Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial / 中华创伤杂志(英文版)

PURPOSE@#Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability. However, the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis. It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation. Therefore, we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.@*METHODS@#Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries. This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method. The study was performed at a level one trauma center. A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B, respectively). Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications. Secondary outcomes included operative time, amount of blood loss, intraoperative assessment of reduction, need of another operation, length of hospital stay, ability to weight bear postoperatively and pain control metrics. We used student t-test to compare the difference in means between two groups, and Chi-square test to compare proportions between two qualitative parameters. We set the confidence interval to 95% and the margin of error accepted to 5%. So, p ≤ 0.05 was considered statistically significant.@*RESULTS@#The mean follow-up duration was 18 months. The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B. Also, despite the higher frequency of rami displacement before union in the same group, there were no significant differences in terms of radiological outcome (excellent outcome with OR = 2.357), clinical outcome (excellent outcome with OR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.@*CONCLUSION@#The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament. Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation, but with less morbidity (shorter operation time, lower amount of blood, and no records of postoperative wound infection).

A Rare Cause of Thoracic Spinal Cord Compression by Multiple Large Tarlov Cysts / 대한신경손상학회지

Spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Bifocal location of thoracic and sacral SEACs is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral Tarlov cysts (TC). The surgical management and postoperative outcome of the patient are discussed. A 34-year-old woman was referred to the hospital for acute thoracic pain with a history of chronic long-standing back pain. She complained of walking difficulties. Neurological examination demonstrated incomplete spastic paraplegia with sensory level in T9. Magnetic resonance imaging revealed a large cystic formation from T7-11 and at the level of the sacrum. We performed laminectomies at the level of interest from T7-11. The cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Subsequently, a duraplasty was performed with autologous grafts from the lumbar fascia. The condition of the patient improved after surgery and he was recovering well at follow-up. Although the surgical treatment of TC is controversial, especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.

Manual placental removal versus cord traction for placental delivery at caesarean section in correlation to blood loss

Background: Delivery by cesarean section is one of the most commonly performed obstetrical operations all over the world, but it exposes women to the inherent risks of major abdominal surgery, e.g., injury to the pelvic structures, infection, and the need for blood transfusion etc. Antepartum physiological adaptation in preparation for blood loss at delivery includes a 42% increase in plasma volume and a 24% increase in red blood cell volume by the third trimester

Objective: The aim of this work was to compare the manual removal of placenta and spontaneous placental delivery combined with cord traction at caesarean section. Patients and Methods: We compare between both groups using computer programs to evaluate the safety and efficacy of each method

Results: There was a significantly higher estimated intraoperative blood loss in women who had their placentae manually separated when compared to women who had spontaneous placental separation

Conclusion: There was a statistically significant drop of hematocrit level in both groups with no statistically significant drop of hemoglobin. In addition, there was increased incidence of endometritis

Risk factors and management of venous thromboembolic diseases in donor of living donor Liver transplant

Background: liver transplantation surgically replaces a failing or diseased liver with one that is normal and healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or machine reliably performs all of the functions of the liver

Aim of the Work: this study aimed to highlight risk factors of the venous thromboembolism in donors of living donor liver transplant and its management

Patients and Methods: this study included 40 patients who underwent hepatectomy for living donor liver transplant. All patients were evaluated extensively, including history and physical examination and specialty consultations when indicated. All patients did haematological studies to detect the risk factors of thromboembolic disease

Results: in patients with manifestations of venous thromboembolism 2 donors have single risk factor for venous thromboembolism and 4 donors have double risk factors

Conclusion: presence of multiple risk factors for venous thromboembolism led to increase in its incidence, so during preoperative assessment of the donors, if they have multiple risk factors for thrombosis some precautions should be taken to avoid venous thrombosis

Recommendations: preoperative precautions include heamatological consultations for the donors and prophylaxis dose of anticoagulant. Intra operative precautions included pneumatic calf pressure, elastic stocking. Finally postoperative precautions should be continued, these donors should take therapeutic doses of anticoagulants and follow up by lower limb venous duplex

Standardization of rehabilitation after limb salvage surgery for sarcomas improves patients' outcome

