Omohyoid Research Articles

An unreported accessory muscle on the neck region

Anatomical variations or accessory muscles on the neck region are important for clinicians and surgeons. This case report aims to contribute to the literature by demonstrating the presence of a previously unrecognized muscle on the lateral neck region. During routine gross anatomy dissection of a 59-year-old male cadaver; an unreported muscle was observed next to the scalene muscles on the left lateral neck region. The distance between the center of the scalenus medius and the insertion of the muscle was 6.17 cm, and the distance between the scapular notch and the insertion of the muscle was 1.56 cm. The distance between the aponeurosis that connects the superior and the inferior bellies of the omohyoideus muscle and the first head of the muscle was 6.24 cm. This anatomical formation, which is not included in the literature, has anatomical and clinical importance in controversial clinical cases in neck pathologies.

438. TECHNIQUE OF COMPLETELY ROBOTIC MCKEOWN (3-HOLE) ESOPHAGECTOMY WITH INTRA-CORPOREAL GASTRIC CONDUIT CREATION, AND CERVICAL ESOPHAGO-GASTRIC ANASTOMOSIS FOR MID-ESOPHAGEAL ADENOCARCINOMA

Abstract Background Esophageal cancer is the 7th leading cause of cancer deaths, with an estimated total case of 22,370 in both males and females in 2024. Adenocarcinoma and squamous cell carcinoma account for over 90% of histology at diagnosis. The incidence of adenocarcinoma continues to rise due to the rising incidence and prevalence of obesity, gastro-esophageal reflux disease and Barrett's esophagus. Multi-modality treatment is currently the standard of care for locally advanced disease. This consists of neoadjuvant concurrent chemotherapy and radiation therapy, followed by esophagectomy. Minimally invasive approaches to esophagectomy are associated with decreased post-operative morbidities and overall satisfactory outcomes. While the Ivor Lewis esophagectomy with intra-thoracic anastomosis is the most common surgical approach to resection of distal esophageal and gastroesophageal (GE) junction tumors, the McKeown (3-hole) esophagectomy with cervical esophago-gastric anastomosis is best suited for tumors located in the proximal and mid-esophagus. Methods We describe our technique of robotic McKeown (3-hole) esophagectomy for mid-esophageal adenocarcinoma after neoadjuvant concurrent chemo-radiation therapy for clinical stage uT3N0M0 tumor. The thoracic esophagus is completely mobilized from the esophageal hiatus of the diaphragm up to the thoracic inlet via a right thoracoscopic approach, with harvesting of the regional lymph nodes together with the specimen. The left neck incision is made along the anterior border of the sternocleidomastoid muscle and the inferior belly of the omohyoid muscle is transected. The cervical esophagus is then completely mobilized into the wound and secured using a Penrose drain. Using a laparoscopic approach, the entire stomach is mobilized with division of the left gastric vessels but careful preservation of the right gastro-epiploic arcade while transecting the greater omentum and the short gastric vessels. An intra-corporeal creation of the gastric conduit then follows. The gastric conduit, secured to the proximal stomach at the resection staple line, is subsequently tunneled via the esophageal hiatus and through the mediastinum to exit at the left neck incision by applying traction on the cervical esophagus. The specimen is separated from the conduit, and the cervical esophagus is transected at the desired location for the anastomosis. A stapled end-to-side but functional end-to-end esophago-gastric anastomosis (Orringer's technique) is then created. Results A completely robotic technique of McKeown (3-hole) esophagectomy without the need to exteriorize the stomach to fashion the gastric conduit via a (mini)laparotomy is successfully accomplished in the majority of our patients with proximal or mid-esophageal tumors. An uneventful postoperative recovery was made. Fluoroscopic esophagram on post-operative day 5 did not demonstrate leakage from the anastomotic site. Gastric conduit emptying was satisfactory despite the lack of a routine gastric drainage procedure or injection of botulinum toxin into the pyloric ring. Conclusion Robotic-assisted thoracoscopic esophageal mobilization combined with laparoscopic completely intra-corporeal fashioning of gastric conduit with cervical esophago-gastric anastomosis is a technically feasible minimally invasive approach to performing McKeown esophagectomy with satisfactory post-operative outcomes and conduit functioning. https://www.dropbox.com/scl/fi/gzc1vzdzhzqn7niz95b8t/Robotic-McKeown-Esophagectomy-Video-3.mp4?rlkey=c4ja7s1aob10ah6ps500z7y29&dl=0

