Transoral endoscopic thyroidectomy vestibular approach versus conventional open thyroidectomy for the treatment of benign thyroid tumours: A prospective cohort study.

INTRODUCTION: Thyroid tumours are a common condition and open surgery is a conventional method for treating benign thyroid tumours when surgery is indicated. In this study, we evaluate the outcomes of benign thyroid tumour treatment using transoral endoscopic thyroidectomy via vestibular approach (TOETVA) and compare the results with those of conventional open thyroidectomy (COT). PATIENTS AND METHODS: We conducted a prospective cohort study between 100 patients who underwent TOETVA and 100 who underwent COT surgery for benign diseases from June 2018 to December 2021 in our hospital. Outcomes between the two groups, including post-operative complications, operative time and length of stay, were compared. RESULTS: The surgical time in the TOETVA group was significantly longer than in the COT group. The operative time of lobectomy in the TOETVA and COT groups was 77.5 ± 13.3 and 51.5 ± 4.2 min, respectively, with a P < 0.001. The operative time of total thyroidectomy in the TOETVA and COT groups was 108.1 ± 7.0 and 65.0 ± 4.1 min, respectively, with a P < 0.001. There was no difference in post-operative length of stay between the two groups. In TOETVA group, there were no patients who converted to open surgery. Amongst all 200 patients in the study, there were no cases of post-operative bleeding. The transient hypoparathyroidism rate after surgery in the TOETVA and COT groups was 3% and 2%, respectively, with no statistically significant difference (P = 0.651). Similarly, the transient recurrent laryngeal nerve injury rate showed no difference between the two groups, with rates of 5% and 4% in the TOETVA and COT groups, respectively (P = 0.733). There were no cases of post-operative infection in either group in our study. At 3 months postoperatively, the cosmetic satisfaction were significantly higher in the endoscopic groups than in the conventional group (P < 0.001). CONCLUSIONS: TOETVA is a safe and effective method, with a low complication rate and optimal aesthetic results compared to traditional surgery to treat benign thyroid tumours.

Genomics of Breast Cancer Brain Metastases: A Meta-Analysis and Therapeutic Implications.

Breast cancer brain metastases are a challenging daily practice, and the biological link between gene mutations and metastatic spread to the brain remains to be determined. Here, we performed a meta-analysis on genomic data obtained from primary tumors, extracerebral metastases and brain metastases, to identify gene alterations associated with metastatic processes in the brain. Articles with relevant findings were selected using Medline via PubMed, from January 1999 up to February 2022. A critical review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement (PRISMA). Fifty-seven publications were selected for this meta-analysis, including 37,218 patients in all, 11,906 primary tumor samples, 5541 extracerebral metastasis samples, and 1485 brain metastasis samples. We report the overall and sub-group prevalence of gene mutations, including comparisons between primary tumors, extracerebral metastases and brain metastases. In particular, we identified six genes with a higher mutation prevalence in brain metastases than in extracerebral metastases, with a potential role in metastatic processes in the brain: ESR1, ERBB2, EGFR, PTEN, BRCA2 and NOTCH1. We discuss here the therapeutic implications. Our results underline the added value of obtaining biopsies from brain metastases to fully explore their biology, in order to develop personalized treatments.

Bilateral Central Neck Dissection via Transoral Approach in Papillary Thyroid Carcinoma.

BACKGROUND: The transoral endoscopic vestibular approach (TOETVA) for thyroidectomy is gaining popularity (Russell et al. in Thyroid 28(7):825-829, 2018; Le et al. in Surg Laparosc Endosc Percutan Tech 30(3):209-213, 2020; Liao et al. in Laryngoscope 130(6):1603-1608, 2020). TOETVA has been utilized successfully in performing thyroidectomy, parathyroidectomy, and neck dissection, via both endoscopic and robotic techniques (Razavi et al. in Head Neck 40(10):2246-2253, 2018; Otolaryngol Head Neck Surg 159(4):625-629, 2018; Ngo et al. in J ENT, 2020. https://doi.org/10.1177/0145561320943358 ; Ann Surg Oncol 28(5):2766, 2021). In this video, we show bilateral central neck dissection via transoral approach in papillary thyroid carcinoma. PATIENT AND METHODS: A 37-year-old female with no significant medical history was diagnosed pT3bN0M0 intraoperatively with the tumor having slightly invaded the strap muscle. Thus, we decided to perform total thyroidectomy with bilateral central neck dissection via transoral approach. METHODS: Prelaryngeal dissection: in the prelaryngeal compartment, soft tissue containing these lymph nodes was intimately associated with the pyramidal lobe. Right paratracheal dissection: fibrofatty tissue was dissected off the prevertebral fascia and the trachea with preservation of right parathyroid glands. Pretracheal lymph nodes were removed with paratracheal dissection. Left paratracheal dissection: the lymphatic tissue was then dissected off the prevertebral and esophageal musculature and the trachea after identifying the left parathyroid glands. Finally, bilateral central neck dissection was finished with preservation of the nerve and parathyroid glands. RESULTS: The operation was completed successfully without conversion to open surgery. The operative time for central neck dissection was 20 min. There were nine harvested lymph nodes in the central compartments, while there were two metastatic lymph nodes of papillary thyroid carcinoma with 3 × 3 mm maximal dimension. There were no major postoperative complications. CONCLUSION: Central neck dissection via TOETVA is a safe and feasible method in selected patients.

