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Background/Objectives@#Extracapsular dissection has the advantage of reducing complications by minimizing tissue loss of the parotid without intentionally exposing the facial nerve in patients with benign parotid tumor. However, there has been controversy over the surgical results. Thus, the surgical outcomes of extracapsular dissection for benign parotid tumor was compared to those of superficial parotidectomy.Materials & Methods: A retrospective chart review was conducted with 132 patients who received surgery for benign parotid tumor in our center from January 2014 to December 2018 retrospectively. @*Results@#A total of 132 people were enrolled, with 62 people receiving extracapsular dissection, 38 people receiving partial superficial parotidectomy and 32 people receiving superficial parotidectomy. No significant difference was found between the three groups regarding complications such as facial nerve palsy, Frey's syndrome, or first bite syndrome. Operation time and hospital stay was significantly short in extracapsular dissection group. @*Conclusion@#For well-selected cases, extracapsular dissection can be considered as an option for surgery of benign parotid tumor.
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For safe thyroidectomy, preservation of the parathyroid gland is mandatory. However, until recently, there has been no reliable method of identifying the parathyroid glands. Thus, the identification of the parathyroid gland has mainly depended on the surgeon’s personal experience. To overcome this limitation, near infrared autofluorescence (NIRAF) imaging technique has been introduced. Many reports support the claim that NIRAF imaging can help surgeons identify the parathyroid gland. However, there have been no reports on the feasibility of NIRAF imaging in detecting the intrathyroidal parathyroid glands that cannot be seen by the naked eye. Recently, we experienced two cases in which intrathyroidal parathyroid glands were identified and auto-transplanted with the use of NIRAF. We would like to share this experience and hope this paper helps thyroid surgeons identify the parathyroid gland more easily which is always a matter of concern.
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For safe thyroidectomy, preservation of the parathyroid gland is mandatory. However, until recently, there has been no reliable method of identifying the parathyroid glands. Thus, the identification of the parathyroid gland has mainly depended on the surgeon’s personal experience. To overcome this limitation, near infrared autofluorescence (NIRAF) imaging technique has been introduced. Many reports support the claim that NIRAF imaging can help surgeons identify the parathyroid gland. However, there have been no reports on the feasibility of NIRAF imaging in detecting the intrathyroidal parathyroid glands that cannot be seen by the naked eye. Recently, we experienced two cases in which intrathyroidal parathyroid glands were identified and auto-transplanted with the use of NIRAF. We would like to share this experience and hope this paper helps thyroid surgeons identify the parathyroid gland more easily which is always a matter of concern.
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Background and Objectives@#Variable types of electrodes for intraoperative neuromonitoring (IONM) during thyroid surgery have been introduced to make up for the shortcomings of conventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacy of transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN) during thyroidectomy.Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals of vagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors as well as the preoperative and postoperative vocal cord functions of the patients were analyzed. @*Results@#IONM was successful in all nerves at risk without any false loss of signals. There were no complications nor any significant time delay due to adhesive skin electrodes. The mean amplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 µV and 293.48 µV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporary vocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantly higher in the lower body mass index (BMI) group compared to that of the higher BMI group. @*Conclusion@#IONM using transcutaneous skin electrodes may be considered as an alternative technique for IONM during thyroid surgery.
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The publisher and authors would like to draw the reader’s attention to an error in the following article. The author name of “Seon Mi Baek” should be changed to “Sun Mi Baek”.
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Background and Objectives@#Surgical resection is the basic treatment for benign laryngeal tumors and transoral laser microsurgery (TLM) has been used effectively. Transoral videolaryngoscopic surgery (TOVS) is another method of surgical resection that has been introduced. However, there have not been any studies related to the usefulness of TOVS in benign laryngeal tumors. The purpose of this study was to compare the efficacy and surgical outcomes of TLM and TOVS.Subjects and Method A retrospective chart review of 85 patients were conducted. This review included two groups (TLM group, n=44 versus TOVS group, n=41) of patients who underwent transoral surgery for benign laryngeal tumors. Clinicopathologic factors of the patients and surgical outcomes such as the operation time, amount of intraoperative bleeding, hospital stay, and complications were compared between two groups. @*Results@#There were no significant differences between two groups regarding the clinicopathologic factors and surgical outcomes. The TOVS group presented relatively larger tumor size (p=0.067) and showed a tendency of shorter operation time (36.8±34.5 min) compared to that of TLM (45.6±27.9 min), but with no statistical significance (p=0.199). @*Conclusion@#TOVS may be considered as an alternative surgical method for benign laryngeal tumors.
