Cervical Approach Research Articles

A cervical cancer control strategy for lower-resource settings: interventions to complement one-dose HPV vaccination.

One-dose prophylactic HPV vaccination of pre-adolescents may reduce cervical cancer deaths dramatically in lower-resource settings, but the benefits of achieving immediate high coverage among pre-adolescents would not be realized for 20 to 40 years. Prophylactic vaccine efficacy is reduced after sexual debut, and current therapeutic intervention candidates designed to treat existing HPV infections or precancerous lesions have yielded insufficient evidence to warrant widespread use. However, we are developing a feasible, scalable, high-quality cervical screening approach that could prevent hundreds of thousands of deaths, while we work to achieve high coverage of one-dose vaccination for adolescent cohorts. A time-limited "one screen" campaign approach for lower-resource settings could complement parallel efforts to achieve high coverage with one-dose vaccination. This screen-triage-treat strategy would target the highest risk groups of screening age (ie, 25 to 49 years) for once-in-a-lifetime HPV testing of self-collected samples using a low-cost accurate HPV test; subsequent triage relying on extended genotyping and a validated deep-learning algorithm for automated visual evaluation (AVE) would stratify management based on risk to provide treatment for those most likely to develop cancer without overburdening health care systems. Early efficacy of this approach has been demonstrated in 9 countries within the HPV-AVE (PAVE) Study Consortium. We estimate that the cost per death averted of a screen-triage-treat campaign is of similar magnitude to prophylactic vaccination. We do not envision perpetual investment in ubiquitous brick-and-mortar screening programs if "one dose, one screen" is implemented with high coverage and targets the highest-risk populations. In collaboration with in-country stakeholders, efforts to ensure acceptability, risk communication, and cost-effectiveness are underway.

Posterior Endoscopic Cervical Discectomy

Cervical radiculopathy is a prevalent disorder of the cervical spine. With advances in minimally invasive surgery, posterior cervical foraminotomy (PCF) has been conducted using an endoscopic system, demonstrating favorable clinical outcomes. Posterior endoscopic cervical foraminotomy or posterior endoscopic cervical discectomy could reduce blood loss, operating time, and hospital stay compared to conventional open PCF. We performed a full-endoscopic cervical approach employing one portal with integrated working and viewing channels. When conducting foraminotomy and discectomy, we simultaneously applied a partial pediculotomy, partial vertebrotomy approach to minimize neural retraction and ensure sufficient decompression of osseous structures. The authors illustrate the surgical technique of posterior endoscopic cervical foraminotomy with discectomy.

Hybrid surgical approach for a large schwannoma from the cervical esophagus to the upper thoracic esophagus: a case report

BackgroundEsophageal schwannoma is an extremely rare esophageal submucosal tumor. We report a case of a hybrid surgery for a large esophageal schwannoma that had extended from the cervical to the upper thoracic esophagus by using thoracoscopic and cervical approaches.Case presentationA 58-year-old male was referred to our hospital for further examination and treatment of dysphagia and weight loss over the past 6 months. Upper gastrointestinal endoscopy revealed a 5.7-cm submucosal tumor from the cervical esophagus to the upper thoracic esophagus. The submucosal tumor was diagnosed as esophageal schwannoma by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). Contrast-enhanced CT showed that the tumor had not invaded surrounding organs. Since the tumor extended from the cervical esophagus to the upper thoracic esophagus, we decided that it should be resected by not only the cervical but also the thoracoscopic approach. In operation, the patient was first placed in the prone position, and a thoracoscopic dissection of the upper thoracic esophagus containing the tumor was performed from the surrounding area. After changing the patient’s position from prone to supine, a cervical skin incision was performed, and we underwent the tumor enucleation. After enucleation, the esophageal wall was thinned, so the right sternocleidomastoid muscle was used to reinforce the esophageal wall. The tumor size of the specimen was 60 × 52 × 42 mm. The postoperative course was uneventful, and the patient was discharged on the 22nd day after surgery.ConclusionsEnucleation of a large esophageal schwannoma from the cervical to the upper thoracic esophagus could be safely performed using both thoracoscopic and cervical approaches. The sternocleidomastoid muscle flap is useful in the occasion considering stenosis by muscular layer suture.

