Format
Sort by
Items per page

Send to

Choose Destination

Search results

Items: 1 to 20 of 1500

1.
Chirurgia (Bucur). 2019 Sept-Oct;114(5):579-585. doi: 10.21614/chirurgia.114.5.579.

The Tubercle of Zuckerkandl is Associated with Increased Rates of Transient Postoperative Hypocalcemia and Recurrent Laryngeal Nerve Palsy After Total Thyroidectomy.

Abstract

The current concept of complete resection of thyroid parenchyma shifted the practice from subtotal thyroidectomy to total thyroidectomy for a wide range of benign and malignant thyroid affliction and brought the tubercle of Zuckerkandl once again into attention. This embryological remnant has been shown to have a constant relationship with the recurrent laryngeal nerve and the superior parathyroid gland and may be used as a landmark for safe dissection. In order to assess if the presence of the tubercle of Zukerkandl has an impact on the most important complications of thyroid surgery, we have prospectively studied 128 patients diagnosed with nodular goiter who underwent total thyroidectomy. Grade 0 or the absence of the tubercle of Zuckerkandl, according to Pellizo et al, was noted in 42 cases (32.8%). During surgery, we identified 38 grade 1 tubercles (29.7%), 31 grade 2 tubercles (24.2%) and 16 grade 3 tubercles (12.5%). Out of 11 bilateral tubercles, 4 were measured as grade 3.Of all 47 patients with grade 2 and 3 tubercles, 18 (38.3%) developed transient postoperative hypocalcemia (p 0.0001, r=0.47) and 10 (21.3%) transient postoperative nerve palsy (p=0.004, r=0.25). All patients fully recovered during follow-up. The tubercle of Zuckerkandl, when present and of significant macroscopic size is associated with increased rates of transient postoperative hypocalcemia and recurrent laryngeal nerve palsy.

KEYWORDS:

postoperativehypocalcemia; recurrentlaryngealnervepalsy; totalthyroidectomy; tubercleofZuckekandl

PMID:
31670633
DOI:
10.21614/chirurgia.114.5.579
[Indexed for MEDLINE]
Free full text
Icon for Editura Celsius
2.
Ann Otol Rhinol Laryngol. 2020 Jan;129(1):32-38. doi: 10.1177/0003489419870829. Epub 2019 Aug 13.

Morphometric Differences in the Recurrent Laryngeal Nerve in Patients with Vocal Fold Paralysis.

Author information

1
Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.
2
Department of Biology, University of Utah, Salt Lake City, UT, USA.
3
Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA.
4
National Center for Voice and Speech, University of Utah, Salt Lake City, UT, USA.
5
Division of Otolaryngology/Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
6
Department of Surgery, University of Utah, Salt Lake City, UT, USA.

Abstract

OBJECTIVES:

Injury to the recurrent laryngeal nerve (RLN), if severe enough, can result in vocal fold paralysis. Reinnervation surgery can improve patient outcomes, but previous studies have reported a negative correlation between time since onset of paralysis and surgical outcomes. The ability of the paralyzed nerve to serve as a conduit for donor nerve fibers may be a factor in the success of reinnervation; however, changes in RLN composition after paralysis have not been well studied. Therefore, we investigated the morphometric composition of explanted RLN sections from patients who had experienced vocal fold paralysis for varying length of times.

METHODS:

Nine nerve sections from unilateral vocal fold paralysis (UVP) patients and seven control nerve sections were analyzed for morphometric parameters including fascicular area, fiber count, fiber density, fiber packing, mean g-ratio, and fiber diameter distribution. Nerves from UVP patients were also compared as a function of time since UVP onset.

RESULTS:

In comparison to control nerves, paralyzed nerves were found to have significantly lower fiber densities and fiber packing, higher mean g-ratio values, and a shift in diameter distributions toward smaller diameter fibers. With respect to paralysis duration, no significant differences were observed except in fiber diameter distributions, where those with paralysis for >2 years had distributions that were significantly shifted toward smaller diameter fibers.

