (CT) Scan

An axial cut from a CT study obtained after the patient’s initial surgery and second sestamibi single photon emission computed tomographic (SPECT) series confirmed a mass in the left submandibular gland (arrow).

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