Ganglioneuroma in Head and Neck: A Case Report of a Laryngeal Ganglioneuroma and a Systematic Review of the Literature.

Introduction: Ganglioneuroma (GN) is a rare, benign tumor of the autonomic nervous system. It is seldom located in the head and neck (HN) region. GN typically presents as a slow-growing, painless mass, often leading to delayed diagnosis. Case report: We report a unique case of laryngeal-originating GN in a 43-year-old female who presented with worsening dysphonia and dyspnea. Imaging revealed a large mass originating from the larynx. Histological examination confirmed the diagnosis. The tumor was surgically excised with preservation of key structures in the neck. At the follow-up, the patient experienced a significant improvement in symptoms. Material and methods: A systematic literature review following PRISMA guidelines was conducted in January 2024 to investigate the common sites of GN in the HN region and the complications associated with its treatment. Results: In a total of 58 articles, we studied 65 patients, mostly under 30 years old. Surgical excision remains the primary treatment, and post-operative complications were mostly neurological. Discussion: GNs are generally slow-growing and asymptomatic, but they can reveal themselves when compressing nearby structures, especially in the HN region. In symptomatic cases or when the tumor exhibits significant growth or hormonal activity, surgical resection is required. The lateral cervical approach is the most common one. The risk of postoperative complications and recurrence underscores the need for careful surgical planning and long-term follow-up. Conclusion: This unique laryngeal GN case highlights the importance of considering GN in the differential diagnosis of HN masses. Further large-scale studies are warranted to establish evidence-based protocols for their management, especially in the HN region.

Current approaches to facial nerve schwannoma surgery.

Facial nerve schwannomas (FNSs) are exceedingly rare benign tumors. This study aims to report on a series of excised FNSs, providing clinical information and details on their surgical management, including novel approaches. We retrospectively reviewed patients who underwent surgical excision of FNSs in a private otology clinic and public tertiary referral center. The main outcome measures were facial nerve function, complete tumor removal, postoperative complications, tumor recurrence, and hearing. Seventeen patients (10 men and 7 women) with a mean age of 44.23 years (SD, 12.21) underwent surgery during the study period. The most common symptom was facial nerve dysfunction (58.8%). Facial and otoneurologic symptoms (hearing loss, tinnitus, and vertigo) were observed in 88.8% and 77.7% of patients, respectively. The middle cranial fossa (MCF) was the most common approach (six patients, 35.2%), followed by translabyrinthine (TL), transmastoid (TM), and combined TM-MCF (three patients, 17.6% each). Exclusive endoscopic transcanal suprageniculate (ETS) and mastoid combined with cervical approaches were applied once in two patients, 5.8% each. Total tumor removal was achieved in all cases. No significant postoperative complications were observed. The mean follow-up period was 193.2 months (SD, 119.5) and no tumor recurrence was observed. This study provides further evidence for the safety and efficacy of various surgical approaches for FNS, and incorporates the endoscopic transcanal approach. 4.

Abstract A144: Insight into cervical cancer screening and HPV self-sampling among Vietnamese immigrants in Southern California

