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1.
J Coll Physicians Surg Pak ; 31(9): 1111-1113, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34500533

RESUMO

Motor innervation of trapezius and sternocleidomastoid (SCM) muscles is provided solely by the spinal accessory nerve (SAN). SAN palsy most often occurs as a result of iatrogenic injury to the nerve. A patient, who had undergone neck dissection for thyroid cancer, presented with pain and reduced range of motion of the shoulders. Electroneuromyography revealed denervation of the trapezii and SCM muscles secondary to SAN injury. The patient was treated with a course of physical therapy (PT). This case reminds us that a SAN lesion should be considered in the differential diagnosis of a patient presenting with shoulder pain following surgery of the neck. Even though unilateral SAN injury can eventually lead to atrophy of the trapezius, muscle asymmetry may not be obvious, especially in bilateral iatrogenic SAN injuries. In our experience, these patients benefit from PT. However, evidence to support the use of PT in the treatment of shoulder dysfunction secondary to SAN injury is insufficient; the optimum type and timing of PT requires further investigation. Development of best-practice guidelines in terms of management is necessary. Key Words: Spinal accessory nerve, Electroneuromyography, Scapular winging.


Assuntos
Traumatismos do Nervo Acessório , Nervo Acessório , Nervo Acessório/cirurgia , Humanos , Doença Iatrogênica , Esvaziamento Cervical/efeitos adversos , Ombro/cirurgia
2.
Surg Clin North Am ; 101(5): 767-784, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34537142

RESUMO

Cervical endocrine operations include parathyroidectomy, thyroid lobectomy, thyroidectomy, central neck dissection, and lateral neck dissection. The vital structures at risk include the recurrent laryngeal nerves to the intrinsic muscles of the larynx, additional cranial nerves, parathyroid glands essential for calcium homeostasis, aerodigestive structures, and great vessels. Here, the authors discuss complications of endocrine neck surgery, including cervical hematoma and other fluid collections, hypocalcemia from hypoparathyroidism, and nerve injuries, along with their prevention, mitigation, and management. Significant and permanent morbidity can result, but fortunately the overall rate of complications remains low, especially when surgery is performed by high-volume surgeons.


Assuntos
Procedimentos Cirúrgicos Endócrinos/efeitos adversos , Humanos , Esvaziamento Cervical/efeitos adversos , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Tireoidectomia/efeitos adversos
3.
Sultan Qaboos Univ Med J ; 21(3): 481-484, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34522417

RESUMO

Bilateral chylothorax is a rare condition that occurs after a thyroidectomy and neck dissection, which can lead to severe morbidity and, potentially, death, if not managed properly. We report a rare complication of neck surgery and subsequent bilateral pleural effusion in a 35-year-old female patient who presented at Sultan Qaboos University Hospital in 2018 with shortness of breath and respiratory distress. The bilateral pleural effusion and related symptoms occurred one week after a total thyroidectomy with central and left lateral neck dissection. The patient was managed conservatively and subsequently recovered.


Assuntos
Quilotórax , Neoplasias da Glândula Tireoide , Adulto , Quilotórax/etiologia , Quilotórax/cirurgia , Feminino , Humanos , Esvaziamento Cervical/efeitos adversos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos
4.
J Surg Oncol ; 124(5): 740-750, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34152604

RESUMO

BACKGROUND AND OBJECTIVES: The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. METHODS: This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. RESULTS: Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. CONCLUSIONS: IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.


Assuntos
Quimiorradioterapia/mortalidade , Neoplasias de Cabeça e Pescoço/terapia , Esvaziamento Cervical/efeitos adversos , Recidiva Local de Neoplasia/terapia , Complicações Pós-Operatórias/epidemiologia , Terapia de Salvação/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Idoso , Terapia Combinada , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Itália/epidemiologia , Masculino , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Prognóstico , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Taxa de Sobrevida
5.
Ann R Coll Surg Engl ; 103(7): e238-e239, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192484

RESUMO

Head and neck surgeons must have a thorough knowledge of head and neck vascular anatomy and its variations. This case report documents a variation in the superior thyroid artery encountered during a neck dissection and discusses the surrounding literature. A 55-year-old female with squamous cell carcinoma of the tongue underwent a partial glossectomy, right level I-IV neck dissection and reconstruction with a radial forearm free flap. During the procedure, an arterial branch was encountered arising 2-3cm caudal to the common carotid bifurcation. This variant branch was shown to represent the superior thyroid artery. On review of the literature, various classification systems of the superior thyroid artery origin have been described. Awareness of such anatomical variation is vital for the head and neck surgeon to avoid unexpected complication.


