Bilateral Neck Dissection Research Articles

A Rare Case of Right Thoracic Duct Variant: Multimodal Approach to Bilateral Chyle Leak.

Chyle leak is a rare complication of head and neck surgeries, usually on the left side. Bilateral chyle leaks, especially involving an unusual right thoracic duct variant are extremely rare.This report details a 74-year-old male with well-differentiated squamous cell carcinoma of the larynx who underwent total laryngectomy, total thyroidectomy and bilateral neck dissection. A left-sided chyle leak was identified intraoperatively and repaired. Postoperatively, the patient developed a bilateral chyle leak, with the right sided leak increasing despite conservative management. Surgical exploration revealed a high-riding right thoracic duct with multiple puncture sites. An attempt at lymphangiography confirmed an anatomic variant of the right thoracic duct and embolisation to address it was unsuccessful. The chyle leak slowly resolved by day 13 and the patient was discharged well. This case highlights the challenges posed by anatomical variations of the thoracic duct, which can complicate the management of chyle leaks. The report underscores the importance of considering anatomical variations during surgery to minimise complications and improve postoperative outcomes.

Risk Factors for Pulmonary Embolism After Head and Neck Cancers Resection: A Retrospective Case Control Study.

Pulmonary embolism (PE) after surgery is a severe thrombotic event for patients suffering from head and neck malignancies. Our study analyzed the factors related to PE in such patients following radical resection. A case-control study was designed to retrospectively investigate the factors associated with the increased risk. From 2013 to 2022, 5042 radical resections were performed for head and neck malignancies. A control group, matched by age, gender, pathological diagnosis, and cancer stage, but without postoperative PE, was selected in a one-to-three ratio. The perioperative clinical data, encompassing hemodynamic management metrics, were subjected to univariate analyses. Conditional logistic regression modeling was implemented to quantify covariate effects. The prevalence of PE after surgery was 0.75% (95% CI = 0.55-1.03). Multivariable conditional logistic regression revealed PE after surgery was associated with cumulative time of the mean blood pressure (MBP) reductions > 20% (OR = 3.167, 95% CI = 1.651-6.075, p = 0.001), oliguria (OR = 44.055, 95% CI = 2.356-823.886, p = 0.011), and bilateral neck dissection (OR = 3.291, 95% CI = 1.112-9.740, p = 0.031). The maximum area under the curve (AUC) for predicting PE was 0.809 (95% CI 0.716-0.902), achieved using cumulative hypotensive burden (MBP reductions > 20%), with a classification threshold of 1.17 h. Intraoperative hypotension, oliguria, and bilateral neck dissection are significant predictors of postoperative PE following head and neck cancer surgeries. These findings underscore the importance of predictive clinical measures for effective risk control.

Bilateral Neck Dissection in cN0 Supraglottic Squamous Cell Carcinoma: Essential or Not?

There is controversy regarding bilateral neck dissection for cN0 supraglottic squamous cell carcinoma. This study aimed to explore the risk factor of occult isolated contralateral/bilateral metastasis in cN0 supraglottic squamous cell carcinoma and help clinicians better make assessments for these patients. PubMed, the Cochrane Library, CNKI, and CBM were systematically searched for studies on occult lymph node metastasis in cN0 supraglottic squamous cell carcinoma from the inception of each database to May 30, 2024. All patients with supraglottic squamous cell carcinoma and a clinical N0 neck, who had complete records of neck lymph node metastasis, were included in the study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed to extract data. Data were pooled using a random-effects generalized linear mixed model with 95% confidence intervals (CIs). The risk of occult isolated contralateral/bilateral metastatic lymph nodes was analyzed. Fifteen studies including 1609 patients with cN0 supraglottic squamous cell carcinoma were analyzed. The pooled risk of occult isolated contralateral/bilateral metastasis was 7.49% (95% CI: 5.65%-9.87%; I2 = 57%). For Type A tumors, the risk was 4.14% (95% CI: 2%-64%; I2 = 81%), 6.74% for Type B (95% CI: 2.27%-18.33%, I2 = 82%), and 13.62% for Type C (95% CI: 5.82%-28.66%, I2 = 69%). For T1-T2 patients, the risk was 5.18% (95% CI: 2%-64%; I2 = 81%), and 8.73% (95% CI: 5.92%-12.69%, I2 = 0%)for T3-T4 patients. When ipsilateral pN+ was present, the risk increased to 20.97% (95% CI: 16.09%-26.85%, I2 = 29%). Contralateral neck dissection is recommended for Type C patients. Pathologically ipsilateral metastasis confirmed patients should receive contralateral neck dissection, radiotherapy, or even active surveillance follow-up.

