Recently robotic thyroidectomy has gained its popularity for the treatment of differentiated thyroid cancer and benign thyroid tumors. It has been developed to overcome the drawbacks of conventional open trans-cervical thyroidectomy, which is an apparent neck wound that is visible unless concealed with clothes. Robotic thyroidectomy provides surgeons with three-dimensional magnified view and multiarticulated robotic arms that can stabilize hand tremors. It also has advantages over conventional trans-cervical thyroidectomy that include recovery of voice symptoms and acoustic parameters along with superior cosmetic outcomes. Robotic thyroidectomy results in equivalent surgical outcomes including oncologic safety and complications compared with conventional thyroidectomy. Various approaches including transaxillary, postauricular facelift, and breast-axillary approaches have been developed for robotic thyroidectomy. Recently, the indication of robotic surgery has been extended to neck dissection of the lateral compartment. Herein we summarize the indication, procedures, and efficacy of robotic thyroidectomy, and also introduce our experience with robotic thyroidectomy.
Acoustics ; Arm ; Clothing ; Hand ; Neck ; Neck Dissection ; Rhytidoplasty ; Surgeons ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Tremor ; Voice ; Wounds and Injuries

OBJECTIVES: The objective of this study was to determine the various factors that affect the extrusion rate of ventilation tubes (VTs), including the nature of the middle ear effusion. METHODS: A retrospective chart review of 82 pediatric patients (177 ears) who received VT insertion surgery under general anesthesia was carried out to evaluate the relationship between various factors and the VT extrusion rate. The factors we analyzed included age, gender, the adenoid size, the amount and content of the middle ear effusion after myringotomy, bleeding events, associated adenoidectomy and the findings of the tympanic membrane status, the tympanometry and the audiometry of the air bone gap. RESULTS: The mean extrusion time was 254 days (range, 11 to 809 days). The patients with no history of previous VT insertion had a longer extrusion time (mean, 279 days) than did the patients who had undergone previous VT insertion (mean, 203 days). The patients with serous effusion had the shortest extrusion time (mean, 190 days) as compared to those patients with glue (273 days) and pus (295 days) effusions. Other factors had no statistical significant relationship with the extrusion time. CONCLUSION: The mean VT extrusion time was 254 days. The VT extrusion time was significantly related to the characteristics of the middle ear effusion and a history of previous VT insertion. Thus, the nature of middle ear effusion can provide a clinical clue to predict the VT extrusion time.
Acoustic Impedance Tests ; Adenoidectomy ; Adenoids ; Adhesives ; Anesthesia, General ; Audiometry ; Hemorrhage ; Humans ; Otitis Media with Effusion ; Retrospective Studies ; Suppuration ; Tympanic Membrane ; Ventilation

Chin retrusion and micrognathia are deformities that are commonly encountered in patients desiring rhinoplasty. Augmentation genioplasty in these patients improves the profile and enhances cosmetic result of rhinoplasty. For chin augmentation, either sliding osteotomy or implant insertion can be used. In alloplastic chin augmentation, rejection, infection of the materials, or resorption of the mandible can be a major problem. Horizontal sliding osteotomy of the mandibular symphysis with advancement of the mobilized segment can be the technique of choice to avoid these disadvantages. Here we report 2 cases of acquired nasal deformity and chin retrusion treated with simultaneous rhinoplasty and sliding genioplasty with a brief literature review.
Chin ; Congenital Abnormalities ; Cosmetics ; Genioplasty ; Humans ; Mandible ; Nose ; Nose Deformities, Acquired ; Osteotomy ; Rejection (Psychology) ; Rhinoplasty