Assuntos
Variação Anatômica , Lesões das Artérias Carótidas/prevenção & controle , Artéria Carótida Externa/anormalidades , Complicações Intraoperatórias/prevenção & controle , Esvaziamento Cervical/efeitos adversos , Lesões das Artérias Carótidas/etiologia , Feminino , Glossectomia/efeitos adversos , Glossectomia/métodos , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Glândula Tireoide/irrigação sanguínea , Neoplasias da Língua/cirurgia
6.
Eur Arch Otorhinolaryngol ; 278(9): 3579-3581, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34052866

RESUMO

BACKGROUND: The identification and preservation of the spinal accessory nerve (SAN) is essential in neck surgeries due to possible complications. We report the technique to intraoperative neuromonitoring (IONM) of SAN in functional neck dissections. METHOD: SAN was monitored by needle electrodes placed on the trapezius muscle. Preoperative and postoperative nerve mapping was performed. CONCLUSION: IONM for spinal accessory nerve in patients undergoing neck dissection is a useful technique that can be valuable for neck surgeries where spinal nerve injury is at risk.


Assuntos
Esvaziamento Cervical , Músculos Superficiais do Dorso , Nervo Acessório , Humanos , Monitorização Intraoperatória , Esvaziamento Cervical/efeitos adversos
7.
J Surg Res ; 264: 230-235, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33838407

RESUMO

BACKGROUND: Central neck dissection (CND) remains a controversial intervention for papillary thyroid carcinoma (PTC) patients with clinically negative nodes (cN0) in the central compartment. Proponents state that CND in cN0 patients prevents locoregional recurrence, while opponents deem that the risks of complications outweigh any potential benefit. Thus, there remains conflicting results amongst studies assessing oncologic and surgical outcomes in cN0 PTC patients who undergo CND. To provide clarity to this controversy, we sought to evaluate the efficacy, safety, and oncologic impact of CND in cN0 PTC patients at our institution. MATERIALS AND METHODS: Six hundred and ninety-five patients with PTC who underwent thyroidectomy at our institution between 1998 and 2018 were identified using an institutional cancer registry and supplemental electronic medical record queries. Patients were stratified by whether or not they underwent CND; identified as CND(+) or CND(-), respectively. Patients were also stratified by whether or not they received adjuvant radioactive iodine (RAI) therapy. Patient demographics, pathologic results, as well as surgical and oncologic outcomes were reviewed. Standard statistical analyses were performed using ANOVA and/or t-test and chi-squared tests as appropriate. RESULTS: Among the 695 patients with PTC, 492 (70.8%) had clinically and radiographically node negative disease (cN0). The mean age was 50 ± 1 years old and 368 (74.8%) were female. Of those with cN0 PTC, 61 patients (12.4%) underwent CND. CND(+) patients were found to have higher preoperative thyroid stimulating hormone (TSH) values, 2.8 ± 0.8 versus 1.5 ± 0.2 mU/L (P = 0.028) compared to CND(-) patients. CND did not significantly decrease disease recurrence, development of distant metastatic disease (P = 0.105) or persistence of disease (P = 0.069) at time of mean follow-up of 38 ± 3 months compared to CND(-) patients. However, surgical morbidity rates were significantly higher in CND(+) patients; including transient hypocalcemia (36.1% versus 14.4%; P < 0.001), transient recurrent laryngeal nerve (RLN) injury (19.7% vers us 7.0%; P < 0.001), and permanent RLN injury (3.3% versus 0.7%; P < 0.001). CONCLUSIONS: The majority of patients at our institution with cN0 PTC did not undergo CND. This data suggests that CND was not associated with improvements in oncologic outcomes during the short-term follow-up period and led to increased postoperative morbidity. Therefore, we conclude that CND should not be routinely performed for patients with cN0 PTC.