CONCLUSIONS:

The morphometric data presented here suggest that correlations between the time since onset of vocal fold paralysis and reinnervation outcomes may be due to fiber size changes in the paralyzed nerve over time.

KEYWORDS:

morphometric parameters; recurrent laryngeal nerve; reinnervation; vocal cord paralysis

PMID:
31409113
DOI:
10.1177/0003489419870829
[Indexed for MEDLINE]
Icon for Atypon
4.
Head Neck. 2019 Nov;41(11):4060-4061. doi: 10.1002/hed.25901. Epub 2019 Aug 5.

Tailored approach for recurrent laryngeal nerve dissection according to different endoscopic endocrine surgery.

Author information

1
Division of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
2
Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University Hospital G. Martino, University of Messina, Messina, Italy.
PMID:
31381202
DOI:
10.1002/hed.25901
[Indexed for MEDLINE]
Icon for Wiley
5.
Surgery. 2019 Sep;166(3):369-374. doi: 10.1016/j.surg.2019.05.019. Epub 2019 Jun 28.

Complete and incomplete recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Characterizing paralysis and paresis.

Author information

1
Surgical Department, Rudolfstiftung, Wien Kliniken, Rudolfstiftung, Vienna, Austria.
2
Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria. Electronic address: valerie.dahm@meduniwien.ac.at.
3
Department of Otorhinolaryngology, Wien Kliniken, Rudolfstiftung, Vienna, Austria.
4
Department of Neurology, Wien Kliniken, Rudolfstiftung, Vienna, Austria.

Abstract

BACKGROUND:

Injury of the recurrent laryngeal nerve and consequent disorder of vocal fold movement is a typical complication in thyroid and parathyroid surgery. During postoperative laryngoscopy we observed not only a complete standstill (vocal fold paralysis), but also a hypomobility (paresis). In this prospective study, we investigated the difference in incidence and prognosis as well as risk-factors, intraoperative neuromonitoring, and symptoms between vocal fold paralysis and vocal fold paresis.

METHODS:

Data were prospectively collected and analyzed in a single high-volume thyroid center between 2012 and 2016. Vocal fold paresis was defined as hypomobility in abduction or adduction, a reduction in range and speed of vocal fold movement. Vocal fold paralysis was defined as asymmetry and missing purposeful vocal fold movement.

RESULTS:

The study included 4,707 surgeries and 7,992 at-risk nerves at risk. Vocal fold paralysis was diagnosed in 374 patients (4.68% of 7,992 nerves at risk) and vocal fold paresis in 114 patients (1.43%). Exclusively in the paralysis group, 36 patients (0.45%) developed permanent loss of vocal fold function (P < .001). In follow-up, vocal fold paresis patients regain normal vocal fold function significantly earlier than vocal fold paralysis (mean duration: 6.96 ± 6.506 vs 10.77 ± 7,827 weeks) and presented with significantly less symptoms like hoarseness, diplophonia, dysphagia, and dyspnea (68.8% vs 95.9 %). In intraoperative neuromonitoring, vocal fold paresis showed a significantly higher postresectional N. vagus amplitude than vocal fold paralysis patients (0.349 mV vs 0.114 mV, P < .001).

CONCLUSION:

After thyroidectomy, vocal fold paresis must be distinguished from vocal fold paralysis and should be implemented as a separate outcome parameter in the postoperative quality assessment.

PMID:
31262569
DOI:
10.1016/j.surg.2019.05.019
[Indexed for MEDLINE]
Icon for Elsevier Science
6.
Langenbecks Arch Surg. 2019 Jun;404(4):421-430. doi: 10.1007/s00423-019-01798-7. Epub 2019 Jun 28.

