Humans ; Mouth Neoplasms ; surgery ; Neck Dissection ; adverse effects ; methods

Adult ; Chylothorax ; etiology ; Female ; Humans ; Neck Dissection ; adverse effects

Adult ; Aged ; Chylothorax ; etiology ; therapy ; Female ; Humans ; Middle Aged ; Neck Dissection ; adverse effects ; Retrospective Studies ; Thyroid Neoplasms ; surgery

Objective: To explore the feasibility and safety of the gasless transoral vestibular robotic thyroidectomy using skin suspension. Methods: The clinical data of 20 patients underwent gasless transoral vestibular robotic thyroidectomy in the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from February 2022 to May 2022 were retrospectively analyzed. Among them, 18 were females and 2 were males, aged (38.7±8.0) years old. The intraoperative blood loss, operation time, postoperative hospital stay, postoperative drainage volume, postoperative pain visual analogue scale (VAS) score, postoperative swallowing function swallowing impairment score-6 (SIS-6), postoperative aesthetic VAS score, postoperative voice handicap index-10 (VHI-10) voice quality, postoperative pathology and complications were recorded. SPSS 25.0 was used for statistical analysis of the data. Results: The operations were successfully completed without conversion to open surgery in all patients. Pathological examination showed papillary thyroid carcinoma in 18 cases, retrosternal nodular goiter in 1 case, and cystic change in goiter in 1 case. The operative time for thyroid cancer was 161.50 (152.75, 182.50) min [M (P₂₅, P₇₅), the same below] and the average operative time for benign thyroid diseases was 166.50 minutes. The intraoperative blood loss 25.00 (21.25, 30.00) ml. In 18 cases of thyroid cancer, the mean diameter of the tumors was (7.22±2.02) mm, and lymph nodes (6.56±2.14) were dissected in the central region, with a lymph node metastasis rate of 61.11%. The postoperative pain VAS score was 3.00 (2.25, 4.00) points at 24 hours, the mean postoperative drainage volume was (118.35±24.32) ml, the postoperative hospital stay was 3.00 (3.00, 3.75) days, the postoperative SIS-6 score was (4.90±1.58) points at 3 months, and the postoperative VHI-10 score was 7.50 (2.00, 11.00) points at 3 months. Seven patients had mild mandibular numbness, 10 patients had mild cervical numbness, and 3 patients had temporary hypothyroidism three months after surgery and 1 patient had skin flap burn, but recovered one month after surgery. All patients were satisfied with the postoperative aesthetic effects, and the postoperative aesthetic VAS score was 10.00 (10.00, 10.00). Conclusion: Gasless transoral vestibular robotic thyroidectomy using skin suspension is a safe and feasible option with good postoperative aesthetic effect, which can provide a new treatment option for some selected patients with thyroid tumors.
Male ; Female ; Humans ; Adult ; Middle Aged ; Thyroidectomy/adverse effects* ; Robotic Surgical Procedures/adverse effects* ; Retrospective Studies ; Blood Loss, Surgical ; Hypesthesia/surgery* ; Neck Dissection/adverse effects* ; Thyroid Neoplasms/surgery* ; Pain, Postoperative/surgery* ; Postoperative Complications/etiology*

OBJECTIVETo approach reasonable operational mode of differentiated thyroid cancer.

METHODSRetrospectively review 546 differentiated thyroid cancer patients who received bilateral thyroidectomy with or without cervical lymph node excision from January 2001 to December 2006.

RESULTSNo death case happened during operation and hospitalization. The positive percentage of cervical lymph node metastasis was 76.2% (358/470). The incidence rate of single lateral recurrent laryngeal nerve injury was 1.1% (6 cases), parathyroid gland partly injury was 0.4% (2 cases), superior laryngeal nerve injury was 0.7% (4 cases), bleeding was 0.6% (3 cases) and esophagus injury after operation was 0.2% (1 case). There were no bilateral recurrent laryngeal nerve injury found.

CONCLUSIONSTotal thyroidectomy is an essential operational mode for differentiated thyroid cancer. It is necessary to excise cervical lymph node when the tumor's diameter exceeds 1 cm.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Neck Dissection ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; adverse effects ; methods

OBJECTIVETo study the surgical management of fatal hemorrhage following head and neck surgery for cancer.