Radiological assessment of the dissection area in supraomohyoid neck dissection

PurposeThe current supraomohyoid neck dissection (SOHND) is performed above the omohyoid muscle to dissect levels I, II, and III in the levels of cervical lymph nodes. However, the anatomical boundary between levels III and IV is the inferior border of the cricoid cartilage. We investigated the anatomical relationship between the omohyoid muscle and cricoid cartilage using contrast-enhanced CT (CE-CT) images to assess the validity of the current SOHND.MethodsCE-CT images of the head and neck regions in patients were reviewed. The patients were divided into two groups: “malignant tumors” and “others”. The vertebral levels corresponding to the positions of anatomical structures such as the intersection of the omohyoid muscle and internal jugular vein (OM-IJ), and the inferior border of the cricoid cartilage (CC), were recorded.ResultsThe OM-IJ was located around the seventh cervical to the first thoracic vertebra. There was a significant difference between the malignant tumor and others groups in females (p = 0.036). The CC was located around the sixth to seventh cervical vertebrae. There was a significant sex difference in each group (malignant tumor: p < 0.0001; others: p = 0.008). Both sexes tended to have lower OM-IJ than CC, and females had significantly lower OM-IJ than males.ConclusionThis study provides clear anatomical evidence showing the difference between the SOHND dissection area and levels I, II, and III. It could be considered that in most cases SOHND invades level IV, not just levels I, II, and III, especially in female patients.

Unusual anatomical variants of infrahyoid muscles - case report.

Anatomical anomalies of neck muscles are rarely observed and usually comprise variations of digastric and omohyoid muscles. Neck muscles' abnormalities might be correlated with embryological development and are observed in individuals with aneuploidies such as Edward's syndrome (18-trisomy) or Down syndrome (21-trisomy). Some infrahyoid muscles are important landmarks during surgery, therefore their anatomical variations of these muscles are related to higher risk of surgical complications. Herein, we present a rare case of infrahyoid muscles anomalies found during routine dissection of male cadaver. Redundant muscle bellies of sternohyoid muscle (sternohyoid azygos muscle), presence of levator glandulae thyroideae and also one hypoplastic superior belly of the omohyoid muscle were observed. Presence of muscle fibers within found structures was confirmed using Masson's trichrome staining method.

Quantitative comparison of three thyroidectomy approaches on neck muscles, voice, and swallowing functions

ObjectiveThis study compares endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and sternocleidomastoid leading-edge approach (SLEA) with conventional open thyroidectomy (COT) in hemithyroidectomy. The main focus is on the protection of neck muscles (sternocleidomastoid, omohyoid, sternothyroid) and the postoperative function of voice and swallowing yielded through these common approaches. MethodsA total of 302 patients who underwent hemithyroidectomy were enrolled and divided into three groups: ETGUA (n = 101), SLEA (n = 100), and COT (n = 101). Ultrasound was used to measure the thickness of bilateral neck muscles, including the sternocleidomastoid, omohyoid, and sternothyroid. The changes in thickness on the surgical side compared to the non-surgical side. Analyzed factors included muscle thickness changes, Swallowing Impairment Score (SIS), Voice Handicap Index (VHI), Scar Cosmesis Assessment and Rating (SCAR), Neck Incision Index (NII), surgery duration, drainage volume, hospitalization, and number of lymph nodes. ResultsThe clinical characteristics among the three groups were consistent except for differences in sex, age, and BMI. Metrics such as sternocleidomastoid muscle, NII, hypocalcemia, postoperative PTH, transient hoarseness, and number of lymph nodes showed no significant differences among the three groups. However, significant differences were found in the duration of surgery, drainage volume, hospitalization period omohyoid muscle, Sternohyoid muscle, VHI, SIS, and SCAR (all p < 0.001). ConclusionIn comparison to COT, ETGUA and SLEA demonstrate superiority in protecting neck muscles and preserving voice and swallowing function without compromising surgical safety or radicality.