Abstract Background: Screening can effectively identify precancerous lesions for early treatment to prevent cervical cancer. However, only 69% of Vietnamese immigrants in the U.S. reported screening in the past 3 years compared to 84% of non-Hispanic White women. Human papillomavirus (HPV) self-sampling is a novel cervical cancer screening approach that does not require women to visit healthcare providers and has been shown to increase screening uptake in several minority populations. Understanding the attitudes towards cervical cancer screening, including HPV self-sampling, among Vietnamese immigrants could inform strategies to improve their screening rates. Methods: We conducted two online semi-structured focus groups with a total of nine Vietnam-born women aged 50-65 living in Southern California, which has the largest Vietnamese community outside of Vietnam, to understand their awareness of, attitudes towards, and experiences with cervical cancer screening. Participants also watched two short videos on two cervical cancer screening methods (Papanicolaou "Pap" test and HPV self-sampling) and shared their thoughts on each method. Each focus group was recorded, transcribed, translated into English, and coded and analyzed using NVivo 14. Results: Three main themes emerged from the focus groups. First, participants showed a strong acceptance of cervical cancer screening despite poor knowledge of the disease and its prevention as well as logistic and psychosocial barriers associated with visiting healthcare providers for screening. Second, participants found HPV self-sampling to be highly acceptable, mentioning advantages like its convenience and the lack of embarrassment compared to visiting healthcare providers. However, there were some concerns regarding the mailing of the self-collected samples and the cost of the test. Third, participants described circumstances that may be immigrant-specific, such as a shift from making gynecologic appointments themselves in Vietnam to relying on family doctors as gatekeepers for such appointments in the U.S., a strong preference for Vietnamese- speaking providers, and the use of English as a Second Language (ESL) centers, community organizations, radio stations, and newspapers targeting Vietnamese communities to obtain healthcare information. Conclusions: HPV self-sampling has the potential to improve cervical cancer screening uptake in Vietnamese immigrants since it can overcome barriers associated with visiting healthcare providers for a Pap test. Education campaigns are needed to increase awareness of cervical cancer screening and address concerns related to HPV self-sampling. Engagement with healthcare providers, organizations, and media channels that serve Vietnamese communities may be effective since Vietnamese immigrants often receive health-related information from these sources. It is necessary to explore the perceptions of younger immigrants and U.S.-born Vietnamese women to inform efforts that can improve screening uptake in all Vietnamese women; focus groups and interviews of these women are underway. Citation Format: Minh T. Phung, Ivy Nguyen, Bethany Nguyen, Hailey Nguyen, Becky Nguyen, Dung Hua, Celeste L. Pearce, Alice W. Lee. Insight into cervical cancer screening and HPV self-sampling among Vietnamese immigrants in Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A144.

Knowledge and perception of medical students regarding remote-access thyroidectomy in Tabuk: the effects of extensive counseling-an interventional study.

Remote-access scarless thyroidectomies are relatively new surgical procedures, and their uptake for cosmetic concerns is rapidly evolving. However, demographic factors, previous thyroid surgery, and culture substantially influence the patient's choice. This is the first study to assess the extensive counseling effect on the patient's preference for remote-access thyroidectomies compared to conventional transcervical approaches. We aimed to assess the same among medical students at the University of Tabuk, Saudi Arabia. This interventional study was conducted from December 2023 to March 2024. A structured questionnaire was used to gather information about demographic factors, knowledge, and perception of the medical students regarding remote-access thyroidectomies before and after a slide presentation. Of 394 medical students (age 22.65 ± 1.62 years), 53.8% were women. Initially, the majority of the students preferred remote-access thyroidectomy over the conventional approach (85.3% vs. 14.7%, respectively); however, a substantial change toward the cervical approach was evident after extensive counseling [odds ratio, 2.59; 95% confidence interval (CI), 1.58-4.27; and P-value <0.00]. Knowledge regarding remote-access thyroidectomy was poor (26.9%). The students were anxious regarding postoperative complications (3.22 ± 1.59/5), thyroid scar appearance (3.28 ± 1.36/5), and postoperative pain (3.17 ± 1.38/5). Concerns regarding body satisfaction and cost were lower. Medical students at the University of Tabuk, Saudi Arabia, demonstrated low knowledge. The strong preference for remote-access thyroidectomy over transcervical thyroidectomy shifted substantially toward the conventional approach after counseling. The main factors were thyroid scar appearance, pain, and complications. Further larger-scale studies involving the general public and assessing the effect of extensive counseling on surgical choice are needed.

Percutaneous dilational tracheostomy following anterior cervical spine fixation – a retrospective propensity-matched cohort study

PurposeIn patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF.MethodsWe performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen’s definitions of complications and Clavien-Dindo’s classification were used.ResultsA total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected.ConclusionPDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare.

