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Lederer AK, Staubitz-Vernazza JI, Margies R, Wild F, Musholt TJ. Continuous Intraoperative Nerve Monitoring of a Non-Recurrent Laryngeal Nerve: Real-Life Data of a High-Volume Thyroid Surgery Center. Cancers (Basel) 2024; 16:1007. [PMID: 38473368 DOI: 10.3390/cancers16051007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Thyroid surgery is associated with a risk of injury to the recurrent laryngeal nerve, especially in the presence of anatomical variants such as a non-recurrent laryngeal nerve (NRLN). Injury to the nerve leads to transient or permanent vocal cord palsy (VCP). A novel method to prevent VCP is continuous intraoperative nerve monitoring (cIONM), but less is known about the applicability of this method in patients with NRLN. The aim of this study was to evaluate our own data regarding feasibility and detailed characteristics of cIONM in NRLN patients. We performed a monocentric retrospective cohort analysis including clinical data and intraoperative nerve monitoring data (measured by Inomed Medizintechnik GmbH, Emmendingen, 'C2' and 'C2 Xplore' device) of all thyroid surgery patients, showing NRLN between 2014 and 2022. Of 1406 patients who underwent thyroid surgery with cIONM between 2014 and 2022, 12 patients (0.9%) showed NRLN intraoperatively. Notably, cIONM was feasible in eight patients (67%). In all cases the onset latency of the right vagus nerve was shorter (<3.0 ms) than usually expected, suggesting that a short latency might be suitable to distinguish NRLN. None of the patients had a post-operative VCP. Overall, cIONM appears to be feasible and safe in NRLN patients and provides helpful information to prevent VCP.
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Affiliation(s)
- Ann-Kathrin Lederer
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Center for Complementary Medicine, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Julia I Staubitz-Vernazza
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Rabea Margies
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Florian Wild
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
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Zhou B, Cheng F, Zhu X, Zhu L, Li Z. Effect of intraoperative active exploration of parathyroid glands to reduce the incidence of postoperative hypoparathyroidism, and risk factors of hypoparathyroidism after total thyroidectomy: a single-center study. Front Surg 2023; 10:1203595. [PMID: 37545843 PMCID: PMC10401036 DOI: 10.3389/fsurg.2023.1203595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/12/2023] [Indexed: 08/08/2023] Open
Abstract
Background The risk factors for hypoparathyroidism after thyroid surgery have not been fully identified. This study analyzes the risk factors of hypoparathyroidism before and after total thyroidectomy. Methods We retrospectively collected the clinical data of 289 patients who underwent total thyroidectomy at the Thyroid Surgery Center of Lishui Central Hospital from June 2018 to June 2020. For the anatomy and protection of parathyroid glands during the operation, one group of patients used the parathyroid avoidance method, and the other group used the active exploration method. Various risk factors affecting parathyroid dysfunction were studied using logistic regression models. Results A total of 289 patients were included in this study. The average age of patients was 47.21 ± 11.78 years, including 57 males (19.7%) and 232 females (80.3%). There were 149 (51.6%) patients with transient hypoparathyroidism and 21 (7.3%) with permanent hypoparathyroidism. The main risk factors of hypoparathyroidism were parathyroid avoidance method (P = 0.005), parathyroid autotransplantation (P = 0.011), bilateral central neck lymph node dissection (CND) (P = 0.001), lymphatic metastasis (P = 0.039), and parathyroid in the specimen (P = 0.029). The main risk factors associated with permanent hypoparathyroidism were bilateral CND (P = 0.038), lymphatic metastasis (P = 0.047), parathyroid hormone (PTH) < 1.2 pg/ml within three days after surgery (P = 0.006). Conclusion Hypoparathyroidism is common but mostly transient after bilateral total thyroidectomy. Compared with parathyroid avoidance method, the active exploration method during operation may reduce the incidence of postoperative hypoparathyroidism. PTH <1.2 pg/ml within three days after surgery was predictive in patients with permanent hypoparathyroidism.