BACKGROUND AND OBJECTIVES: Pulmonary thromboembolism (PTE) after surgery is one of the rare but fatal complications causing sudden respiratory failure. This study was performed to evaluate PTE after head and neck surgery and to report our recent experience with review of the literature. SUBJECTS AND METHOD: We retrospectively analyzed 1096 patients who underwent head and neck surgery from January 2011 to June 2013 in a tertiary hospital. We evaluated the incidence and characteristics of PTE and risk factors of PTE such as smoking, body mass index, comorbidities, coronary artery disease, coagulation disorder and Caprini risk assessment model. RESULTS: PTE occurred in five of 1096 patients (0.46%; two were male and three were female, with a mean age of 56.2 year). All patients with PTE were categorized into high risk group of PTE by Caprini model. The mean Caprini risk score were 6.6 and 4.6 in the PTE patients and non-PTE patients, respectively. The significant risk factors were long operative time, cancer patients and high Caprini score in this study. One PTE patient underwent cardiopulmonary resuscitation due to respiratory arrest, afterwards received thromboembolectomy by thoracotomy. Four patients received anticoagulation therapy only. CONCLUSION: Risk stratification for PTE is necessary in patients who receive long operation for head and neck cancer or have high Caprini score.
Body Mass Index ; Cardiopulmonary Resuscitation ; Comorbidity ; Coronary Artery Disease ; Female ; Head and Neck Neoplasms ; Head* ; Humans ; Incidence ; Male ; Neck* ; Operative Time ; Pulmonary Embolism* ; Respiratory Insufficiency ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Tertiary Care Centers ; Thoracotomy ; Venous Thrombosis

Granular cell tumor is an uncommon neoplasm that can occur everywhere in the human body. Granular cell tumor of the thyroid gland is very rare and only eight cases of thyroid granular cell tumor have been reported. Histopathologically, granular cell tumor consists of large polygonal cells with small dark nuclei and abundant, fine, granular eosinophilic cytoplasm that show positive immunohistochemical staining using S-100 protein. Surgical excision is the treatment of choice for granular cell tumor. Recurrence is rare, but inadequate resection of granular cell tumor may cause local recurrence. We have experienced one case of thyroid granular cell tumor that we report here with a review of literatures.
Cytoplasm ; Eosinophils ; Granular Cell Tumor* ; Human Body ; Recurrence ; S100 Proteins ; Thyroid Gland*

BACKGROUND AND OBJECTIVES: Diagnosis of thyroid disease requiring surgery and subsequent thyroidectomy may affect patients' emotion and quality of life. The purpose of this study is to evaluate the patients' understanding and concern about the disease and recovery rate after thyroidectomy, and therefore to enhance the satisfaction of hospitalization. SUBJECTS AND METHOD: MethodZZSeventy-seven patients undergoing thyroidectomy in a tertiary hospital from April 2009 to October 2009 were enrolled. Questionnaires were filled out on the admission day, discharge day, and 2 weeks after operation. Questionnaires consisted questions regarding the understanding of the disease, details of concern, recovery rate after surgery, and satisfaction on hospitalization duration. Retrospective chart review was also performed. RESULTS: Many patients (42.9%) acquired their knowledge of thyroid cancer through the internet. The possibility of voice change was the major concern before surgery (46.8%), whereas the major postoperative concern was adjuvant therapy (37.7%). The patient group with higher understanding of the disease showed higher recovery rate than the others at the time of discharge (mean postdischarge surgical recovery 67.4% vs. 55.3%, p=0.01). The patient group with lower understanding wanted longer hospitalization than the other group at discharge (p<0.001). CONCLUSION: Patient education about the thyroid disease may reduce patients' anxiety and therefore may enhance subjective recovery rate and satisfaction of hospitalization.
Anxiety ; Cognition ; Hospitalization ; Humans ; Internet ; Patient Education as Topic ; Quality of Life ; Surveys and Questionnaires ; Retrospective Studies ; Tertiary Care Centers ; Thyroid Diseases ; Thyroid Neoplasms ; Thyroidectomy ; Voice

