Objective To investigate the correlation between level Ⅱ cervical lymph node metastasis (CLNM) and thyroid disease background,tumor size,location,and local lymph node metastasis in patients with papillary thyroid carcinoma (PTC).Methods A thyroid cancer database was established using Access database software.62 patients with PTC undergoing neck dissection in the 1st Department of Head and Neck surgery of Sichuan Cancer Hospital from Aug.2013 to Mar.2014 were retrospectively reviewed in terms of their sex,age,thyroid disease background,number of nodules,tumor size,location,and CLNM.Results 30 out of 62 patients had level Ⅱ cervical lymph node metastasis (Ⅱa:27 cases,Ⅱb:6 cases).13 out of 23 patients without history of other thyroid disease had level Ⅱ CLNM,9 out of 17 patients with Hashimoto's thyroiditis had level Ⅱ CLNM,3 out of 18 patients concomitant with nodular goiter had level Ⅱ CLNM and 2 patients concomitant with hyperthyroidism and having received radioactive iodine 131 treatments had level Ⅱ CLNM.Among patients with level Ⅱ CLNM,2 patients had tumors ＜10 mm,17 patients had tumors between 10 mm and 40 mm,and 4 patients had tumors ＞40 mm.Most of the tumors (11/17) with level Ⅱ CLNM were located in the upper polar of the thyroid,while the rest were located in the middle (12/23) and lower (3/12) region of thyroid.Conclusions Level Ⅱ CLNM is a common feature of thyroid carcinoma.It has been well accepted that level Ⅱ cervical lymph node should be dissected when extracapsular invasion or CLNM to level Ⅲ or Ⅳ occurs.In addition to traditional risk stratification,level Ⅰ CLNM is correlated with tumor size,location,and thyroid disease background.Therefore,close attention should be paid to level Ⅱ cervical lymph node when tumors are located in the upper polar of thyroid and individualized treatment should be chosen for each patient.

Objective To discuss the surgical treatment of differentiated thyroid carcinoma ( DTC) viola-ting larynx and trachea .Methods 29 patients with DTC violating larynx and trachea received primary tumor re-section.Among them, 6 patients were with larynx violation , 3 patients with larynx and trachea violation , 16 pa-tients with trachea violation , and 4 patients with anterior strap muscles and skin violation .In addition, 5 patients were type I , 4 patients type II , 9 patients type III , and 11 patients type IV .All patients accepted the total thy-roidectomy.For patients with larynx and trachea violations , 9 received the slashing tracheal surgery ( type I and II) , 15 patients received the window resection and sternocleidomastoid muscle periosteal flap reconstruction , sleeve resection and anastomosis reconstruction , and window resection and gastrostomy .3 patients received total laryngectomy , 2 patients received partial laryngectomy and 4 patients with skin invasion received the reconstruc-tion with pectoralis major muscle flap .Results For these patients , 25 patients were with papillary adenocarcino-ma, and 4 patients with follicular carcinoma .All patients were followed up for 1 to 8 years.3 cases suffered from recurrence, 2 cases with tracheal recurrence received reoperation .3 cases with lung metastasis received the I 131 therapy, among whom 2 cases achieved the local control of lung tumor and the other one survived with tumor .1 patient died of the neck lymph nodes recurrence .25 patients survived over 3 years.13 patients survived over 5 years.Conclusions For patients with DTC with larynx and trachea violation , we should try our best to eliminate the tumor tissues.For the organs invaded by tumors , if possibly, elimination is also needed .This will eliminate or release the suffocation resulted from bleeding or obstruction .In addition , the function of larynx and trachea can be reconstructed and the life quality of these patients can be improved through the flap reconstruction and trachea anastomosis.Standard endocrine therapy and nuclear medicine therapy contribute to the prognosis improvement .

Purpose To observe the impact of sleep deprivation (SD) for 24 hours on human brain regional homogeneity (ReHo) by using functional magnetic resonance imaging (fMRI),and briefly discuss the intervening effect of transcranial direct current stimulation (tDCS) on ReHo after SD.Material and Methods Sixteen healthy individuals were enrolled,and self-controlled study were adopted.Resting-state fMRI scans were performed in wakefulness,after SD,and after tDCS (true or placebo stimuli).The ReHo analysis approach was employed to calculate the ReHo values of whole brain in different states.The differences between before and after SD,and between true and false tDCS after SD,were analyzed.Results Compared with wakefulness,SD mainly enhanced ReHo in brain regions of left precentral gyrus,right precentral gyrus,bilateral temporal lobe and thalamus,but decreased ReHo in brain regions of right precuneus,left superior occipital gyrus,limbic lobe and bilateral angular gyrus,superior frontal gyrus,middle frontal gyrus.Compared with placebo stimuli,the true tDCS enhanced ReHo in brain regions of bilateral precuneus,angular gyrus and right forehead,superior middle gyrus,but decreased ReHo in brain regions of the medial side of left frontal lobe,right precentral gyrus,parahippocampal gyrus,substantia nigra and bilateral temporal lobe,pons and so on.Conclusion SD can cause ReHo change in a large number of brain regions.The tDCS on the prefrontal cortex improves the brain regions with ReHo reduction caused by SD.The improved brain regions mainly include bilateral precuneus/posterior cingulate cortex.Therefore,tDCS on the prefrontal cortex can improve brain dysfunction caused by SD.