A Single Needle Tip Position Approach ‘The Middle Trunk’ Block-for Supraclavicular Block: An Anatomic Cadaveric Study

Abstract Background: Using conventional anatomical landmark or nerve stimulator guidance, injection of local anesthetic following paresthesia of the middle two fingers resulted in >97% block efficacy. “Corner pocket” and “intracluster” injections during ultrasound-guided supraclavicular brachial plexus have been suggested for better dermatomal coverage but have limitations. We hypothesized that a single injection of dye at the level of the middle trunk (MT) would result in diffusion in the superior and inferior trunks. Methods: After ethics approval, ultrasound-guided injections were performed with a needle tip positioned within fatty connective tissue at the level of the MT bilaterally in 6 soft-embalmed cadavers. We injected 3.5, 7.5, and 15 ml diluted methylene blue dye in 2 cadavers each. Bilateral neck dissections were performed in the posterior triangle of the neck 30 min after injection in all cadavers to visualize the dye spread. Results: Injection of the lower volume of dye (3.5 ml) spared the superior trunk, suprascapular and phrenic nerve (except 1 specimen), while an injection of the higher volume of dye (15 ml) consistently stained all trunks after a single injection at MT level. Similarly, the suprascapular and phrenic nerves were congruously stained with 15 ml injections, while with 7.5 ml 50% times, the PN was soaked. Dye dispersion in cadaveric brachial plexuses was deep with 15 ml and mild-to-moderate stain pattern with others. Conclusion: We postulate that the use of a single injection MT block technique with an injectate volume of 7.5 ml or more can be an effective technique for a supraclavicular brachial plexus block. However, the findings of this cadaveric study need substantiation from clinical studies.

Acute intestinal obstruction due to duodenal metastasis of laryngeal squamous cell carcinoma: A CARE case report.

Acute intestinal obstruction due to duodenal metastasis of laryngeal squamous cell carcinoma: A CARE case report.

Surgical complications and quality of life according to the extent of neck dissection in patients treated for oral squamous cell carcinoma.

Quality of life (QoL) and the degree of postoperative morbidity is an important aspect for patients suffering from oral squamous cell carcinoma (OSCC), which can be affected by several aspects of cancer treatment and especially the extent of surgical therapy. The aim of this study was to evaluate the clinical outcome and QoL in patients in relation to different types of neck dissection (ND) for OSCC. In this observational single center cohort study, OSCC patients who underwent primary resection and ND between 2017 and 2022 were included and assessed for postoperative complications. Furthermore, a subcohort of patients who presented in regular tumor aftercare was prospectively examined regarding QoL and shoulder functioning, using a modified version of the EORTC quality of life core questionnaire with its head and neck cancer module (EORTC-QLQ-H&N43). Differences in QoL between patients were analyzed regarding the extent of ND (selective vs. modified radical ND; ipsilateral vs. bilateral ND), adjuvant therapy and presence of postoperative complications. Overall, 350 patients with a mean age of 66 years (± 11.6) were enrolled in the study. The overall complication rate was 12.6%, while extended ND procedures (modified radical ND and bilateral ND) were associated with higher complications. A subcohort of 57 patients participated in QoL assessment. There were clinically relevant differences (20 points and more in QoL) in relation to the extent of ND in the following domains: impaired swallowing of solid food, mouth opening limitation, sticky saliva, impaired smelling, impaired eating ability, impaired speech, shoulder pain and stiffness in the neck and shoulder area, while selected objects were influenced by adjuvant therapy. While patients with extended neck treatment presented with significantly more shoulder pain, there were no significant differences in shoulder functioning among the different ND modalities. The results of this study provide an insight into QoL issues in relation to OSCC and may help to consult patients who are confronted at the beginning of the disease as well as by approaching selected health issues by specific functional treatment during follow-up. In this study, it could be shown that extensive surgical neck treatment is associated with higher complication rates and lower quality of life, highlighting the relevance of surgical de-escalation if feasible.