OBJECTIVES: The number of metastatic lymph nodes (LNs) and the ratio between the number of metastatic LNs and the total number of retrieved LNs (the LN ratio [LNR]) have been proposed as risk factors for recurrence of papillary thyroid carcinoma (PTC). However, the significance of the number of LNs and the LNR in patients with clinically node negative PTC has not been clearly determined. The purpose of this study is to evaluate their significance. METHODS: We retrospectively analyzed 382 patients with PTC who had undergone total thyroidectomy with prophylactic central neck dissection (CND) between January 2000 and December 2010. We excluded patients with lobectomy, concurrent lateral compartment neck dissection, a follow-up period less than at least 2 years, number of harvested central LNs less than or equal to one, clinically positive LN, distant metastasis, recurrent cancer or other types of malignancy. The correlations between recurrence and various clinicopathologic characteristics including tumor size, extrathyroidal extension (ETE), stage, number of metastatic central LNs, and the LNR were investigated. RESULTS: After a mean follow-up period of 82.2±26.4 months, recurrence occurred in 14 patients (3.7%). Tumor size ≥20 mm, maximal ETE, presence of central LN metastasis, number of metastatic LNs ≥2, and LNR ≥0.31 correlated with recurrence in the univariate analysis. However, tumor size ≥20 mm, maximal ETE, number of metastatic LNs ≥2, and LNR ≥0.31 were significantly associated with recurrence in the multivariate analysis (hazard ratio=6.61, 7.17, 3.43, and 11.23, respectively). CONCLUSION: The LNR and the number of metastatic LNs are independent prognostic risk factors for recurrence in patients with clinically node negative PTC, and these factors can be used to guide postoperative adjuvant therapy and follow-up strategy after prophylactic CND.
Follow-Up Studies ; Humans ; Lymph Nodes* ; Multivariate Analysis ; Neck Dissection ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Post-operative dizziness and vertigo have been variously reported from 30 to 60% after cochlear implantation. There have been reported that delayed vertigo is the most common type and characterized by similarities with dizziness in Meniere's syndrome. Authors experienced a man who had delayed onset of vertigo, which developed six months after cochlear implantation on the left side. Postoperative left caloric response was decreased in both warm and cold stimulation. The direction of spontaneous nystagmus during spell was right side with torsional down beat and definite catch up saccades were observed during head thrust test on the plane of the left horizontal canal and posterior canal, which was resolved on the next day. These episodic and recurrent spells of vertigo might suggest that the hydropic changes of labyrinth corresponding to the pathology of Meniere's disease occurred in this patient.
Cochlear Implantation ; Cochlear Implants ; Cold Temperature ; Dizziness ; Ear, Inner ; Endolymphatic Hydrops ; Head ; Humans ; Meniere Disease ; Saccades ; Vertigo

Deep neck infection is a surgical emergency that can result in life threatening complications such as airway obstruction, aspiration, thrombosis of major vessels and mediastinitis by spread of infection along fascial planes. Although appropriate surgical intervention and prompt antibiotics are given, revision surgeries are often required. We report a patient with mediastinal abscess caused by a deep neck infection that was initially intractable with usual surgical drainage but was eventually successfully treated with the modified application of a vacuum-assisted closure (VAC) device (InfoV.A.C. Therapy Unit; Kinetic Concept Inc., USA). We inserted silastic drain tubes into paratracheal area. It was difficult to pack the VAC foams, so they were prone to fail, with complete debridement. With modified VAC therapy assisted by silastic drain tube, the deeply located mediastinal abscess that had been unresponsive to conventional surgical drainage was successfully treated.
Abscess* ; Airway Obstruction ; Anti-Bacterial Agents ; Debridement ; Drainage ; Emergencies ; Humans ; Mediastinitis ; Neck* ; Negative-Pressure Wound Therapy* ; Retropharyngeal Abscess ; Thrombosis

Inflammatory myofibrolastic tumor (IMT) is a rare borderline neoplasm. It frequently occurs in the lung but occasionally occurs in extrapulmonary sites such as the genitourinary tract, gastrointestinal tract, breast, salivary glands, sinonasal tract, orbit, and the central nervous system. Laryngeal involvement of IMT is very rare.A 61-year-old woman who complained of hoarseness persisting for 3 months visited our hospital. Laryngoscopy showed an elevated lesion in the right true vocal cord. Incisional biopsy was confirmed as larygeal inflammatory myofibrolastic tumor. We performed a transoral excision with CO2 LASER under suspension examination. Regional recurrence or distant metastasis was not observed after 9 months of follow-up. Herein we report a case of larygeal inflammatory myofibrolastic tumor that was treated with surgery alone, with a literature review.
Biopsy ; Breast ; Central Nervous System ; Female ; Follow-Up Studies ; Gastrointestinal Tract ; Hoarseness ; Humans ; Laryngoscopy ; Larynx ; Lasers, Gas ; Lung ; Middle Aged ; Myofibroblasts ; Neoplasm Metastasis ; Orbit ; Recurrence ; Salivary Glands ; Vocal Cords