Effect of surgeons' annual operative volume on the risk of permanent Hypoparathyroidism, recurrent laryngeal nerve palsy and Haematoma following thyroidectomy: analysis of United Kingdom registry of endocrine and thyroid surgery (UKRETS).

Author information

1
Consultant Endocrine Surgeon, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK. Sebastian.Aspinall@nhs.net.
2
Specialist Registrar in General Surgery, Northumbria Healthcare NHS trust, North Tyneside General Hospital, North Shields, UK.
3
Consultant Endocrine Surgeon, Nottingham University Hospitals NHS Trust, City Campus, Nottingham, UK.

Abstract

PURPOSE:

Categorize data to investigate the surgeon volume outcome relationship in thyroidectomies. Determine the evidence base for recommending a minimum number of thyroidectomies performed per year to maintain surgical competency.

METHODS:

Data on thyroid operations in the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) from 01/09/2010 to 31/08/2016 was analysed. The primary outcome measure was permanent hypoparathyroidism (PH). Recurrent laryngeal nerve palsy (RLN) and post-operative haematoma were also examined. Exclusion criteria included patient age > 85 or < 18 years, and surgeons contributing <10 operations. Data analysis was performed using general additive models and mixed effect logistic regression for PH and binary logistic regression for others.

RESULTS:

For PH 10313 bilateral thyroid operations were analysed. The Annual rate (AR, p = 0.012) and nodal dissection (P < 10-7) were significant factors. 25,038 thyroidectomies were analysed to investigate the effect of surgeon Volume on RLN palsy and haematoma. Age, retrosternal goitre, routine laryngoscopy, re-operation, nodal Dissection, bilateral thyroidectomy, RLN monitoring and surgeon volume were significantly associated with RLN palsy. Post-operative haematoma showed no significant correlation to surgeon volume. Categorisation of AR showed that PH and RLN palsy rates declined in surgeons performing >50 cases/year to a minimum of 3% and 2.6% respectively in highest volume AR group (>100 cases/year).

CONCLUSION:

Surgeon annual operative volume is a factor in determining outcome from thyroid surgery. Results are limited by a high proportion of missing data, which could potentially bias the outcome, but tentatively suggests the minimum recommended number of thyroid operations / year should be 50 cases.

KEYWORDS:

Chronic hypocalcaemia, permanent hypoparathyroidism, operative volume; Endocrine surgery; Surgeon volume; Thyroidectomy; Volume-outcome

PMID:
31254103
DOI:
10.1007/s00423-019-01798-7
[Indexed for MEDLINE]
Icon for Springer
7.
N Z Vet J. 2019 Sep;67(5):264-269. doi: 10.1080/00480169.2019.1635538.

Ex vivo investigation of the effect of the transverse arytenoid ligament on abduction of the arytenoid cartilage when performing equine laryngoplasty.

Author information

1
a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK.
2
b Department of Clinical Sciences , College of Veterinary Medicine, Cornell University , Ithaca , NY , USA.

Abstract

Aims: To investigate the effect of the transverse arytenoid ligament (TAL) on abduction of the arytenoid cartilage when performing laryngoplasty. Methods: Modified prosthetic laryngoplasty was performed on right and left sides of 13 cadaver larynges. Increasing force was sequentially applied to the left arytenoid cartilage at 3 N intervals from 0-24 N, when the force on the right arytenoid cartilage was either 0 or 24 N, before and after TAL transection. Digital photographs of the rostral aspect of the larynx were used to determine the left arytenoid abduction angles for these given force combinations and results compared before and after TAL transection. Longitudinal and transverse sections of the TAL from seven other equine larynges were also examined histologically. Results: Increasing force on the left arytenoid cartilage from 0-24 N produced a progressive increase in the angle of the left arytenoid cartilage (p < 0.001) and increasing force on the right arytenoid cartilage from 0-24 N reduced the angle of the left arytenoid cartilage (p < 0.001). Following transection of the TAL the mean angle of the left arytenoid increased from 36.7 (95% CI = 30.5-42.8)° to 38.4 (95% CI = 32.3-44.5)°. Histological examination showed that the TAL was not a discrete ligament between the arytenoid cartilages but was formed by the convergence of the ligament and the left and right arytenoideus transversus muscles. Conclusions: Transection of the TAL in ex vivo equine larynges enabled greater abduction of the left arytenoid cartilage for a given force. These results indicate that TAL transection in conjunction with prosthetic laryngoplasty may have value, but the efficacy and safety of TAL transection under load in vivo, and in horses clinically affected with recurrent laryngeal neuropathy must be evaluated. Abbreviations: Fmax: Force needed to maximally abduct the left or right arytenoid; TAL: Transverse arytenoid ligament.