The purpose of this study is to establish a standardized postoperative rehabilitation protocol following limb salvage surgery [LSS] in patients with primary bone sarcoma in five major anatomical locations: distal femur, proximal tibia, proximal and total femur, humerus and shoulder girdle and pelvic resections. Retrospective study. All LSSs were performed by an orthopedic oncology surgeon, and rehabilitation of all patients was based on a devised standardized rehabilitation protocol. Patient outcomes were measured using the modified Musculoskeletal Tumor Society-International Symposium on the Limb Salvage [MSTS-ISOLS] scoring system. A total of 59 patients received LSS in the above mentioned locations; endoprostheses were used in 49, bone allograft in five, while no replacements were made in five patients. At a mean follow-up of 24 months, the mean modified MSTS-ISOLS score for all patients was 87% [95% CI; 0.85-0.89]. The highest scores were encountered for patients with distal femur replacement: 93% [95% CI; 0.91-0.95]. Seven patients had interruption of more than six weeks in their rehabilitation and had a mean score of 71% [95% CI; 0.64-0.82]. The proposed rehabilitation protocol is a comprehensive, organized and applicable guideline to be used after performing LSS at the above mentioned anatomical locations. The use of standardized rehabilitation protocol resulted in improved patient functional outcome

High-dose chemotherapy followed by stem cell transplantation in the management of retinoblastoma: a systematic review

In recent years, there has been an increasing role for stem cell transplantation in the management of retinoblastoma. The aim of this study was to systematically review the role high-dose chemotherapy followed by stem cell transplantation in the treatment of patients with metastatic or relapsed, trilateral or bilateral advanced retinoblastoma, and in patients with tumor at the surgical margin of the optic nerve and/or extrascleral extension. Systematic literature review. We performed an extensive PubMed database search on 25 February 2012 for studies describing the use of high-dose chemotherapy followed by stem cell transplantation in the management of patients with retinoblastoma. We located 15 studies that met the inclusion criteria and that included 101 patients. Following treatment for metastatic and relapsed disease, 44 of 77 patients [57.1%] were alive with no evidence of disease at the time of follow-up. However, a higher rate of local relapse developed in patients with CNS metastases [73.1%], which dropped to 47.1% in patients who received thiotepa. In patients with trilateral or bilateral advanced retinoblastoma, 5 of 7 [71.4%] with reported outcome data were alive with no evidence of disease at the time of followup. In patients with tumor at the surgical margin of the optic nerve and/or extrascleral extension, 6 of 7 patients [85.7%] were alive with no evidence of disease at the time of follow-up. Durable tumor control is possible in patients with non-CNS metastases, trilateral or bilateral advanced retinoblastoma, and in patients with tumor at the surgical margin of the optic nerve and/or extrascleral extension. Patients with CNS metastases require thiotepa to improve tumor control

Choroidal metastasis as the sole initial presentation of metastatic lung cancer

Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy [EBRT] is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. We present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adeno-carcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. Choroidal metastasis as an initial presentation of metastatic lung cancer is exceedingly rare, as only 30 cases have been reported. EBRT and systemic chemotherapy are effective therapeutic modalities. This case report could prove helpful to clinicians faced with a similar exceedingly rare scenario

Epidemiological studies on echinococcosis and characterization of human and livestock hydatid cysts in Mauritania

Echinococcosis/hydatidosis is considered endemic in Mauritania. The aim of this study is to present an epidemiological study on the echinococcosis in man and animals in the Nouakchott region. The internal organs from livestock carcasses were inspected for research of hydatid cysts. The hydatid fluid was examined for research of the protoscoleces. Dogs were necropsied for the collect of Echinococcus granulosus. In the Nouakchott Hospital, 24 surgical operation of human hydatid cysts have been performed, out of which 50% were localised in the lung, 33% in the liver and 17% elsewhere. Then, the incidence rate would be of 1.2% per 100 000 inhabitants in Mauritania. In the dog, the prevalence rate is 14%. The average number of E. granulosus on the whole dogs is 172 and 1227 on the positive dogs. Concerning the livestock, hydatid cysts found in 30.1% of the dromedary, 5.5% of the cattle and 6.5 of the sheep. The fertility rate of hydatid cysts in humans [75%] and camels [76%] was significantly higher than that of sheep [24%] and cattle [23%] [P<0.0001]. Hydatid infestation is characterized globally by the dominance of pulmonary localizations in humans [50%] and camels [72.7%] and in the liver in sheep [76.1%] and cattle [82.3%]. The differences between prevalence rates, the fertility of hydatid cysts and diversity sites localization observed in humans and camels of one hand and the sheep and cattle on the other hand, depends possibly the strain[s] diversity of E. granulosus

challenges of managing glioblastoma multiforme in developing countries: a between cost and quality of care