Duplicated internal jugular vein: a case report

Anatomical variants of the venous central system are very infrequent; nevertheless, it is useful to be aware of them in order to avoid complications during common procedures. The purpose of the present study is to describe an anatomical variant of the Right Internal Jugular Vein (RIJV), and to investigate the frequency of this variant reported in the current literature. Authors present an anatomical variant of RIJV, found during the dissection of an adult male cadaver, previously fixed in a formaldehyde-based solution, who was voluntarily donated to the Faculty of Medicine of Universidad de la República in Montevideo, Uruguay. The cadaveric material was used taking into account the Helsinki Declaration regarding prior live donation and informed consent. A photographic record and a bibliographic search in electronic bases were carried out in order to discover the frequency with which this variant occurs. It was described as an isolated duplicated RIJV, which had its origin at the level of the right jugular foramen, and had its division next to the thyroid cartilage after a path of 6.5 cm into two branches (anteromedial and posterolateral) that ended separately, and were 7.2 cm and 5.4 cm in length, respectively. The relations with near structures such as the accessory nerve and the omohyoid muscle were also described and compared with the literature reviewed.

Diagnostic value of high-frequency ultrasound in omohyoid muscle syndrome.

To investigate the diagnostic value of high-frequency ultrasound in omohyoid muscle syndrome. A retrospective analysis of 11 patients diagnosed with omohyoid muscle syndrome was carried out, and the characteristics of high-frequency ultrasound images were summarized. Ultrasonography of the omohyoid muscle showed a narrow band of hypoechoic muscle bundle. The ultrasonographic manifestation of omohyoid muscle syndrome showed a thickening of the omohyoid muscle on the affected side. The omohyoid muscle on the affected side bulged forward during swallowing and lifted the overlying sternocleidomastoid muscle. The difference between the thickness of the omohyoid muscle intermediate tendon on the affected side and the healthy side at rest was statistically significant (t = 58.23, P < 0.001). The difference between the thickness of the affected omohyoid muscle intermediate tendon at rest and during swallowing was statistically significant (t = 14.57, P < 0.001). There was no statistically significant difference between the thickness of the omohyoid muscle intermediate tendon on the healthy side at rest and during swallowing (t = 0.56, P > 0.05). High-frequency ultrasound is the preferred imaging method in the diagnosis of omohyoid muscle syndrome.

An Independent C1 Nerve Root Variant of the Ansa Cervicalis: A Case Report

The ansa cervicalis (AC) is a neural loop within the carotid triangle of the anterior neck. The loop is traditionally formed by nerve roots C1–C3 of the cervical plexus and extends multiple motor branches. The current case was discovered during a routine dissection as an anatomical variation of the right AC in an 86-year-old Caucasian male cadaver. In this variation, the C1 nerve root did not form the typical loop with the C2 and C3 nerve roots, but instead, remained independent, traveling deep to the superior belly of the omohyoid muscle to supply the sternothyroid muscle. Because no loop was formed, the anatomy of the current case was not an ansa according to the Latin origin of the word, meaning handle or loop. The AC is an important anatomical landmark within the neck and is implicated in laryngeal reinnervation and respiratory nerve stimulation for patients with sleep apnea. The current anatomical variant contributes to a relatively limited catalog of identified anomalies. Knowledge of new AC variations can guide future surgical interventions and further develop the current base of knowledge surrounding the neuromuscular structures of the head and neck.

