the key to thyroidectomy is the dissection of the upper pole of the thyroid and the key to that dissection is the anatomy of the Superior thyroid artery. If you know the branches of this artery and its relationships you know the steps to mobilising the upper pole.

There are 13 branches.....

1. superior thyroid artery origin
2. internal laryngeal
3. infra-hyoid
4. crico-thyroid
5. crossing branch
6. sternomastoid branch
7. strap muscle branch
8. thyroid and parathyroid capsular branches
9. anteromedial thyroid artery proper
10. anterolateral thyroid artery
11. posterior thyroid artery
12. inferior thyroid artery connecting branch
13. superior parathyroid branch

Generally the order in which you encounter these is the capsular branches from the strap muscle branch, the antero-medial branch to the thyroid propria, the crossing branch in the cave of Reeve connecting the crico-thyroid and the antero-medial branch, the antero-lateral branch and the posterior branch with the artery to the superior parathyroid. At this point the dissection turns to finding the termination of the recurrent laryngeal nerve as it enters the larynx below the small wedge of the inferior constrictor. The connecting branch from the antero-lateral or sometimes the posterior branch to the inferior thyroid artery may extend over the lobe of Zuckerkandl at this point and make the mobilisation of this area difficult, but it must not be divided until all the branches of the recurrent laryngeal nerve are found, as the artery and nerve run nearly in the same direction, and rarely the recurrent laryngeal nerve runs superficial to the lobe of Zuckerkandl