The Effects of Nutrition Intervention on Postoperative Patients with Tongue Cancer and Floor of Mouth Cancer.

The aim of this study is to evaluate the effect of intensive nutrition support on patients with tongue cancer and floor of mouth cancer after surgery at K Hospital, Tan Trieu campus. Study the clinical intervention with a control group. We conducted the intensive nutrition intervention for our patients by giving counseling materials, sample menu and nutritional supplements, while the control group had only advice about dietary regimens. We evaluated a group before and after the intervention, at the same time compare the two groups before and after the intervention. After 1 mo, the intervention group increased 0.51±1.43 kg in comparison with their weight at the beginning; the weight of the control group lost -0.59±2.33 kg; the difference had statistical significance (p=0.025). After 1 and 2 mo of intervention, the rates of the participants without risk of malnutrition in the intervention group increased significantly in comparison with that in the control group; the difference has statistical significance with p=0.001 and p=0.003. In terms of quality of life, patients' problems related to areas including health status, functioning, symptoms of the intervention group improved more greatly than those of the control group. Especially, anorexia symptoms and financial impact were improved well in the intervention group (p=0.033, p=0.018). Nutrition intervention in patients with tongue cancer and floor of mouth cancer has shown a beneficial effect of nutrition counseling and intervention to improve patients' status in terms of nutrition and their quality of life.

Surgical Treatment of Advanced Thyroid Cancer with Tracheal Invasion.

INTRODUCTION: Tracheal invasion in thyroid cancer occurs in one-third of locally advanced cases and is the third most common site of infiltration following strap muscles and recurrent laryngeal nerves. Surgical resection plays an important role in the management strategy followed by either radioactive iodine or external beam radiotherapy. Nonetheless, there has been still controversy about the optimal extension of the surgery. Case Presentation. Total thyroidectomy, airway resection and bilateral neck dissection were performed in two cases diagnosed as advanced thyroid cancer with tracheal invasion (stage IV according to McCaffrey). The first case underwent partial tracheal resection and direct anastomosis by the V-shape technique, while the latter one required tracheal resection and permanent tracheotomy. After one-year follow-up, no evidence of tumor recurrence or any postoperative complications were found. CONCLUSION: Surgical resection still remains the mainstay of management for advanced thyroid cancer in general and for tracheal invasion cases in particular. The decision of surgical resection and tracheal reconstruction methods mostly depends on the extent of tracheal invasion.

Comparison of Transoral Thyroidectomy Vestibular Approach and Unilateral Axillobreast Approach for Endoscopic Thyroidectomy: A Prospective Cohort Study.

Background: Various approaches for endoscopic thyroidectomy have been developed recently that improve the cosmetic outcome, and some are even scar free. In this study, we compared the safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and unilateral axillobreast approach (UABA) thyroid surgery performed by a single surgeon. Materials and Methods: We conducted a prospective cohort study among 101 patients undergoing endoscopic thyroidectomy from 2018 to 2019 in our institution. The factors analyzed included patients' clinical characteristics, types and time of operation, blood loss, hospital stay, postoperative complications, and cosmetic satisfaction. Results: Among 101 patients, 51 underwent TOETVA and 50 had UABA surgery. UABA has shorter operative time for lobectomy (91.7 ± 16.5 minutes versus 50.4 ± 6.8 minutes, P < .001), whereas TOETVA is associated with less postoperative pain (visual analogue scale score day 1 of 4.6 ± 1.0 versus 5.8 ± 1.0, P < .001). There were no significant differences between TOETVA and UABA groups regarding rates of transient recurrent laryngeal nerve injury (9.8% versus 2.0%, P = .205) and hypothyroidism (11.5% versus 2.0%, P = .112), in which all patients fully recovered 6 months after surgery and most of them were satisfied with the cosmetic result. Conclusions: Both TOETVA and UABA have been shown to be effective and safe surgical options for endoscopic thyroid surgery, as well as gave excellent cosmetic result. Each approach has its own advantages and disadvantages, and choice of technique should be tailored for each individual, and patient preference should be integrated in the treatment plan.