A rare variation of omohyoid and its embryological correlations- A case report

The omohyoid muscle is important in radical neck dissection, as it is a landmark for this operation. Because it divides the anterior and posterior cervical triangles into smaller triangles and its particular relationship to the large cervical vessels, the presence of an anatomical variation of the omohyoid muscle is important. Either belly may be absent or double; and the inferior belly may be attached directly to the clavicle and the superior is sometimes fused with sternohyoid. Variations in the omohyoid muscle might be linked to differences in embryological development, which could influence the muscle’s final form and function. Anderson (Anderson, 1881) theorized that the superior belly of the omohyoid muscle is a true infrahyoid muscle, whereas the inferior belly most likely shares a common embryology with the subclavius muscle. As omohyoid mucle is used to achieve the reconstruction of the laryngeal muscles and bowed vocal folds, the knowledge of the possible anomalies of the omohyoid muscle is important.In the present study, we have found a case with two inferior bellies &amp; aberrant course of superior belly of omohyoid on right side of 40 years female cadaver embalmed with formalin during routine dissection at Department of Anatomy AIIMS Gorakhpur.Omohyoid muscle is closely related to large vessels of neck &amp; brachial plexus, so variations in this muscle are clinically important.

An Unusual Variation of the Omohyoid Muscle with Surgical Implications and Review of the Literature

An Unusual Variation of the Omohyoid Muscle with Surgical Implications and Review of the Literature

Lateral Approach to Thyroid Surgery: An Alternative Open Thyroidectomy Technique

Background: Thyroidectomy is one of the common surgical procedures for thyroid related various pathology. Midline approach is the classical and common in which thyroid gland is approached after splitting the strap muscles in midline. The objective of this research is to elaborate the surgical technique of lateral thyroid approach for hemi-thyroidectomy, also to measure the efficacy in preserving the important anatomical structures and to assess the complications. Materials: A cross-sectional study was conducted in the department of ENT-Head and Neck Surgery of Bharatpur Hospital, Chitwan, Nepal during January 2019 to March 2021. Benign thyroid diseases that required hemi-thyroidectomy were included in this study. Surgical technique was discussed with special focus for access of superior pedicle and preservation of important anatomical structures. Results: Among 36 cases most of those 16(44.4%) were operated after 1 year of disease occurrence. Not a single case was undergone strap muscle cutting or sacrifice of superior belly of omohyoid muscle. Recurrent laryngeal nerve was found in 94.4% (33 cases). External branch of superior laryngeal nerve (EBSLN) was in 91.7 %( 33) cases. Superior parathyroid glands were found in majority of the cases but not found in 8.3 %( 3). Inferior parathyroid glands were found in all cases. Post-operative drainage was 38 ml(mean). Conclusion: Vital structures were preserved in more than 90% cases and major complication occurred in none of the cases. We conclude that this approach is good, safe and comfortable to the surgeon.

Dynamic ultrasound examination painting the picture of omohyoid muscle strain and associated suprascapular nerve entrapment.

Journal Article Accepted manuscript Dynamic Ultrasound Examination Painting the Picture of Omohyoid Muscle Strain and Associated Suprascapular Nerve Entrapment Get access Wei-Ting Wu, Wei-Ting Wu Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, TaiwanDepartment of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan Search for other works by this author on: Oxford Academic PubMed Google Scholar Kamal Mezian, Kamal Mezian Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University, in Prague, Prague, Czech Search for other works by this author on: Oxford Academic PubMed Google Scholar Vincenzo Ricci, Vincenzo Ricci Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Chia-Shiang Lin, Chia-Shiang Lin Department of Anesthesiology, Shuang Ho Hospital, Ministry of Health Welfare, New Taipei City, TaiwanDepartment of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Search for other works by this author on: Oxford Academic PubMed Google Scholar Ke-Vin Chang, Ke-Vin Chang Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, TaiwanDepartment of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, TaiwanCenter for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan Correspondence: Ke-Vin Chang, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Bei-Hu Branch, No. 87, Nei-Jiang Rd., Wan-Hwa District, Taipei 108, Taiwan, E-mail: kvchang011@gmail.com phone: +886223717101-5309. Search for other works by this author on: Oxford Academic PubMed Google Scholar Levent Özçakar Levent Özçakar Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, pnad085, https://doi.org/10.1093/pm/pnad085 Published: 24 June 2023 Article history Received: 26 April 2023 Revision received: 03 June 2023 Accepted: 21 June 2023 Published: 24 June 2023

