Thyroid surgery in children and adolescents: A series of 65 cases

ObjectivesTo describe the specificities and complications of thyroid surgery in children and adolescents.Material and methodsThis retrospective study was based on 64 patients under the age of 18 who underwent thyroid surgery between January 2004 and March 2012, with two operations in one case. The following data were analysed: anatomical variants of the recurrent laryngeal nerve, postoperative recurrent laryngeal nerve paralysis rate, postoperative hypoparathyroidism rate, and histological results.ResultsTwo cases of right non-recurrent inferior laryngeal nerve were observed (2.2% of the 93 recurrent laryngeal nerves dissected). One case of persistent left recurrent laryngeal nerve paralysis was observed (1.1%) despite intraoperative recurrent laryngeal nerve monitoring. Eight cases of immediate postoperative hypocalcaemia were observed (23.5% of the 34 total thyroidectomies) and permanent hypocalcaemia was observed in 5 cases (14.7%) with a significantly lower immediate postoperative serum calcium than in the case of transient hypocalcaemia (P = 0.035). Among the 11 patients operated for familial medullary thyroid carcinoma (MTC), 36.3% presented one or more sites of C-cell carcinoma. Among the 32 patients operated for thyroid nodule, 6.3% presented papillary adenocarcinoma. Histological results were benign in all other cases.ConclusionsThyroid surgery in children and adolescents is part of global multidisciplinary management of thyroid disorders in children. Recurrent laryngeal nerve paralysis is a rare complication, but may occur despite the use of intraoperative recurrent laryngeal nerve monitoring. Permanent hypoparathyroidism is the most common complication and is correlated with immediate postoperative serum calcium. Systematic prophylactic total thyroidectomy in patients with a RET proto-oncogene mutation allowed early diagnosis of MTC in one-third of cases. In view of the low rate of malignant nodules in our series, the malignant thyroid nodule rates reported in children in the literature may be overestimated.     

Acoustic neuroma surgery. Results and complications in 348 cases

OBJECTIVES: The aim of this study was to evaluate post-operative complications after acoustic neuroma surgery. METHODS: This was a retrospective study of 348 patients, who had acoustic neuroma surgery between 1984 and 1999. Symptoms, pre-operative evaluation, surgery and post-operative complications were analysed. RESULTS: 174 men and 174 women had an operation. Mean age was 51.8 years (11-78). 31 patients had a grade I tumour, 106 a grade II, 71 a grade III and 140 had a grade IV tumour. 195 patients have been operated through the translabyrinthine approach, 110 through the retrolabyrinthine approach, 42 through the sub-occipital approach, and one through the transcochlear approach. Mortality was 0.85%, 59.2% patients had a post-operative facial paralysis. Most of patients had post-operative dizziness, and 30% still had vestibular disturbances after one year. 9 patients (2.6%) had a cerebrospinal rhinorrhea and 24 patients had a cerebrospinal wound leak (6.9%). 22 patients had post-operative meningitis (6.3%). 2 patients had a cerebello pontine angle haemorrhage, and 3 patients had a brain stem infarct. CONCLUSION: Transpetrous approaches are safe for acoustic neuroma removal and the post-operative complication rate is low. The retrolabyrinthine approach seems to be a good hearing preservative approach, regardless of tumour volume.     

鼻窦内窥镜手术眼眶并发症117例分析

目的:探讨鼻窦内窥镜手术眼眶并发症的原因及预防。方法:回顾分析1998年2月至2004年3月行鼻内窥镜手术3?514例的临床资料。结果:117例（侧）发生眶并发症,其中一侧内直肌受损2例,眶内蜂窝织炎12例,眶脂肪疝出14例,眶周瘀斑89例,总发生率为3.33%。结论:熟悉鼻内镜下的解剖结构、标志及定位,术前仔细阅片、术中精确定位判断对预防眶并发症十分重要。     

鼻内镜鼻窦手术颅内并发症2例

鼻内镜下鼻窦开放是有效治疗鼻窦炎、鼻息肉的方法和手段,各地已广泛开展,临床上常只注重其积极治疗作用的一面,对其并发症,尤其是颅内严重并发症重视不够,术者缺乏有关知识,无防范和预防措施,这是十分危险的。最近我院发生2例     

Paraganglioma surgery: complications and treatment

Paragangliomas are vasculature in nature and are surrounded by vital neurovascular structures. The extirpation of these lesions requires careful preoperative evaluation, meticulous surgical technique, and the aid of experienced skull base surgical and rehabilitative teams. When surgery is performed in this way, complications can be minimized, and the function of the upper aerodigestive tract can be protected.     

Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery.