The Role of Bilateral Versus Ipsilateral Neck Dissection in Oropharyngeal and Oral Cancer with Contralateral cN0 Neck in cT3 and cT4 Disease

Introduction: Head and neck cancer (HNC) is a significant global health issue, with Head and Neck Squamous Cell Carcinoma (HNSCC) ranking among the most prevalent cancers worldwide. In particular, India faces high incidence rates due to tobacco and areca nut usage. While HNSCC primarily affects the oral cavity carcinoma (OC), larynx, and oropharyngeal carcinoma (OPC) outcomes are linked to HPV status and T-, N-, and M-status. The necessity of elective neck dissection (END) for contralateral clinically node-negative (cN0) necks remains debated, with limited literature on its impact. Methodology: This retrospective study analyzed 300 OC/OPC patients with contralateral cN0 necks who underwent bilateral or ipsilateral neck dissection. Data on patient demographics, tumor characteristics, and treatment outcomes were collected over three years. Survival analysis employed Kaplan-Meier techniques and Cox regression. Result: In OC/OPC, midline-reaching/crossing tumors were more common with bilateral neck dissection, but contralateral neck node metastasis was rare. There was no significant difference in OS or RFS between ipsilateral and bilateral neck dissection groups. Conclusion: Contralateral neck dissection in OC/OPC patients with clinically node-negative necks did not enhance OS or RFS. The potential benefits of wait-and-scan strategies warrant further investigation through prospective trials. Keywords: Head and Neck cancer (HNC), Oropharyngeal squamous cell carcinoma (OPC), Elective neck dissection (END), Recurrence free survival (RFS)

Tailored Surgery for Medullary Thyroid Cancer (MTC) Based on Pretherapeutic Basal Calcitonin and Intraoperative Diagnosis of Desmoplastic Stroma Reaction: A Proposal for a New Surgical Concept.

Pretherapeutic sex-specific basal calcitonin (bCt) cutoff levels and intraoperative diagnosis of desmoplastic stroma reaction (DSR) by frozen section independently facilitate the prediction of lymph-node metastases (LNM) and long-term outcomes in patients with medullary thyroid cancer (MTC). The relevance of combining these two parameters to "tailor" lymph-node (LN) surgery has thus far not been analyzed. This single-center analysis included 306 patients covered by a calcitonin screening program. A uniform surgical protocol [thyroidectomy, bilateral central neck dissection (CND), lateral neck dissection (LND)] was applied. Risk groups were subdivided on the basis of predefined bCt cutoffs ("minimal risk," "low risk," and "high risk"), and the intraoperative classification of DSR was correlated with LN involvement in each patient. Biochemical long-term outcomes (mean follow-up: 8.3 years) were documented with the endpoints "disease-free," "persistent," or "recurrent" disease. Patients in the "minimal risk" group (37.6%) and "low risk" group (16.3%) showed central but never lateral LNM in 2.6% and 6.0% of patients, respectively (cure rate: 98.2%). In the "high risk" group (46.1%), LNM (central and/or lateral) were found in 51.1% of the patients (cure rate: 60.9%). In all risk groups, DSR negativity (overall 20.6%) confirmed absence of LNM (cure rate:100%). The analysis facilitates the recommendation to individualize the extent of LND combining pretherapeutic bCt and the presence of DSR. Independent of bCt levels (risk groups), LND can be avoided following thyroidectomy in patients with DSR-negative tumors. Patients with DSR-positive tumors should undergo thyroidectomy and bilateral CND. In addition, in "high risk" patients, unilateral LND is recommended in those with bCt < 350 pg/mL. Bilateral LND should be discussed in patients with M0 status and bCt > 350 pg/mL.