The management of glioblastoma multiforme [GBM] in developing countries is hindered by the paucity of clear protocols due in part to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes for patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide. Retrospective case series. Charts of consecutive patients with a pathologic diagnosis of high-grade glioma diagnosed between January 2003 and December 2008 were retrospectively reviewed. We identified 146 adult patients, including 105 males and 41 females between 19 and 81 years of age [median age, 51 years], with histologically confirmed high-grade glioma. All patients underwent craniotomy. Eighty-two patients were treated with radiotherapy and temozolomide, of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide; 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months [median, 9.4 months]. The median survival for the whole cohort was 10.2 months. The median survival for the radiotherapy-alone group was 5.3 months and for combined radiotherapy/temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months compared with standard therapeutic modalities. The results compare favorably to those reported in developed nations. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients

Retinoblastoma in Jordan: an epidemiological study [2006-2010]

The epidemiological characteristics of retinoblastoma have been extensively studied in developed countries, however epidemiological data is scarce in the Middle East. We present a detailed epidemiological analysis of retinoblastoma in Jordan in an attempt to aid national and regional strategies for improved cancer surveillance and control. Retrospective review of retinoblastoma cases presenting to the sole and exclusive ocular oncology referral center in Jordan. Forty children [59 eyes] presenting with clinically and/or histologically confirmed retinoblastomas were treated at King Hussein Cancer Center [Amman, Jordan] between January 2006 and December 2010. This case series included 28 boys and 12 girls. Data relating to age at diagnosis, laterality, gender, treatment modality and survival were recorded. The mean age-adjusted incidence of retinoblastoma in Jordan was 9.32 cases per million children per year for children aged 0-5 years. The male: female ratio was 2.3:1. Bilateral cases were encountered in 19 patients [47.5%] while 21 patients [52.5%] harbored unilateral retinoblastoma. At the time of follow-up, 38 patients [95%] were alive. Overall, 40 eyes [67.8%] were successfully preserved without the need for enucleation. The national epidemiological data gathered in this study indicates that the incidence of retinoblastoma in Jordan is similar to that reported in various countries of the world. Jordanian boys, however, are at significantly higher risk for developing retinoblastoma than age-matched girls. Furthermore, Jordanian patients are more likely to harbor bilateral retinoblastoma

Evidence for the use PET for radiation therapy planning in patients with cervical cancer: a systematic review

In recent years, the role of positron emission tomography [PET] in the staging and management of gynecological cancers has been increasing. The aim of this study was to systematically review the role of PET in radiotherapy planning and brachytherapy treatment optimization in patients with cervical cancer. Systematic literature review. Systematic review of relevant literature addressing the utilization of PET and/or PET-computed tomography [CT] in external-beam radiotherapy planning and brachytherapy treatment optimization. We performed an extensive PubMed database search on 20 April 2011. Nineteen studies, including 759 patients, formed the basis of this systematic review. PET/ PET-CT is the most sensitive imaging modality for detecting nodal metastases in patients with cervical cancer and has been shown to impact external-beam radiotherapy planning by modifying the treatment field and customizing the radiation dose. This particularly applies to detection of previously uncovered para-aortic and inguinal nodal metastases. Furthermore, PET/ PET-CT guided intensity-modulated radiation therapy [IMRT] allows delivery of higher doses of radiation to the primary tumor, if brachytherapy is unsuitable, and to grossly involved nodal disease while minimizing treatment-related toxicity. PET/ PET-CT based brachytherapy optimization allows improved tumor-volume dose distribution and detailed 3D dosimetric evaluation of risk organs. Sequential PET/ PET-CT imaging performed during the course of brachytherapy form the basis of "adaptive" brachytherapy in cervical cancer. This review demonstrates the effectiveness of pretreatment PET/ PET-CT in cervical cancer patients treated by radiotherapy. Further prospective studies are required to define the group of patients who would benefit the most from this procedure

Mothers knowledge, attitude and practice toward immunization against poliomyelitis among children up to 5 years age in Dar Saad District. Aden 2005

This work was conducted with the principal objective of contributing to the study of the accomplishment of the immunization coverage against poliomyelitis in Dar Sad district, Aden Governorate, the knowledge, attitude and practice related to this problem and the socioeconomic factors influencing it. A sample of 180 children under the age of five years was studied using stratified, cluster and random sampling methods. A closed type questionnaire was used and filled by the researcher during the interview of the mother of each selected child. An over all evaluation of the accomplishment of the immunization programs in Dar Sad district was made. The results showed a coverage level of 85% receiving complete vaccination, 12% receiving incomplete vaccination and 3% without vaccination. The drop out rate was 12.6% .The main causes for discontinuation and not doing the vaccination, and related factors to these problems were identified. Some factors were determined as strong as relationship between the educational level of both the mother and the father and the immunization coverage of children. Other influencing factors were; giving credit to rumors, no faith in immunization and ignorance of the importance of returning for the second and the third dose, prevalence of false contraindication to vaccinations among some mothers. Recommendations for increasing the rate of vaccination coverage and decreasing the drop out rate were proposed in order to improve the immunization against poliomyelitis and other types of vaccines in the future and meet the goals stated by the World Health Organization