KEYWORDS:

Equine; laryngoplasty; larynx; transection; transverse arytenoid ligament

PMID:
31234719
DOI:
10.1080/00480169.2019.1635538
[Indexed for MEDLINE]
8.
Ann R Coll Surg Engl. 2019 Nov;101(8):589-595. doi: 10.1308/rcsann.2019.0087. Epub 2019 Jun 20.

Intraoperative nerve monitoring during thyroidectomy: evaluation of signal loss, prognostic value and surgical strategy.

Author information

1
Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey.

Abstract

INTRODUCTION:

Intraoperative neural monitoring of the recurrent laryngeal nerve has been widely used to avoid nerve injury during thyroidectomy. We discuss the results of the change in surgical strategy after unilateral signal loss surgeries using intermittent intraoperative neural monitoring in a high-volume referral centre.

MATERIALS AND METHODS:

Details of consecutive patients who underwent thyroidectomy with intermittent intraoperative neural monitoring between January 2014 and December 2017 were prospectively recorded and retrospectively reviewed. Loss of signal was defined as recurrent laryngeal nerve amplitude level lower than 100 μV during surgery. The rate of loss of signal and change in surgical strategy during the operation were evaluated.

RESULTS:

Loss of signal was detected in 25 (5.4%) of 456 patients for whom intermittent intraoperative neural monitoring was performed. Four patients had anatomic nerve disruption and surgery was completed by an experienced endocrine surgeon making use of intraoperative neural monitoring with continuous vagal stimulation. Staged thyroidectomy was performed on 16 patients with unilateral loss of signal in whom the nerves were intact visually. Postoperative vocal cord paralysis was encountered in 18 of 21 (85.7%) patients with loss of signal, and 16 of 18 (88.8%) were improved during the follow-up period. Patients' voices were subjectively normal to the surgeon postoperatively in 9 of 21 (42.8%) patients who were found to have loss of signal with intact nerves.

CONCLUSIONS:

Intraoperative neural monitoring can be used safely in thyroid surgery to avoid recurrent laryngeal nerve injury. It enables the surgeon to diagnose recurrent laryngeal nerve injury intraoperatively to estimate the postoperative nerve function and to modify the surgical strategy to avoid bilateral vocal cord paralysis.

KEYWORDS:

Intraoperative neuromonitoring; Recurrent laryngeal nerve; Thyroidectomy

PMID:
31219340
PMCID:
PMC6818062
[Available on 2020-11-01]
DOI:
10.1308/rcsann.2019.0087
[Indexed for MEDLINE]
Icon for Atypon
9.
J Cardiothorac Surg. 2019 Jun 19;14(1):111. doi: 10.1186/s13019-019-0927-6.

Combined recurrent laryngeal nerve monitoring and one-lung ventilation using the EZ-Blocker and an electromyographic endotracheal tube.

Author information

1
Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany. andreas.moritz@kfa.imed.uni-erlangen.de.
2
Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
3
Department of Thoracic Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.

Abstract

BACKGROUND:

Intraoperative neuromuscular monitoring (IONM) is a widespread procedure to identify and protect the recurrent laryngeal nerve (RLN) during thyroid surgery. However, for left thoracic surgery with high risk of RLN injury, both reliable recurrent laryngeal nerve monitoring and one-lung ventilation could interfere.