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Gaydarski LL, Georgiev GP, Olewnik Ł, Karauda P, Landzhov B. A Rare Variation of the Levator Scapulae Muscle: A Case Report and Review of Literature. Cureus 2023; 15:e42355. [PMID: 37621798 PMCID: PMC10445243 DOI: 10.7759/cureus.42355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Muscle variations in the posterior neck region are mainly categorized as variations in the origin and insertion of the muscles and the presence of accessory slips or rudimentary muscles. The levator scapulae muscle is a variable muscle with several different types of variations described throughout the literature. Herein, we report a rare unilateral case of an accessory slip from the levator scapulae. Aberrant muscle slip originates from the distal one-third of the levator scapulae. Then, it passes upwards and outwards above a vascular bundle containing a superficial branch of the transverse cervical artery and vein. The deviant muscle slip inserts onto the superior nuchal line. Muscle variations in the neck's posterior region and the levator scapulae's variations, as per se, have the utmost clinical significance since they might be mistaken for tumor mass. Moreover, such variations might be deceptive during surgical procedures in the region. Therefore, detailed knowledge of such complex muscular variations in the posterior region of the neck is paramount for surgeons and radiologists alike.
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Affiliation(s)
- Lyubomir L Gaydarski
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR
| | - Georgi P Georgiev
- Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Sofia, BGR
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, POL
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, POL
| | - Boycho Landzhov
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR
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Díaz-García A, Caballero-Rodríguez E, García-Martínez R, Balanzá JJ, Gómez MÁB. Primary cavernous hemangioma of the thyroid mimicking an ectopic cervical thymoma. J Surg Case Rep 2022; 2022:rjac411. [PMID: 36196135 PMCID: PMC9526541 DOI: 10.1093/jscr/rjac411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Hemangiomas are one of the most common soft tissue tumors, most of which are located in the skin and subcutaneous tissue. However, a primary thyroid hemangioma is extremely infrequent, so there are only a few cases described in the current literature. As the clinical presentation and characteristics in the imaging tests are non-specific, it is difficult to obtain a preoperative diagnosis. In most cases, the definitive diagnosis is achieved by the histological examination. Due to the rarity of this tumor, we described the case of a 51-year-old female patient affected by thyroid cavernous hemangioma, the differential diagnosis that we considered and a review of the current literature.
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Affiliation(s)
- Alberto Díaz-García
- Correspondence address. General Surgery Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain. Tel: +34-653191629; E-mail:
| | | | - Rubén García-Martínez
- Head and Neck Surgery Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Julio Jordán Balanzá
- Head and Neck Surgery Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
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Ricciardiello F, Mazzone S, Viola P, Guggino G, Longo G, Napolitano A, Russo G, Sequino G, Oliva F, Salomone P, Perrella M, Romano GM, Cinaglia P, Abate T, Gargiulo M, Pisani D, Chiarella G. Deep Neck Infections: decisional algorithm for patients with multiple spaces involvement. Rev Recent Clin Trials 2021; 17:46-52. [PMID: 34514992 DOI: 10.2174/1574887116666210910153033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/20/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Deep Neck Infections (DNIs) spread along fascial planes and involve neck spaces. Recently, their incidence has decreased due to the introduction of antibiotics; nevertheless, complications related to DNIs are often life-threatening. OBJECTIVE The purpose of this article is focused on the identification of predisposing factors of these complications, as well as on the development of a reliable therapeutic algorithm. METHOD Sixty patients with DNIs were enrolled from 2006 to 2019 for a retrospective study. The exclusion criteria for the present study was cellulitis, small abscesses responding to empiric or specific antibiotic therapy or with involvement of only one deep neck space. During the analysis the following parameters of interest have been evaluated: gender, age, site of origin, pathways of spread, comorbidities, clinical features, bacteriology data, type of surgical approach required, complications, duration of hospitalization and mortality rate. On admission, microbial swab analysis was performed. RESULTS Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), iron deficiency anemia and the involvement of multiple spaces have been associated with a significantly higher risk of developing complications. Most of our patients had polymicrobial infections. All patients underwent surgical drainage. The complication rate had occurred in 56.6% of patients, while death in 18.3%. CONCLUSION DNIs represent a medical and surgical emergency with potential serious complications, thus avoiding diagnostic delay is mandatory. Our preliminary data suggest the importance of evaluating the extent of infections because the involvement of multiple spaces requires timely surgery due to the higher risk of complications and mortality.
