Complications of neck dissection at a tertiary level hospital: study of 30 cases.

Metastatic dissemination into lymph nodes of neck occurs frequently in head neck cancers which down grade the patient's curability and survival. Neck dissection is a curable option for its management. To evaluate the complications following different types of neck dissection. This cross sectional study was conducted among patients undergone different types of neck dissection due to cervical nodal metastasis and attended follow up during July 2010 to June 2011 in Department of ENTs and Head-Neck surgery Dhaka Medical College Hospital, Dhaka, Bangladesh. Among 30 selected patient, 23 were male (76.67%) and 7 were female (23.33%), age ranged from 31-72 years (Mean=59.1±5.44). In different modalities of neck dissection 11 were modified neck dissection (36.67%) and 10(33.33%) were radical neck dissection. Common indication was carcinoma of unknown origin (66.67%). Involved neck nodes were commonly level II-IV (69.99%). Nodal stage was N2(50%) and N3 (40%).Common immediate complications were bleeding 03(10%), facial oedema 02 (6.67%) and thoracic duct injury 02(6.67%). Intermediate complications were seroma 05(16.67%), wound infection 04(13.33%) and chylous fistula 02(6.67%), Late Complications were hypertrophic scar 07(23.33%) and shoulder syndrome 06(20%). Proper indications, skilled surgery along with early recognize and treatment in both early and late manifestations of neck dissection preventing its grave sequence.

Management of differentiated thyroid carcinoma.

The study was done to determine the clinical, radiological and histopathological characteristics along with the management outcome of differentiated thyroid carcinoma. This Retrospective study included sixty patients with differentiated thyroid carcinoma presented to Department of Otolaryngology and Head-Neck Surgery at Dhaka Medical College Hospital and Apollo Hospitals Dhaka from June 2006 to December 2008. The data of each patient included age, sex, presenting symptoms and signs, provisional diagnosis, preoperative investigations, operation notes, histopathological examination and state at follow up. This study included 28 males and 32 females. The mean age was 42.7 years. Maximum patients presented at 4th decade. The commonest presentation was thyroid swelling followed by lateral neck swelling. Detailed clinical assessment before operative treatment has been done for all patients. Fifty five patients (91.66%) presented with single nodule. Distant metastasis was found in 2 cases. All patients underwent fine needle aspiration cytology which was conclusive in 38 patients (63.33%). All the sixty patients underwent surgical excision; either total thyroidectomy or completion thyroidectomy. Neck dissection was performed in 8 patients. All patients received postoperative radio-iodine. Fifty one cases were papillary carcinoma and 9 cases were follicular carcinoma. Except for one case with local recurrence the remaining cases were disease free on follow up (up to 10-40 months). One patient died with bone metastasis 2 years after operation. Of all thyroid cancers, majority cases are papillary cancer (85%). In contrast to other cancers, thyroid cancer is almost always curable. Most thyroid cancers grow slowly and are associated with a very favorable prognosis. Early diagnosis and treatment of the same is strongly advisable.