METHODS:

In this prospective study, a new method for IONM during one-lung ventilation combining RLN monitoring with an electromyographic (EMG) endotracheal tube (ETT) and lung separation using the EZ-Blocker (EZB) is described and its clinical feasibility and effectiveness were assessed.

RESULTS:

A total of 14 patients undergoing left upper lobe surgery and left upper mediastinal lymph node dissection were enrolled. The EZB was introduced and positioned without any problems and sufficient lung collapse was achieved in all patients. No tracheobronchial injuries or immediate complications occurred. A stable EMG signal was present in all patients and no RLN palsy and no negative side effects of the NIM EMG ETT or the EZB were observed postoperatively.

CONCLUSIONS:

The described method is technically feasible, easy to apply and save. It provides both reliable IONM and independent lung separation for optimal surgical exposure. The combined use of the EZB and the NIM EMG ETT might reduce the risk for RLN palsy and impaired lung separation during left thoracic surgery with high risk for RLN injury.

KEYWORDS:

EZ-Blocker; Intraoperative monitoring; One-lung ventilation; Recurrent laryngeal nerve; Thoracic surgery

PMID:
31217035
PMCID:
PMC6585134
DOI:
10.1186/s13019-019-0927-6
[Indexed for MEDLINE]
Free PMC Article
Icon for BioMed Central Icon for PubMed Central
10.
Anticancer Res. 2019 Jun;39(6):3203-3205. doi: 10.21873/anticanres.13459.

Intraoperative Neurological Monitoring During Neck Dissection for Esophageal Cancer With Aberrant Subclavian Artery.

Author information

1
Department of Surgery, Kochi Medical School, Nankoku, Japan.
2
Department of Surgery, Kochi Medical School, Nankoku, Japan tsutomun@kochi-u.ac.jp.

Abstract

We report a case of esophageal cancer with a non-recurrent inferior laryngeal nerve associated with aberrant right subclavian artery that was treated by neck dissection using intraoperative neurological monitoring followed by thoracoscopic esophagectomy. A 76-year-old man had dysphagia. Endoscopy revealed thoracic esophageal cancer, and computed tomography revealed the presence of an aberrant right subclavian artery between the esophagus and vertebrae. We performed neck dissection followed by thoracoscopic esophagectomy. During the neck dissection, we confirmed a non-recurrent inferior laryngeal nerve through intraoperative neurological monitoring. No postoperative complications were observed, and the patient was discharged 19 days after surgery. We recommend using intraoperative neurological monitoring to avoid injury to the non-recurrent inferior laryngeal nerve associated with the aberrant right subclavian artery.

KEYWORDS:

Intraoperative neurological monitoring; aberrant right subclavian artery; esophageal cancer; non-recurrent inferior laryngeal nerve

PMID:
31177168
DOI:
10.21873/anticanres.13459
[Indexed for MEDLINE]
Icon for HighWire
11.
Int J Pediatr Otorhinolaryngol. 2019 Sep;124:76-78. doi: 10.1016/j.ijporl.2019.05.033. Epub 2019 May 25.

Subcutaneous emphysema and vocal fold paresis as a complication of a dental procedure.

Author information

1
Medical College of Wisconsin Affiliated Hospitals, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA. Electronic address: lnorth@mcw.edu.
2
Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave, PO Box 1997, Milwaukee, WI 53201, USA. Electronic address: csulman@mcw.edu.

Abstract

Third molar extraction is a common oral surgery performed in the pediatric population. Here we report a case of extensive subcutaneous emphysema of the orbital, masticator, parapharyngeal, retropharyngeal spaces, bilateral carotid and visceral spaces, and pneumomediastinum after third molar extraction with turbine drill. This was treated with intubation for airway protection, transoral drainage, and intravenous antibiotics. After discharge the patient reported persistent dysphonia and was found to have left vocal fold paresis. This was likely related to extensive pneumomediastum causing injury to the recurrent laryngeal nerve. This is the first report of cervicofacial emphysema leading to vocal cord paresis after third molar extraction, demonstrating the importance of serial clinical monitoring in these cases.

