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>

Tumoral calcinosis in secondary hyperparathyroidism

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To  report  a  case  of  tumoral  calcinosis  from  secondary hyperparathyroidism  and  to describe its surgical management.<br /><strong>METHODS:</strong><br /><strong> Design:</strong> Case Report<br /> <strong>Setting:</strong> Tertiary Public University Hospital<br /> <strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 34-year-old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal  parathyroidectomy,  right  thyroid  lobectomy  with  isthmusectomy,  and  transcervical thymectomy.    Follow-up  revealed  marked  decrease  in  parathyroid  hormone,  and  progressive resolution of the tumoral calcinosis.<br /><strong>CONCLUSION:</strong> Subtotal  parathyroidectomy  and  transcervical  thymectomy  have  a  role  in  the management  of  tumoral  calcinosis,  and  in  this  case  led  to  excellent  post-operative  results. The rare  presentation  of  secondary  hyperparathyroidism  and  intervention  in  this  patient  may  have potential lessons for future management of similar cases.</p>