A unilateral sternopharyngeal branch of the sternocleidomastoid muscle in an aged Caucasian male: a unique cadaveric report.

The sternocleidomastoid muscle (SCM) consists of a sternal and a clavicular head which merge together and inserts distally posterolateral on the mastoid process and superior nuchal line, hence separating the anterior from the posterior triangle of the neck. Many types of structural variations in SCM have already been reported before. A unique variation of this muscle was discovered in an aged Caucasian male cadaver during an anatomical dissection at the Paracelsus Medical University in Nuremberg, Germany. This study reports a right unilateral accessory muscular branch at the sternal head of the SCM which formed a tendon on the level of omohyoid muscle before dividing into anterior and posterior fascicles. The posterior fascicle attached to the external carotid artery at the site where a common trunk for lingual and facial artery branched off, drawing external carotid artery inferiorly to build an inferior loop, whereas the anterior fascicle passed further superior and broadened to form a muscular belly. This superior muscular belly extended to the posterior and lateral side of the pharynx to ultimately merge into the superior constrictor pharyngeal muscle. Such anatomical variation has never been reported before. Therefore, we propose the nomenclature of this variational structure as a sternopharyngeal branch of the SCM. This report helps not only to inform the clinicians regarding the possible variation of this muscle during surgical procedures or radiological diagnostics but also encourage developmental researches in the future.

Dynamic reanimation of severe blepharoptosis using the neurotized omohyoid muscle graft

Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft. Retrospective analysis of patients receiving a neurotized omohyoid muscle graft for levator palpebralis substitution between January and December 2019. Five patients were operated (2 male, 3 female); median age was 35.5 years. Median palpebral aperture was 0mm and levator function was<1mm in all cases. Median denervation time for the levator muscle was 9 years. All surgeries were uneventful, and no postoperative complications were seen. Twelve months after the procedure, all patients presented with adequate palpebral aperture on activation of the spinal nerve. Median palpebral aperture was 6.5mm Postoperative electromyography revealed muscle contraction when stimulation was applied to the spinal nerve. This study introduces the concept of severe blepharoptosis correction using the omohyoid muscle. We believe that with time and further technical refinements it could become an invaluable tool in eyelid reconstruction surgery.

Pharyngeal Closure Reinforced With Sternohyoid and Omohyoid Muscle After Total Laryngectomy

Pharyngocutaneous fistula occurring after total laryngectomy is a bothersome complication as it can even cause a massive bleeding due to carotid artery rupture. Preoperative radiation, extensive diseases which need flap reconstruction, low albumin or hemoglobin level, history of smoking, or underlying diseases have been domestically reported to have a relationship with the condition. To reduce this complication, simultaneous coverage for the pharyngeal closure has been developed using flaps, such as the pectoralis major muscle, the radial forearm or the anterolateral thigh, which are distant from the radiation field. However, these methods need additional surgical techniques and times. Another method advocated is pharyngeal reinforcement using flaps that can be easily obtained from the same surgical field, such as the sternocleidomastoid or the infrahyoid muscle or the acellular dermal graft with relative significances. Here we suggest reinforcement of pharyngeal closure after total laryngectomy using the sternohyoid and omohyoid muscle flaps.