KEYWORDS:

Pneumomediastinum; Third molar extraction; Vocal cord paresis

PMID:
31170557
DOI:
10.1016/j.ijporl.2019.05.033
[Indexed for MEDLINE]
Icon for Elsevier Science
12.
J Ayub Med Coll Abbottabad. 2019 Apr-Jun;31(2):168-171.

Diverse Anatomical Configuration Of Recurrent Laryngeal Nerve In Relation To Inferior Thyroid Artery, An Experience With 51 Thyroidectomies.

Author information

1
ENT Department, Combined Military Hospital, Abbottabad, Pakistan.
2
Combined Military Hospital, Multan, Pakistan.
3
Army Burn Hall College (for girls), Abbottabad, Pakistan.

Abstract

BACKGROUND:

Objective of the study is to elaborate the anatomical variants of recurrent laryngeal nerve in relation to inferior thyroid artery, encountered during thyroidectomy operation. It is descriptive, case series, conducted at the Department of Ear Nose & Throat, Combined Military Hospital, Abbottabad. The study was conducted from January 2016 to September 2017.

METHODS:

Fifty-one patients underwent extra-capsular thyroidectomy in general anaesthesia. The dissection was carried out in a standard way in all patients. Recurrent laryngeal nerves were identified and exposed in every patient, and their anatomical relations were recorded in database.

RESULTS:

Recurrent laryngeal nerve was seen over riding the ramification of inferior thyroid artery in majority of left sided dissected specimen, however on the right side the principal nerve was found to be ascending through the branches of inferior thyroid artery..

CONCLUSIONS:

Iatrogenic vocal cord paralysis has sinister implication on quality of life of the patient undergoing thyroidectomy. Anatomic variants of recurrent laryngeal nerve are well known and frequent. The disastrous outcome of inadvertent recurrent laryngeal nerve trauma can be adequately prevented by thoroughly knowing its anatomical variants, and intra-operatively identifying and exposing the principal nerves.

KEYWORDS:

Anatomy; Iatrogenic; Thyroidectomy; Recurrent laryngeal nerve; Vocal cord paralysis

PMID:
31094109
[Indexed for MEDLINE]
Free full text
Icon for Ayub Medical College
13.
Surg Radiol Anat. 2019 Aug;41(8):943-949. doi: 10.1007/s00276-019-02252-5. Epub 2019 May 13.

Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging.

Author information

1
Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, USA. appoled7@yahoo.com.

Abstract

The right non-recurrent (inferior) laryngeal nerve (NRLN) is a rare anatomical variant associated with an arterial anomaly, the aberrant right subclavian artery (ARSA), that is detectable by pre-operative imaging (POI) using computed tomography and/or ultrasound. Most surgical studies have utilized two major types, NRLNs arising near the upper pole of the thyroid gland (type 1), vs. at a lower level (type 2) but with two subtypes defined by relationships to the inferior thyroid artery (ITA). This review found 8 English language surgical studies using POI that reported at least 1 NRLN and had anatomical information; of the 88 right NRLNs, 69.3% were classified as type 2 and 30.7% as type 1. Meta-analysis yielded a weighted proportion of 74.0% for type 2, but with substantial heterogeneity. For a subgroup of 5 POI studies with information on subtypes, 22 (59.5%) of 37 type 2 nerves were type 2a (i.e., running at or above the ITA). Similarly, a separate review of large surgical series without POI found that 60.4% of all 91 type 2 NRLNs were type 2a. The study findings should be relevant to the increasing numbers of anterior neck surgeries including bilateral thyroidectomies. A need was identified for studies on inter-observer reliability (agreement) among surgeons on NRLN types, and on injury rates (and related symptoms) by the type of NRLN.

