Abstract
BackgroundThe influences of patients’ different mandibular jawlines on transoral endoscopic thyroidectomy via vestibular approach (TOETVA) have not been described before. The objective of this study was to introduce a new classification to assess different mandibular jawlines, and to evaluate the effects on TOETVA in terms of safety, feasibility, and postoperative feelings in the treatment of papillary thyroid carcinoma (PTC).MethodsThe crossing angle of esthetic plane and mandibular plane was defined as Wang Angle, used to assess patients’ different mandibular jawlines. Mandibular classifications of A (angle: 80° ~ 110°), B (angle > 110°), and C (angle < 80°) types were compared to evaluate the surgical outcomes of TOETVA by a retrospective study. 690 patients of PTC who received TOETVA were included in this study, which were divided into three groups according to mandibular classifications.ResultsClinicopathological characteristics of the patients including age, gender, body mass index, tumor size, Hashimoto thyroiditis were similar in the three groups. Patients’ length of jay in group C was significantly longer than group A and group B (P < 0.01). The ratios of using suspension system in group C were significantly higher than group A and group B (P < 0.01). The scores of postoperative visual analogue scale (VAS) and ratios of mandibular swell in group C were significantly higher than group A and group B (P < 0.01). There was no significant difference in the three groups regarding surgical outcomes, including postoperative vocal cord paralysis, hypocalcemia, serum white blood cells and C-reactive protein levels.ConclusionsThe Wang angle and mandibular jawline classifications were firstly introduced in TOETVA. All the patients of class A, B, and C mandibular jawline can achieve safe and effective surgical outcomes in the treatment of PTC with TOETVA. Patients of class C need more assistance of suspension system, would experience higher scores of VAS, and higher ratios of mandibular swell compared with class A and B.
Highlights
Transoral endoscopic thyroidectomy is new that does not cause neck scarring and requires a smaller subcutaneous flap elevation than that of remote access thyroid surgery methods [1]
The Wang Angle of each patient was defined as the crossing of esthetic plane and mandibular plane, which was used to assess the different mandibular jawline classifications
Our group has reported a large cohort of thyroidectomy via vestibular approach (TOETVA) cases, in which we demonstrated that transoral endoscopic thyroidectomy has the same surgical safety compared with total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy [9]
Summary
Transoral endoscopic thyroidectomy is new that does not cause neck scarring and requires a smaller subcutaneous flap elevation than that of remote access thyroid surgery methods [1]. The objective of this study was to introduce a new classification of mandibular jawlines into transoral endoscopic thyroidectomy, and to evaluate the effects on TOETVA in terms of safety, feasibility, surgical outcomes, and postoperative feelings in the treatment of papillary thyroid carcinoma (PTC). Patients’ different mandibular jawlines were classified into three types according to the degree of Wang Angle, including A (angle: 80° ~ 110°), B (angle > 110°), and C (angle < 80°) types This new classification was firstly introduced in TOETVA. The objective of this study was to introduce a new classification to assess different mandibular jawlines, and to evaluate the effects on TOETVA in terms of safety, feasibility, and postoperative feelings in the treatment of papillary thyroid carcinoma (PTC)
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