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1.
Medicine (Baltimore) ; 98(41): e17567, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593142

RESUMO

RATIONALE: Pediatric-type follicular lymphoma (PTFL) is a rare neoplasm with features that differ from those of adult-type follicular lymphoma. Compared to patients with adult-type follicular lymphoma, PTFL patients often show an excellent response. Preoperative diagnosis is challenging and, therefore, an accurate diagnosis is based on the findings of postoperative pathological examination and immunohistochemistry. PATIENT CONCERNS: A 13-year-old boy presented with a slow-growing mass on the right side of his neck. DIAGNOSES: The patient was diagnosed with PTFL based on the findings of histopathological examination and immunohistochemistry. INTERVENTION: The mass was completely resected. OUTCOMES: After 12 months of postoperative follow-up, the patient achieved good recovery without recurrence. LESSONS: The optimal treatment for PTFL has not yet been defined. However, patients with PTFL always show satisfactory prognoses, regardless of treatment strategy (targeted radiotherapy, multiagent chemotherapy, or "watch and wait" strategy). Clinically, pathological and immunohistochemical analyses are necessary in the diagnoses of PTFL cases, especially for distinguishing PTFL from reactive follicular hyperplasia, to avoid unnecessary treatment.


Assuntos
Linfoma de Células B/patologia , Linfoma Folicular/imunologia , Linfoma Folicular/patologia , Pescoço/patologia , Adolescente , Assistência ao Convalescente , Humanos , Imuno-Histoquímica/métodos , Linfoma de Células B/diagnóstico , Linfoma de Células B/imunologia , Linfoma de Células B/cirurgia , Linfoma Folicular/diagnóstico , Linfoma Folicular/cirurgia , Masculino , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Resultado do Tratamento , Ultrassonografia
4.
Medicine (Baltimore) ; 98(31): e16670, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374044

RESUMO

RATIONALE: Fetal giant cervical cyst (FGCC) is a rare congenital anomaly. Sometimes FGCC may extend into the mediastinum, and result in severe tracheal compression, which is a life-threatening event at birth. PATIENT CONCERNS: We present a rare case of FGCC, which extended from the right neck into the superior mediastinum, and resulted in severe tracheal compression. DIAGNOSES: An FGCC was observed by ultrasonography and magnetic resonance imaging (MRI) at 27+4 weeks' gestation (WG). Fetal MRI at 35+1 WG showed that the FGCC was 3.3 × 8.2 × 7.5 cm and extended from the right neck into the superior mediastinum. Severe tracheal compression was observed and the inside diameter of the narrowest section of tracheostenosis appeared thread-like and measured only 0.1 cm. INTERVENTIONS: Cervical cyst reduction was performed prenatally under ultrasound guidance to alleviate the tracheal compression and maximize the chance of fetal survival 2 days before birth. At 36+3 WG, cesarean section was performed, and a female neonate was immediately delivered and intubated (3.5-mm tube) by an experienced anesthesiologist. Neonatal intralesional sclerotherapy and cystic component aspiration as guided by digital subtraction angiography were performed under general anesthesia. Anesthesia was maintained only with sevoflurane 3% in 2 L/min oxygen. Extubation was performed soon after surgery. OUTCOME: The neonate recovered uneventfully and was discharged 2 days postoperatively. After 140 days of follow-up, the neonate had recovered completely. LESSONS: If an FGCC is suspected by abdominal ultrasound, a fetal MRI is recommended to assess the severity of tracheal compression before birth, if feasible. An anesthesiologist should assess the risk of intubation failure at birth according to those results. If fetal severe tracheal compression is detected and it may result in inability of intubation at birth, prenatal cervical cyst reduction under ultrasound guidance may be effective for alleviating tracheal compression at birth, if feasible. This could maximize the chance of fetal survival. Improvement of fetal short- and long-term outcomes is important.


