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The case was a 77-year-old man. He had dizziness and dysphagia for 2 years, and underwent detailed screening at the internal medicine department for general malaise and bloody sputum. He was hospitalized for aspiration pneumonia due to dysphagia of unknown origin. This time, he visited a local doctor with palpitations and shortness of breath. Echocardiography indicated a left atrial tumor involving the mitral valve and arrhythmia. Emergency surgery was performed to remove the left atrial myxoma and close the patch at our hospital's cardiovascular surgery department. After the excision, swallowing function was restored, and the patient was diagnosed with postoperative Ortner's syndrome. We report a case where echocardiography was considered important as a detailed investigation of the cause of swallowing dysfunction and dizziness.
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OBJECTIVE To investigate the clinical significance of preoperative recurrent laryngeal nerve palsy (RLNP) for thyroid nodules with regard to the incidence of malignancy,recurrent laryngeal nerve involvement and histopathological character.METHODS Eighty patients with preoperative RLNP treated in Zhejiang Cancer Hospital between Jan 2007 to Dec 2014 were enrolled,their clinicopathological data were recorded and retrospectively analyzed.RESULTS Of 80 patients,16 patients had benign thyroid disease,while the other 64 had malignancies (80.0％).The preoperative RLNP incidence of benign and malignant lesions was 0.3％ and 0.9％ respectively.Poorly differentiated and anaplastic thyroid cancer had the higher incidence of preoperative RLNP comparing with other pathology types (25.93％,P＜0.05).The RLN did not preserved intraoperatively in 2 patients with benign lesions (2/16,12.5％) and in 42 patients with malignancy lesions (42/48,87.50％).All nerves were sacrificed in poorly differentiated and anaplastic thyroid cancer patients.The RLN could be isolated from 14 benign lesions and 6 malignancies,with or without adhesion,and the nerve function was recovered postoperatively.CONCLUSION The probability of preoperative RLNP is significantly higher in malignant lesions than benign lesions.Thyroid tumors with RLNP are strongly suggested of malignancy,with higher rate of intraoperative nerve sacrifice.The RLN should be preserved if it has not been invaded by the tumor,which offers a chance of functional recovery postoperatively.
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Recurrent laryngeal nerve palsy is one of the most serious complications associated with thyroid cancer surgery. This study aimed to assess the efficacy of intraoperative neural monitoring (IONM) in preventing recurrent laryngeal nerve palsy during thyroid cancer surgery, analyze and elaborate the theory, operation standard, application, benefits and disadvantage based on clinical practice.
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Objective To explore the clinical significance of intraoperative neuromonitoring (IONM)of recurrent laryngeal nerve (RLN) during thyroid cancer surgery.Methods 200 patients undergoing thyroid cancer surgery from Oct.2011 to May 2012 were retrospectively reviewed.The 200 patients were divided into 2 groups:100 patients in group A with IONM and 100 patients in group B without IONM.Results Group A had less RLN exposure time than group B(10.5 vs 15.3 mins,P ＜0.01).Group A had shorter operation time than group B (78.5 vs 82.3 mins).The difference had no statistical significance (P ＞ 0.05).Transient RLN palsy occurred to 5 cases in group A and 11 cases in group B(P＜0.05).Permanent RLN palsy occurred to 1 case in group A.No one in groupB had permanent RLN palsy (P ＞ 0.05).Conclusions IONM can reduce the incidence of transient RLN palsy compared with visualization alone.It is an effective procedure for identifying and protecting RLN in thyroid cancer surgery.
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PURPOSE: A total thyroidectomy for the treatment of bilateral thyroid benign nodules is still controversial. This study prospectively compared the prognosis and complications of a total thyroidectomy with those after a subtotal thyroidectomy. METHODS: Between September 2003 and October 2006, a total of 110 consecutive patients with bilateral thyroid benign nodules underwent either a total (n=77) or subtotal thyroidectomy (n=33). Temporary or permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve palsy, operation time, the length of hospital stay, postoperative thyroxine dosage in both operation groups were compared. In addition, the detection rate of a malignancy through a permanent biopsy was examined. RESULTS: There was a higher rate of temporary hypoparathyroidism, longer length of hospital stay and higher thyroxine dosage needed in the total thyroidectomy group than in the subtotal thyroidectomy group. There were no significant differences in the permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve palsy and operation time between the two groups. The histopathological diagnosis was a malignant tumor in 13 patients. CONCLUSION: This study suggests that a total thyroidecotmy can be performed without increasing risk of complications. A total thyroidectomy avoids recurrent nodules for the removal of the whole thyroid tissue, which avoids the need for secondary surgery with an increased risk of complications when compared with primary thyroid surgery. A total thyroidecotmy is considered the first choice for the management of bilateral thyroid benign nodules.
Subject(s)
Humans , Biopsy , Diagnosis , Hypoparathyroidism , Length of Stay , Prognosis , Prospective Studies , Thyroid Gland , Thyroidectomy , Thyroxine , Vocal Cord ParalysisABSTRACT
The most frequent cause of diaphragmatic paralysis and hoarseness of voice is involvement of phrenic nerve and recurrent laryngeal nerve by a thoracic malignancy. Here, we describe a patient who developed diaphragmatic paralysis and hoarseness of voice due to mediastinal tuberculous lymphadenopathy, which is not a common etiological factor leading to it.
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BACKGROUND AND OBJECTIVES: Despite the fact that the rate of complications is constantly decreasing, the immediate and severe complications of thyroid surgery emphasize the need for precise surgical techniques and to provide patients with the most benefical treatment that results in lower morbidity. To clarify the safety of thyroid surgery, 147 thyroidectomy cases were reviewed. MATERIALS AND METHODS: From April 1998 through March 2000, 147 thyroidectomies were performed at the otolaryngologic department. The risk of recurrent laryngeal nerve lesion is based on the number of nerves at risk, and the risk of hypocalcemia is based on the number of patients undergoing bilateral procedures, or contralateral surgery in patients previously operated on. The risk of superior laryngeal nerve injury is based on the number of all thyroidectomies. RESULTS: The number of nerves at risk was 210. The rate of postoperative permanent recurrent laryngeal nerve palsy was 1.4% (3/210), which is iatrogenic. Four recurrent nerves (1.9%) invaded by cancer were sacrificed intentionally. Transient paralysis was found in 1.4% of the cases (3/210). Transient superior laryngeal nerve injury was found in 0.7% (1/147), all within one month of recovery. Of 89 patients undergoing dissection of both thyroid lobes, 1.1% (1/89) developed postoperative permanent hypocalcemia. Transient postoperative hypocalcemia was found in 7 patients (7.9%), with a recovery period ranging from one to two weeks. Postoperative bleeding, infection, and seroma were not noted in this study. CONCLUSION: The data strongly indicate that careful surgical techniques, understanding of anatomic variation and surgical experiences hold the clue for a low rate of complications following thyroid surgery.