OBJECTIVE: Retrospective study and review of the complications other than those related to the facial nerve and hearing, encountered in acoustic neuroma surgery. Also, an evaluation of hospital stay and its relation with various factors. STUDY DESIGN: Retrospective case review. SETTING: Tertiary neurotologic and skull base referral center. PATIENTS: A series of 707 patients who underwent surgical removal of acoustic neuroma from April 1987 to December 2001. INTERVENTIONS: The surgical approaches used were the enlarged translabyrinthine approach, the enlarged middle fossa approach, and the retrosigmoid approach. In a small number of cases, the operations were performed through other approaches. MAIN OUTCOME MEASURES: The duration of hospital stay and appearance of complications in the perioperative period along with their management. Results related to the facial nerve and hearing were not considered in this study. RESULTS: The most frequent complication was abdominal subcutaneous hematoma (site of fat harvest), which occurred in 23 patients (3.2%). Cerebrospinal fluid leak was present in 20 patients (2.8%), 15 of whom needed revision surgery. Other complications included VIth cranial nerve dysfunction in 12 cases (1.68%), subdural hematoma in 3 cases (0.4%), cerebellopontine angle hematoma in 4 cases (0.6%), cerebellar edema in 2 cases (0.28%), brainstem hematoma in 1 case (0.14%), transitory aphasia in 1 case (0.14%), and lower cranial nerve dysfunction in 1 case (0.14%). Mortality occurred in only one case (0.14%). Medical complications seldom occurred. The postoperative hospital stay ranged from 2 to 36 days, with an average of 6.4 days. The overall hospital stay diminished over time from 10.2 days in 1987 to 1990, to 4.9 days in 2001. There was a significant relation between hospital stay and tumor size, approach used, and presence/absence of complications. CONCLUSIONS: Perioperative complications in acoustic neuroma surgery do exist, but this study demonstrated how low the incidence is. The authors believe that the low percentage of complications is mainly attributable to the majority of operations being carried out in specialized clinics, where they are considered routine operations. They believe that following individualized approaches, depending on tumor size and on the preoperative function of the cranial nerves, is the proper way to reach a significant reduction in complications while maintaining a high percentage of total tumor removal. The results of this study, considered as a basis of comparison with other studies, will certainly be useful in preoperative patient counseling.     

气管支气管异物特殊并发症５例的治疗与分析

目的 探讨气管支气管异物的特殊并发症治疗与分析。方法 回顾性分析943例气管、支气管异物患儿的病历资料,均行支气管镜下异物取出术。异物顺利取出 907例,围手术期出现并发症36例。结果 围手术期出现特殊并发症5例,包括椎管积气3例、气管食管瘘1例、负压性肺水肿1例。结论 针对此类特殊并发症发生原因进行分析,以探讨此类并发症的预防和处理措施,以减少气管支气管异物围手术期并发症发生率,降低死亡率。     

Traditional endonasal and microscopic sinus surgery complications versus endoscopic sinus surgery complications: a meta-analysis

The aim of this study was to compare the incidence of complications of endoscopic sinus surgery (ESS) to the incidence of complications of traditional and microscopic sinus surgery. A meta-analysis was carried out on 28 series of patients (a total of 13,405) who had undergone ESS, 8 series of patients (3,887 in total) who had undergone traditional endonasal sinus surgery and 7 series of patients (1,630 in total) who had undergone microscopic sinus surgery. The authors used the Bayesian inference package WinBUGS operating from within the statistical computer program R (version 2.7.1). Major complications had a higher incidence after traditional sinus surgery than ESS but this fact did not cause a significant statistical difference, whereas microscopic surgery had significantly more complications than ESS (p < 0.05). Carrying out our meta-analytic study, comparing major and minor complications of endonasal surgical approaches, was very difficult due to several methodological biases of data extraction and evaluation from studies concerning a broad timespan. Regarding major complications, we only found a significant statistical difference (p < 0.05) between the endoscopic (1%) and the microscopic methods (2.0%), but, if we had analyzed the data considering the natural learning curve of the latest ESS surgical approach, and if we had not considered the results produced in the first 10 years (1988–1998) concerning ESS in our meta-analysis, we would have found a statistically significant difference (p < 0.05) between the endoscopic (0.4%) and the traditional (1.1%) approach as well.     

Stapes surgery: complications and airway infection

From a group of 1,111 patients who had stapedectomy or stapedotomy performed in a 10-year period, a thorough investigation was made of 11 patients who had a total hearing loss and 8 patients who developed a partial sensorineural hearing loss after operation. The data obtained indicate that postoperative infection with influenza virus may be responsible for unexpected complications following stapedectomy. A close relation was found between the appearance of complications and periods of epidemics of influenza.     