Assuntos
Fetoscopia/métodos , Hidropisia Fetal/patologia , Hidropisia Fetal/cirurgia , Linfangioma Cístico/patologia , Linfangioma Cístico/cirurgia , Pescoço/patologia , Pescoço/cirurgia , Adulto , Cesárea , Feminino , Idade Gestacional , Humanos , Hidropisia Fetal/diagnóstico por imagem , Recém-Nascido , Intubação Intratraqueal , Linfangioma Cístico/complicações , Linfangioma Cístico/diagnóstico por imagem , Imagem por Ressonância Magnética , Pescoço/diagnóstico por imagem , Pescoço/embriologia , Gravidez , Doenças da Traqueia/diagnóstico por imagem , Doenças da Traqueia/etiologia , Ultrassonografia Pré-Natal
6.
BMC Surg ; 19(1): 98, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340806

RESUMO

BACKGROUND: In this systematic review and meta-analysis, we aimed to determine the risk factors associated with neck hematoma requiring surgical re-intervention after thyroidectomy. METHODS: We systematically searched all articles available in the literature published in PubMed and CNKI databases through May 30, 2017. The quality of these articles was assessed using the Newcastle-Ottawa Quality Assessment Scale, and data were extracted for classification and analysis by focusing on articles related with neck hematoma requiring surgical re-intervention after thyroidectomy. Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS: Of the 1028 screened articles, 26 met the inclusion criteria and were finally analyzed. The factors associated with a high risk of neck hematoma requiring surgical re-intervention after thyroidectomy included male gender (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.60-2.17, P < 0.00001), age (MD: 4.92, 95% CI: 4.28-5.56, P < 0.00001), Graves disease (OR: 1.81, 95% CI: 1.60-2.05, P < 0.00001), hypertension (OR: 2.27, 95% CI: 1.43-3.60, P = 0.0005), antithrombotic drug use (OR: 1.92, 95% CI: 1.51-2.44, P < 0.00001), thyroid procedure in low-volume hospitals (OR: 1.32, 95% CI: 1.12-1.57, P = 0.001), prior thyroid surgery (OR: 1.93, 95% CI: 1.11-3.37, P = 0.02), bilateral thyroidectomy (OR: 1.19, 95% CI: 1.09-1.30, P < 0.0001), and neck dissection (OR: 1.55, 95% CI: 1.23-1.94, P = 0.0002). Smoking status (OR: 1.19, 95% CI: 0.99-1.42, P = 0.06), malignant tumors (OR: 1.00, 95% CI: 0.83-1.20, P = 0.97), and drainage used (OR: 2.02, 95% CI: 0.69-5.89, P = 0.20) were not significantly associated with postoperative neck hematoma. CONCLUSION: We identified certain risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy, including male gender, age, Graves disease, hypertension, antithrombotic agent use, history of thyroid procedures in low-volume hospitals, previous thyroid surgery, bilateral thyroidectomy, and neck dissection. Appropriate intervention measures based on these risk factors may reduce the incidence of postoperative hematoma and yield greater benefits for the patients.


Assuntos
Doença de Graves/cirurgia , Hematoma/cirurgia , Tireoidectomia/efeitos adversos , Drenagem , Doença de Graves/complicações , Hematoma/etiologia , Humanos , Pescoço/cirurgia , Reoperação , Fatores de Risco
7.
Rev. Asoc. Méd. Argent ; 132(2): 12-14, jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1026330

RESUMO

Se revisan la fisiopatología y los mecanismos que producen la sofocación en el hematoma cervical y se determina que el único tratamiento con posibilidades de éxito vital es el inmediato drenaje del hematoma.


In this article are reviewed the physiopathology and the mechanisms that causes suffocation in the cervical hematoma. It is determined that the only treatment with possibilities of vital success is the immediate drainage of the hematoma.