Assuntos
Esvaziamento Cervical/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Procedimentos Cirúrgicos Profiláticos/efeitos adversos , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/diagnóstico , Metástase Linfática/prevenção & controle , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/estatística & dados numéricos , Recidiva Local de Neoplasia/prevenção & controle , Procedimentos Cirúrgicos Profiláticos/métodos , Procedimentos Cirúrgicos Profiláticos/estatística & dados numéricos , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Resultado do Tratamento
8.
Surg Radiol Anat ; 43(8): 1249-1258, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33665748

RESUMO

PURPOSE: To determine local variations of cervical sympathetic ganglia (CSG) according to vertebral levels on preoperative neck magnetic resonance imaging (MRI) by designating carotid artery (CA) as the standard landmark at the center, in attempts to prevent injury to CSG in the anterior-anterolateral approaches performed in the cervical spinal region. MATERIALS AND METHODS: The retrospective study reviewed neck MRI images of 281 patients, of which the images of 231 patients were excluded from the study based on the exclusion criteria. As a result, the MRI images of the remaining 50 patients were included in the study. The circumference of carotid artery (CA) was divided into eight equal zones with CA defined as the standard landmark at the center. High-risk zones were determined based on the anterior-anterolateral approaches. RESULTS: At C1 level, a superior ganglion was located on the right side in 32 (64%) and on the left side in 30 (60%) patients. At this level, it was most commonly located in Zone 6. Middle ganglion was observed most frequently at C3 level, which was detected on the right side in 17 (34%) and on the left side in 17 (34%) patients. At this level, it was most commonly located in Zone 2. CONCLUSION: Variations in the localizations of superior and middle cervical ganglia should be taken into consideration prior to surgical procedures planned for this region. This study sheds light on high-risk zones in the surgical site and could guide surgeons to better understand the location of cervical sympathetic ganglia before surgical planning.


Assuntos
Pontos de Referência Anatômicos , Artérias Carótidas/anatomia & histologia , Gânglios Simpáticos/anatomia & histologia , Pescoço/inervação , Artérias Carótidas/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Gânglios Simpáticos/diagnóstico por imagem , Gânglios Simpáticos/lesões , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Imageamento por Ressonância Magnética , Pescoço/diagnóstico por imagem , Esvaziamento Cervical/efeitos adversos , Esvaziamento Cervical/métodos , Período Pré-Operatório , Estudos Retrospectivos
9.
J Laryngol Otol ; 135(4): 355-358, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33785086

RESUMO

OBJECTIVE: This study aimed to analyse the results of chyle fistula testing using the SD LipidoCare system in patients who had undergone neck dissections performed in our hospital in 2019. METHOD: Sixty patients who underwent neck dissections from March 2019 to November 2019 were identified based on their medical records. RESULTS: Post-operative chyle fistulas were observed in 3 of 60 patients (5 per cent). All patients who developed chyle fistulas had undergone left-sided neck dissections. Within 3 minutes, the SD LipidoCare test had produced triglyceride results of 49, 56 and 207 mg/dl in the three patients. The remaining 57 patients measured 'low' for triglycerides on the SD LipidoCare test system. CONCLUSION: The SD LipidoCare test quickly and accurately diagnosed chyle fistulas in patients who had undergone neck dissections. All patients improved with conservative treatment following the early diagnosis of chyle fistulas.


Assuntos
Fístula/diagnóstico , Testes Hematológicos/instrumentação , Esvaziamento Cervical/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Triglicerídeos/análise , Adulto , Quilo , Diagnóstico Precoce , Feminino , Testes Hematológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Reprodutibilidade dos Testes
10.
Eur J Endocrinol ; 184(5): R165-R175, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33599211

