Endoscopic Lateral Neck Dissection (IIA, IIB, III, and IV) Using a Breast Approach: Outcomes From a Series of the First 24 Cases.

INTRODUCTION: In order to avoid large neck scar caused by conventional lateral neck dissection. We have explored and introduced endoscopic lateral neck dissection (IIA, IIB, III, and IV) using a breast approach. Now, we summarized and shared the outcomes of the first 24 cases. MATERIALS AND METHODS: All the patients were treated in our institute from January 2017 to May 2018, and followed-up for more than 1 year. The details of patients and this technique have been summarized and analyzed retrospectively. RESULTS: A series of first 24 cases were successfully managed with this technique, and no cases were converted to an open approach. Among these 24 patients, levels III + IV dissection had been performed in 6 patients and levels II+III+IV dissection had been performed in 18 patients. The mean age, body mass index, and sex were 39.3±10.5 years old, 24.1±3.5, and 2 male/22 female, respectively. The average operative time of total operation and lateral neck dissection was 238.8±37.2 minutes and 128.8±21.1 minutes, respectively. The mean dissected lateral lymph nodes were 5.9±2.2 (level II) in 18 cases and 15.9±3.9 (levels III+IV) in 24 cases. In addition, with no severe complications to date, such as asphyxia, main nerves injury (cervical plexus, vagus nerve, etc.), and permanent hypoparathyroidism, nor permanent recurrent laryngeal nerve injury, and so on. However, unexpectedly, had some mild and common complications like transient hypocalcemia in 4 cases (16.67%), transient horse 1 case (4.2%), controllable lymphatic leakage in 2 cases (8.3%), and controllable jugular vein injury in 2 cases (8.3%). One year after the operation, 1 case found lung metastasis but no local recurrence. In other 23 patients, no recurrence/metastasis and the average of serum thyroglobulin is 3.2±3.8 ng/mL. CONCLUSIONS: This technique can yield adequate oncological dissection for selected patients. Endoscopic thyroidectomy along with lateral neck dissection using a breast approach may provide an option for selected patients who favor avoiding a visible neck incision.

Studies on the performance of selective laser melting porous dental implant by finite element model simulation, fatigue testing and in vivo experiments.

Biomaterials have been widely used for stomatological reconstructive surgery in recent years. Many studies have demonstrated that the porous structure of an implant promotes bone ingrowth and its stiffness can be controlled via the design of the porosity. Although some researchers have paid attention to investigating the porous structure for dental implants, the biomechanical properties and osseointegration have not been well studied. In this study, finite element analysis and experiments have been used to evaluate the biomechanical performance and osseointegration of dental implants with porous/solid structures fabricated by selective laser melting using commercially pure titanium (CP-Ti, Grade 2). The implants were tested and the fracture surfaces were observed by scanning electron microscope to investigate the failure mechanisms. To reduce bone resorption, the porosity of dental implant was designed to optimize its stiffness. Finally, animal experiments revealed that bone tissue ingrowth was seen into the porous structure. It is believed that the porous dental implants have great potential in future applications.