Transoral Excision of a High Retropharyngeal Parathyroid World

In patients with renal failure, hypocalcemia leads to multiglandular parathyroid growth and parathyroid hypersecretion. Parathyroidectomy has been shown to decrease cardiovascular events and mortality in these patients. One of the challenges of surgery for secondary hyperparathyroidism is the high reported incidence of supernumerary and ectopic glands. This in conjuction with reported low sensitivity of preoperative imaging studies in multigland disease and unclear criteria for intraoperative PTH in 2HPT may lead to incomplete parathyroidectomy and need for reoperation. We report a case of recurrent 2HPT from an ectopic supernumerary gland in the high retropharyngeal region found by CT imaging. Due to the patient’s obesity, short neck and history of prior neck surgery, we elected to excise the gland transorally using intraoperative EUS.