RESUMO

Background: Permanent postsurgical hypoparathyroidism (POSH) is a major complication of anterior neck surgery in general and of thyroid surgery in particular. Depending on diagnostic criteria, up to 10% of patients undergoing bilateral thyroid surgery develop POSH. This leads to a multitude of symptoms that decrease the quality of life and burden the healthcare provision through complex needs for medication and treatment of specific complications, such as seizures and laryngospasm. Methods: Narrative review of current medical treatments for POSH and of the experience accumulated with parathyroid allotransplantation. Results: In most patients, POSH is controlled with regular use of calcium supplements and active vitamin D analogues but a significant proportion of patients continue to experience severe symptoms requiring repeated emergency admissions. Replacement therapy with synthetic PTH compounds (PTH1-34, Natpara® and PTH1-84, teriparatide, Forsteo®) has been assessed in multicentre trials, but the use of this medication is restricted by costs and concerns related to the risk of development of osteosarcoma. Based on recent case reports of successful allotransplantation of parathyroid tissue between siblings, there is renewed interest in this technique. Data on selection of donors, parathyroid cell preparation before allotransplantation, site and timing of transplantation, need for immunosuppression and long-term outcomes are reviewed. Conclusion: A prospective trial to assess the efficacy of parathyroid allotransplantation in patients with severely symptomatic protracted post-surgical hypoparathyroidism is warranted.


Assuntos
Hipoparatireoidismo/etiologia , Hipoparatireoidismo/terapia , Esvaziamento Cervical/efeitos adversos , Glândulas Paratireoides/transplante , Tireoidectomia/efeitos adversos , Serviços Médicos de Emergência/métodos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Transplante Homólogo
11.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541954

RESUMO

Cavernous sinus thrombosis is a rare but fatal condition arising due to various infectious and noninfectious causes. Although its incidence is very low in the setting of head and neck surgery, including radical neck dissection, a high index of suspicion with prompt treatment is the key to a successful outcome. We report a case of a 50-year-old woman with a chondrosarcoma of left lower alveolobuccal complex who underwent en bloc tumour resection with infratemporal fossa clearance and left modified radical neck dissection. Subsequently, she developed cavernous sinus thrombosis, which was successfully managed with a multidisciplinary approach. This case highlights the importance of high clinical suspicion in the postoperative setting to diagnose this potentially lethal complication.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico , Condrossarcoma/complicações , Neoplasias de Cabeça e Pescoço/complicações , Osteotomia Mandibular , Mioepitelioma , Esvaziamento Cervical/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X
12.
Surgery ; 169(5): 1145-1151, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33446359

RESUMO

BACKGROUND: Although higher thyroidectomy volume has been linked with lower complication rates, its association with incidental parathyroidectomy remains less studied. The volume relationship is even less clear for central neck dissection, where individual parathyroid glands are at greater risk. METHODS: Patients undergoing thyroidectomy with or without central neck dissection were evaluated for incidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Univariate and multivariable analyses were performed using binary logistic regression. RESULTS: Overall, 1,114 thyroidectomies and 396 concurrent central neck dissections were performed across 7 surgeons. Incidental parathyroidectomy occurred in 22.4% of surgeries (range, 16.9%-43.6%), affecting 7.1% of parathyroids at risk (range, 5.8%-14.5%). When stratified by surgeon, lower incidental parathyroidectomy rates were associated with higher thyroidectomy volumes (R2 = 0.77, P = .008) and higher central neck dissection volumes (R2 = 0.93, P < .001). On multivariable analysis, low-volume surgeon (odds ratio 2.94, 95% confidence interval 2.06-4.19, P < .001), extrathyroidal extension (odds ratio 3.13, 95% confidence interval 1.24-7.87, P = .016), prophylactic central neck dissection (odds ratio 2.68, 95% confidence interval 1.65-4.35, P <.001), and therapeutic central neck dissection (odds ratio 4.44, 95% confidence interval 1.98-9.96, P < .001) were the most significant factors associated with incidental parathyroidectomy. In addition, incidental parathyroidectomy was associated with a higher likelihood of temporary hypoparathyroidism (odds ratio 2.79, 95% confidence interval 1.45-5.38, P = .002) and permanent hypoparathyroidism (odds ratio 4.62, 95% confidence interval 1.41-5.96, P = .025), but not permanent hypocalcemia (odds ratio 1.27, 95% confidence interval 0.48-3.35, P = .63). Higher lymph node yield in central neck dissection was not associated with higher incidental parathyroidectomy rates (odds ratio 1.13, 95% confidence interval 0.85-8.81, P = .82). CONCLUSION: Higher surgical volume conferred a lower rate of incidental parathyroidectomy. Nonetheless, greater lymph node yield in central neck dissections did not result in greater parathyroid-related morbidity. Such findings support the value of leveraging surgical volume to both optimize oncologic resection and minimize complication rates.