METHODSThe clinical data of 32 cases of fatal hemorrhage following head and neck surgery from 1976 to 2008 in our department were analyzed retrospectively.

RESULTSHemorrhage was caused by carotid blowout in 20 cases. The carotid ligation was performed in 13 cases, only 6 cases got long-term survival. In 12 cases, hemorrhage was caused by tracheo-innominate artery fistula, only 2 cases received surgical management, and no long-term survivors.

CONCLUSIONFatal hemorrhage following head and neck surgery is an uncommon but frequently fatal complication, and the successful management of it depends on early diagnosis and correct treatment.

Adult ; Aged ; Carotid Artery, Common ; surgery ; Female ; Head and Neck Neoplasms ; pathology ; radiotherapy ; surgery ; Humans ; Laryngectomy ; adverse effects ; methods ; Ligation ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Postoperative Hemorrhage ; etiology ; surgery ; Retrospective Studies ; Young Adult

OBJECTIVEThe aim of this study was to examine the effects of deep branches of cervical plexus on trapezius muscle.

METHODSThe evoked electromyography of 32 trapezius of 16 SD rats was examined in different time and results obtained were processed by statistical methods.

RESULTSAfter cutting the accessory nerves, stimulating the deep branches of cervical plexus evoked the myoelectricity, the myoelectricity results varied according to different time.

CONCLUSIONThe deep branches of cervical plexus are another important motorial supply to trapezius muscles. After cutting the accessory nerves, if the branches were undamaged, the shoulder's function would be greatly preserved.

Accessory Nerve ; physiology ; Animals ; Cervical Plexus ; physiology ; Electromyography ; Male ; Muscle, Skeletal ; anatomy & histology ; innervation ; physiology ; Neck Dissection ; adverse effects ; Neck Muscles ; anatomy & histology ; injuries ; physiology ; Rats ; Rats, Sprague-Dawley ; Shoulder ; innervation

OBJECTIVE: Evaluating the function of the internal jugular vein after selective neck dissection on patients affected by squamous cell carcinoma of the head and neck by color Doppler ultrasonography. METHOD: Forty patients (76 internal jugular veins) who had undergone bilateral selective neck dissection(36 patients) or unilateral selective neck dissection (4 patients) were collected and divided into 2 groups depending on operation area. Group A consisted of 39 internal jugular veins (IJVs) which dissected level II, III and group B included 37 IJVs which disseted level II - IVor II - V spring the IJV. All patients underwent Doppler ultrasonography before and after selective neck dissection at the 1st and 3rd postoperative months. The following measurements were assessed in each test: presence of thrombosis, expiratory jugular flow, expiratory caliber, area both during expiratory and Valsalva maneuver, expiratory flow speed, Valsalva flow speed. All data were statistically analyzed in two groups by comparisons of preoperative conditions and postoperative conditions. RESULT: (1) None of the 76 internal jugular veins showed thrombosis before or after selective neck dissection. (2) Patency rate at the 1st and 3rd postoperative months were respectively 85.5% and 96.1%. Patency rate of the internal jugular vein in two groups showed no significant changes at the 1st and 3rd postoperative months (P > 0.05). (3) In group A, Valsalva flow speed showed no significant changes at the 1st postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. Expiratory calibe, area during Valsalva maneuve, expiratory flow speed and Valsalva flow speed had significant difference at the 3rd postoperative months (P < 0.05), compared with preoperative. In group B, Valsalva flow speed showed no significant changes at the 1st postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. Expiratory jugular flow had no significant difference at the 3rd postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. All parameters at the 3rd postoperative months had significant difference compared with 1st postoperative months between these two groups, excepting expiratory flow speed. (4) Differences of the operation area had no significant impact on indications of the internal jugular vein (P > 0.05). CONCLUSION (1) None of the internal jugular veins showed thrombosis after selective neck dissection. The results indicate that thrombosis of the internal jugular veins can be avoided though careful operation, proper operative skill, appropriate management postoperation. (2) Although most of the parameters changed at early stage after selective neck dissection, many of them improved at the 3rd postoperative months, and expiratory jugular flow recovered to the normal range. The results indicate that the internal jugular veins can basically maintain its normal function at long time postoperation.
Carcinoma, Squamous Cell ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Jugular Veins ; diagnostic imaging ; physiology ; Neck Dissection ; adverse effects ; Postoperative Period ; Regional Blood Flow ; physiology ; Ultrasonography, Doppler ; Vascular Patency ; Venous Thrombosis ; prevention & control

OBJECTIVETo explore a cosmetic incision in the neck dissection for differentiated thyroid carcinoma.