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Affiliation(s)
| | | | - Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
| | - Gianluca Guggino
- Thoracic Surgery Department, AORN Cardarelli Hospital, Napoli. Italy
| | - Giuseppe Longo
- Direzione Generale,"A. Cardarelli" Hospital, Naples. Italy
| | | | - Giuseppe Russo
- Direzione Sanitaria, AORN Cardarelli Hospital, Naples. Italy
| | - Giulio Sequino
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | - Flavia Oliva
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | | | - Marco Perrella
- Department of Anesthesia and Intensive Care, AORN Cardarelli Hospital, Naples. Italy
| | - Giovanni Marco Romano
- Department of Anesthesia and Intensive Care, AORN Cardarelli Hospital, Naples. Italy
| | - Pietro Cinaglia
- Department of Surgical and Clinical Science, Magna Graecia University, Catanzaro. Italy
| | - Teresa Abate
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | - Maurizio Gargiulo
- Thoracic Surgery Department, AORN Cardarelli Hospital, Napoli. Italy
| | - Davide Pisani
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
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Ru Z, Mingliang W, Maofei W, Qiaofeng C, Jianming Y. Analysis of Risk Factors for Hypoparathyroidism After Total Thyroidectomy. Front Surg 2021; 8:668498. [PMID: 34095206 PMCID: PMC8175897 DOI: 10.3389/fsurg.2021.668498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To analyze the risk factors of hypoparathyroidism after total thyroidectomy. Methods: Clinical data of patients who undergo total thyroidectomy in the Luwan Branch of Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University was collected from January 2015 to December 2018, retrospectively. Logistic regression was used to analyze the risk factors associated with transient and long-term hypoparathyroidism. Results: A total of 537 patients were collected. The patients' average age included in the study was 47.3 ± 12.7 years old, including 135 males (25.1%) and 702 females (74.9%). There were 194 patients (36.1%) with transient postoperative hypoparathyroidism, and 21 patients (3.9%) had long-term postoperative hypoparathyroidism. After multivariate analysis, the main risk factors related to postoperative transient hypoparathyroidism were gender (P = 0.038, OR 0.686), combined lymph node dissection (P = 0.008, OR 1.569), and the maximum diameter of the thyroid (P = 0.011, OR 1.192), second operation (P = 0.001, OR 1.974), preoperative blood calcium (P < 0.001, OR 0.028). The main risk factors associated with long-term postoperative hypoparathyroidism are combined with lymph node dissection (P = 0.011, OR 1.594), maximum thyroid diameter (P = 0.032, OR 1.254), and PTH on the first day after surgery (P < 0.001, OR 1.199). Conclusions: Gender, combined lymph node dissection, maximum thyroid diameter, a second surgery, and preoperative blood calcium are risk factors for transient hypoparathyroidism after thyroid surgery. The combined lymphatic dissection and the thyroid gland's maximum diameter are risk factors for long-term hypoparathyroidism after thyroid surgery. PTH on the first day after surgery has a predictive effect on patients with long-term hypoparathyroidism.