428. MIDDLE MEDIASTINAL LYMPHADENECTOMY IN MEDIASTINOSCOPIC ESOPHAGECTOMY FOR ESCC

Abstract (Introduction) In mediastinoscopic esophagectomy, it is necessary to secure a view of the deep middle mediastinum. Although tracheal carina lymph nodes can be stably dissected using a cervical approach, but they are dissected using a hiatal approach when it is difficult to secure the field of view. (Middle mediastinum dissection) It is important to at least peel off the tracheal membrane or azygos vein in order to reduce the risk of secondary injury in the hiatal approach, even if cervical approach is difficult. In that case, the attachment between the esophagus and subcarinal tissue should be maintained for the en-block dissection. In the hiatal approach, the dissection along the pericardial and aortic surface is continuous with the dissection layer in the cervical approach and left and right tracheal cartilage are exposed enough. In the left side, the dissection along the inferior pulmonary vein is connected to the dissection of No.109L lymph node. Then, in the right side, similarly dissect the subcarinal lymph nodes along the right bronchus (No.109R lymph node). At this time, it is important to carefully check the position of azygos vein to avoid injury. Finally, the lymph nodes at the apex of the tracheal carina are sufficiently cauterized and dissected. (Conclusion) When it is difficult to reach the subcarinal tissue in cervical approach due to body type or tumor factor, the hiatal approach is necessary for sufficient lymphadenectomy of the middle mediastinum. At that case, prior detachment of the tracheal membrane and azygos vein will be important to reduce the risk of secondary injuries. Maintaining the continuity between the esophagus and dissected tissue is also important for the stable field of view.

559. SURGICAL PROCEDURE AND CLINICAL OUTCOME OF TRANSMEDIASTINAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract Background We started performing esophagectomy by a laparoscopic transhiatal approach in 2009, and 577 patients had undergone to date. Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a technique for total mediastinal lymph node dissection (390 patients). Methods The upper and middle mediastinal lymph node dissection including lymph nodes along the left recurrent laryngeal nerve, using a left cervical approach, was performed with a single-port mediastinoscopic technique. This approach with pneumomediastinum by AirSeal System improved the visibility and handling in the deep mediastinum around the aortic arch. We recently performed intraoperative monitoring of the recurrent laryngeal nerve using Nerve Integrity Monitor system. For dissection of upper and middle mediastinal lymph nodes, the left recurrent laryngeal nerve was sometimes compressed by the shaft of the sealing device or the retractor. We used continuous monitoring with the Automatic Periodic Stimulation electrode for the left recurrent laryngeal nerve, and immediately recognized dangerous procedures. Frequency of recurrent laryngeal nerve palsy was dramatically reduced to half by the introduction of Nerve Integrity Monitor system. Furthermore, to understand the anatomy of bilateral bronchial arteries, we performed 3-dimensional computed tomography angiography preoperatively, which was crucial to avoid intraoperative bleeding. Results The outcome of patients performed transmediastinal radical esophagectomy was compared with those performed the right thoracotomy by using propensity score matching. The operative time, the operative bleeding, and postoperative respiratory complications were significantly decreased by transmediastinal radical esophagectomy. Conclusion Our surgical procedure resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications. https://intconferenceservices-my.sharepoint.com/:v:/g/personal/barbarav_icsevents_com/ER9oAGbon3xJvdMGlJ2EUbIBgaq_8XDlKNA-wzVH3-7Hcg?nav=eyJyZWZlcnJhbEluZm8iOnsicmVmZXJyYWxBcHAiOiJPbmVEcml2ZUZvckJ1c2luZXNzIiwicmVmZXJyYWxBcHBQbGF0Zm9ybSI6IldlYiIsInJlZmVycmFsTW9kZSI6InZpZXciLCJyZWZlcnJhbFZpZXciOiJNeUZpbGVzTGlua0NvcHkifX0&amp;e=KbAfDr

572. TECHNICAL DETAIL AND SHORT-TERM OUTCOMES OF ROBOT-ASSISTED CERVICAL ESOPHAGECTOMY (RACE) WITH BILATERAL CERVICAL APPROACH FOR ESOPHAGEAL CANCER