Assuntos
Erros Médicos/estatística & dados numéricos , Esvaziamento Cervical/efeitos adversos , Paratireoidectomia/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Tireoidectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/estatística & dados numéricos , Estudos Retrospectivos , Tireoidectomia/estatística & dados numéricos
13.
Eur Arch Otorhinolaryngol ; 278(2): 509-516, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32621248

RESUMO

PURPOSE: Lack of routine screening for a range of physical impairments that can result after neck dissection (ND) may hinder physiotherapy referral and treatment. The purpose of this study was to implement an intervention that targeted both physiotherapists and surgeons to increase their post-operative physical screening of ND patients and in turn improve physiotherapy referral rates. METHODS: The authors undertook a translational controlled pilot study, conducted over a 12-month period that utilised three tertiary hospital sites. The target groups were physiotherapists at one intervention site and surgeons at the other intervention site, with the third hospital acting as a control site and receiving usual care. The intervention included a physiotherapy brochure and a clinical pathway for screening, to promote early identification and prompt referral of patients with a physical impairment. The primary outcome variables were screening and referral rates between sites at the study end-point. RESULTS: Logistic regression analyses were conducted on n = 174 to assess differences in screening and referral rates between sites. Patients at the intervention site that targeted physiotherapists had four times the odds of being screened for shoulder dysfunction compared to the control site (p = 0.0002), and three times the odds of being referred to physiotherapy (0.0039). There were no statistically significant differences in the odds of patients being screened for shoulder dysfunction or referred to physiotherapy at the intervention site that targeted surgeons. CONCLUSION: The translational intervention undertaken by physiotherapists resulted in significantly greater screening and referral rates of post-operative ND patients for physiotherapy.


Assuntos
Esvaziamento Cervical , Modalidades de Fisioterapia , Humanos , Esvaziamento Cervical/efeitos adversos , Projetos Piloto , Encaminhamento e Consulta , Ombro
14.
Eur Arch Otorhinolaryngol ; 278(4): 1189-1198, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32691233

RESUMO

PURPOSE: The purpose of the study was to investigate the predictive factors for hypoparathyroidism and its severity on the first postoperative day (POD1) after total thyroidectomy (TT) with or without central neck dissection (CND) in patients with papillary thyroid carcinoma (PTC). METHODS: From February 2014 to February 2019, 2550 PTC patients were admitted to our department. PTC patients who underwent TT were enrolled in this study. A parathyroid hormone (PTH) level lower than 15 pg/mL on POD1 was defined as hypoparathyroidism, and the severity of hypoparathyroidism was classified into three categories according to the level of PTH on POD1: mild hypoparathyroidism (10 pg/mL ≤ PTH < 15 pg/mL), moderate hypoparathyroidism (5 g/mL ≤ PTH < 10 pg/mL), and severe hypoparathyroidism (PTH < 5 pg/mL). Multiple clinical, pathological and surgical parameters of these two different groups were compared and analyzed to demonstrate the possible causes of hypoparathyroidism. Furthermore, patients who developed postoperative hypoparathyroidism were also included in a subgroup analysis according to the severity of their hypoparathyroidism. The underlying factors affecting different severities of hypoparathyroidism were also illustrated with univariate and multivariate analyses. RESULTS: Ultimately, 690 patients who underwent TT were enrolled in this retrospective study. Through the univariate analysis, different surgeons (P < 0.001), extent of CND (P = 0.009), prophylactic calcium supplementation (PCS) (P < 0.001), preoperative (pre-op) PTH level (P < 0.001), and pre-op phosphorus concentration (P = 0.022) were found to be significantly correlated with postoperative hypoparathyroidism. According to the multivariate analysis, PCS was the only independent high-risk factor for hypoparathyroidism. In the univariate analysis of patient subgroups with different severities of hypoparathyroidism, we demonstrated that the tumor T stage (P = 0.021) and pre-op PTH level (P < 0.001) were associated with the severity of hypoparathyroidism. Furthermore, after the multivariate analysis, hypertension (P < 0.001) and pre-op PTH (P < 0.001) were the two independent predictive factors for the severity of hypoparathyroidism after surgery. CONCLUSIONS: Postoperative PCS could increase the risk for PTC patients developing hypoparathyroidism after thyroid surgery. Patients with a history of hypertension and a relatively high pre-op PTH level may not develop severe hypoparathyroidism after TT with CND.