Attitude of male toward contraceptive methods in Aden governorate, 2004

Family planning has direct relation with women's and children's health in developing countries, though important efforts have been done since the 1970's establishing MCH centers in urban and rural areas to achieve the objectives of the family planning program in accordance with the global goal of [Health for all by the year 2000]. Still the family planning services are neither sufficient nor adequately accessible. The performance of family planning program in Aden governorate and some related social factors are evaluated through this study of Knowledge, Attitude and Practice of contraception among male living in Aden. The interview of a random sample of 1080 men in all directorate of Aden governorate is made with a confidence of 95% and 3% allowable error, considering [p.q]:= [0.5 x 0.5] as the highest possible variability. The results showed that 33.3% [353 from 1060] of men were not using contraceptive method, higher in Seera 44.7, in non workers, and decrease by level of education, the main reasons for not use is because they want more children, although the percentage of men who consider not use because religion prohibition is high, and the preferable method was considered the pills, followed by breastfeeding. The conclusion is that the attitude toward contraception is considered favorable

correlative study of angiogenesis extent and expression of matrix metalloproteinase-9 with upgrading and myometrial invasion in endometrial endometrioid carcinoma

Changes in angiogenesis and expression of extracellular matrix-degrading enzymes have been substantiated during tumor changeover and progression. This study was carried out on 60 retrospective endometrial endometrioid carcinoma [EEC] cases in addition to 15 normal endometrial biopsies as controls. EEC cases were grouped according to both histological grade [G], from G1 to G3, and the depth of myometrial [M] invasion, from M1 to M3. The study investigated all cases immunohistochemically to determine their microvessel number and the expression of matrix metalloproteinase-9 [MMP-9] and showed significantly high counts in EEC as a whole over the control endometria [P < 0.001]. Moreover counts of the G1 group overlapped those of the control endometra, increased significantly [P < 0.01] in the G2 and even more in the G3 group. G3 cases, in particular, displayed most microvessels widely scattered in the tumor tissue, in close association with tumor cells and as winding and arborized tubes, often dilated in microaneurysmatic segments. The counts also increased in M2 and M3 [P < 0.001] while those of the M1 group overlapped the counts of control endometria. Expression of MMP-9, evaluated as percentages of positive cases, revealed that the overall EEC cases gave a significant increase [P < 0.01] over the normal control endometria. Also, the frequencies of expression were significantly increased with the histologic grade [P = 0.01] and with the depth of myometrial invasion [P = 0.08]. The increases for MMP-9 were more evident on transition from G2 to G3 than from G1 to G2. The relationship to the depth of invasion revealed that the increases for MMP-9 were found at each depth, mostly on transition from M2 to M3. By contrast, only two of the control biopsies [13.5%] expressed few MMP-9. In EEC, MMP-9, as well, was, expressed by the host stromal cells. These data suggest that angiogenesis and degradation of extracellular matrix occur simultaneously with EEC upgrading and advancing depth of invasion. Also, they suggest that EEC cells and some host stromal cell populations cooperate in the tumor progression