Abstract Background The transcervical mediastinoscopic esophagectomy is a relative new technique that has gradually demonstrated because of its ease of dissection along the organ sheath and its less invasive nature. However, the conventional cervical approach to mediastinoscopy has been reported to have a relatively high rate of recurrent nerve palsy due to interference in the mediastinum caused by the straight forceps. The robot-assisted transcervical esophagectomy (RACE) approach is novel procedure expected to reduce these interferences and improve maneuverability around the recurrent nerve. In this report, we describe a surgical technique and short-term outcome of RACE. Methods In this study, we included 26 RACE cases performed between Feb 2023 to Feb 2024. Principally, our hospital performs transcervical esophagectomy mainly on patients who are difficult to approach by transthoracic approach due to history of thoracic diseases, etc. In our department, transcervical esophagectomy is usually performed via a bilateral cervical approach, starting from the right neck and continuing to the left neck, and RACE is performed using the da Vinci Xi via a bilateral cervical approach as well. Recently, we have been shortening the operation time by performing simultaneous cervical and abdominal operations without muscle relaxation using NIM. Results Patient background: mean age 74.5, male to female ratio 22:4, cStage I/II/III/IV: 13/3/9/1, NAC: 46.1%, more than 80% had some history of pulmonary disease/systemic history. All patients underwent RACE via bilateral cervical approach, and no intraoperative complications or thoracoscopic conversion were observed. Postoperative complications (CD Grade≥1) included recurrent nerve palsy in 15.6% and respiratory complications in 7.6%. In addition, the recent operation with simultaneous cervical/abdominal NIM and no muscle relaxant has significantly shortened the average total operative time to 4 hours and 40 minutes. Conclusion Robot-assisted Cervical Esophagectomy (RACE) is a relatively safe procedure that offers a natural anatomic approach, fewer respiratory complications, and a significant reduction in operative time due to simultaneous neck and abdominal manipulation. With the advancement of robotics and devices, RACE is expected to become more effective and more widely used in the future.

223. OUR SURGICAL TECHNIQUE OF TRACHEAL RESECTION AND ANTERIOR MEDIASTINAL TRACHEOSTOMY (AMT) IN THE MULTIDISCIPLINARY TREATMENT OF ESOPHAGEAL CANCER INVADING TRACHEA

Abstract Combined tracheal resection and anterior mediastinal tracheostomy (AMT) for esophageal cancer with tracheal invasion is a challenging treatment and technically demanding. Herein, we introduce our surgical procedure of AMT and its tips to reduce postoperative complications. Briefly, in a supine position with cervical approach, the manubrium, the medial half of the clavicle, and the adjacent first and second ribs on both sides were removed to achieve an open cervico-thoracic view. After completion of tumor resection, AMT was performed; after encircling brachiocephalic artery and transected innominate vein if needed, the tracheal stoma was translocated from the left to right side of the brachiocephalic artery to avoid postoperative hemorrhage caused by tracheal compression. In a case of free-jejunum reconstruction, we usually harvest mesentery as much as possible to fill in the surrounding dead space in the upper mediastinum around trachea and major arteries to prevent infection (we also use the pectoral myocutaneous flap and omentum for this purpose). The tracheal stoma was finally created using interrupted stitched to attach the tracheal stump to the native chest skin. https://photos.google.com/photo/AF1QipNDuxhBpSYDIDydLYD_0Vk917Kd13bG5t6ILtb6

A new approach: Cervical approach for marginal resection of the posterior mandible

Gingival squamous cell carcinoma (SCC) of the posterior mandible often requires marginal resection of the mandible in conventional surgery. However, the posterior location of the lesion can limit surgical visibility, which is critical for complete tumor removal and minimizing recurrence. Typically, marginal resection of the posterior mandible is achieved through a midline lower lip incision and mental nerve transection, providing adequate exposure but resulting in nerve damage, lip numbness, and facial scarring. In this paper, we describe a case using a submandibular incision for neck dissection, extending from the mandibular angle to the mental foramen, to fully expose the posterior mandible. The intraoral incision, extending 1 cm beyond the tumor margin, connected with the submandibular incision. Under direct vision, we performed a marginal resection of the mandible, preserving the inferior alveolar neurovascular bundle and the mental nerve, and maintaining at least 1 cm of the inferior mandibular margin. This technique achieved complete tumor removal while preserving mental nerve function and lower lip integrity, reducing surgical difficulty and patient trauma. This approach maintains nerve function and aesthetics as much as possible, with a faster postoperative recovery. In treating gingival SCC of the posterior mandible, it is essential to preserve surrounding healthy tissue and critical anatomical structures, minimizing postoperative complications while ensuring complete tumor resection.