Assuntos
Hipoparatireoidismo , Neoplasias da Glândula Tireoide , Humanos , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/epidemiologia , Hipoparatireoidismo/etiologia , Esvaziamento Cervical/efeitos adversos , Hormônio Paratireóideo , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos
15.
Laryngoscope ; 131(5): E1489-E1495, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33016340

RESUMO

OBJECTIVES/HYPOTHESIS: The individualized risk of airway obstruction after head and neck cancer surgery is unclear, especially oral and oropharyngeal cancer. The study aimed to establish an individualized predictive model for the necessity of temporary tracheotomy in these patients. METHODS: Patients who underwent oral and oropharyngeal cancer surgery from 1999 to 2019 were retrospectively reviewed. A nomogram was developed and validated in patients treated from 1999 to 2009 and 2010 to 2019, respectively. RESULTS: In total, 1551 patients were included. Oropharyngeal cancer, large tumor, midline crossing, preoperative radiation, mandibulectomy, flap reconstruction, and neck dissection were independent risk factors of postoperative airway obstruction in the training group (n = 707). A nomogram incorporating these factors had a C-index of 0.931 and was validated in the testing group (n = 844) (C-index, 0.918). Good calibration curves were observed in both groups. CONCLUSIONS: The nomogram successfully predicted the individual risk of postoperative airway obstruction for patients with oral and oropharyngeal cancer. LEVEL OF EVIDENCE: 4. Laryngoscope, 131:E1489-E1495, 2021.


Assuntos
Obstrução das Vias Respiratórias/epidemiologia , Neoplasias Bucais/cirurgia , Neoplasias Orofaríngeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Traqueotomia/estatística & dados numéricos , Adolescente , Adulto , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Feminino , Humanos , Masculino , Osteotomia Mandibular/efeitos adversos , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Nomogramas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/transplante , Adulto Jovem
17.
Ann Vasc Surg ; 70: 230-236, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32795652

RESUMO

BACKGROUND: Patients meeting criteria for intervention of carotid stenosis with a history of prior cervical radiation or neck dissection are considered "high risk" for carotid endarterectomy. This is a well-established indication for carotid artery stenting (CAS). The long-term outcomes of CAS in this population are less frequently published in the literature but are poor. The purpose of this study was to review long-term results of CAS in veteran patients with a prior history of treatment for head and/or neck cancer. METHODS: This is a retrospective review of a veteran patient population from 1998 to 2016. All patients at our institution with a prior history of treatment for head and/or neck cancer who underwent CAS were included in the analysis. During this time period, 44 patients met inclusion criteria and were treated with 57 carotid stenting interventions. The Kaplan-Meier analysis was used to determine survival and primary patency. The secondary aims were to analyze early outcomes and to identify predictive risk factors for mortality and reintervention. RESULTS: The mean follow-up was 42.9 ± 36.6 months. The cumulative survival at 1, 5, and 10 years was 91%, 67%, and 48%, respectively. The primary patency at 1, 5, and 10 years was 95%, 86%, and 86%, respectively. The reintervention rate was 11% (n = 6) with an assisted primary patency rate of 100%. No neurologic events occurred within 30 days. There were 3 strokes in late follow-up and no stroke-related deaths. Eighteen patients (41%) died during the follow-up period, 15 of whom died during the first 5 years of follow-up. Ten (66%) of those patients died of recurrent or active index cancer. On univariate analysis, tumor, node, metastasis stage IV was significantly associated with death (P = 0.02). Multivariate models were not statistically significant for predicting mortality or reintervention CONCLUSIONS: On the basis of the results in this series, CAS can be performed in these patients with low long-term rates of neurologic events and need for reintervention. However, the survival of patients with head and neck cancer undergoing CAS in this cohort is poor, which is consistent with other published series of patients undergoing CAS for head/neck cancer with at least 5-year follow-up. In this specific patient population, a more critical analysis of the patient's overall prognosis, especially as related to cancer, should be undertaken before offering CAS.