Assuntos
Humanos , Asfixia/etiologia , Drenagem , Hematoma/fisiopatologia , Hematoma/terapia , Complicações Pós-Operatórias , Asfixia/fisiopatologia , Vértebras Cervicais/cirurgia , Pescoço/cirurgia
8.
J Pediatr Surg ; 54(8): 1702-1707, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30981424

RESUMO

PURPOSE: The purpose of this work was to determine the epidemiology and the predictive factors of success of the surgical management of fourth branchial anomalies. METHODS: This is a multicentric retrospective review from 1998 to 2016 of patients who presented with an endoscopically-confirmed fourth branchial pouch anomaly. Data were analyzed according to sex, age, clinical features, number of recurrences, treatment modalities (endoscopic and/or cervicotomy), post-operative complications and follow-up. RESULTS: Fifty-two children have been included. The average age at diagnosis was 4.5 years. Among them, 73.1% were female, 11.4% were neonatal forms; 94.2% of lesions were left-sided; 75% of patients presented a cervical abscess as first symptom, and 7.7% of children presented with dyspnea. Average time between first symptoms and management was 9.5 months. Management was endoscopic in 73.1% of patients (laser in 84.2%, coagulation in 15.8%) with about a third of recurrence after one procedure. Overall success of endoscopic procedures reached 84.2%. A cervical open surgery was performed in 26.9% as first line treatment. Overall success of cervicotomy reached 85.7%. No complications of endoscopic surgery have been identified. There were 35.7% complications of cervicotomy (2 recurrent nerve palsy, 2 keloid scars, 1 pharyngostoma). An association was proved between recurrences and initial abscess (OR = 2.44), and with age between 3 and 5 (OR = 4). CONCLUSION: Endoscopic treatments appear to be effective in first line approach in the management of fourth branchial anomalies, offering an excellent efficiency with rare complications. We identified two risk factors of recurrence: age between 3 and 5 years old and history of cervical abscesses. LEVEL OF EVIDENCE: IV.


Assuntos
Região Branquial/anormalidades , Região Branquial/cirurgia , Pescoço/cirurgia , Abscesso/etiologia , Adolescente , Criança , Pré-Escolar , Dispneia/etiologia , Endoscopia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
9.
Ann Anat ; 224: 97-101, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30998972

RESUMO

INTRODUCTION: Anatomical knowledge and manual skills are required for every surgical procedure. During the regular study the students only have few opportunities to practice their surgical skills actively. To improve this situation, an interdisciplinary hands-on-course for head and neck anatomy and surgery has been set up at the RWTH Aachen University. MATERIALS AND METHODS: The new course has been devised for one week with a full-time schedule. A special anatomical region has been studied each day. After an anatomical lecture, dissections under tutorial instructions took place. According to the anatomical region, a clinical lecture was given. Afterwards, surgical techniques were demonstrated and put into practice on fresh cadaver heads. To check the students' knowledge and the knowledge acquisition during the course, participants had to pass a pre- and post-test. The course was finished with an anonymous written evaluation of the course and an open feedback. RESULTS: The evaluations revealed a very high satisfaction of the students with the course. The post-test showed significant better results in anatomical and clinical knowledge than the pre-test. The mean result of the test was raised from 6.8 to 10.0 (p < 0.001) for the anatomical questions and from 5.9 to 10.5 (p < 0.001) for the clinical questions. CONCLUSION: The new interdisciplinary hands-on course is an effective method to consolidate anatomical knowledge and to link this awareness to a better understanding of head and neck surgery. The students improve their manual skills and get more interested and more open-minded for oral and maxillofacial surgery.


Assuntos
Anatomia/educação , Cirurgia Geral/educação , Cabeça/anatomia & histologia , Cabeça/cirurgia , Pescoço/anatomia & histologia , Pescoço/cirurgia , Cadáver , Educação Médica , Humanos , Gravação em Vídeo
10.
J Med Case Rep ; 13(1): 110, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31029172

RESUMO

BACKGROUND: Cervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer. CASE PRESENTATION: A 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae. CONCLUSIONS: Aggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment.