Otosclerosis surgery: hearing results and complications

A retrospective study was made of 183 stapedectomies performed at the Santiago de Compostela Hospital from 1989 to 1996. Sixty-seven percent (67.3%) of patients were women and 32.7% were men. Good results were obtained in 87% of cases (79% had an air-bone gap closure difference under 10 dB, and 8% 10-20 dB). Ten pefect had not change in air threshold and the rest deteriorated. There were no significant differences between stapedectomy and stapedotomy. The 4. 000-Hz improvement obtained was inferior to those in 500, 1,000 and 2,000 Hz. In 8.7% of patients with obliterated footplate, heaving outcome was significantly worse. In patients with exposed or overhanging facial nerve, floating footplate, middle ear fibrosis, and necrosis of the long incus process had better results. Total sensorineural hearing loss occurred in 1.1% of cases.     

Thyroid surgery: changing patterns of practice

Objective: The practice of thyroidectomy has evolved over the past 10 years with the introduction of minimally invasive surgery, laryngeal nerve monitoring, and outpatient surgery. We sought to investigate corresponding trends in the disciplines performing thyroid surgery. Methods and Materials: The authors conducted a nonrandomized, case‐controlled comparison of surgical volumes and systematic analysis of publication volumes. Two surrogates for the proportion of thyroidectomies being performed by otolaryngologists–head and neck surgeons (OHNS) and general surgeons (GS) were chosen: 1) the operative case logs of graduates from American training programs in OHNS and GS from 1995 through 2004 were compared; and 2) the number of scientific articles published relating to thyroid surgery were systematically queried for two timeframes (1990–1994 and 2000–2004). Results: There was a gradual increase in the mean number of thyroidectomies performed by GS residents from 13.2 in 1995 to 18.2 in 2004. During the same timeframe, the mean number of thyroidectomies performed by OHNS residents more than doubled from 15.0 to 33.5. The number of American GS thyroid publications from 1990 to 1994 was 79, compared with 98 in the period 2000 to 2004, representing a 24% increase. During the same timeframe, the number of American OHNS articles increased from 14 to 49 (a 250% increase). The relative proportion of thyroid publications authored by American otolaryngologists more than doubled from 15.1% to 33.3% (P = .0017). Conclusions: A clear trend is emerging in the pattern of thyroid surgery in that a growing proportion of publications are being authored by otolaryngologists compared with general surgeons, and the average number of procedures performed by graduating chief residents is now 84% higher in otolaryngology compared with general surgery.     

Thyroid surgery: surgical and metabolic causes of hypocalcemia

Patients undergoing radical surgical treatment of head and neck neoplasms often are seen with a history of cirrhotic liver disease, electrolyte abnormalities, and other stigma of chronic disease. Despite skillful thyroid surgical technique performed as an isolated procedure or in combination with other procedures such as laryngectomy, hypocalcemia can occur. Common causes of lowered serum calcium levels secondary to removal of parathyroid glands, blood transfusions, hypoalbuminemia, gastrointestinal malabsorption, and renal insufficiency are well known. Less well known is the recently elucidated role of dependence of calcium metabolism on magnesium. Recently, it has been well documented that alcoholism directly lowers serum magnesium levels in both human and animal models without prior liver disease or malabsorption. The fact that three mechanisms are needed to explain calcium homeostasis implies that the magnesium-calcium interdependence is not clearly understood.     

中耳炎的颅内外并发症

目的：探讨化脓性中耳炎引起颅内外并发症的临床特征。方法：回顾性分析1993年3月一2002年8月我院收治的有颅内外并发症的急慢性化脓性中耳炎患者60例的临床资料。结果：60例患者中，单项并发症49例(81．6％)，2项以上并发症11例(18．3％)，总计74例次，其中乙状窦病变13例，硬膜外脓肿2例，脑膜炎4例，脑脓肿3例，迷路炎20例，耳周围脓肿18例，颈部脓肿2例，面瘫12例。结论：颅内外并发症的发病率较以前有所降低，严重的并发症少见；影像学检查可提供重要的诊断依据，手术探查是最可靠的诊断和治疗方法。     