Assuntos
Estenose das Carótidas/terapia , Procedimentos Endovasculares/instrumentação , Neoplasias de Cabeça e Pescoço/terapia , Esvaziamento Cervical/efeitos adversos , Lesões por Radiação/terapia , Stents , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Estenose das Carótidas/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/mortalidade , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/mortalidade , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Saúde dos Veteranos
18.
J Plast Reconstr Aesthet Surg ; 74(6): 1239-1245, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33288470

RESUMO

BACKGROUND: Free flap failure secondary to internal jugular vein thrombosis (IJVT) is a significant complication after head and neck reconstructive surgery. A consensus has not yet been reached among reconstructive surgeons regarding the treatment of IJVT. METHODS: We retrospectively evaluated the incidence of IJVT in 118 patients who underwent free flap reconstruction at Hyogo Cancer Center, Akashi, Japan. The occurrence of IJVT-related flap circulation crisis and pulmonary thromboembolism (PTE) was studied. This study was approved by the institutional ethics committee, and written informed consent was obtained from each patient. RESULTS: From 118 patients who underwent head and neck reconstructive surgery, we included 116 internal jugular veins (IJVs) preserved after neck dissection in the present study. IJVT was confirmed in 25 (21.6%) IJVs from 23 patients. One patient (0.8%) developed venous congestion due to IJVT, which resulted in total flap necrosis. Two patients (1.7%) exhibited PTE associated with IJVT. They were treated with direct oral anticoagulants for 3 months and were discharged without any sequelae. CONCLUSION: Our results suggest that IJVT after head and neck reconstructive surgery caused not only flap circulation crisis but also PTE. Reconstructive surgeons should be aware of the potential risks due to serious complications associated with IJVT.


Assuntos
Retalhos de Tecido Biológico , Veias Jugulares , Esvaziamento Cervical , Complicações Pós-Operatórias , Embolia Pulmonar , Procedimentos Cirúrgicos Reconstrutivos , Trombose Venosa , Inibidores do Fator Xa/administração & dosagem , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/irrigação sanguínea , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Incidência , Japão/epidemiologia , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/patologia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Esvaziamento Cervical/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Risco Ajustado/métodos , Trombose Venosa/tratamento farmacológico , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Trombose Venosa/fisiopatologia
20.
J Plast Reconstr Aesthet Surg ; 74(6): 1269-1278, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33257300

RESUMO

This article aims to illustrate various applications of facial artery-based islanded myomucosal (iFAMM) and osseous/osteo-myomucosal flaps (iFOMM) in head and neck reconstruction. A retrospective analysis of 75 patients who underwent the reconstruction of various head and neck mucosal defects with iFAMM/iFOMM in a tertiary head and neck cancer department from May 2015 to May 2019 was performed. The patients had surgery for cancer, which involved the oral tongue, floor of mouth, oropharynx, lower alveolus, larynx, hypopharynx, cricopharynx and trachea. iFOMM was used in 3 patients. Functional and esthetic outcomes, short-term and long-term complications were analyzed. The flap was successful in 74 out of 75 patients. Speech was intelligible in almost all patients and majority of patients could take oral feeds without any restrictions. The esthesis of reconstruction was scored high with a mean visual analog scale score of 8.4. The most commonly observed complication was marginal mandibular paresis, which improved with time. Mouth opening was >3 cm in 68/75 patients. Adjuvant radiation was a common factor in patients with <3 cm mouth opening. Flap was sensate by 4 months in majority of patients. The reach, pliability, and esthetics of the flap combined with recoverable morbidity of donor site present in the facial artery-based flap as a good option in the reconstruction of various head and neck subsites. Reduced operative time, lesser complication rates, less financial burden, and simplicity of the procedure make it a cost-effective alternate solution for reconstruction.


Assuntos
Músculos Faciais , Neoplasias de Cabeça e Pescoço , Membrana Mucosa/transplante , Esvaziamento Cervical , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Artérias/cirurgia , Músculos Faciais/irrigação sanguínea , Músculos Faciais/transplante , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Esvaziamento Cervical/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/transplante , Escala Visual Analógica
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