Assuntos
Abscesso/diagnóstico , Fasciite Necrosante/diagnóstico , Mediastinite/diagnóstico , Pescoço , Abdome/diagnóstico por imagem , Abscesso/terapia , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Drenagem , Fasciite Necrosante/terapia , Humanos , Laparotomia , Masculino , Mediastinite/terapia , Pescoço/diagnóstico por imagem , Pescoço/patologia , Pescoço/cirurgia , Toracotomia , Tórax/diagnóstico por imagem
12.
Eur Arch Otorhinolaryngol ; 276(7): 2105-2108, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31028533

RESUMO

INTRODUCTION: A variant of the innervation of the infrahyoid neck musculature is reported in which the typical looped ansa cervicalis structure is absent. In this variant, the infrahyoid muscles (sternohyoid, sternothyroid omohyoid and thyrohyoid) were innervated by a presumptive superior root of "ansa cervicalis" traveling with vagus nerve (CN X) and not branching from hypoglossal nerve (CN XII). The omohyoid muscle, typically innervated by the inferior root of ansa cervicalis, is instead innervated by nerve fibers branching from the accessory nerve (CN XI). This formation created a non-looping variant of ansa cervicalis. Furthermore, the omohyoid muscle did not attach to the hyoid bone but instead attached to the mastoid process of the temporal bone by merging its fibers superiorly and posteriorly with the clavicular portion of the sternocleidomastoid muscle, creating a "sternocleidoomomastoid" muscle innervated by a branch of accessory nerve. MATERIALS AND METHODS: This variation was found in one black male cadaver from a cohort of 25 male and female cadavers. RESULTS: Only one variation of ansa cervicalis was observed. CONCLUSIONS: As neck dissections and surgical procedures of this region are performed for a variety of conditions-including coronary artery bypass grafting and metastatic neck disease-variations of this type are of broad clinical surgical importance.


Assuntos
Nervo Acessório/patologia , Nervo Hipoglosso/patologia , Esvaziamento Cervical/métodos , Músculos do Pescoço , Pescoço , Análise de Variância , Anatomia Regional , Cadáver , Plexo Cervical/patologia , Feminino , Humanos , Masculino , Processo Mastoide , Pescoço/patologia , Pescoço/cirurgia , Músculos do Pescoço/inervação , Músculos do Pescoço/patologia , Nervo Vago/patologia
13.
J Craniofac Surg ; 30(4): 1268-1269, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30839459

RESUMO

OBJECTIVE: To investigate the 1-stage repair for postoperative wound of large facial malignant tumors. MATERIALS AND METHODS: The angular perforator flap of the face and neck was used for 1-stage rotary advancement repair of the large skin wound following tumor resection. RESULTS: After using the angular perforator flap for 1-stage wound repair, the flap was completely preserved, and the donor incision site healed well. The suture was removed after some 7 to 9 days, and the flap color was similar to that of the surrounding skin. After 12 months follow-up, there was no obvious scar growth observed. CONCLUSION: The design of the neck and face angular perforator flap was flexible with a good blood supply, and thus can be used for 1-stage repair of the large defect wound after facial malignant tumor resection. Also, the observed prognosis was good.


Assuntos
Neoplasias Faciais/cirurgia , Retalho Perfurante/cirurgia , Transplante de Pele/métodos , Idoso de 80 Anos ou mais , Cicatriz/cirurgia , Face/cirurgia , Feminino , Humanos , Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Ferida Cirúrgica/cirurgia
14.
J Cardiothorac Surg ; 14(1): 48, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819218

RESUMO

BACKGROUND: Angiomatoid fibrous histiocytoma (AFH) is a soft-tissue tumor that generally affects the extremities of children and young adults. AFH overlaps with primary pulmonary myxoid sarcoma (PPMS) and can occur in unusual locations. CASE PRESENTATION: We present a case of a 22-year-old female with AFH in the distal trachea. In addition to describing the challenge in making a correct diagnosis of AFH, we describe the first case of successful hybrid bronchoscopic and surgical resection of endotracheal AFH. A staged removal procedure was required to quickly secure the airway, allowing a lower-risk elective distal tracheal resection through a cervical approach for complete resection. A more conventional, but more invasive, more painful and cosmetically less satisfying thoracotomy was avoided. CONCLUSIONS: A distal tracheal resection for AFH can be safely performed in young adults through a cervical approach with excellent follow-up results.