Transoral Endoscopic Thyroidectomy by Vestibular Approach with Central Lymph Node Dissection for Thyroid Microcarcinoma.

Background: The transoral endoscopic thyroidectomy by vestibular approach (TOETVA) has been developed for thyroid microcarcinoma (TMC) treatment worldwide, with low rate of complications and excellent oncological results. However, this approach has still not been routinely performed. Thus, in this study, we aim to demonstrate the feasibility and safety of this technique in the clinical practice. Methods: In this prospective cohort study, 29 patients diagnosed TMC and clinically node negative underwent thyroidectomy and prophylactic central lymph node dissection by TOETVA. The clinicopathologic characteristics, surgical outcomes, and cosmetic results were evaluated. Results: The mean age was 34.7 ± 8.5 years. Three patients had underlying Grave's disease. Thyroid lobectomy with isthmusectomy was performed in the majority of cases (72.4%). All patients underwent prophylactic central node dissection. The mean number of retrieved central node was 7.8 ± 3.7 (3-19). Seven patients (24.1%) had lymph node metastasis in postoperative pathology. Among them, the mean number of metastatic lymph nodes was 2.1 ± 1.7 (1-5). The mean operative time was 121.2 ± 22.6 minutes. Four patients experienced transient hoarse and 1 patient had hematoma. Visual analog scale score on first postoperative day was 2.8 ± 1.4 (0-5). Most of patients were satisfied with cosmetic outcome. Conclusions: The TOETVA is new technique for TMC in Vietnam. The initial results of oncology, postoperative complications, and cosmetic supported the application of TOETVA in TMC.

"Very High-Grade" Pulsatile Mass of an Aberrant Internal Carotid Artery in the Nasopharyngeal Wall: A Case Report and Review of Literature.

BACKGROUND The prevalence of aberrant internal carotid artery (ICA) is extremely low in the general population. It commonly occurs in the neck. Close proximity of the pulsatile submucosal mass of the aberrant ICA to the nasopharyngeal wall is dangerous. The complications include severe or fatal hemorrhage resulting from a missed diagnosis before intervention in this area, including tonsillectomy, adenoidectomy, eustachian tube dilation, oropharynx biopsy or resection, tracheal intubation, and neck surgery. We report the case of a 66-year-old woman who had a pulsatile mass of the kinked ICA in close proximity to the lateral nasopharyngeal wall, and provide a review of the literature. CASE REPORT The patient presented to our Ear, Nose, and Throat Clinic with persistent cough with phlegm. Endoscopic examination revealed an abnormal pulsatile mass in the lateral nasopharyngeal wall. Subsequent contrast-enhanced computed tomography angiography confirmed the presence of unilateral acute maxillary sinusitis, and a high-grade kinked submucosal mass of the ICA in the ipsilateral nasopharyngeal wall, concomitant with stenosis of the left ICA and left middle cerebral artery occlusion. CONCLUSIONS Pulsating and extremely high-grade kinking of the ICA in the lateral nasopharyngeal wall is a particularly dangerous condition. Clinicians must always consider the possibility of hemorrhage during surgery, especially in older women with arteriosclerosis. Otolaryngologists should perform comprehensive visual examinations before deciding on surgery or other medical interventions in the neck, to prevent severe or fatal hemorrhage as far as possible.

A Prototypical Template for Rapid Face Detection Is Embedded in the Monkey Superior Colliculus.

Human babies respond preferentially to faces or face-like images. It has been proposed that an innate and rapid face detection system is present at birth before the cortical visual pathway is developed in many species, including primates. However, in primates, the visual area responsible for this process is yet to be unraveled. We hypothesized that the superior colliculus (SC) that receives direct and indirect retinal visual inputs may serve as an innate rapid face-detection system in primates. To test this hypothesis, we examined the responsiveness of monkey SC neurons to first-order information of faces required for face detection (basic spatial layout of facial features including eyes, nose, and mouth), by analyzing neuronal responses to line drawing images of: (1) face-like patterns with contours and properly placed facial features; (2) non-face patterns including face contours only; and (3) nonface random patterns with contours and randomly placed face features. Here, we show that SC neurons respond stronger and faster to upright and inverted face-like patterns compared to the responses to nonface patterns, regardless of contrast polarity and contour shapes. Furthermore, SC neurons with central receptive fields (RFs) were more selective to face-like patterns. In addition, the population activity of SC neurons with central RFs can discriminate face-like patterns from nonface patterns as early as 50 ms after the stimulus onset. Our results provide strong neurophysiological evidence for the involvement of the primate SC in face detection and suggest the existence of a broadly tuned template for face detection in the subcortical visual pathway.