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Background and Objectives@#Near-infrared (NIR) fluorescence photo imaging provides real time parathyroid anatomy enhancement. Moreover, autofluorescence enables intraoperative virtual reality parathyroid exploration of the optical characteristics of the parathyroid gland. This study was performed to demonstrate the new technique of visualizing the parathyroid gland using video-guided autofluorescence during thyroid and parathyroid surgery and to evaluate the outcomes. This is the first study that introduces the video-monitoring technique for intraoperative parathyroid mapping.Subjects and Method A total of 26 patients underwent 18 total thyroidectomies and 8 hemithyroidectomies in 2016. Fifty-six parathyroid glands were enrolled in this study. Surgery was performed by NIR video-monitoring via thyroid lateral side dissection to find the parathyroid tissues and extract the thyroid glands. With the operation room light turned on, the parathyroid glands were identified by the video-guided autofluorescence detection technique carried out in 3 stages (P1, P2, and P3), which are imaging with surgeon’s eyes before parathyroids exposure (P1), after identification (P2), and in extracted specimen (P3). @*Results@#The parathryoid autofluorescence could be video-monitored in real time by our NIR camera system with the indoor room light turned on. Of the total 56 parathyroids, 52 were detected by fluorescence. Of these, the location of 43 glands were predicted by using the high signal in a before-exposure state and the glands were confirmed as containing parathyroid tissues [in P1, sensitivity=82.69%, positive predictive value (PPV)=100.00%]. Of the nine glands that did not show high signals in P1, seven glands visually showed fluorescence signals (in P1 and P2, sensitivity=96.15%, PPV=100.00%). One of the two glands that showed high signals in the extracted tissue was identified as parathyroid, but the other one was proved not by histologic examination by despite high intensity fluorescence signal (in P1-P3, sensitivity=100.00%, PPV=98.08%). The accuracy of video-guided parathyroid mapping in P1, P2, and P3 were 83.93%, 96.43%, and 96.43%, respectively. @*Conclusion@#This is the first study that demonstrates the parathyroid gland autofluorescence as a real-time video-monitoring technique and shows that it could be applied to real surgery. Although parathyroid autofluorescence is a phenomenon seen in the invisible wavelength, our data suggest that the operator can see the parathyroid fluorescent signal in real time on the video-monitor. This technique could help the operator to predict the gland location and preserve them safely.
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Background and Objectives@#Recurrent laryngeal nerve (RLN) palsy is a critical complication of thyroid surgery. The aim of this study was to investigate the incidence of iatrogenic temporary or permanent RLN palsy and to determine the surgeon’s experience factor for iatrogenic RLN palsy.Subjects and Method We retrospectively reviewed 3404 patients, who underwent thyroidectomy between 2010 and 2019, to identify the surgeon’s experience factor for iatrogenic RLN palsy. Information about patient demographics, surgeon factor, whether or not intraoperative neuromonitoring (IONM) were used, and the postoperative status of RLN were collected. The incidence of RLN injury was analyzed according to the surgeon experience, surgery for thyroid cancer, effect of IONM and the extent of surgery. @*Results@#A total of 4479 RLNs were at risk in 3094 thyroidectomies in this study. There were 34 (1.10%) postoperative vocal cord palsy (VCP) cases after thyroidectomy. All patients with RLN palsy showed a unilateral type. VCP was temporary in 26 (0.84%) cases and permanent in 8 (0.26%) cases. Using the nerve at risk (NAR) method, we found that there were 34 NAR palsy out of the total (4479) NAR (0.76%), 26 NAR temporary palsy (0.58%), and 8 NAR permanent palsy (0.18%). The mean recovery time after temporary VCP ranged between 2-180 days (50.6 days in average). The incidence of permanent RLN injury was higher in surgery conducted by less experienced surgeon (1.71% in less experienced vs. 0.05% in experienced surgeon, odds ratio 35.991, p<0.001). Application of IONM had no impact on incidence of iatrogenic RLN injury. @*Conclusion@#The present study demonstrated that less experienced surgeon is associated with an increased risk of iatrogenic permanent RLN palsy after thyroidectomy.