Assuntos
Histiocitoma Fibroso Maligno/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Neoplasias da Traqueia/cirurgia , Broncoscopia , Diagnóstico Tardio , Feminino , Histiocitoma Fibroso Maligno/diagnóstico , Histiocitoma Fibroso Maligno/patologia , Humanos , Imagem por Ressonância Magnética , Pescoço/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/patologia , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/diagnóstico , Neoplasias da Traqueia/patologia , Adulto Jovem
15.
Chirurgia (Bucur) ; 114(1): 103-108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30830851

RESUMO

BACKGROUND AIMS: To describe unilateral and bilateral modified radical neck dissections with access to the thyroid gland and all neck lymph node levels through a single supraclavicular transverse incision. Methods: Ten patients with thyroid or lip carcinomas were submitted to unilateral or bilateral neck dissection through a transverse supraclavicular neck incision. All anterior and lateral neck lymph nodes associated with surrounding fibrofatty tissue were dissected and removed, preserving both sternocleidomastoid muscles and internal jugular veins. Patients with thyroid carcinoma were also submitted to a total thyroidectomy during the same procedure. Results: This surgery was feasible in all patients, preserving oncological principles with no adverse event. Conclusions: A single supraclavicular transverse incision allows adequate access to all levels of the neck lymph nodes, minimises the risk of tissue breakdown and scar disorder, with good cosmetic results. This incision is indicated for radical lymphadenectomy and may be combined with other neck surgeries.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Labiais/cirurgia , Excisão de Linfonodo/métodos , Esvaziamento Cervical/métodos , Neoplasias da Glândula Tireoide/cirurgia , Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Humanos , Neoplasias Labiais/patologia , Metástase Linfática , Pescoço/cirurgia , Ferida Cirúrgica , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(10): e14674, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855457

RESUMO

RATIONALE: Deep neck infections (DNIs) in the head and neck area are difficult to treat due to the anatomical complexity of the cervical region. Since inflammation causes changes in anatomy, it is often difficult to find the exact location of the abscess, which leads to failed surgical drainage. PATIENT CONCERN: A 76-year-old female patient was referred to our clinic with trismus and right-side facial swelling. After extraction of her lower third molar 2 weeks ago, due to chronic periodontitis, her trismus had aggravated and her maximal mouth opening was 20 mm. DIAGNOSES: Computed tomography (CT) revealed an approximately 2.5 cm-sized abscess pocket with cellulitis in the right pterygomandibular space. INTERVENTIONS: Since the first surgical drainage attempt using the intraoral approach under general anesthesia had failed and conservative antibiotic treatment was also ineffective, a second surgical procedure with a CT-guided navigation system was performed and the pus was successfully evacuated. OUTCOMES: After drainage with CT-guided navigation, the clinical symptoms and septic conditions of the patient showed remarkable improvement, and there was no recurrence of infection within a year after the procedure. LESSONS: Drainage with CT-guided navigation can be used as a successful surgical tool to aid in the surgery of patients with DNI when it is difficult to accurately target the abscess due to inflammation.


Assuntos
Abscesso , Antibacterianos/administração & dosagem , Drenagem/métodos , Pescoço , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Extração Dentária/efeitos adversos , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/fisiopatologia , Abscesso/cirurgia , Idoso , Periodontite Crônica/cirurgia , Feminino , Humanos , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Reoperação , Extração Dentária/métodos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(10): e14765, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855479

RESUMO

BACKGROUND: The insufficient reliability of preoperative imaging technology and limited convenience of intraoperative visualizing techniques have been associated with difficulty in surgical navigation in neck endocrine surgery. Indocyanine green (ICG) fluorescence imaging has stood out as the real-time intraoperative guide amidst research for novel modalities, with an emerging use in endocrine surgery. METHODS: We performed a systematic review of the PubMed, Scopus and Embase databases, to identify published studies on parathyroid and thyroid operations employing ICG. Well-described articles were selected according to 7 criteria and analyzed per operation type and organ structure. RESULTS: Twenty-one articles matched our selection criteria. Dosage, equipment, and techniques are well-described in literature. ICG was found to significantly enhance the surgical experience and outcomes. Occasional discrepancy among studies was attributed to the lack of standard quantification of values and divergence of study designs. CONCLUSION: The most successful applications of ICG are:Future research is needed for standard quantification of fluorescence intensity and objective comparisons.


