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OBJECTIVES: We encountered patients with a congenital cutaneous sinus tract in the sternoclavicular joint region, which we designate as "congenital sternoclavicular sinus (CSCS)." The aim of this investigation is to enhance recognition of this subtle yet noteworthy entity and develop standardized protocols for its management. PATIENTS AND METHODS: Between 2013 and 2023, 172 patients, including 78 males and 94 females, were referred to our institution for the management of CSCS. Clinical charts were retrospectively reviewed. RESULTS: The majority of patients (60.5%) were young children below 3 years of age, with only six adult patients and a median age of 27.5 months. The left side was implicated in 157 cases (91.3%). In 146 cases (84.9%), a faint skin streak was noted above the orifice. Yet, no pharyngeal sinus tracts were detected, either through barium swallow studies or direct laryngoscopy. All skin lesions featured a diminutive orifice near the sternoclavicular joint, with the tract extending deeply into the subcutaneous tissue and terminating blindly, short of entering the joint, after a distance of 10 mm (ranging from 5 to 21 mm). Histopathological analysis revealed that the epithelial lining predominantly consisted of stratified squamous epithelium (87.8%), with ciliated columnar epithelium accounting for the remaining 12.2%. CONCLUSIONS: CSCS, though infrequent, presents with distinctive pathological and clinical features. The condition predominantly affects the left sternoclavicular joint region, with the notable "skin streak sign" aiding in diagnosis. We considered CSCS as one disease entity of branchial arch anomalies. Complete surgical excision offers a definitive cure. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.
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Objective:To discuss the clinical application and significance of the modified piriform fossa fistulectomy based on segmental anatomy of fistula. Methods:The clinical data of 84 patients with CPSF treated by modified pyriform sinus fistulectomy were analyzed retrospectively. The modified piriform fossa fistula resection adopts the fistula anterograde anatomy method to fine dissect the fistula. The operation procedure can be summarized into four parts: retrograde anatomy of recurrent laryngeal nerve, anatomy of external branch of superior laryngeal nerve, anterograde anatomy of fistula and partial thyroidectomy. Results:All 84 patients successfully completed the operation and discharged from the hospital. The operation time wasï¼64.6±20.0ï¼ min, the intraoperative bleeding wasï¼19.6±13.0ï¼ mL, and the average hospital stay wasï¼6.8±1.1ï¼ d. Postoperative infection occurred in 1 caseï¼1.19%ï¼, temporary vocal cord paralysis in 1 caseï¼1.19%ï¼, no bleeding, pharyngeal fistula, dysphagia, permanent vocal cord paralysis and choking cough. The incidence of complications was 2.3%ï¼2/84ï¼. No complications such as permanent vocal cord paralysis and hypothyroidism occurred. Follow up for 57-106ï¼Median 74ï¼ months showed no recurrence. Conclusion:A modified procedure based on segmental dissection of the fistula not only simplifies the traditional procedure, but also procedures the specific steps to provide a targeted and precise resection, which provides a proven surgical solution for complete eradication of the lesion and significantly reduces complications and recurrence.
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Fístula , Seno Piriforme , Parálisis de los Pliegues Vocales , Humanos , Cuello/cirugía , Seno Piriforme/patología , Parálisis de los Pliegues Vocales/patología , Estudios Retrospectivos , Fístula/cirugía , Fístula/congénitoRESUMEN
Objective:To investigate the embryologic origin and diagnosis and management of cutaneous cartilage remains of gill origin in the neck. Methods:A total of 15 patients with cervical chondrocutaneous branchial remnants treated in Guangdong Provincial People's Hospital from January 2005 to December 2021 were retrospectively analyzed. They had a common feature showing a tumor in the lower third of the front of sternocleidomastoid muscle. The tumor looked like accessory auricle, never appeared pain or other symptoms of infection, and had no skin orifice. All patients underwent ultrasound examination, which showed an anechoic area under subcutaneous tissue of the neck or face. MRI examination in 6 cases showed subcutaneous irregular nodules the location of the lesion. Surgical resection of cervical chondrocutaneous branchial remnants was performed in all cases. Results:Postoperative pathological examination showed elastic cartilage. No complications were noticed. Recurrence was not observed in the cases by following-up of 8 months to 52 monthsï¼median: 41 monthsï¼. Conclusion:Cervical chondrocutaneous branchial remnants are relatively rare, which may originate from the second branchial arch and may be associated with other congenital malformations. The curative treatment is a complete excision preschool.
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Músculos del Cuello , Cuello , Humanos , Preescolar , Estudios Retrospectivos , Cuello/cirugía , Cartílago , Imagen por Resonancia Magnética , Región Branquial/cirugía , Región Branquial/anomalíasRESUMEN
PURPOSE: To investigate the therapeutic efficacy, feasibility, and safety of total parathyroidectomy (tPTX) in the treatment of secondary hyperparathyroidism (SHPT). METHODS: The clinical data of 34 SHPT patients admitted to the Department of Nephrology, Yuxi People's Hospital, from January 2018 to January 2021 who had received tPTX, were retrospectively analyzed. The indications for tPTX were severe SHPT that did not respond to medical treatment and was ineligible for kidney transplantation. tPTX without autotransplantation was adopted to compare the level of symptom relief and changes in serum intact parathyroid hormone (iPTH), blood calcium, and blood phosphorus pre- and postoperatively. RESULTS: In 34 patients, 142 parathyroid glands were removed, including 21 ectopic parathyroid glands (14.78%). Six patients (17.64%, 6/34) had supernumerary parathyroid glands. At 6 h postoperatively, arthralgia and bone pain were significantly reduced to almost zero in 94.12% (32/34) of patients. At 24 h postoperatively, relief of bone pain and improvement of limb movement were observed in 100% (34/34) of patients, and pruritus almost disappeared in 86.36% (19/22) of patients. There were significant differences in iPTH (χ2 = 134.93, P < 0.05), calcium (χ2 = 23.02, P < 0.05), and phosphorus (χ2 = 102.11, P < 0.05) levels preoperatively and 40 min, 24 h, 1 week, half a year, and last available (> 1 year) postoperatively. The patients were followed up for 15-47 months (median 33 months). Hypoparathyroidism was observed in three patients, who underwent neck dissection or partial thymotomy concurrently for different reasons. No intractable hypocalcemia or adynamic bone disease occurred during the follow-up period. CONCLUSION: In SHPT patients who were ineligible for renal transplantation, tPTX was effective, safe, and reliable, with a low recurrence rate. However, when tPTX was performed alone without autologous transplantation, bilateral neck exploration was sufficient, and central neck dissection and thymic resection were inadvisable.