Objective To evaluate the benefits of CT angiography (CTA) in preoperative mapping of anterolateral thigh perforator flap (ALTPF) for reconstruction of defect after head and neck cancer resection.Methods Twenty-four patients underwent reconstruction of postoperative defect with ALTPF from March 2011 to March 2014 were retrospectively reviewed.According to the imaging methods used for examining perforating artery,these patients were divided into two groups:color Doppler flow imaging (CDFI)-group and CTA-group,12 patients in each group.The surgical results of all patients were evaluated for consistency in number of perforating artery,operation time and flap-related complications.Results Only one of all patients had complete flap necrosis,with an overall flap survival rate of 95.83％.All perforating branches showed with preoperative CTA were found in operation (12/12),significantly higher than CDFI-group (8/12).The mean operation time of CTA-group was significantly shorter than that of CDFI-group (Unilateral neck dissection:(6.80 ± 0.53) vs (8.39 ± 0.75) h,bilateral neck dissection:(8.79 ± 0.97) vs (10.96 ± 0.26)h,both P ＜0.05).Flap-related complication occurred in one case in CTA-group,but in 5 cases in CDFI-group.Conclusions CTA can accurately provide anatomical information of perforator vessels and guide preoperative design of ALTPF to improve operative outcomes,including the decrease in operation time and surgical injury.

Objective To explore the value of free latissimus dorsimyocutaneous flap in repairing severe defect of head and neck after resection of tumor.Methods Free latissimus dorsimyocutaneous flap was used to repair defect after resection of tumor in 12 patients (13 sides) with head and neck tumors.Of them 2 cases underwent radical radiotherapy before operation.and 3 cases received adjuvant radiotherapy postoperatively.Results Aside from one flap with necrosis, other 12 flaps survived after operation including 5 cases with radiotherapy.Conclusion Free latissimus dorsimvocutaneous flap can afford large tissue, has reliable blood supply, is easy to survive, and resist to radiotherapy, which is fit for repairing severe defect of head and neck.

Thyroid cancer is a common head and neck malignant tumor,it has become a malignant tumor of the highest incidence in young women in China.The treatment of thyroid cancer is a surgery-based comprehensive therapy,and the protection of the parathyroid gland during surgery has always been a major problem for clinicians.The methods for protection of parathyroid glands are in situ preservation or immediate parathyroid autotransplantation according to whether or not the blood supply can be maintained.To identify the parathyroid gland is the key issue of the protection during thryoidectomy.This article reviews the recent progress of the identification and protection of parathyroid glands at home and abroad.

The TNM staging system is an essential standard for cancer treatment and evaluation, and is used to assess a patient''s prog-nosis. Therefore, every update made to the system is of great significance. According to the recently released edition of the American Joint Committee on Cancer (AJCC) Staging Manual, several major changes to head and neck cancer staging have been made. In this pa-per, we analyze the advantages and disadvantages of these amendments and offer a direction for making future amendments. Our goal is to provide a brief introduction of recent research on head and neck cancers, which can be used as a reference by clinicians.

Objective:To examine the posterior sternocleidomastoid border approach which elevated whole sternocleidomastoid in gasless transaxillary endoscopic thyroidectomy.Methods:The clinical data of 46 patients with papillary thyroid carcinoma treated with gasless transaxillary endoscopic thyroidectomy from May 2019 to June 2020 at Department of Head and Neck Surgery, Sichuan Cancer Hospital was analyzed retrospectively. There were 9 males and 37 females, aged (38.6±12.0) years (range: 19 to 74 years). Fourteen and 32 cases performed posterior sternocleidomastoid border and sternocleidomastoid fascia approach, respectively. Comparative analysis were performed on clinical characters, surgical outcomes, postoperative complications, postoperative pain score, and quality-of-life of postoperative 1 month by t test, Wilcoxon rank sum test, Fisher exact test and χ 2 test,respectively. Resuts Complete exposure of central compartment was higher (11/14 vs. 34.4%(11/32),χ2=7.624, P=0.006), more lymph nodes was retrieved (4.2±2.9 vs. 2.0±2.5, t=2.663, P=0.011) in posterior sternocleidomastoid border approach. There were no significant differences between groups in postoperative complications such as recurrent laryngeal nerve palsy (1/14 vs. 3.1%(1/32), P=0.521) and transient hypoparathyroidism (0 vs. 6.2%(2/32), P=1) and pains and quality-of-life. Conclusion:Posterior sternocleidomastoid border approach of gasless transaxillary endoscopic thyroidectomy is safe and reliable and has the advantage of central compartment dissection without increasing trauma.

Objective:To examine the posterior sternocleidomastoid border approach which elevated whole sternocleidomastoid in gasless transaxillary endoscopic thyroidectomy.Methods:The clinical data of 46 patients with papillary thyroid carcinoma treated with gasless transaxillary endoscopic thyroidectomy from May 2019 to June 2020 at Department of Head and Neck Surgery, Sichuan Cancer Hospital was analyzed retrospectively. There were 9 males and 37 females, aged (38.6±12.0) years (range: 19 to 74 years). Fourteen and 32 cases performed posterior sternocleidomastoid border and sternocleidomastoid fascia approach, respectively. Comparative analysis were performed on clinical characters, surgical outcomes, postoperative complications, postoperative pain score, and quality-of-life of postoperative 1 month by t test, Wilcoxon rank sum test, Fisher exact test and χ 2 test,respectively. Resuts Complete exposure of central compartment was higher (11/14 vs. 34.4%(11/32),χ2=7.624, P=0.006), more lymph nodes was retrieved (4.2±2.9 vs. 2.0±2.5, t=2.663, P=0.011) in posterior sternocleidomastoid border approach. There were no significant differences between groups in postoperative complications such as recurrent laryngeal nerve palsy (1/14 vs. 3.1%(1/32), P=0.521) and transient hypoparathyroidism (0 vs. 6.2%(2/32), P=1) and pains and quality-of-life. Conclusion:Posterior sternocleidomastoid border approach of gasless transaxillary endoscopic thyroidectomy is safe and reliable and has the advantage of central compartment dissection without increasing trauma.