P-59 A CASE REPORT: A RARE CASE OF PAPILLARY THYROID CARCINOMA WITH BRAIN METASTASIS WITHOUT LOCAL RECURRENCE

Abstract Introduction Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and generally has an excellent prognosis. However, distant metastases, particularly to the brain, are rare and associated with poor outcomes. This case report presents a 67-year-old female patient with a history of PTC, who developed brain metastasis in the follow-up. Clinical Case A 67-year-old female patient presented four years ago with a rapidly growing 4 cm mass, extending from the right thyroid gland to the right jugular vein. Fine-needle aspiration biopsy (FNAB) of the lesion was reported as suspicious for follicular neoplasm. Ultrasound imaging revealed pathological lymphadenopathy in the bilateral cervical chains. The patient underwent total thyroidectomy and bilateral neck dissection. Pathology confirmed the diagnosis of the follicular variant of papillary thyroid carcinoma (PTC), with extrathyroidal extension into muscle and adipose tissue, as well as lymph node metastases. After surgery, while the patient's TSH level was 68.6 µIU/ml, her thyroglobulin (Tg) level was 1.02 ng/ml, with negative anti-Tg antibodies. The patient received 150 mCi of radioactive iodine (RAI) approximately 3 months after surgery. One year after RAI therapy, a whole-body iodine scan showed no evidence of residual disease or metastasis. Follow-up Tg levels of the patient remained around 0.04 ng/ml. 3.5 years after surgery, there was a slight increase in thyroglobulin levels (0.26 ng/ml), although no recurrent disease was detected on ultrasound of the thyroid bed. The patient was planned to be under close surveillance but she did not come to visits regularly. The patient subsequently presented with complaints of imbalance and brain MRI revealed a mass lesion measuring 46x43x55 mm in the frontal region. The mass was surgically resected, and the pathology confirmed metastatic papillary thyroid carcinoma (PTC). A postoperative whole-body iodine scan was negative for metastatic disease. At that time, the TSH level was 0.5 µIU/ml, and thyroglobulin (Tg) was 0.04 ng/ml. Cranial radiotherapy was planned for the patient. Conclusion Approximately 10% of patients with PTC develop distant metastases, most commonly to the lungs and bones. Brain metastasis from PTC is extremely rare, occurring in less than 1% of cases. Due to its rarity, brain metastasis from PTC is not typically considered in the differential diagnosis for patients presenting with new neurological symptoms, potentially delaying diagnosis. Despite aggressive treatment, the prognosis for patients with PTC and brain metastasis remains poor, with a median survival of approximately 17 months. This case highlights the importance of considering the possibility of brain metastasis in high-risk PTC patients who present with neurological symptoms despite the lack of significant elevation in thyroglobulin (Tg) levels or evidence of recurrence on neck ultrasound.

Path analysis of factors influencing length of stay and hospitalisation expenses for oral cancer patients in tertiary hospitals in southeastern China: a cross-sectional study

AimsTo investigate the associations between influencing factors with length of stay (LOS) and hospitalisation expenses in oral cancer (OC) patients, and to explore the potential pathways through which these factors...

Laryngofissure for Airway Management in Thyroid Malignancy - ‘Food for Thought’

Paediatric thyroid cancer (PTC) is a rare disease, and treatment for thyroid malignancy is primarily surgical. Airway considerations can be challenging in such surgeries. An 8-year-old boy with a huge neck mass and a history of hoarseness and stridor at rest was diagnosed with PTC and scheduled to undergo total thyroidectomy with bilateral neck dissection. Airway imaging showed critical airway narrowing. An awake tracheostomy under local anaesthesia was planned. As the thyroid lesion was adherent to the trachea, tracheostomy was unsuccessful in an awake, agitated child and the surgeon had to perform laryngofissure (median thyrotomy) as a desperate measure to access the airway. The endotracheal tube was railroaded over a bougie through the laryngofissure opening. General anaesthesia with neuromuscular blockade was provided subsequently. The surgery was uneventful. A conventional tracheostomy was performed at the end of the surgery, and the laryngofissure opening was closed in layers.

Trends in the Incidence, Organization of Care, and Surgical Treatment of Medullary Thyroid Cancer: A Population-Based Study.

