Is trans-thyroid cartilage monitoring as good as endotracheal tube monitoring during thyroidectomy?

PURPOSE: To evaluate whether trans-thyroid cartilage nerve monitoring for thyroid surgeries is as effective and safe as endotracheal tube monitoring. METHODS: Fifty-one thyroidectomies (38 hemithyroidectomies and 13 total thyroidectomies, analyzed as two separate hemi-thyroidectomies) were included. Patients undergoing surgery from 6/2020 to 8/2021 were monitored simultaneously with the NIM® Nerve Monitoring System TriVantage™ Electromyography (EMG) endotracheal tube and EMG trans-thyroid cartilage. Electrophysiological responses of 64 vagus and recurrent laryngeal nerves were obtained. Peri-operative evaluation and 12-month post-operative follow-up were conducted to examine nerve function. Wilcoxon signed-rank and Spearman coefficient tests were used to determine whether there were differences between the methods. RESULTS: The average initial amplitude measured with the trans-thyroid cartilage method was higher in the recurrent laryngeal and vagus nerves (p = 0.002, p = 0.003, respectively). The mean difference in EMG amplitude from start to end of surgery for 10 damaged nerves (7 temporary and 3 permanent) differed from intact nerves in both methods and nerves (p < 0.05 for all). Among intact recurrent laryngeal nerves, 20.4% had 20-80% decrease in amplitude in endotracheal tube electrodes and 16.7% in trans-thyroid cartilage electrodes (p = 0.92). All cases with stable EMG signals or with increased EMG amplitude (with both types of electrodes and with both nerves) had normal post-operative vocal function. No significant difference was found between the two methods when measuring the vagus and recurrent laryngeal nerves. No complications occurred when using trans-thyroid cartilage electrodes. CONCLUSIONS: Trans-thyroid cartilage nerve monitoring for thyroid surgeries is as effective and safe as the current standard monitoring using an endotracheal tube. During thyroid surgery, patients are monitored to avoid damaging nerves near the vocal cords. This study compared monitoring through a throat tube with the easier method of monitoring outside of the throat to see if it is as effective and safe. No major difference was found between the two methods and there were no problems.

Dermatoscopy as an Aid for Detecting Tumor Borders During Mohs Surgery.

Mohs micrographic surgery (MMS) is a widely used technique for removing cutaneous tumors. Currently, there is no accepted protocol to evaluate and determine lesion borders prior to surgery. Our aim was to evaluate the use of dermatoscopy as an aid for identifying lesion borders prior to MMS. Clinical and dermatoscopic images of skin lesions were evaluated by plastic surgery specialists and students to assess whether they were completely excised, the number of stages required, and characteristics of the lesions. A total of 133 patients and 2128 photographs were included in the study. Overall, specialists were better than students in evaluating lesion borders dermatoscopically (P < 0.001) and clinically (P = 0.015). The use of a dermatoscope increased accurate analysis of both groups for patients who required multiple stages. Dermatoscopy is a powerful tool, complementary to clinical examination and can be used to help delineate lesion borders prior to MMS, especially when evaluating complex skin lesions.

Reconsidering routine admission for children under age 3 undergoing partial tonsillectomy: a prospective study.

BACKGROUND: Partial Tonsillectomy (PT) is an alternative method to treat sleep disordered breathing (SDB) and/or obstructive sleep apnea (OSA). The current guidelines do not differentiate it from traditional tonsillectomy. Thus, children younger than 3 years old undergoing PT are admitted for surveillance similar to traditional tonsillectomy due to possible postoperative complications. The aim of this study is to assess the risks of PT in children 3 years old and younger, compared to older children. METHODS: Children underwent inpatient partial tonsillectomy and/or adenoidectomy, due to SDB/OSA, from 2018 to 2020. A special protocol was designed, including follow-up at 2-, 4-, 6-, 8- and 24-h after surgery. Variables analyzed included visual analogue pain score, oral intake, oxygen saturation, pulse rate, postoperative hemorrhage, urine output, temperature, analgesics and fluid administration. Furthermore, major interventions were recorded. Comparison of all variables between children younger than 3 years old with older children was performed. RESULTS: Ninety-two children were included; mean age of the whole cohort was 44.5 ± 21.9 months. Thirty-five (38%) children were 3-years old or younger and n = 57 (62%) were older than 3 years old, with no significant statistical difference in sex (p = 0.22). Mean age in the younger group was 25.7 ± 6.9 months, and 56.1 ± 20.1 months in the older group. In total we had 7 children with post-operative complications; 4 with fever, 3 with low intake. There were no major interventions recorded in either group. The complications were more common in the older group (n = 5) than the younger group (n = 2) without a statistical significance (p = 0.59). There were no differences in VAS, use of painkillers, oral intake, urine output, oxygen saturation and tachycardia among the two groups. CONCLUSION: This study supports that children undergoing ambulatory PT may be at low risk of complications, regardless of age.