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Hiperparatiroidismo Secundario , Paratiroidectomía , Humanos , Estudios Retrospectivos , Calcio , Hiperparatiroidismo Secundario/etiología , Hiperparatiroidismo Secundario/cirugía , Glándulas Paratiroides/cirugía , Hormona Paratiroidea , Trasplante Autólogo , Fósforo , DolorRESUMEN
A 63-year-old female with 3 years of hemodialysis and 1 year of joint pain was treated with calcimimetics and other drugs for a long time. The bone and joint pain did not improve, and the serum PTH continued to rise. The left thyroid nodule was found during the preoperative localization examination of parathyroid gland. Preoperative examination showed that PTH 1258.9 ng/L, Ca 2.48 mmol/L, P 2.32 mmol/L, ALB 36.70 g/L, ALP 227.00 IU/L. Cervical ultrasonography showed thyroid nodules in the left lobeï¼TI-RADS 4bï¼, parathyroid hyperplasia and enlargement, and abnormal lymph nodes in the â ¢ region of the left neck. Postoperative pathology: â Thyroid papillary carcinoma on the left side, the size of the tumor was about 0.7 cm; â¡There were 3 lymph nodes in â ¢ region, of which 1 showed metastasis, and 1 consistent with sarcoidosis; â¢4 parathyroid glands showed proliferative lesions, including the formation of pseudotumor-like nodules on the left upper parathyroid gland with hyperparathyroidism and no cancer invasion; â£There were 6 lymph nodes in the central region, of which 3 showed metastasis; â¤There was 1 prelaryngeal lymph node and showed metastasis; â¥There were 8 lymph nodes in â ¡ region, of which 1 showed metastasis; â¦There were 21 lymph nodes in â £ region, all of which had no metastasis.
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Hiperparatiroidismo , Sarcoidosis , Neoplasias de la Tiroides , Femenino , Humanos , Ganglios Linfáticos , Metástasis Linfática , Persona de Mediana Edad , Disección del Cuello , Sarcoidosis/complicaciones , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
A 6 year-old boy, who complained right neck abscesses and X-ray showed left pyriform fistula, was diagnosed as bilateral pyriform sinus fistulas. For bilateral pyriform sinus fistulas, endoscopic COî2laser cauterization should be the first treatment choice.
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Fístula , Seno Piriforme , Cauterización , Niño , Fístula/cirugía , Humanos , Masculino , Cuello , Estudios RetrospectivosRESUMEN
Objective:To explore the adjacent anatomic relationship and classification of Work â congenital first branchial cleft anomalyï¼CFBCAï¼ in order to guide clinical practice. Method:The data of 48 cases of Work â CFBCA with complete data were analyzed retrospectively. Result:All 48 lesions were completely resected. 48 sidesï¼100.0%ï¼ were anatomically preserved facial nerve, partial parotidectomy was performed on 33 sidesï¼68.8%ï¼, superficial lobe+deep lobe partial parotidectomy was performed on 9 sidesï¼18.8%ï¼, and 6 sidesï¼12.5%ï¼ was not performed parotidectomy. External auditory canal reconstruction was performed on 32 sidesï¼66.7%ï¼; 43 sidesï¼89.6%ï¼ underwent the anatomical preservation of the auricular lobe branch of the great auricular nerve; 9 sidesï¼18.8%ï¼ was performed selective cervical lymphadenectomy at the same time. 45 sides of Work â CFBCA presented irregular cystic or lobulated structure, the lesion was located below and behind the junction of the external auditory meatus bone and cartilage and distributed along the longitudinal axis of the external auditory canal; 3 sides were isolated in superficial lobe parenchyma of parotid gland. All lesions were located on the superficial surface of the main trunk and branches of the facial nerve. The average value of the shortest vertical distance between the lower edge of the lesion and the outlet of the main trunk of the facial nerve at the stylomastoid foramen was 7.2 ï¼0-13.4 ï¼mm. Based on preoperative images and intraoperative findings, according to the adjacent relation with external auditory meatus , parotid gland and facial nerve, the classification of Work â congenital first branchial cleft anomaly is proposed, which is specifically divided into 4 types: C1ï¼posterior wall of the external auditory meatusï¼ 17 casesï¼35.4%ï¼, C2ï¼inferior wall of the external auditory meatusï¼ 13 casesï¼27.1%ï¼, C3 ï¼multi wall of the external auditory meatusï¼ 15 casesï¼31.3%ï¼, C4ï¼isolated from parotid gland parenchymaï¼ 3 casesï¼6.3%ï¼. Conclusion:Work â CFBCA has a close relationship with the adjacent anatomy of the region, and familiar with the classification of Work â congenital first branchial cleft anomaly is helpful for the treatment of type and accurate resection.