Background: Medullary thyroid cancer (MTC) is a rare cancer with variable disease course. To enable optimal care, centralization and consensus guidelines are essential. This study describes trends in the incidence, organization of care, surgical treatment, and outcomes of MTC over 30 years in the Netherlands. Methods: All patients with a histological MTC diagnosis between 1989 and 2018 were identified from the Netherlands Cancer Registry and linked to the Dutch Pathology register (PALGA). Incidence rates, relative to the Dutch population, were assessed throughout time. Clinicopathological parameters and extent of lymph node (LN) surgery were extracted from PALGA pathology reports. Period A (1989-1998), period B (1999-2008), and period C (2009-2018) were compared. Results: Throughout 30 years, the population-adjusted incidence remained stable with 0.17 ± 0.04 diagnoses per 100,000 people per year (p = 0.247). Of all 795 patients, 54% were female and 63% were treated in an academic hospital, at a median age of 48 years (interquartile range [IQR] 34-61). Age at diagnosis increased over time from 42 years (IQR 25-61) in period A to 52 years (IQR 42-63) in period C (p < 0.001). The proportion of treatments occurring in an academic hospital increased from 41% of patients in period A to 58% and 86% in period B and C, respectively (both p < 0.001). At primary treatment, a LN dissection was performed in 582 (73%) patients. Of these patients, 88%, 36%, and 20% underwent a central neck dissection (CND), unilateral neck dissection, and bilateral neck dissection, respectively. CND was performed more frequently in period C (93%) than in period A (77%) or B (87%) (p = 0.009, p = 0.027, respectively). Overall survival improved from period A (55%) to C (88%) and B (65%) to C (p = 0.022, p = 0.007, respectively). Locoregional recurrence rates remained stable. Conclusions: This study shows a stable incidence and improved survival of MTC in the Dutch population over the last three decades. In addition, these data indicate a transition of treatment to academic hospitals, likely due to centralization, and a higher rate of CNDs, following the introduction of recommendation guidelines.

Incidental Detection of Prostatic Lesion on 18 F-FDG PET/CT and 68 Ga-PSMA-11 PET/CT Leading to Diagnosis of Second Primary Prostatic Adenocarcinoma in a Patient of Differentiated Thyroid Cancer.

Second primary malignancies are being increasingly detected in the setting of thyroid cancer, because of adoption of the advanced imaging modalities including PET/CT. Herein, we present a patient of papillary thyroid carcinoma who initially underwent total thyroidectomy with bilateral neck dissection followed by 131 I radioactive iodine therapy. A prostatic lesion was incidentally detected on 18 F-FDG PET/CT scan, which was intensely 18 F-FDG avid and also showed intense focal 68 Ga-prostate-specific membrane antigen (PSMA) uptake on 68 Ga-PSMA-11 PET/CT scan. This led to the diagnosis of prostatic adenocarcinoma as a second primary cancer in this patient with papillary thyroid carcinoma.

The Effect of Central Lymph Node Dissection Before Thyroidectomy on Incidental Parathyroidectomy in Patients with Thyroid Cancer

Introduction: It is the fact that the incidence of thyroid cancer has been increasing recently. Thyroid cancer often tends to metastasize to the cervical lymph nodes and as a result, central region lymph node dissection increases the risk of incidental parathyroidectomy. In this study, the effect of two different surgical techniques on incidental parathyroidectomy (IP) has been investigated. Material and Method: A total of 115 patients who underwent bilateral total thyroidectomy (BTT) and cervical neck dissection (CND) for thyroid cancer at the Department of General Surgery Clinics have been included in the study. Patients were divided into two groups according to the surgical technique used. The first group consisted of patients who underwent CND after thyroidectomy. The second group consisted of patients who underwent lateral neck dissection (LND) before CND or then underwent CND after ligation and transection of the middle thyroid vein and, if necessary, the superior thyroid artery. Results: Incidental parathyroidectomy (IP) has been identified in the pathology specimen in 47.4% (54) of the patients. While IP was performed on 1 gland in 29.8% (34) of the patients in group 1, on 2 glands in 14% (16), and on 3 glands in 3.5% (4) of the patients, no IP was detected in group 2 (p &lt; 0.001). It was observed that hypoparathyroidism did not develop in patients in the second group. However, 12.3% (14) of the patients who underwent BTT followed by CND developed transient hypoparathyroidism and 3.5% (4) of them developed permanent hypoparathyroidism. When the collected data is analyzed, it has been concluded that the tumor size and the diameter of the largest metastatic lymph node are significantly larger in men than in women (p &lt; 0.001 and p &lt; 0.001, respectively). Conclusion: IP is commonly encountered in thyroid surgery. It is concluded that performing CND and LND before thyroidectomy might reduce IP.