KEYWORDS:

Aberrant right subclavian artery; Anatomical variation; Meta-analysis; Non-recurrent laryngeal nerve; Recurrent laryngeal nerve; Thyroidectomy

PMID:
31087139
DOI:
10.1007/s00276-019-02252-5
[Indexed for MEDLINE]
Icon for Springer
14.
BMC Surg. 2019 Apr 24;18(Suppl 1):116. doi: 10.1186/s12893-018-0447-7.

May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score.

Author information

1
Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy. valerio.dorazi@uniroma1.it.
2
Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy. valerio.dorazi@uniroma1.it.
3
Translational Oncogenomics Unit, Molecular Medicine Area, "Regina Elena" National Cancer Institute, Rome, Italy.
4
Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.
5
Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy.
6
Department of General Microsurgery and Hand, Surgery Section of phoniatrics and speech therapy, "Fabia Mater" Hospital, Rome, Italy.
7
Department of General Microsurgery and Hand Surgery, Section of physiotherapy, "Fabia Mater" Hospital, Rome, Italy.
8
Chief of Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.

Abstract

BACKGROUND:

Although thyroidectomy is one of the most common surgical procedures performed worldwide, some permanent complications, despite the considerably reducing incidence, may affect dramatically the patients quality of life. The purpose of this study is to evaluate whether factors identified preoperatively and expressed in a score could be predictors of major surgical difficulty during total thyroidectomy and influence the incidence of complications.

METHODS:

A total of 164 patients who underwent total thyroidectomy were examined. For each patient we calculated a preoperative score, including seven parameters, which we evaluated to be predictors of difficulty in thyroid surgery, that is, sex, body mass index (BMI), neck length, neck extension, thyroid gland volume, thyroiditis, and increased parenchymal vascularization. The overall score was also compared with peri- and post-operative factors describing objectively the difficulty in thyroid surgery. These factors are the duration of the operation, the length of hospitalization, the incidence of complications such as hemorrhage, hypoparathyroidism, and recurrent laryngeal nerve injuries.

RESULTS:

There was no statistically significant association between our score and either the percentage of postoperative complications or the length of hospitalization. The operative time was the only variable remarkably associated with the score value (p < 0.00001). Comparing the duration of the operation with each of the preoperative predictive factors, we found that none of the factors reached the value of statistical significance, but a close association could be noted with the thyroid volume and the BMI.

CONCLUSIONS:

In our study, predictors of difficulty in thyroidectomy did not affect morbidity rates, as suggested by previous studies, but only operative times, which were significantly increased in patients with higher score. Although our results have limited statistical significance, they allow us to confirm the fundamental role of a systematic use of optical magnification and microsurgical technique in thyroidectomy. Further studies, with a larger cohort of patients, are needed to validate our results and to formulate a universally accepted predictive score of difficulty in thyroidectomy preoperatively.

KEYWORDS:

Difficult thyroidectomy; Predictive factors; Preoperative difficulty score; Thyroid surgery

PMID:
31074389
DOI:
10.1186/s12893-018-0447-7
[Indexed for MEDLINE]
Free full text
Icon for BioMed Central
15.
Otolaryngol Clin North Am. 2019 Aug;52(4):681-692. doi: 10.1016/j.otc.2019.03.012. Epub 2019 May 6.

Unilateral Vocal Fold Immobility in Children.

Author information

1
Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, Schulich School of Medicine, Western University, 800 Commissioner's Road East, London, Ontario N6A 5W9, Canada. Electronic address: elise.graham@lhsc.on.ca.
2
Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA; Division of Otolaryngology, University of Utah School of Medicine, 50 North Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA.