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Affiliation(s)
- Zhou Ru
- Department of General Surgery, School of Medicine, Ruijin Hospital/Lu Wan Branch, Shanghai Jiaotong University, Shanghai, China
| | - Wang Mingliang
- Department of General Surgery, School of Medicine, Ruijin Hospital/Lu Wan Branch, Shanghai Jiaotong University, Shanghai, China
| | - Wang Maofei
- Department of General Surgery, School of Medicine, Ruijin Hospital/Lu Wan Branch, Shanghai Jiaotong University, Shanghai, China
| | - Chen Qiaofeng
- Department of General Surgery, School of Medicine, Ruijin Hospital/Lu Wan Branch, Shanghai Jiaotong University, Shanghai, China
| | - Yuan Jianming
- Department of General Surgery, School of Medicine, Ruijin Hospital/Lu Wan Branch, Shanghai Jiaotong University, Shanghai, China
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Abstract
Objective To retrospectively review our experience with the diagnosis and treatment of carotid bifurcation tumors (CBFT). Methods This was a retrospective study of 60 patients with CBFT who underwent surgical and conservative treatment. The patients’ clinicopathological features, imaging examination findings, treatment strategy, and prognosis were analyzed. The surgical grade, blood loss, tumor size, operative time, and postoperative complications were analyzed by Spearman’s correlation. Results Resection was performed in 52 patients with 53 tumors. The mean tumor volume, operative time, estimated blood loss, and follow-up time was 47.62 ± 65.28 cm3, 176.1 ± 86.55 minutes, 231.3 ± 354.0 mL, and 44.42 ± 29.30 months, respectively. Pathological examination showed that the number of carotid body tumors (CBT; paraganglioma), neurilemmoma, mesenchymal tissue tumor, and angioleiomyoma was 42, 8, 1, and 1, respectively. Of the CBT group, the rate of Shamblin Type I, II, and III was 11.9%, 59.5%, and 28.6%, and three cases were malignant CBT with lymph node metastasis. Spearman’s correlation analysis showed that complication grade was significantly related to surgical difficulty grade and operative time. Conclusion CBT is the most frequent lesion in CBFT, and CBT may be treated safely by surgical management. The severity of surgical complications is significantly correlated with surgical difficulty.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Weichang Zhang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China.,Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Lei Zhang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Jieting Zhu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
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Carsky K, Iwanaga J, Clark M, Aysenne A, Tubbs RS. A Nerve of McKenzie With a Variant Communicating Branch Between the Vagus Nerve and Cranial Root of the Accessory Nerve: A Cadaveric Case Report. Cureus 2021; 13:e14343. [PMID: 33972901 PMCID: PMC8105212 DOI: 10.7759/cureus.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Anatomical variations of the craniocervical junction including a nerve of McKenzie, a branch between the spinal accessory nerve (XI) and the ventral root of the first cervical nerve (C1), have been identified. During routine dissection, a nerve of McKenzie with an interneural connection between the cranial root of the accessory nerve and the vagus nerve was observed on the left side. To our knowledge, a case with these two anatomical variations in the same cadaver and on the same side has not previously been reported. These variants may complicate surgery of the nerves of the craniocervical junction, and should thus be appreciated by the surgeon. Here, we discuss this case, its possible embryological origins, and the clinical significance.
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Affiliation(s)
- Katie Carsky
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - McKenzie Clark
- College of Human Sciences, Florida State University College of Medicine, Tallahassee, USA
| | - Aimee Aysenne
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
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Parmeggiani D, Gualtieri G, Terracciano G, Gambardella C, Parisi S, Brusciano L, Ruggiero R, Docimo L. Prolonged iatrogenic thoracic duct chylous fistula in Neck Surgery: conservative management or surgery? A Literature review. Scand J Surg 2021; 110:550-556. [PMID: 33423617 DOI: 10.1177/1457496920987076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon's experience. AIMS The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring. METHODS A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic-chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation. CONCLUSIONS In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.