Cancer Integrin Imaging With 68 Ga-Trivehexin PET-CT in Head and Neck Squamous Cell Carcinoma Improves Diagnostic Accuracy.

Oral squamous cell carcinoma (OSCC) is one of the most common malignancies worldwide. Locoregional nodal involvement by OSCC is commonly encountered. Current conventional and functional imaging modalities have limited diagnostic accuracy in nodal assessment, particularly in head and neck cancer. Thus, definitive management of head and neck malignancies customarily addresses the locoregional nodes along with the primary malignancy. However, OSCC, particularly tongue cancer, shows erratic lymphatic drainage and thus commonly requires extensive bilateral neck dissection, leading to significant morbidity. Cancer integrin imaging with 68 Ga-trivehexin PET-CT can offer highly specific result and thus has the potential for effective tailored management.

Impact of contralateral occult neck metastasis in HPV-associated tonsil cancer: Is elective contralateral neck dissection required?

Impact of contralateral occult neck metastasis in HPV-associated tonsil cancer: Is elective contralateral neck dissection required?

Superficial Cervical Plexus Block for Postoperative Pain Management in Patients Undergoing Supraglottic Laryngectomy and Bilateral Neck Dissection: A Case Series

Süperfisyal servikal pleksus bloğu (SCPB), baş ve boyun cerrahilerinde anestezi ve analjezi yönetiminde yaygın olarak kullanılmaktadır. Bu olgu serisi, larinks karsinomu nedeniyle supraglottik larenjektomi, bilateral boyun diseksiyonu ve trakeostomi uygulanan hastalarda SCPB ile postoperatif analjezi yönetimindeki deneyimlerimizi paylaşmayı amaçlamaktadır. 15 Ocak 2023 ile 15 Mart 2023 tarihleri arasında supraglottik larenjektomi, bilateral boyun diseksiyonu ve trakeostomi yapılan, ASA skoru 2 veya 3 olan 18 yaş üzeri 10 hastaya SCPB uygulandı. Bloklar, ultrasonografi rehberliğinde, %0,25 bupivakainin 0, 1 mL/kg'lik dozu ile gerçekleştirildi. Rutin anestezi indüksiyonunu takiben, %2 sevofluran ve intravenöz remifentanil infüzyonu ile idame sağlandı. Postoperatif ağrı, 1, 6, 12 ve 24 saatlerde sayısal derecelendirme skalası (NRS) kullanılarak değerlendirildi. Ortalama NRS skorları postoperatif 1. saatte 1,6, 6. saatte 2,3, 12. saatte 2,4 ve 24. saatte 2,4 olarak kaydedildi. SCPB, postoperatif ağrıyı azaltmada etkili olmuş ve minimal ek analjezi gereksinimi doğmuştur. SCPB ile ilgili herhangi bir komplikasyon gözlenmemiştir. SCPB, supraglottik larenjektomi ve bilateral boyun diseksiyonu geçiren hastalarda etkili postoperatif ağrı yönetimi sağlamaktadır ve güvenli bir profil sunmaktadır. Ancak, bu bulguların doğrulanması için daha büyük hasta grupları ve karşılaştırma gruplarını içeren çalışmalar gerekmektedir. Anahtar kelimeler: Baş ve boyun cerrahisi, rejyonel anestezi, servikal pleksus bloğu, trakeostomi Superficial cervical plexus block (SCPB) has been widely utilized in anesthesia and analgesia management for head and neck surgeries. This case series aims to share our experience with SCPB for postoperative analgesia in patients undergoing supraglottic laryngectomy, bilateral neck dissection, and tracheostomy due to laryngeal carcinoma. SCPB was administered to 10 patients aged over 18 years with an ASA score of 2 or 3, who underwent supraglottic laryngectomy, bilateral neck dissection, and tracheostomy between January 15, 2023, and March 15, 2023. The blocks were performed using ultrasonography guidance with 0.1 mL/ kg of 0.25% bupivacaine. Routine anesthesia induction was followed by maintenance with 2% sevoflurane and intravenous remifentanil infusion. Postoperative pain was assessed using the numeric rating scale (NRS) at 1, 6, 12, and 24 hours. The average NRS scores were 1.6 at 1 hour, 2.3 at 6 hours, 2.4 at 12 hours, and 2.4 at 24 hours postoperatively. SCPB was effective in reducing postoperative pain, with minimal additional analgesia required. No complications related to SCPB were observed. SCPB provides effective postoperative pain management for patients undergoing supraglottic laryngectomy and bilateral neck dissection, with a favorable safety profile. However, further studies with larger sample sizes and comparison groups are needed to validate these findings.