Thyroid surgery in children and adolescents

Authors present 114 children and adolescents of the total 3865 patients that underwent surgery on the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Department of Otorhinolaryngology of IPVZ, Prague because of a thyroid disease in years 1991-2000. The male/female ratio in the group was 1:6.5, 16 (13.9%) males and 99 (86.1%) females. For non-malignant disease, the male/female ratio was 1:6.5 and for malignant disease, it was 1:5.4. Thyroid surgery was indicated for non-malignant disease in 82 (71.9%) cases--11 males and 71 females. Most frequently it was indicated because of Graves-Basedow and Hashimoto toxicosis--in 39 children (34.2%), in 5 children (4.4%) for toxic adenoma. Because of the polynodular goiter surgery was indicated in 13 cases (11.4%), in 22 cases (19.3%) for mononodular goiter. Three girls (2.6%) were recommended for surgery because of Hashimoto thyreoiditis and for mechanic syndrome in diffuse goiter one girl (0.9%). Malignant tumor was found in 32 children (28.1%)--5 males and 27 females. Most frequent histological type was papillary cancer--in 25 cases (21.9%). Follicular cancer was diagnosed in four cases (3.5%) and medullar cancer in three cases (2.6%). TNM classification in children and adults is summarized in Table 1. Surgery was carried out in two children with distant metastases (lung localization). In both children the pre-disease stage lasted more than 12 months. The first manifestation of the disease was a finding of enlarged and palpable nodes on the neck. The authors summarize indications for surgery of thyroid diseases in children and adolescents. A treatment of the thyroid gland is a teamwork. Indication for surgery is carried out by a pediatric endocrinologist in cooperation with a surgeon specialized in thyroid surgery. The possible identification of the recurrent laryngeal nerve by a surgery microscope is an unquestionable advance. Children and adults should be centralized into health-care centers capable not only of surgery, but also of endocrinology care. In children with a malignant disease there is a need for cooperation with a pediatric oncologist and a following oncological treatment on a nuclear medicine department. The authors summarize the information about today's thyroid surgery care possibilities for children and adolescents. They point out the differences in indications and the decision about extent of surgery in children and adolescents.     

躯体形式障碍在耳鼻咽喉-头颈外科的表现(附4例报告)

目的：为强调“生物-心理-社会”医学模式在耳鼻咽喉临床工作中的重要性。方法：报告4例典型的躯体形式障碍（somato-form disorder）的耳鼻咽喉患者的临床表现和治疗,并对其发生原因、经验教训进行讨论。结果：4例患者虽有耳鼻咽喉头颈外科疾病,但均有躯体型精神障碍,其中2例自杀,另2例经适当治疗治愈。结论：在临床实践中应注意患者的心理社会因素在疾病发生过程中的作用,以改进治疗措施。     

Thyroid and parathyroid surgery in pregnancy

The consideration of surgery during pregnancy requires weighing the benefit of urgent surgery against the risk to mother and fetus. Surgery during pregnancy involves an increase in both maternal and fetal risks. Thyroid and parathyroid surgery involves physiological risks to both mother and fetus specific to the disease and function of these endocrine glands. Evaluation of a thyroid mass is similar in pregnant patients with ultrasound and fine-needle aspiration biopsy providing the most important information, while the use of radiographic imaging is severely constrained except when specifically required. In general, thyroid surgery can be delayed until after delivery except in cases of airway compromise or aggressive cancer. In contrast, parathyroid surgery is recommended during pregnancy to avoid adverse effects to the neonate.     

鼻窦内窥镜手术严重并发症的预防及处理(附3例报告)

目的分析功能性鼻窦内窥镜手术(FESS)中罕见严重并发症的原因,探讨避免及发生后的处理方法.方法回顾分析3例鼻窦内窥镜手术严重并发症的术中情况,患者全身情况,术者情况,及严重并发症发生的原因.结果发生严重并发症者术中出血均较多,视野不清,手术器械设备状况不好,有的与患者体质有关.结论对拟行鼻窦内窥镜手术的患者须行全面细致的体格检查,对术中可能发生的并发症做出应急预案,发生后针对具体情况有针对性地处理.     

Association of chronic pulmonary obstructive disease (COPD) and complications in head and neck surgery

COPD presents in a variety of forms patients with head and neck cancer; it may affect therapeutic decision-making or postoperative outcomes due to its complications.Aim: To correlate the severity of COPD in patients with head and neck SCC treated with surgery, who present postoperative complications.Method: A retrospective analysis of 31 patients undergoing en bloc resections, from 2008 to 2009. All cases were evaluated and classified using the GOLD scale. The COPD grade, intubation period, ICU stay and hospital stay were studied.Results: The mean age was 64.8 years; COPD was mild in 24 cases, moderate in 6 and severe in 1 case. ICU stay was 2.7 days and the intubation period was 1,12 days. The mean hospital stay was 24.4 days. There was no relation between COPD grade and brochopneumonia, intubation period, ICU stay and hospital stay.Conclusion: Patients with head and neck SCC have a tendency to acquire COPD; its severity was not related with postoperative pulmonary complications, prolonged intubation period, ICU stay and hospital stay.