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Affiliation(s)
- D Parmeggiani
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Gualtieri
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Terracciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - C Gambardella
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - S Parisi
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Brusciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - R Ruggiero
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Docimo
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
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Hadedeya D, Shalaby M, Akkera M, Lee G, Harris K, Kholmatov R, Anwar M, Murad F, Alawaad S, Kandil E. Prophylactic external beam radiation therapy for keloid prevention in thyroid surgery patients. Gland Surg 2021; 10:65-72. [PMID: 33633963 PMCID: PMC7882325 DOI: 10.21037/gs-20-511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Poor cosmesis, secondary to keloid or hypertrophic scar, following thyroid surgery may cause considerable patient distress and be a significant challenge to treat. In this case series we examined the efficacy of prophylactic external beam radiation therapy (EBRT) for prevention of keloid formation in keloid-prone patients undergoing thyroid surgery. While much has been published about documenting the efficacy in reducing keloid formation following keloid excision, very little literature exists documenting prophylactic use related to surgeries with the goal of prevent de novo keloid formation. METHODS We retrospectively evaluated a series of ten patients, who underwent a prophylactic EBRT for keloid prevention after thyroid surgery between January 2013 and February 2019. Patient demographics, primary diagnosis, surgical procedure, EBRT dosage, and post-operative visit records were reviewed. RESULTS All ten patients who received EBRT for keloid prophylaxis following a thyroid surgery were female. Half of the patients were African Americans, 40% Caucasians, and 10% Hispanic. The mean age was 46.40±15.63 years with BMI of 31.5±5.5 kg/m2. Radiation was initiated within 6 hours of the surgery with an average radiation dose per session of 5.7±1.7 Gy. The total average EBRT dose delivered was 17.4±4.2 Gy. Mean follow-up period was 13 months post-thyroidectomy, with the longest follow-up at 23 months. One patient, who underwent a lateral neck dissection in addition to thyroid surgery, developed hypertrophic scar in less than 10% of her incision length. Nine other patients (90%) showed no post-surgical keloid nor hypertrophic scar formation and patients were satisfied with postsurgical cosmesis. CONCLUSIONS We examined the efficacy of prophylactic EBRT in keloid-prone patients undergoing thyroid surgery. Prophylactic EBRT following thyroid surgery is effective in achieving a satisfactory cosmetic outcome in patients at high risk for keloid formation.
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Affiliation(s)
- Deena Hadedeya
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Shalaby
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mounika Akkera
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Grace Lee
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kendra Harris
- Department of Radiation Oncology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Roostam Kholmatov
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Muhammad Anwar
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Fadi Murad
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Saad Alawaad
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Sideris A, Rao A, Maher N, Parker A, Crawford J, Smee R, Jacobson I, Gallagher R. Acinic cell carcinoma of the salivary gland in the adult and paediatric population: a survival analysis. ANZ J Surg 2020; 91:1233-1239. [PMID: 33205582 DOI: 10.1111/ans.16421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acinic cell carcinoma (AcCC) is a rare malignant neoplasm of the salivary glands and generally considered to be a low-grade tumour. Surgical treatment is often curative, but a more aggressive high-grade variant has been associated with poorer survival and propensity for distant metastasis. No standard treatment guidelines exist and the approach to treatment is varied in the published series. The aim of this study is to present the experience of three major hospitals in Sydney, Australia, in treating AcCC of the salivary gland, with a focus on clinico-pathological features of disease and their associations with survival outcomes. METHODS Adult and paediatric cases of AcCC of the salivary gland during the time period 1979-2018 were retrospectively included. Demographic, clinico-pathological, treatment and survival outcome data were extracted. Survival analysis was undertaken to assess the effect of clinical and pathological variables on overall and disease-free survival. RESULTS Thirty-two cases were reviewed (29 adult and three paediatric). Thirty tumours (93.8%) were parotid gland primary tumours. Mean overall and disease-free survival was 17.0 ± 0.7 and 16.0 ± 0.9 years, respectively. Features associated with poorer survival were cT staging >1, presence of preoperative clinical facial nerve deficit and local recurrence. Positive margins were associated with recurrence. CONCLUSION These data suggest that disease-free and overall survival in AcCC of the salivary gland is excellent with surgery as the first-line treatment. Poor survival outcomes are uncommon and may be associated with locally advanced disease in the presence of other well-established high-risk features.