Association Between Thyroid-Stimulating Hormone Level and Bell's Palsy.

OBJECTIVE: To investigate whether dysregulated thyroid hormone function is associated with Bell's palsy. STUDY DESIGN: Cross-sectional. SETTING: Electronic medical record database of Clalit Health Services (CHS). CHS is an Israeli payer-provider, integrated health care system, serving >4.5 million members (54% of the Israeli population). PATIENTS: Older than 18 years with Bell's palsy, during 2002 to 2019. INTERVENTIONS: None. METHODS: A total of 1,374 patients with Bell's palsy who had thyroid-stimulating hormone (TSH) blood levels measured up to 60 days before the palsy were matched (1:2) for age and sex with 2,748 controls who had TSH blood levels and no history of Bell's palsy. RESULTS: Retrospective review of the CHS database, from 2002 to 2019 yielded 11,268 patients with Bell's palsy, of which, 1,374 met the inclusion criteria. Mean age was 57.9 years, and 61.4% were female. A higher percentage of patients in the Bell's palsy group had low TSH (≤0.55 mIU/L) compared with controls (5.7% vs. 3.6%, p < 0.001). Low TSH compared with TSH > 0.55 mIU/L, was independently associated with 1.45-fold increased odds for having Bell's palsy (95% CI 1.11-2.02, p < 0.001), when controlled for age, sex, body mass index, diabetes, hypertension, prior cerebrovascular accident, hemoglobin level, and purchasing thyroid hormone drugs. Among the patients with TSH ≤ 0.55 mIU/L, 95.5% had normal free thyroxin and 97.7% had normal free triiodothyronine levels (subclinical hyperthyroidism). For 47.1% of patients, TSH remained ≤0.55 mIU/L, 3 to 12 months after the Bell's palsy occurred and most patients had normal free thyroxin (95.4%) and normal free triiodothyronine (91.8%). CONCLUSIONS: Subclinical hyperthyroidism is independently associated with Bell's palsy after controlling for multiple confounding factors.

Powered Intracapsular Tonsillotomy and Adenoidectomy in Infants ≤36 Months Compared to Older Children: A Retrospective Analysis.

OBJECTIVES: To evaluate the safety and outcomes of powered intracapsular tonsillotomy and adenoidectomy (PITA) for the treatment of sleep disordered breathing in infants up to 36 months of age compared to older children. METHODS: This retrospective analysis included children who underwent PITA from 2013 to 2019 at a single tertiary care medical center. The patients were divided into 2 groups: up to 36 months, and 36 to 72 months. The data were collected from electronic medical records and from a telephone survey based on a modified version of the OSA-18 questionnaire. Post-operative complications, and short- and long-term outcomes were compared. RESULTS: A total of 48 patients met the inclusion criteria for the main study group (up to 36 months of age). They were compared to 59 children 36 to 72 months of age. There were no differences in subjective outcomes between age groups (P = .65). There were no differences in the frequency of post-operative complications between age groups (P = .8) or in the number of hospitalization days (P = .91). CONCLUSION: The short- and long-term outcomes and safety of PITA for the treatment of sleep disordered breathing in infants up to 36 months of age are similar to those of older children.

Outcomes and safety of adenoidectomy in infants up to 12 months of age compared to older children.

PURPOSE: To evaluate the safety and outcomes of adenoidectomy for the treatment of sleep disordered breathing (SDB) in infants up to 12 months of age as compared to children ages 13-72 months METHODS: A retrospective analysis was performed by reviewing the medical records of children who underwent adenoidectomy from 2005 to 2018. The data of older age groups were also collected for comparison. The patients were divided into three groups: up to 12 months (infants), 13-36 months (toddlers) and 37-72 months (preschool). The data were collected from electronic medical records and from a telephone survey based on a modified version of the OSA-18 questionnaire. Postoperative complications, and short and long-term outcomes were compared. RESULTS: Twenty-one patients met the inclusion criteria for the main study group (infants). They were compared with forty-four toddlers and thirty-two preschoolers. Among the infants, four (19%) needed additional surgical intervention, none of the toddlers and four (12.5%) preschoolers. There were no differences in subjective outcomes between age groups (p = 0.365) in the first year after surgery. One year after surgery, outcomes remained similar in all age groups (p = 0.302) with regard to SDB, but subjective improvements in mouth breathing and nasal discharge were better among the older children (p = 0.011 and p = 0.012), respectively. CONCLUSION: The outcomes of adenoidectomy for the treatment of SDB in infants up to 12 months of age is similar to children ages 13-72 months.