THE USUAL Kocher collar incision is made, and the superior and inferior flaps expose the deep cervical fascia from the thyroid cartilage of the larynx to the suprasternal notch. The sternohyoid and sternothyroid muscles are reflected laterally and individually from the midline to the neurovascular bundle (Fig. 1). The superior portion of the sternohyoid muscle is retracted, exposing the insertion of the sternothyroid muscle (Fig. 2). By careful sharp and blunt dissection the sternothyroid muscle is reflected over most of the superior pole. The posterior lateral edge of this muscle is freed of areolar tissue, and the common carotid artery and internal jugular vein are mobilized posteriorly (Fig. 3).
With care, the musculotendinous insertion of the sternothyroid muscle is completely cut, thus exposing the entire superior pole of the thyroid gland including its vessels. This obviates the necessity of cutting the sternohyoid and sternothyroid muscles in their midportion, which actually