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Affiliation(s)
- Anders Sideris
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Department of ENT/Head and Neck Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Amshuman Rao
- Department of Otolaryngology/Head and Neck Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Nigel Maher
- SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Andrew Parker
- SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Julia Crawford
- Department of Otolaryngology/Head and Neck Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Robert Smee
- Department of Radiation Oncology, Tamworth Hospital, Tamworth, New South Wales, Australia.,Department of Radiation Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ian Jacobson
- Department of ENT/Head and Neck Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of ENT/Head and Neck Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Richard Gallagher
- Department of Otolaryngology/Head and Neck Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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12
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Galli M, Fusconi M, Federici FR, Candelori F, De Vincentiis M, Polimeni A, Testarelli L, Cassese B, Miccoli G, Greco A. Minimally Invasive Intraoral Approach to Submandibular Lodge. J Clin Med 2020; 9:jcm9092971. [PMID: 32937980 PMCID: PMC7563973 DOI: 10.3390/jcm9092971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to describe the Minimally Invasive Intraoral Approach (MIIA) performed on selected cases of abscesses and neck phlegmons of odontogenic origin when the infection has not spread beyond the inferior mandibular margin. This technique allows us to avoid cervicotomy by a direct approach to the abscess, draining it through the oral cavity. If the limits have already been crossed, then cervicotomy is necessary. The aim of the study is to show the surgical outcomes that we have achieved during a time span of two years, and to show the effectiveness of the MIIA and its results. We selected 66 patients with abscesses and neck phlegmons, from January 2018 to June 2020. Among these cases, five patients were excluded as it was not possible to recover medical records from database. The MIIA technique has been performed on 16 patients (26.2%) when a successful dental extraction and drainage of the submandibular lodge were accomplished. The patients who underwent the MIIA surgery have all perfectly healed and did not suffer from relapses during the follow-up. The results show the achievement of excellent healing, underlining the lower impact required by MIIA when compared to a more traditional approach through cervicotomy.
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Affiliation(s)
- Massimo Galli
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Massimo Fusconi
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
| | - Francesca Romana Federici
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Francesca Candelori
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
| | - Marco De Vincentiis
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Luca Testarelli
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Benedetta Cassese
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Gabriele Miccoli
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
- Correspondence: or ; Tel.: +39-388-045-9246
| | - Antonio Greco
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
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13
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Riba M, Bejarano M, Hernández C, Moraleda I, Massaguer C, Ribalta T, Gómez M, Krauel L, Parri FJ, Albert A. Midline Cervical Cleft: An Anatomical Finding and a Proposal for a New Approach. Cleft Palate Craniofac J 2020; 57:1422-1427. [PMID: 32806933 DOI: 10.1177/1055665620947957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Congenital midline cervical cleft is a rare malformation. Typical case shows an area of hypotrophic skin, a cranial nipple-like structure, and a caudal blind sinus. Cervical extension is limited. Relapse of the retraction is common following cutaneous z-plasty. The aim of this study is to describe the radiological, surgical, and histological findings of the 4 cases treated in our center in the last 8 years and communicate the finding of a contractile structure, anterior to the platysma, composed by striated muscle, figure not previously described. This distinct muscular band is responsible for neck retraction. Removal of this releases cervical tension and is essential to avoid the relapse.
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Affiliation(s)
- Mireia Riba
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Miguel Bejarano
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Carlos Hernández
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain.,Department of Pediatric Surgery, 156300Hospital Universitario de Burgos, Spain
| | - Inés Moraleda
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Clara Massaguer
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Teresa Ribalta
- Department of Pathological Anatomy, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Marta Gómez
- Department of Radiology, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Lucas Krauel
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Francisco J Parri
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Asteria Albert
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
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14
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Di Meo G, Karampinis I, Gerken A, Lammert A, Pellicani S, Nowak K. Indocyanine Green Fluorescence Angiography Can Guide Intraoperative Localization During Parathyroid Surgery. Scand J Surg 2019; 110:59-65. [PMID: 31554490 DOI: 10.1177/1457496919877581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Intraoperative localization of pathologic parathyroid glands is of major importance for the hyperparathyroidism treatment. Based on the small size and the anatomic variability, the localization can be very challenging. The current practice is to compare preoperative ultrasonography with Technetium-99m sestamibi scintigraphy (MIBI) and plan the resection accordingly. In this study, we implemented indocyanine green angiography for the intraoperative localization of parathyroid glands. MATERIALS AND METHODS This is a retrospective analysis of 37 patients with primary, secondary, or tertiary hyperparathyroidism who were operated using indocyanine green angiography for the intraoperative localization of pathological parathyroid glands. An indocyanine green solution of 2.5 mg was were intravenously administered for parathyroid gland visualization. Different fluorescence scores were correlated with changes in postoperative parathyroid hormone levels. RESULTS Patients were divided into two groups depending on the presence of uniglandular or multiglandular disease. Sixty-four lesions were resected, and the final histopathologic analysis confirmed the parathyroid origin in 62 of them (96.8%). None of the patients with uniglandular disease developed postoperative hypoparathyroidism, whereas three patients in the multiglandular group developed temporary hypoparathyroidism symptoms. Indocyanine green imaging had higher sensitivity for the intraoperative detection of parathyroid glands compared with ultrasonography and MIBI (p < 0.001). CONCLUSION Indocyanine green angiography indicated high sensitivity for the intraoperative identification of pathologic parathyroid glands leading to a resection rate of 95.16%. The modality was useful, especially in cases of revisional surgery or ectopic parathyroid glands. Randomized trials have already proven the value of indocyanine green imaging in predicting postoperative hypocalcemia. Our results support the regular use of this method during parathyroid surgery.