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BACKGROUND AND OBJECTIVES: The controversy over the optimal extent of thyroidectomy for papillary thyroid carcinoma (PTC) has persisted over a long time period. Particularly, there is a lack of consensus in low-risk PTC sized >1 cm and ≤2 cm. In this retrospective study, we analyzed the oncologic outcomes between hemi-thyroidectomy and total thyroidectomy in patients with low-risk PTC sized 2 cm or less.MATERIALS AND METHODS: A retrospective chart review of 1107 patients who were diagnosed as unilateral low-risk PTC with maximal tumor size 2 cm or less and initially underwent either hemi-thyroidectomy (n=550) or total thyroidectomy (n=557) was conducted. All patients underwent ipsilateral prophylactic central neck dissection. Patients had no evidence of gross extrathyroidal extension or lymph node metastasis. Clinicopathologic factors and recurrence rate were compared according to the surgical extent and factors correlated to recurrence were analyzed.RESULTS: While the total thyroidectomy group had more aggressive clinicopathologic factors such as minimal extrathyroidal extension, multifocality, and lymph node metastasis, recurrence rate was higher in the hemi-thyroidectomy group (p=0.006). However, when the contralateral lobe recurrence was excluded there was no difference in recurrence between the two groups (p=0.597). In patients with tumor sized >1 cm and ≤2 cm there was no significant difference in recurrence between the two groups (p=0.100).CONCLUSION: Total thyroidectomy may not decrease recurrence in patients with PTC presented with unilateral tumor sized >1 cm and ≤2 cm. Hemi-thyroidectomy could be considered the treatment of choice in these patients when they are presented as a low-risk group.
Subject(s)
Humans , Consensus , Lymph Nodes , Neck Dissection , Neoplasm Metastasis , Recurrence , Retrospective Studies , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
OBJECTIVE: To evaluate the efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) in a large population.MATERIALS AND METHODS: Cases of 152 biopsy-proven PTMCs from 133 patients who had undergone RFA for PTMC between May 2008 and January 2017 were included in this study. All patients were either of high surgical risk or refused to undergo surgery. They were followed up for at least 6 months after initial RFA. Ultrasonography (US) and computed tomography were performed to evaluate the PTMC and the presence of neck metastasis before treatment. RFA was conducted using an internally cooled thyroid-dedicated electrode system. Follow-up US was performed at 1 week, and 2, 6, and 12 months, after the initial RFA, and then at every 6–12 months. We evaluated serial changes of ablated tumors, newly developed cancers, lymph node (LN) or distant metastasis and complications.RESULTS: Complete disappearance was found in 91.4% (139/152) of ablated tumors. Among the 13 tumors in patients who did not show complete disappearance, no tumor displayed any regrowth of the residual ablated lesion during the follow-up period. The mean follow-up period was 39 months. During the follow-up period, there were no local recurrence, no LN or distant metastasis, and no newly developed thyroid cancers. No patients were referred to surgery. The overall complication rate was 3% (4/133) of patients, including one voice change. There were no life-threatening complications or procedure-related deaths.CONCLUSION: Our results suggest that RFA is an effective and safe option for treating low-risk PTMC patients who are of high surgical risk or refuse surgery.
Subject(s)
Humans , Catheter Ablation , Electrodes , Follow-Up Studies , Lymph Nodes , Neck , Neoplasm Metastasis , Recurrence , Thyroid Gland , Thyroid Neoplasms , Ultrasonography , VoiceABSTRACT
BACKGROUND AND OBJECTIVES: Blood neutrophil-to-lymphocyte ratio (NLR) has been reported to have poor prognostic impact in variable malignancies. However, studies evaluating the clinical significance of blood NLR in patient with papillary thyroid carcinoma (PTC) has been relatively rare, and the outcomes were inconsistent. In this study, we sought to analyze the clinical value of NLR in patients with PTC who had cervical lymph node metastasis. MATERIALS AND METHODS: Retrospective chart review was conducted with 174 patients with confirmed neck metastasis of PTC after initial thyroidectomy. Blood NLR was estimated by dividing the absolute number of blood neutrophil with that of lymphocyte. Statistical analysis was conducted to evaluate correlation between NLR and clinicopathologic factors, patterns of metastatic lymph nodes, and recurrence. RESULTS: Higher NLR (>1.74) was correlated to younger age of patients ( < 45 years, p=0.045) and smaller size of tumor ( < 1 cm, p=0.017). Blood NLR had no impact on patterns of lymph node metastasis or recurrence. CONCLUSION: Blood NLR may not be considered as a predictive factor for clinical aggressiveness or prognosis in patients with PTC with lymph node metastasis.