Assuntos
Procedimentos Cirúrgicos Endócrinos , Corantes Fluorescentes , Verde de Indocianina , Pescoço/cirurgia , Imagem Óptica , Cirurgia Assistida por Computador , Humanos , Pescoço/diagnóstico por imagem
18.
J Laparoendosc Adv Surg Tech A ; 29(4): 513-518, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30835151

RESUMO

BACKGROUND: Esophagectomies are a notoriously difficult procedure that have undergone drastic changes over the last decade. In particular, the adoption of minimally invasive esophagectomies (MIEs) as the gold standard. METHODS: We examine the evolution of the MIE, the support for this method, and our preferred methods for the creation of anastomoses following the resection. RESULTS: The submission of techniques that, after many years of practice, have become our standard methods for anastomosing the Neo-esophagus to the remnant esophagus both at the neck, and within the thorax. CONCLUSION: No matter which MIE technique is chosen, these anastomotic methods are readily available. Each is provided with step-by-step instructions, performed with standard laparoscopic instruments, and in a safe and reproducible manner.


Assuntos
Anastomose Cirúrgica/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Humanos , Laparoscopia/instrumentação , Pescoço/cirurgia
19.
Spine (Phila Pa 1976) ; 44(14): 975-981, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30817742

RESUMO

STUDY DESIGN: A mechanism-based reasoning and retrospective cohort study. OBJECTIVE: To establish a quantitative relationship between the change of clivo-axial angle (CXA) and the change of subaxial cervical lordosis (CL) in correction surgery of atlantoaxial dislocation (AAD). SUMMARY OF BACKGROUND DATA: The evolving understanding of mechanism has dramatically improved the treatment modality of AAD. Cervical sagittal alignment is another important aspect of the surgery, in addition to reduction of odontoid process. However, a quantitative reference for correction surgery has not been established. METHODS: Frankfort-axial angle (FXA) was introduced. Based on two assumptions, (1) sagittal alignment of the spine aims at keeping horizontal gaze and (2) deformities at craniovertebral junction make little impact on slope of T1 vertebra, we deduced that the change of CXA equaled change of CL (ΔCXA = -ΔCL). We retrospectively reviewed our case cohort to validate this finding with linear regression analysis. RESULTS: Sixteen cases (eight male and eight female, mean age 40.4±12.5 yr old) were included. Liner fitting equation for ΔFXA and ΔCXA is y=1.005x (coefficient of determination, R=0.966; significance of the estimated coefficients P<0.001, t-statistics) and that for ΔCL and ΔCXA is y=-1.023x (R=0.976, P<0.001). These results support our deduction that ΔCXA = -ΔCL, which can be used as a guidance of quantitative correction of sagittal deformity in AAD. CONCLUSION: Correction of CXA will influence the subaxial cervical lordosis (ΔCXA = -ΔCL) of AAD patients. This equation can serve as a quantitative reference for preoperative planning and intraoperative refining of the correction of cervical sagittal deformity in AAD. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Lesões do Pescoço/cirurgia , Espondiloartropatias/cirurgia , Adulto , Idoso , Feminino , Humanos , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Processo Odontoide/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/cirurgia
20.
J Craniofac Surg ; 30(3): e275-e276, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817539

RESUMO

Cervical lymphangiomas are benign congenital malformations of lymphatic system usually seen in children under 2 years of age. It is rare in adults. They can be seen in any part of the body but the most common area in the neck region is posterior triangle. They usually present as asymptomatic masses. There are various ways of treatment, but the most common treatment modality is surgical resection. Here, the authors present a giant lymphangioma in the neck region of an adult who is treated with surgical resection without any complication.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Linfangioma/cirurgia , Pescoço/cirurgia , Adulto , Humanos
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