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Affiliation(s)
- G Di Meo
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari, Bari, Italy.,Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - I Karampinis
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A Gerken
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A Lammert
- Dialyse-Praxis Grünstadt, Grünstadt, Germany
| | - S Pellicani
- Section of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari, Bari, Italy
| | - K Nowak
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
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15
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Abstract
The ansa cervicalis is located around the carotid sheath and forms a neural loop, which consists of superior and inferior roots. It innervates the infrahyoid muscles. Anatomical variations of the superior root of the ansa cervicalis are uncommon. Herein, we present an extremely rare case of the superior root of the ansa cervicalis arising both from the hypoglossal and vagus nerves.
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Affiliation(s)
| | - Joe Iwanaga
- Medical Education and Simulation, Seattle Science Foundation, Seattle, USA
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, JPN
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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16
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Eriksen PRG, Hvilsom GB, Homøe P. Infected "Mycotic" Aneurysm of the Common Carotid Artery-A Differential Diagnosis to Tumor of the Neck. Front Surg 2019; 5:75. [PMID: 30619876 PMCID: PMC6297873 DOI: 10.3389/fsurg.2018.00075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Infected "mycotic" Aneurysm (IA) of the extracranial carotid artery is a rare condition that can be fatal if mistaken for other pathology. An 83-year-old man presented with a mass on the neck initially suspected malignant. Weeks later it grew rapidly and was found to be an IA, thus requiring acute surgery. Via this case report, we discuss diagnostics and approach when diagnosing masses in relation to vessels of the neck not readily explained. Case Report: After diagnostic imaging and clinical assessment an unknown primary tumor of the neck was suspected. Fine needle aspiration was inconclusive. The patient did not present with any signs of infection or neurological symptoms-only discomfort and pain. Approximately two weeks later, the mass grew and the patient became dysphagic, febrile, and confused. Computed tomography angiography revealed an IA of the right common carotid artery. The patient underwent acute surgery consisting of ligation of the internal and external carotid arteries and resection of the internal jugular vein. The pathogen found was E. coli, supposedly from the bladder after surgical intervention due to polyposis. Conclusion: IA is a very rare entity and can have many etiologies. Since it can be fatal, it is necessary to keep IA in mind when diagnosing masses in relation to vessels of the neck. As shown in this case of a E. coli-induced IA, patients can present with atypical symptoms, on diagnostic imaging it can be mistaken for other pathology, and pathogenesis can be unclear.