Mortality statistics as indicators of quality of hospital care

Death rates have always been important information for hospitals to provide a solid base for the evaluation of the quality of their medical care. This study was carried out to find out the gross death rate [GDR] as well as net death rate [NDR] in King Fahad hospital, Jeddah, Kingdom of Saudi Arabia [KSA] in the period from 1994-2000 and also to find out demographic characteristics of deaths in the year 2000 according to ICD-10 as indicators of quality of hospital care. Medical records of discharged patients including deaths during the year 2000 were reviewed [13386]. Complete data about deaths were obtained. Results of the studied hospital showed gradual decrease in GDR from 5.8% to 4.5% [1994-1998] then slight increase from 4.9%to 5.0% [1999-2000] but still below the year 1994 [5.8%] and also there is gradual decrease in NDR from 4.6% to 3.6% in the studied period. GDR in different departments of the hospital during the year 2000 showed that Medical ICU was the highest [24.5%] followed by Surgical ICU [17.9%] followed by Cardiac ICU [14.3%] while GDR in the Medical department was found to be [12.9%] of the discharged subjects. According to nationality; proportional mortality rate [PMR] of Saudis represented 62% of total deaths followed by Yemenis [8.2%] meanwhile Egyptians represented 3.7% of total deaths in the studied year. As concerned to age groups; the highest PMR was found among those aged 65-74 years [21.9%] while the lowest PMR was found among those aged 13-24 years [4.2%]. The highest PMR of deaths during the studied year was reported in March [10.4%] followed by April [9.7%] then February [9.4%] which are the months of pilgrimage season while the lowest frequency was found in December [6.9%]. Also PMR was found to be higher among females [57%] compared to males [43%]. According to International Classification of Diseases [ICD-10]; diseases of the circulatory system were found to be the commonest underlying cause of death in the studied year. It represented 35.5% of all deaths followed by neoplasms [11.2%] while the lowest cause reported was mental and behavioral disorders [0.1%]. In conclusion, combination of the previous indicators and comparing the results with other hospitals in different countries indicates good quality of medical care in the studied hospital

Stereotactic evacuation of intracerebral hematoma

Stereotactic evacuation of intracerebral hematomas is a technique that can be easily learned and safely performed with minimal complications usually done under local anesthersia. With this method from 10 to 80% of the hematoma can be removed depending upon the individual patient and the technique employed. Stereotactic evacuation of intracerebral hematomas was performed for 20 patients admitted to neurosurgery department in Al Azhar. University Hospitals during the period from the 1st of January 1995 till the end of December 2000. Patients had hematomas of different pathogenesis, locations and sizes. The results have been analyzed and discussed.

Criteria of pedicular plate and screw system instrumentation of unstable thoracolumbar and lumbar fractures

Between April 1995 and December 2000. Twenty-five out of 73 total thoraco-lumbar and lumbar fracture admissions in King Khaled general hospital Hafr Al Batin Saudi Arabia and AL Azhar university hospitals Cairo Egypt were selected for pedicular plate and screw fixation. Nineteen patients were male 76% and six were female 24%. The age varied between 23 to 49 years average 35.56. The causative trauma was mainly due to road traffic accidents [RTA] twenty cases 80%, fall from a height three cases 12%, one case had explosion injury 4% and one had assault 4%. Seventeen patients had burst fractures, seven of them had significant kyphotic angulation deformity, six patients had fracture dislocation and two had lateral distraction injury. Clinical presentation of the patients was variable, all cases had severe pain and tenderness over the fracture site, paraplegia 6 cases, one of them had cauda equina, partial motor neurological deficit 9 cases, variable degree of sensory deficit in 20 patients, and 5 cases had no definite neurological deficit table 1. One or two levels above and below the fracture segment were used for pedicular screw fixation according to final clinical and radiological evaluation for every case separately. Follow up over a period from 14 to 50 months revealed variable degrees of recovery in 21 cases with satisfactory reduction and fixation with no residual neurological deficit, one case No 24 had gradual improvement transferred to rehabilitation center walking with support one month post operative, one case [No 17] had residual partial foot drop, trophic ulcer in the planter surface of the. left foot and one loose screw, the system was removed after one year with minimal residual kyphotic angle and cases [No 4 and 5] were not recovered due to primary cord transection

Posterolateral foraminotomy versus anterior cervical discectomy for single level discogenic cervical radiculopathty

Twenty patients having one level posterolateral disc with unilateral cervical radiculopathy were surgically treated through anterior cervical discectomy without fusion and posterolateral foraminotomy for decompression of affected-nerve root. The age of patients ranged from 33 to 68 years [average age46.6 years] 12 males constituted 60% of the series The main symptoms and signs were radicular pain [100%] neck pain, and hypothesia. The most common affected level was found at C5-6 in 8 patients [40%]. Anterior cervical discectomy-performed for 10 patients and posterolateral foraminotomy was performed for another 10 patients. The follow up period ranged from 3 months to 2 years the overall outcome was good to in excellent in 95%. In patients operated by interior cervical discectomy without fusion good and excellent outcome was found in 100%, and patients operated by posterolateral foraminotomy, good and excellent outcome was found in 90% and fair outcome in 10%. However the posterolateral foraminotomy technique is a simple, takes a short time, and avoid major complications which may occur in anterior approach, like injury of trachea, oesophagus, and recurrent laryngeal nerve, also the patients stay in the hospital for a very short time and no need for postoperative immobilization