Surgery and radiation management for chondrosarcoma of the temporo-mandibular joint: A Vietnamese case report.

INTRODUCTION: Chondrosarcoma is a malignant tumor originated from cartilage cells. The most common sites of chondrosarcoma are pelvis, femur and ribs. The temporo-mandibular joint (TMJ) chondrosarcoma is extremely rare, with approximately 30 cases reported in worldwide. PRESENTATION OF CASE: In this report, we present a case of chondrosarcoma in the left TMJ, which was successfully treated with surgery and radiation therapy. A 47 year-old women was admitted to our hospital with a mass in left pre-auricular region. On examination and para-clinical test results, the initial diagnosis was parotid gland cancer. In operation, the lesion was a mass originating from the left TMJ. Tumor resection was performed with close margin. The post-operative pathological result was well-differentiated chondrosarcoma. She was indicated adjuvant radiation therapy due to inadequate surgical therapy. There was no evidence of recurrence after 6 months follow-up. CONCLUSION: The TMJ chondrosarcoma is needed to distinguish from other diseases especially parotid gland tumor. Surgery and adjuvant radiation therapy are standard care with the aim of preserving joint function.

Primary Mucoepidermoid Carcinoma of the Thyroid: A Report of a Rare Case with Bone Metastasis and Review of the Literature.

Mucoepidermoid carcinomas (MECs) are generally found in salivary gland, but they have also been mentioned in other organs such as the larynx, esophagus, breast. MECs are considered to be a low-grade carcinoma and their occurrence in the thyroid is extremely rare. We present a 54-year-old male patient admitted to our clinic, complaining about having back pains for approximately three months. A lumbosacral spine MRI and a PET/CT scan revealed multiple lesions in the L4, L5, S1 vertebra bodies, sacral bone and left pelvis bone, suggesting of a metastatic disease. The result of thyroid FNA was carcinoma and a biopsy of the vertebra bone confirmed the presence of a metastatic carcinoma. A total thyroidectomy and level VI neck dissection was conducted followed by palliative external beam radiotherapy (30 Gy) to the vertebra bodies, sacral bone and left pelvis bone. In pathological studies, the diagnosis of thyroid mucoepidermoid carcinoma was confirmed. Six months after treatment, the patient died due to severe pain and fatigue caused by the disease. Here, we report a rare case with bone metastasis as the first symptom of MEC and a brief review of published literature on the subject.

Surgical treatment result of giant thyroid tumor: Case series in Vietnam.

INTRODUCTION: Giant thyroid tumors can be associated with severely compressive symptoms and surgery is inevitable for treatment strategy. However, the risk of surgical complications is higher as well as the duration of operation may be longer than those of small thyroid tumors. PRESENTATION OF CASES: Two patients with large neck tumors were admitted with history of thyroid goiters for more than 10 years. Recently, the patients have complained of worsening compressive symptoms including dyspnea and dysphagia. Imaging work-up indicated a deviation and compression of trachea. Both patients underwent either lobectomy or thyroidectomy and were discharged without any complications. Final histological results were thyroid adenoma in both cases. CONCLUSION: Surgical management is considered as primary treatment for most patients with giant thyroid tumors. It is necessary to be aware of complications and careful dissection to archive a good outcome.

Lower lip squamous cell carcinoma: A Vietnamese case report of surgical treatment with reconstruction by local flap.

INTRODUCTION: Squamous cell carcinoma (SCC) of lower lip comprises over 25% of oral cancer. Surgical treatment plan for SCC patients includes tumor excision, lymph node dissection and reconstruction. CASE PRESENTATION: A 68-year-old patient was admitted with 1-year history of tumor in his lower lip. Examination revealed a large lower lip tumor with expansion to the upper lip and a 2 cm submental lymph node. Biopsy result of the tumor was SCC and fine needle aspiration result of the lymph node was metastasis SCC. He underwent a complete removal of the lower lip and 1/3 external of the upper lip plus dissection of bilateral cervical lymph node plus reconstruction with local flap. After a 4-hour operation and 14-day hospitalization, patient recovered with flap in excellent condition and without any complications. CONCLUSION: Treatment with tumor excision, lymph node dissection and reconstruction by local flap is primary treatment for patients with lower lip cancer. Choice of reconstruction method depends on various factors, whereas V-Y advancement flap presents dominant advantage in lower lip cancer treatment.