Intraoperative Spinal Accessory Nerve Monitoring During Neck Dissection Surgery as a Predictor for Shoulder Dysfunction.

Shoulder dysfunction is one of the most common complications seen in patients who have undergone neck dissection surgery. The prevalence of shoulder dysfunction increases depending on the type and extent of neck dissection surgery. We aim to study the relationship between changes in intraoperative neuromonitoring (IONM) threshold during SAN stimulation, ultrasonographic measurement of muscle size and shear wave elastography with shoulder dysfunction. This is a prospective study. All patients who have undergone neck dissection in our centre have been recruited. Analysis of demographic data, IONM threshold during exposure and pre-closure, shoulder function score, neck disability index score (NDII) and ultrasonographic parameters pre-op and during follow up was done. The cohort was divided into patients who suffered from shoulder dysfunction post op (Group A) and patients with normal shoulder function post op (Group B). Statistical significance were seen in IONM threshold during SAN stimulation and Constant shoulder score for 6 months follow up in Group A. IONM threshold difference during exposure and pre-closure could effectively prognosticate shoulder dysfunction post op. A return of shoulder function could be seen in patients who suffered from shoulder dysfunction if early physiotherapy could be commenced.

Right Parapharyngeal Cavernous Hemangioma, A Rare Entity: Case Report and Literature Review.

Cavernous hemangioma is a noncancerous vascular growth that arises from different parts of the head and neck region. However, parapharyngeal space contributes a very small percentage for its occurrence. We present a case of right parapharyngeal cavernous hemangioma, a very rare clinical presentation. This is a 57-year-old female presented with throat discomfort for 3 months. Examination finding showed a soft, diffuse, and non-pulsating mass over the right upper jugulodigastric region. A contrasted computed topographic scan revealed multiple calcifications in right parapharyngeal space. T2-weighted magnetic resonance imaging showed right parapharyngeal space mass with high signal and multiple phleboliths and dynamic angiogram unremarkable. Surgical resection done via transcervical approach and histopathological report revealed cavernous hemangioma with calcified thrombi. In conclusion, surgical intervention is the mainstay treatment and transcervical approach which is adopted in this case is the commonest approach used in surgical resection of cavernous hemangioma.

Iodide-Induced Severe Encephalopathy: A Case Report and Literature Review.

A physically independent and mentally competent 61-year-old gentleman was diagnosed with left upper alveolar spindle cell carcinoma. He underwent left infrastructure maxillectomy with reconstruction and had bismuth iodoform paraffin paste packed in the post-operative cavities. The patient subsequently exhibited labile emotions and acute delirium. Further investigation showed that his urine iodine level was highly elevated. He eventually made a full recovery and returned home.

Effectiveness of Direct Transcricothyroid Electromyographic Monitoring in Thyroidectomy Surgery.

Thyroid surgeries are associated with complications of vocal cord palsy and hypocalcemia which can be debilitating. The usage of intraoperative nerve monitoring is a useful adjunct to direct nerve visualization in thyroidectomies. We advocate the usage of direct transcricothyroid electromyographic monitoring in identifying recurrent laryngeal nerve. We retrospectively collected data of all patients who underwent thyroidectomies (total thyroidectomy, hemithyroidectomy, isthmusdectomy) using direct transcricothyroid electromyographic monitoring from April 2020 to August 2021. Data was analysed based on patient's demographics, comorbidities, complications post thyroidectomy such as vocal cord palsy, transient and permanent hypocalcemia. 50 thyroidectomies were performed, 10 developed unilateral vocal cord palsy. Out of 22 total thyroidectomies, 7 developed transient hypocalcemia and 4 permanently. 1 patient developed vocal cord hematoma secondary to direct insertion of intraoperative nerve monitor's electrode. Direct transcricothyroid electromyographic monitoring is a feasible and effective method in intraoperative monitoring of recurrent laryngeal nerve during thyroid surgeries.

Isolated third nerve palsy: Lessons from the literature and 4 case studies.

A patient's age, clinical presentation, medical history, and circumstances at time of palsy onset suggest likely underlying causes and help prioritize choice of imaging.