Because parathyroid glands may be compromised during radical head and neck procedures, the transplantation of normal parathyroid tissue at the time of such procedures will substantially reduce the incidence of permanent hypoparathyroidism, and there has been little controversy about this indication. Since the original reports of TPTx in patients with primary or secondary parathyroid hyperplasia, investigators at numerous centers have published their experience with this technique. Results have varied from center to center, but generally they have been comparable to those achieved with SPT. The only randomized controlled trial comparing SPT versus TPTx was a single-institution study in patients with renal osteodystrophy. In this study, patients treated by TPTx had a more rapid normalization of serum calcium and alkaline phosphatase than those treated with SPT, as well as more rapid improvement in radiological signs and greater relief of symptoms such as pruritus and muscle weakness [8]. Unfortunately, no prospective, multicenter, randomized clinical trials have compared the results of the two operative procedures in patients with either primary or secondary parathyroid hyperplasia.