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Humans , Lymph Nodes , Lymphocytes , Neck , Neoplasm Metastasis , Neutrophils , Prognosis , Recurrence , Retrospective Studies , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Humans , Advisory Committees , Consensus , Counseling , Drug Therapy , Glottis , Laryngeal Neoplasms , NeckABSTRACT
BACKGROUND AND OBJECTIVES: Various methods to induce tracheal stenosis in an animal model have been introduced. However, most methods use non-physiologic mechanical or chemical injury to tracheal mucosa or cartilage. In this study, we sought to develop an animal model of tracheal stenosis using a segmented endotracheal tube. MATERIALS AND METHOD: Nine New Zealand White Rabbits were included in this feasibility study. A segmented 1.5 cm LEVIN-Tube (16 French) was inserted into tracheal lumen via tracheotomy site and fixed with a nylon tape circumferentially tied around the trachea. The tube was removed transorally one week later and the tracheal lumen was observed with bronchoscopy every week. Rabbits were sacrificed two weeks after the tube removal and the trachea was evaluated with histologic image. Three rabbits underwent tracheotomy and closure only to evaluate possible impact of tracheotomy procedure to tracheal stenosis (sham surgery). RESULTS: None of the 6 rabbits showed significant complications or death during the study. No significant change of tracheal lumen was identified in 3 sham models. The mean grade of stenosis was 57.2±9.9% (range, 43-70%). Histologic image showed thickening and fibrosis of lamina propria with relatively intact tracheal cartilage framework. CONCLUSION: We developed an animal model of tracheal stenosis using a segmented endotracheal tube fixed with a nylon tape. Since this model has similar pathophysiology to prolonged endotracheal intubation, it may be used in various studies related to tracheal stenosis.
Subject(s)
Animals , Rabbits , Bronchoscopy , Cartilage , Constriction, Pathologic , Feasibility Studies , Fibrosis , Intubation, Intratracheal , Methods , Models, Animal , Mucous Membrane , Nylons , Trachea , Tracheal Stenosis , TracheotomyABSTRACT
A variety of treatment methods have been proposed for parotid sialocele. These include multiple aspirations and compression dressings, reconstruction of the duct, creation of a controlled internal fistula, superficial or total parotidectomy, radiation therapy and ductal ligation, etc. Most of these procedures are invasive with variables and often with poor success rates. This paper presents an unusual incidence of iatrogenic parotid sialocele after sialendoscopy and its management by a relatively simple, safe and effective technique, which is constituted of draining saliva into the intraoral.
Subject(s)
Aspirations, Psychological , Bandages , Drainage , Fistula , Incidence , Ligation , SalivaABSTRACT
BACKGROUND AND OBJECTIVES: Lymph node (LN) metastasis occurs in 30-80% of patients presenting for initial treatment of papillary thyroid carcinoma (PTC). The presence of LN metastasis is an independent risk factor for recurrence, which can add significant treatment morbidity. The LN ratio (LNR) and extranodal extension (ENE) have been shown to be important prognostic factors in PTC. The purpose of this study was to assess the characteristic features of LNR and ENE. SUBJECTS AND METHOD: We undertook a retrospective study of 411 patients treated between January, 2011 and December, 2013 for central compartment node-positive PTC by thyroidectomy and central compartment neck dissection (CCND) at our institution. We compared various clinicopathologic parameters such as age, gender, tumor size, multifocality, bilaterality, local invasion, extrathyroidal extension and aggressive variants between LNR and ENE. RESULTS: The significant associated factors for high LNR (defined as higher than 0.5) in multivariate analysis were gender (p=0.001, odds ratio=2.285) and multifocality (p=0.027, odds ratio=2.092). On the other hand, the significant associated factors for ENE in multivariate analysis were primary tumor size (p=0.023, odds ratio=1.965) and local invasion (p=0.043, odds ratio=1.870). CONCLUSION: Being male, multifocality, large primary tumor size (defined as larger than 1 cm) and local invasion were revealed as associated factors for LNR and ENE. Therefore, elective CCND should be considered for patients with PTC, for whom a thorough investigation of associative factors should be made before surgery.
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Humans , Male , Carcinoma, Papillary , Hand , Lymph Nodes , Lymphatic Metastasis , Multivariate Analysis , Neck Dissection , Neoplasm Metastasis , Recurrence , Retrospective Studies , Risk Factors , Thyroid Neoplasms , ThyroidectomyABSTRACT
A 61-year-old woman who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) five years previously referred for a cervical retrotracheal mass. The mass had intense fluorodeoxyglucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT), and was thus thought to be malignant. Transcutaneous ultrasonography with fine needle aspiration (FNA) was not feasible, so we tried endobronchial ultrasonography (EBUS) with transbronchial needle aspiration (TBNA) to obtain a cytology specimen. After surgery, the mass was confirmed to be a metastatic lymph node from the previous PTC, confirming the TBNA results. Although the utility of EBUS-TBNA for evaluating mediastinal metastasis has been reported in a number of studies, few reports have addressed its utility in the cervical region. Here we report this unusual case of metastatic lymph node of PTC that recurred in the cervical retrotracheal area. It was found to exhibit esophageal muscular invasion, and was accurately diagnosed on EBUS-TBNA.