514. ESOPHAGOGASTRIC ANASTOMOSIS STRICTURE AFTER A CERVICAL FISTULA: LONG TERM COMPLICATION AFTER THE MCKEOWN PROCEDURE STERNOTOMY APPROACH: ANASTOMOSIS RESECTION

Abstract Background Anastomotic stricture after anastomotic leakage is a common long term complication after mckeown procedure. It can be resolved by endoscopic dilations on most occasions. However, if endoscopic aproach fail, we have to solve the estenosis with a surgery procedure. This type of reintervention could be a really hard aproach due to an intense fibrosis and anatomical layer destructuring. In this video, we show a initial cervical approach to do a anastomosis resection and reanastomosis. However, due to the intense fibrosis and the difficulty in dissecting the gastric plasty from the sternal table, the incision had to be extended and a partial sternotomy was performed. With this approach, we can see the gastric plasty, making the dissection. The we can perform a new esophagus gastric anastomosis safety. In conclusion, partial sternotomy allows us to visualize the gastric plasty and perform the dissection safety making a tensión free anastomosis. https://we.tl/t-6MTce26lI1

Esophageal dedifferentiated liposarcoma resected by the cervical approach: a case report

BackgroundWhile liposarcomas tend to mainly occur in the soft tissues of the extremities and retroperitoneum, esophageal liposarcoma is rare. Herein, we report a case of a patient who underwent complete resection of an esophageal dedifferentiated liposarcoma via the cervical approach, leading to the preservation of the esophagus.Case presentationA 69-year-old man underwent an upper gastrointestinal endoscopy, as a result of which a submucosal-like tumor was observed. Upper gastrointestinal imaging showed a 12-cm tumor with a stalk arising from the esophageal entrance, extending to the middle intrathoracic esophagus, with a normal surface mucosa. Endoscopic ultrasound-fine needle aspiration biopsy showed that the nuclei of tumors cells were positive for murine double minute (MDM) and weakly positive for cyclin-dependent kinase 4 (CDK4). We diagnosed the tumor as the esophageal dedifferentiated liposarcoma, and planed tumor resection via the cervical approach. The tumor was successfully resected and the postoperative course was uneventful.ConclusionThis case report highlights the use of tumor resection via the cervical approach as a good option for esophageal liposarcoma.

Eagle syndrome presentation and outcomes in a large surgical case series.

The purpose of this study is to describe both the common and uncommon symptoms associated with Eagle syndrome and share our experience treating a large group of patients with surgical intervention, primarily intraoral excision of the calcified stylohyoid ligament. This retrospective case series included 56 patients at least 18 years of age or older with a diagnosis of Eagle syndrome. All operations were conducted by a single surgeon at a tertiary medical center from 2015 to 2022. Charts were reviewed for demographics, prior medical/surgical history, symptoms, imaging results, operative details, and follow-up history. A phone survey inquired about presenting symptoms and symptom resolution following surgery. The most common areas of pain were the ear (64.3%), underneath the angle of the mandible (50%), throat (46.4%), and neck (30.4%). Over 70% of patients reported tinnitus, dysphagia, and pain that were exacerbated by head rotation. Fifty-one of the 56 patients underwent surgical treatment, 92.2% via intraoral and 7.8% via cervical approaches. All patients (100%) reached in a phone survey stated that their symptoms resolved or improved after surgery. Eagle syndrome typically presents with common symptoms. However, healthcare providers must also be vigilant for less common manifestations, such as seizures or episodes of dizziness/fainting. These may be caused by calcification of the stylohyoid ligament. Intraoral surgical resection of the calcified ligament is a safe and effective treatment for most patients. Level 4.

Endoscopy-assisted high cervical anterolateral retropharyngeal approach to clivus: a cadaveric study.

The surgical management of pathologies involving the clivus and craniocervical junction has always been considered a complex procedure because of the deeply located surgical targets and the surrounding complex neural and vascular anatomical structures. The most commonly used approaches to reach this area are the transnasal, transoral, and transcervical approaches. This approach was performed unilaterally on five cadaver heads and bilaterally on one cadaver head. We described a modified endoscope-assisted high cervical anterolateral retropharyngeal approach in which each stage of the procedure was demonstrated on human cadavers in a step-by-step manner using endoscopic camera views. This approach was broken down into nine steps. The neurovascular structures encountered at each step and their relationships with each other are demonstrated. The advantages and disadvantages of our modified approach were compared to the conventional transcervical, transoral, and endoscopic endonasal approaches.

Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda

Background The majority of women in low- and middle-income countries have low awareness of cervical cancer. This study sought to establish awareness of cervical cancer risk factors and preventive approaches, as well as sources of information and perceived causes of cervical cancer among secondary school girls in northern Uganda. Methods This was a cross-sectional study conducted in rural northern Uganda. We collected data using an investigator administered pre-tested questionnaire. Analysis was done with STATA version 14.0. Multivariate analyses with logistic regressions models were used to determine magnitudes of association between independent and outcome variables. Odds ratios and accompanying 95% confidence intervals are reported. Statistical significance was considered if the two sided p-value <.05. Results Most participants (97%; n = 624) had heard of cervical cancer before this study. The most common source of information about cervical cancer was friends (31.1%; n = 194). More than half of the participants (59%; n = 380) had heard about a vaccine that prevents cervical cancer, but only a third (33%; n = 124) had ever received a dose of the vaccine. The majority of participants (89%; n = 550) reported that cervical cancer could be prevented; however only half (52%; n = 290) knew that vaccination of girls aged 9–13 years could prevent cervical cancer. The majority of participants did not recognize the risk factors for cervical cancer; for example, only 15% (n = 98), 7% (n = 45), and 1.4% (n = 9) recognized early onset of sexual intercourse, infection by the human papillomavirus (HPV), and smoking respectively. On adjusting for age, students’ class, and religion, students in schools with school health programs were twice (aOR = 2.24: 95%CI; 1.24–4.06) more likely to know that cervical cancer is preventable. Conclusion Secondary school girls need information on cervical cancer risk factors and approaches to prevention so that they may avoid exposures to the risk factors and promptly seek and undertake preventive approaches including HPV vaccinations.

A controlled study of the hygienic technical evaluation of the transaxillary approach for inflation-free single-port lumpectomy versus conventional transcervical anterior open surgery in radical thyroid cancer resection

ObjectiveTo evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the conventional open anterior cervical approach (COACAS) in a controlled manner.MethodsThis work was a retrospective analysis of the clinical data of 60 patients admitted to our hospital for unilateral radical thyroid cancer surgery between 01/2021 and 12/2022. The control group underwent COACAS (30 patients), and the experimental group underwent TAWISES (30 patients). The patients’ operative time, intraoperative bleeding volume, 24-h postoperative pain index, drainage tube carrying time, hospitalization duration and complication rate were compared and analyzed. The patients were followed up for 3, 6 and 12 months postoperatively and evaluated based on numbness, muscular tightness, pain and other discomfort in the neck, as well as satisfaction with social adaptation and cosmetic incisions. The recurrence status was assessed for 1 year in both groups of patients. A questionnaire survey was conducted to assess patient acceptance of the two surgical approaches. The economic characteristics (cost-effectiveness and cost-utility) of the different approaches in our region were evaluated comprehensively.ResultsThe length of the incision, drainage tube carrying time and hospitalization duration were greater in the experimental group than in the control group (P < 0.05). The differences in complication rate, intraoperative bleeding volume, 24-h postoperative pain index and recurrence rate were not statistically significant between the two groups (P > 0.05). Neck discomfort was greater in the control group, and the difference was statistically significant at the 3-month postoperative follow-up (P < 0.05). The differences at the 6- and 12-month postoperative follow-ups were not statistically significant (P > 0.05). However, mild discomfort was significantly more common in the experimental group (63.33% > 36.67%, 80% > 53.33%, P < 0.05). The experimental group had better social adaptability, greater total medical costs, and better overall patient medical satisfaction than did the control group (P < 0.05). The acceptance of TAWISL was greater than that of COACAS (P < 0.05).ConclusionCompared with COACLAS, TAWISES is safe and effective and better meets the cosmetic, psychological and social adaptation needs of patients. TAWISES is also more cost effective and can be better utilized for the population in our region, filling the gap in surgical modalities for thyroid cancer in in our region.

Simultaneous transcatheter aortic and tricuspid valve replacement via bilateral cervical approach.

Simultaneous transcatheter aortic and tricuspid valve replacement via bilateral cervical approach.