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Affiliation(s)
- Patrick R G Eriksen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Gitte B Hvilsom
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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17
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Affiliation(s)
- Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center (CHUM) and Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Tareck Ayad
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center (CHUM) and Maisonneuve-Rosemont Hospital, Montreal, Canada
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18
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Becker C, Csatari Z, Pfeiffer J. Truncus bicaroticus: an underestimated anatomic variation. Laryngoscope 2013; 124:1141-2. [PMID: 24123078 DOI: 10.1002/lary.24444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/10/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To illustrate that a truncus bicaroticus and an elongated truncus brachiocephalicus are underestimated anatomic variations; and to highlight the risk of injury of these vessel anomalies during routine surgical interventions. DATA SOURCE Report of a woman with long-term ventilation who was planned for conventional surgical tracheostomy. Due to a strong pulsatile vessel crossing the cricoid cartilage, the procedure was stopped. Further diagnostics revealed anomalies of the supraaortic vessels, including a truncus bicaroticus. CONCLUSION Anomalies of supraaortic vessels are not rare and injuries may cause severe bleeding; therefore, we recommend performing a preoperative ultrasound, particularly before starting dilatative tracheostomy.
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Affiliation(s)
- Christoph Becker
- Department of Otorhinolaryngology-Head and Neck Surgery (C.B., J.P.), University of Freiburg, Freiburg, Germany
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19
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Mukhopadhyay S, Niyogi M, Dutta M, Ray R, Gayen GC, Mukherjee M, Mukhopadhyay BS. Bilateral superficial cervical plexus block with or without low-dose intravenous ketamine analgesia: effective, simple, safe, and cheap alternative to conventional general anesthesia for selected neck surgeries. Local Reg Anesth 2012; 5:1-7. [PMID: 22915895 PMCID: PMC3417975 DOI: 10.2147/lra.s28360] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background General anesthesia is commonly used for surgery in the neck region. Superficial cervical plexus block is adequate to produce anesthesia in the anterior and anterolateral aspects of the neck. Our aim was to observe the effectiveness of bilateral cervical plexus block for surgery in this region of the neck. Methods A total of 136 neck surgery cases were enrolled in this prospective uncontrolled study. All patients were administered ropivacaine 0.5% as a bilateral cervical plexus block. The incision line was infiltrated with lignocaine 1% and adrenaline 1:100,000. For thyroglossal cyst and thyroglossal fistula, an additional 1.5 mL of LA solution was deposited over the hyoid bone on both sides of the midline. Any anesthetic inadequacy was corrected using ketamine 25 mg intravenously and repeated if necessary. Results Of 37 patients with thyroglossal cyst, the block was sufficient in 36 patients, and one patient required ketamine. Block was adequate in 23 of 24 patients with thyroglossal fistula, and one patient required ketamine. Among the branchial cyst and branchial fistula cases, six of 16 patients required ketamine supplementation. Of three thyroidectomy patients, one required ketamine supplementation, and one was converted to conventional general anesthesia. For lymph node excision and lymph node biopsy patients, LA block was sufficient in all 31 cases. In the last group, one of 25 patients required ketamine supplementation. Conclusion The overall success of bilateral cervical plexus block as a sole method of anesthesia in these selected neck surgeries was 91.9% and with low-dose ketamine supplementation it approached more than 99%. However, cervical plexus block was not a good method of anesthesia for thyroid surgery in this study. For the remainder of cases, bilateral cervical plexus block alone or in conjunction with ketamine appeared to be a cheap, safe, and effective alternative to conventional general anesthesia.
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20
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Abstract
Endoscopic surgery in the neck was attempted in 1996 for performing parathyroidectomy. A similar surgical technique was used for performing thyroidectomy the following year. Most commonly reported endoscopic neck surgery studies in literature have been on thyroid and parathyroid glands. The approaches are divided into two types i.e., the total endoscopic approach using CO(2) insufflation and the video-assisted approach without CO(2) insufflation. The latter approach has been reported more often. The surgical access (port placements) may vary-the common sites are the neck, anterior chest wall, axilla, and periareolar region. The limiting factors are the size of the gland and malignancy. Few reports are available on endoscopic resection for early thyroid malignancy and cervical lymph node dissection. Endoscopic neck surgery has primarily evolved due to its cosmetic benefits and it has proved to be safe and feasible in suitable patients with thyroid and parathyroid pathologies. Application of this technique for approaching other cervical organs such as the submandibular gland and carotid artery are still in the early experimental phase.
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Affiliation(s)
- P K Chowbey
- Department of Minimal Access and Bariatric Surgery Centre, Sir Ganga Ram Hospital, New Delhi, India
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