Abstract

Unilateral vocal fold paralysis (UVFP) in children may cause dysfunction in voice, swallowing, and breathing, thus influencing all components of laryngeal function. UVFP in children is usually the result of iatrogenic injury. The approach to patients with suspected UVFP should involve a detailed patient history, a focused physical examination with flexible nasopharyngoscopy, and relevant imaging if the cause of UVFP is uncertain. Management aims to strengthen voice, decrease aspiration, and improve quality of life. Laryngeal reinnervation is becoming more common, potentially offering permanent improvement in vocal and swallowing function through increasing bulk and tone to the paralyzed vocal fold.

KEYWORDS:

Dysphonia; Recurrent laryngeal nerve injury; Unilateral vocal fold immobility

PMID:
31072641
DOI:
10.1016/j.otc.2019.03.012
[Indexed for MEDLINE]
Icon for Elsevier Science
18.
Int J Surg. 2019 Jun;66:84-88. doi: 10.1016/j.ijsu.2019.04.015. Epub 2019 May 2.

A critical review of thyroidectomy consent in the UK.

Author information

1
Otolaryngology Department, Imperial College Healthcare NHS Trust, UK. Electronic address: charlotte.mcintyre@nhs.net.
2
Otolaryngology Department, Imperial College Healthcare NHS Trust, UK.

Abstract

BACKGROUND:

In 2015-16, the National Health Service (NHS) Litigation Authority received 10,965 claims for clinical negligence, with surgery having the highest number of claims. Currently a sum amounting to 25% of the annual NHS budget has been ring-fenced to meet extant claims. Claims made on a basis of inadequate informed consent are increasingly seen with many achieving a successful plaintiff outcome. There are presently no UK guidelines for thyroidectomy consent.

METHOD:

A prospective study was performed to investigate current consent practice among the British Association of Endocrine and Thyroid Surgeons (BAETS) membership and patients having previously undergone thyroidectomy. For surgeons, the Bolam legal test applied where surgeons declared what risks and complications they routinely consented for during their practice. A study was also undertaken in patients who had previously undergone thyroidectomy for cancer applying the rule of Montgomery.

RESULTS:

Consent practice from 193 surgeons and data from 415 patients was analysed. In total thyroidectomy for cancer, 95% of surgeons consent for Recurrent Laryngeal Nerve (RLN) injury and temporary or permanent voice change. 70% specifically consent for External Laryngeal Nerve (ELN) injury, 50% for tracheostomy and 55% for general anaesthetic associated complications. Analysis of patient data showed they would like to be consented for far more risks than they are presently informed about in general medical practice. There was significant variation in the consenting practice in BAETS surgeons.

CONCLUSION:

A BAETS approved consensus guideline to standardise UK consent practice would be appropriate. This may reduce complaints, litigation claims and guide expert witnesses.

KEYWORDS:

Consent; Patient consent; Thyroid; Thyroid surgery

PMID:
31055078
DOI:
10.1016/j.ijsu.2019.04.015
[Indexed for MEDLINE]
Icon for Elsevier Science
19.
Laryngoscope. 2019 Aug;129(8):E264. doi: 10.1002/lary.28032. Epub 2019 May 2.

In Response to Letter to the Editor Regarding: Is Cricothyroid Muscle Twitch Predictive of the Integrity of the EBSLN in Thyroid Surgery?

Author information

1
Department of Otorhinolaryngology-Head and Neck Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
2
Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Republic of Korea.
3
Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
PMID:
31046150
DOI:
10.1002/lary.28032
[Indexed for MEDLINE]
Icon for Wiley
20.
Laryngoscope. 2019 Aug;129(8):E263. doi: 10.1002/lary.28033. Epub 2019 May 2.

Regarding: Cricothyroid muscle twitch could be a preventive tool for EBSLN injury in thyroid surgery.

Author information

1
Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
2
Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
3
Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital and Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
PMID:
31046148
DOI:
10.1002/lary.28033
[Indexed for MEDLINE]
Icon for Wiley

Supplemental Content

Loading ...
Support Center