Management of lateral cervical metastases in papillary thyroid cancer: patterns of lymph node distribution.

In this article we discuss the management of lateral cervical lymph node metastases in papillary thyroid cancer (PTC). We conducted a retrospective analysis of cases of PTC at our tertiary academic medical center involving 32 patients who underwent 39 neck dissections for the management of lateral cervical metastases from 2000 to 2007. Of these patients, 18 underwent primary neck dissections at the time of thyroidectomy after fine-needle aspiration biopsy confirmed the PTC. Secondary neck dissections for delayed metastases were performed in 14 patients who had previously undergone thyroidectomy for confirmed PTC. All 32 patients had positive nodes in at least one level. Our results highlight the high incidence of multilevel cervical metastasis associated with PTC and suggest the importance of including level II-B (submuscular recess) when performing a neck dissection; the upper posterior triangle (level V-A) is less likely to harbor occult tumor. Lateral neck metastasis from PTC is common and predictable; locoregional control is improved with a formal, comprehensive neck dissection at the time of thyroidectomy.

Modern injection augmentation for glottic insufficiency.

PURPOSE OF REVIEW: A number of technological advancements in recent years have spurred renewed interest in vocal fold injection augmentation. The present review discusses the characteristics of currently available short-term and long-term injection materials, and the advantages and disadvantages of each. RECENT FINDINGS: Many of the newer laryngeal injectable substances were originally used as dermal fillers born out of the plastic surgery and dermatologic literature. Clinical outcomes have improved as a result of exciting advancements in vocal fold injection material availability and design. New substances now closely mimic the native viscoelastic properties of the vocal folds, but the search for the ideal material is ongoing. SUMMARY: The wide array of injectable materials available is both daunting and exciting. Many variables must be considered in choosing the best temporary or long-term injectable material to meet each patient's needs. Surgeons will be better able to optimize patient outcomes by understanding the advantages and disadvantages each has to offer.