METHODSAn extended collar incision was used for neck dissection in 82 consecutive patients with thyroid carcinoma from May 1999 to December 2006. The incision was designed to start as a conventional thyroid collar incision, and then to extend it along the skin crease to the anterior border of trapezium, so to avoid the vertical limb of conventional hockey stick incision. There were 60 females and 22 males in this series, with a median age of 40.5 years (range, 10 to 80 years). Ninety-six procedures of neck dissection were performed in 82 patients, including one radical neck dissection, one type I modified neck dissection, 8 type II modified neck dissections, and 86 type III modified neck dissections.

RESULTSThe average time of anesthesia was 197 minutes. The average dissected lymph nodes were 37.5, with average metastasis in 8.8 nodes. Eight patients (9.8%) developed complications related to neck dissection. The follow-up period in these patients were 1 to 96 months with a median follow-up time of 23 months. Cervical recurrence was found in only one patient (1.2%). Neither death nor distant metastasis was observed in this series.

CONCLUSIONIt is feasible to perform a modified neck dissection for differentiated thyroid cancer through the extended collar incision. The preliminary results show that the above described incision is not only oncologically safe, but also offers a cosmetic benefit for the patient with thyroid carcinoma.

Adenocarcinoma, Follicular ; pathology ; surgery ; Adenocarcinoma, Papillary ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Follow-Up Studies ; Humans ; Hypocalcemia ; etiology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; adverse effects ; methods ; Thyroid Neoplasms ; pathology ; surgery ; Young Adult

Objective: To investigate the clinicopathological characteristics and the survival of re-operated patients for persistent/recurrent papillary thyroid carcinoma (PTC) and risk factors for re-recurrence after the second operation. Method: A retrospective analysis of 69 cases underwent re-operation for persistent/recurrent PTC in Sichuan Cancer Hospital from January 2010 to December 2016 was performed. There were 21 males and 48 females, aged 14-85 (44.8) years old. According to the imaging after initial treatment, they were divided into a recurrence group (42 cases) and a persistent disease/residual group (27 cases). The positive rates of ipsilateral paratracheal lymph node metastases at re-operation were calculated and compared by chi-square test. Patients were divided into different subgroups according to potential risk factors for re-recurrence. Kaplan-Meier (K-M) method was used for survival analysis. Results: The positive rate of ipsilateral paratracheal lymph node metastasis in recurrence group (15/42, 35.7%) was significantly lower than that in the persistent disease/residual group (17/27, 63.0%) (χ²=4.91, P<0.05). The follow-up period after re-operation was 60-104 months, with a median of 66 months, and 8 patients were lost to follow-up. Permanent hypoparathyroidism occurred in 2 cases (2.9%) and permanent recurrent laryngeal nerve palsy in 1 case (1.4%). Twenty patients had structural recurrences and/or distant metastases. The 5-year disease-specific survival rate was 92.8% and the 5-year recurrence-free survival rate was 68.1%. Survival analysis was performed on risk factors such as age≥55 years old, recurrent tumor diameter ≥4 cm, number of positive lymph nodes ≥ 10, and obvious extracapsular invasion (ENE). Among them, age and diameter of recurrent tumor had significant influences on recurrence-free survival rate (χ² was 6.36, 8.17, respectively, both P values<0.05). There was a statistically significant difference in recurrence-free survival rates between ENE(+) group and ENE(-) group (χ²=5.52, P<0.05). Conclusion: For the re-operated patients due to persistence/ recurrence PTC, attention should be paid to protecting the parathyroid gland and recurrent laryngeal nerve during re-operation. Timely and effective postoperative follow-up for patients aged ≥ 55 years, with recurrent tumor diameter ≥ 4 cm and ENE(+), can significantly improve their prognoses.
Adult ; Carcinoma/pathology* ; Carcinoma, Papillary/surgery* ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Recurrence, Local/surgery* ; Prognosis ; Retrospective Studies ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/pathology* ; Thyroidectomy/adverse effects*