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Female , Humans , Middle Aged , Biopsy, Fine-Needle , Electrons , Lymph Nodes , Needles , Neoplasm Metastasis , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , UltrasonographyABSTRACT
Considering the relatively good prognosis of papillary thyroid carcinoma, surgical treatment should be conducted with an adequate method and extent of surgery with minimal complications. The optimal indications and extent of central neck dissection in papillary thyroid carcinoma has been introduced by variable guidelines. However, there have been controversies in several aspects regarding central neck dissection (i.e., prophylactic versus therapeutic, unilateral versus bilateral), which will remain until a large prospective study is completed. Successful management of cervical lymph node metastasis in papillary thyroid carcinoma requires thorough preoperative evaluation, knowledge on adequate indications and extent of surgery and considerations on surgical anatomy. In this article, we reviewed the rationales for optimal central neck dissection in papillary thyroid carcinoma based on recent studies and presented the surgical strategy and skills based on personal experience of a single surgeon.
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Humans , Lymph Nodes , Neck Dissection , Neoplasm Metastasis , Prognosis , Thyroid NeoplasmsABSTRACT
BACKGROUND AND OBJECTIVES: Papillary thyroid microcarcinoma (PTMC) generally has a highly favorable prognosis, however reports show a 30-65% prevalence of subclinical central lymph node metastasis. Therefore, the role of elective central neck dissection in PTMC treatment remains controversial. Our study focused on preoperative features of clinically lymph node negative and intracapsular (cT1aN0) PTMC and the correlation of these features with subclinical central lymph node metastasis. MATERIALS AND METHODS: Of 584 PTC patients who underwent thyroidectomy at the Kosin University Gospel Hospital from January 2009 to July 2011, 219 patients with cT1aN0 PTMC were reviewed retrospectively. Pathologic results were reviewed and various clinicopathologic prognostic factors were investigated. RESULTS: Postoperative pathology report revealed capsular invasion of primary tumor in 77 patients (35.2%) and subclinical central lymph node metastasis in 62 patients (28.3%). Tumor of the isthmic location was an independent predictor of subclinical central lymph node metastasis by multivariate analysis while multifocality showed borderline significance. The presence of extrathyroidal extension (ETE), multifocality, and cervical lymph node metastasis were significantly related to PTMC of isthmus. Seven of the 14 subjects with PTMC of the isthmus (50%) had pretracheal lymph node metastasis showing significant correlation (p=0.001). CONCLUSION: Despite the absence of ETE and lymph node metastasis in the preoperative imaging studies, higher risk of subclinical central lymph node metastasis should be considered in PTMC with multifocality and tumor of the isthmus.
Subject(s)
Humans , Carcinoma, Papillary , Lymph Nodes , Multivariate Analysis , Neck Dissection , Neoplasm Metastasis , Pathology , Prevalence , Prognosis , Retrospective Studies , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
Generally, the treatment of well-differentiated thyroid cancer is not difficult, but it is so with invasive cancer which invades the airway such as the tracheal or cricoid cartilage. In case of circumferential invasion of the trachea, resection and end-to-end anastomosis is preferred. In the less-than-half involvement of the trachea, conservative management such as sternocleidomastoid periosteal flap, or fenestration and staged closure is feasible. But in more-than-half the involvement of the trachea, these managements are usually not preferred. Authors describe a case of tracheal fenestration and the closure of a tracheal defect, which are not usually found in such of cases. Some techniques and their advantages are presented with a review of related articles.
Subject(s)
Carcinoma , Cricoid Cartilage , Plastic Surgery Procedures , Thyroid Gland , Thyroid Neoplasms , TracheaABSTRACT
Injection laryngoplasty is a simple and noninvasive method for treating unilateral vocal cord paralysis. Lately hyaluronic acid is widely used as injection material, because it is spontaneously resolved after few months and can be injected superficially compared to other materials. However, if hyaluronic acid is injected in the superficial layer of lamina propria (Reinke's space), it can cause inflammation or granuloma, interrupt the vibration of the vocal cord and worsen the quality of voice. We here present a case of granuloma that occurred as a complication of injection laryngoplasty, where simple surgical method was employed to improve voice quality.