Vocal fold paralysis with intraoperative recurrent laryngeal nerve identification versus non-identification of recurrent laryngeal nerve in total thyroidectomy: A retrospective cohort study

@#<p><strong>OBJECTIVE:</strong> To determine the risk of vocal fold paralysis in patients who underwent total thyroidectomy with and without intraoperative recurrent laryngeal nerve identification.</p> <p><strong>METHODS:</strong></p> <p><strong>Design:</strong> Retrospective cohort study </p> <p><strong>Setting:</strong> Tertiary military hospital</p> <p><strong>Participants:</strong> 237 adult patients who underwent total thyroidectomy for benign lesions based on post-operative histopathology operated on by senior third or fourth year residents. Excluded were those who underwent lobectomy with isthmusectomy or reoperation/completion thyroidectomy, had intrathoracic goiters, confirmed malignancies based on post-operative histopathology, or cases wherein the RLN had to be sacrificed due to gross involvement of the nerve caused by malignancy.</p> <p><strong>RESULTS:</strong> Group A, wherein intraoperative identification of RLN was done, had a temporary and permanent RLN injury incidence of 2.75% and 0.92% respectively. Group B, wherein intraoperative identification of RLN was not done, had a temporary and permanent RLN injury incidence of 17.19% and 12.5% respectively.  Through binary linear regression, the probability of having temporary paralysis increases almost two-fold if the nerve is not identified, and the probability of having permanent paralysis increases by almost nine-fold if the nerve is not identified.</p> <p><strong>CONCLUSION:</strong> We recommend routine intraoperative RLN identification, which has a lower risk for temporary and permanent vocal fold paralysis when compared to non-identification of the RLN.</p> <p> </p>

Gastrointestinal stromal tumor of the tongue

@#<p><strong>OBJECTIVE:</strong> To report a case of a gastrointestinal stromal tumor presenting as a recurrent tongue mass.<br /><br /><strong>METHODS: <br />Study Design:</strong> Case Report <strong><br />Setting:</strong> Tertiary Public Military Hospital <br /><strong>Participant:</strong> One patient <strong><br /><br />RESULTS:</strong> A 40-year-old Filipino soldier from Camarines Sur presented with a recurrent tongue mass two years after excision of a progressively-enlarging, firm, fixed, non-tender mass at the left posterior third of the tongue diagnosed as a Schwannoma. Repeat surgery involved partial glossectomy via midline mandibular swing. Final histopathologic report after immunohistochemical studies for CD117, SMA, and S100 was extraintestinal gastrointestinal stromal tumor of the tongue. The patient was started on the c-kit tyrosine kinase inhibitor Imatinib with no recurrence 10 months post treatment.<br /><br /><strong>CONCLUSION:</strong> Gastrointestinal stromal tumor may be considered when presented with a recurrent tongue mass despite complete surgical resection. Surgical removal is curative for most lesions. Post-operative chemotherapy with the use of Imatinib is valuable.</p>