Risk factors for pharyngocutaneous fistula formation: a study focused on pharyngeal reconstruction technique.

This study investigated the risk factors for developing pharyngocutaneous fistula, the most common complication following total laryngectomy. We included all patients who underwent total laryngectomy and bilateral neck dissection from 2009 to 2021. Patients excluded were those with hypopharyngeal involvement, total or partial pharyngectomy, base of the tongue resection, large pharyngeal defects requiring free/pedicle flap reconstruction, or salvage laryngectomy. A total of 164 patients participated in the study. Multivariate regression analysis identified two independent predictors of pharyngocutaneous fistula formation: pharyngeal reconstruction with simple interrupted sutures (odds ratio: 3.12, 95 per cent confidence interval: 1.31-17.00, p = 0.010) and radical neck dissection (odds ratio: 3.16, 95 per cent confidence interval: 1.13-8.82, p = 0.028). Our findings suggest that pharyngeal reconstruction using simple interrupted sutures and radical neck dissection are independent risk factors for pharyngocutaneous fistula development. Based on this, we recommend using the modified Cushing suture technique over simple interrupted sutures due to its association with a significantly lower pharyngocutaneous fistula rate.

Anaplastic transformation of papillary thyroid carcinoma in the cervical lymph nodes showing a variety of rhabdoid, epithelioid and spindle cell phenotype

Abstract Introduction/Objective Anaplastic thyroid carcinoma (ATC) is a rare undifferentiated tumor of thyroid follicular cells with a dismal prognosis. Most ATCs derive from pre-existing, well-differentiated thyroid carcinomas, most commonly papillary thyroid carcinoma (PTC). In nearly all instances, ATC arises within the thyroid gland. Completely divergent morphologies of this tumor between the bilateral cervical nodes as well as the almost exclusive presence of ATC in the metastatic and nodal locations are very unusual and are reported here. Methods/Case Report A 67-year-old man presented with a rapidly enlarging left cervical mass, hoarseness, dry cough, and drooping left eye. MRI demonstrated bilateral enlarged cervical lymph nodes spanning levels II to V, and nodules in thyroid lobes. Subsequent total thyroidectomy with bilateral radical neck dissection was performed. Histologically, the left lateral cervical masses revealed undifferentiated tumor cells with rhabdoid, epithelioid and spindle cells features. Conversely, the tumor within the thyroid lobes and the right cervical lymph nodes exhibited PTC with tall cell features. All undifferentiated tumor components stained positive with AE1-3, CK7, PAX8, and negative with thyroglobulin, EMA, CD34, S100, Melan-A, Sox 10, desmin, myogenin, and P40. INI-1 staining is retained. Only the spindle cell component stained positive with TTF1. Based on the morphology and immunoprofile, a diagnosis of anaplastic thyroid carcinoma was rendred. Results (if a Case Study enter NA) NA Conclusion Diagnosing anaplastic thyroid carcinoma outside the thyroid lesion can be challenging. In our case, only extensive sampling of the surgical specimen identified a small focus of well-differentiated PTC, staining positive for thyroglobulin, in the left cervical anaplastic carcinoma component, identifying its origin. This case adds to the scarce literature documenting unilateral anaplastic transformation in the left cervical metastatic lymph nodes, while the right cervical lymph nodes contained pure well differentiated PTC. This represents a significant potential pitfall in presurgical fine needle aspiration (FNA) evaluation of patients with ATC.

Association between cervical lymph node dissection and dementia: a retrospective analysis

Association between cervical lymph node dissection and dementia: a retrospective analysis