Analysis of Safety of Completion Thyroidectomy: Comparison between Prophylactic Operation Group and Therapeutic Operation Group / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Completion thyroidectomy (CT) is defined as the resection of residual thyroid tissue following the initial operation of less than a total thyroidectomy. But completion thyroidectomy is a rare surgical procedure associated with increased morbidity and is related to recurrent laryngeal nerve injury and hypoparathyroidism. The purpose of present study is to evaluate the various clinical and pathological situation of completion thyroidectomy (CT) and the safety of completion thyroidectomy (CT) according to various parameters. SUBJECTS AND METHOD: From February 2001 through July 2005, 32 consecutive cases who underwent completion thyroidectomy (CT) were retrospectively analyzed. Prophylactic CT was performed in 17 cases and therapeutic CT was performed in 15 cases. Their mean follow-up was 19.8+/-0.6 months (3-44 months). The various parameters were retrospectively analyzed between two groups. These parameters included the time interval between the first and second operations, complication associated with CT, duration of hospital stay, preoperative imaging, preoperative fine needle aspiration cytology, frozen biopsy and permanent pathology. RESULTS: Prophylactic CT was composed of ten cases of follicular carcinoma and seven cases of papillary carcinoma. Therapeutic CT was composed of four cases of papillary carcinoma, one case of follicular carcinoma and 10 cases of benign nodule. The time interval between the first and second operations was 48.9+/-1.3 days (prophylactic CT) and 15.1+/-.8 years (therapeutic CT). The duration of hospital stay was not significantly different between two groups. Transient hypocalcemia occurred in 11.8% (2/17, prophylactic CT) and 13.3% (2/15, therapeutic CT), respectively. Permanent hypocalcemia occurred in 5.9% (1/17, prophylactic CT) and 6.7% (1/15, therapeutic CT). Recurrent laryngeal nerve injury occurred in 0% (0/17, prophylactic CT) and 13.3% (2/15, therapeutic CT) Hypocalcemia was not significantly different between two groups, but the difference of recurrent laryngeal nerve injury was significant. CONCLUSION: Completion thyroidectomy might be a safe operation with minimal morbidity. However, in those therapeutic CT cases where previous operation records are unavailable, special care was needed in preserving the recurrent laryngeal nerve and parathyroid gland. We also suggest that even in unilateral thyroidectomy, the parathyroid gland should be preserved.

Two Cases of Benign Thyroid Tumor Inducing Acute Upper Airway Distress / 대한이비인후과학회지

Generally, the gradual onset of symptoms relating to the upper airway tract may be associated with thyroid tumors involving the tracheal lumen or with large masses compressing the trachea. Even though thyroid diseases are quite common in the general population, acute airway distress due to tracheal compression by thyroid masses rarely occur. Upper airway infection and hemorrhage into the thyroid may precipitate acute symptoms that cause stridor. We experienced two cases of rapidly enlarging benign tumor of the thyroid causing the acute onset of upper airway distress symptoms. So we present the cases with a review of the related literatures.

Usefulness of Autologous Cartilage and Fibrin Glue for the Prevention of Septal Perforation during Septal Surgery: A Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Septal surgery is one of the common causes of nasal septal perforation. In cases of bilateral septal mucosal tearings, autologous cartilage is usually inserted between the injured mucosa. Additionally, we applied the fibrin glue on the margin of injured mucosal surface for the fixation of inserted cartilage and for the promotion of mucosal regeneration. The aim of this study was to evaluate the efficacy of this method in the prevention of nasal septal perforation. SUBJECTS AND METHOD: A total 378 cases of septal surgery was performed during past 2 years. Bilateral septal mucosal injuries at the corresponding area occurred in 32 patients. In group 1 (23 patients), autologous cartilage was inserted between the injured mucosa. In group 2 (9 patients), autologous cartilage was inserted and fibrin glue was applied on the mucosal margin of cartilage insertion site. We compared the perforation rate between two groups. RESULTS: In group 1, nasal septal perforation occurred 8 of 23 patients (34.7%) and in group 2, 1 of the 9 patients (11.1%) had perforation. Although the occurrence rate of perforation was significantly lower in group 2, statistical significance between two groups were absent because of the small number of patients who experienced the septal perforation. CONCLUSION: The application of fibrin glue after cartilage insertion at the defect site is thought to be very useful in the prevention of nasal septal perforation. We report these results as a preliminary data for the future study about the usefulness of fibrin glue in the prevention of nasal septal perforation.