837: CENTRAL VENOUS CATHETER PLACEMENT IN A PRONE POSITIONED PATIENT: POSTERIOR LATERAL APPROACH

Introduction: A significant number of patients with ARDS secondary to Covid-19 pneumonia require prone positioning. Common practice is to return patients to a supine position prior to performing invasive bedside procedures such as central venous access. This may present prohibitive risk in patients with refractory hypoxemia. Description: We present the case of a 46 year old male, admitted to the ICU with Covid-19 pneumonia complicated by ARDS. Intermittent prone positioning was initiated. The patient remained with refractory hypoxemia despite prone positioning, optimal ventilator settings and inhaled epoprostenol. The length of time the patient could be supine progressively decreased. The patient developed AKI necessitating hemodialysis (HD) catheter placement. Attempts to supine patient to perform HD catheter placement resulted in near cardiorespiratory arrest. It was decided to attempt HD catheter placement in the RIJ vein via a posterior lateral approach with the patient prone. Patient was brought to the head of the bed allowing the chin to rest on the edge of the bed with head turned laterally and endotracheal tube supported by the respiratory therapist. The patient was placed in an oblique “swimming position” by aid of a pillow under the center torso and right shoulder girdle. An optimal insertion site was selected via real time ultrasound guidance. Utilizing a micropuncture needle, guidewire, and dilator, a 15cm 12 Fr BARD hemodialysis catheter was placed using a standard Seldinger technique. Discussion: Our experience indicates that a posterior lateral approach for CVC placement is a viable option. Given the complexity of this procedure and the paucity of case reports describing it, we felt it prudent to share our approach. Structures of interest to avoid in posterior approach to the RIJ include the phrenic nerve traveling along the scalenus anterior muscle tissue posterior to the internal jugular vein. Accessing the vein below the omohyoid muscle offers the best opportunity to avoid the phrenic nerve and the scalenus. A steep 90 degree angle to access the RIJ was intentionally attempted to minimize the amount of soft tissue to dilate. Utilizing this approach allowed us to safely and effectively place the line without immediate complications.

A Case of Thyroid Chondrosarcoma

We herein report a rare case of thyroid chondrosarcoma in which laryngeal preservation surgery was performed. The patient was a man in his 40s. A hard mass was palpated on the right lateral side of the thyroid cartilage. Enhanced computed tomography showed a tumor on the right lateral side of the thyroid cartilage with partial destruction of the thyroid cartilage. Ultrasonography-guided fine-needle aspiration cytology suggested the lesion was a tumor of cartilage origin. We therefore diagnosed a thyroid cartilage tumor. We performed partial laryngectomy. Intraoperative findings revealed a hard tumor contiguous with the thyroid cartilage deep in the right omohyoid muscle. The right two-thirds of the thyroid cartilage were cut longitudinally, and the tumor was removed. The pathological diagnosis was a grade 2 chondrosarcoma of thyroid cartilage origin. Two years after surgery, there was no recurrence. There have been 37 cases of laryngeal chondrosarcoma reported in Japan, and only 8 were of thyroid cartilage origin. Surgical treatment was selected in all cases, with 16 cases treated by total laryngectomy and 21 cases by partial laryngectomy. Recurrence was reported in five cases, including local recurrence in three cases, cervical recurrence in one case, and distant metastasis in one case.

Ultrasonographic measurements of the omohyoid muscle during shoulder muscles contraction.

The main function of the omohyoid muscle is to depress and withdraw the hyoid bone. This is an integral part of the swallowing process facilitating hyoid stabilization for tongue movement. Although the muscle is inferiorly attached to the scapula bone, its function during shoulder or scapula muscles contraction has yet not been studied. To investigate whether changes occur in omohyoid muscle morphology during shoulder muscles contraction. The study included 40 healthy subjects (20 males and 20 females, Mean age: 25.68 (± 2.90) years) examined via diagnostic ultrasound. Omohyoid muscle morphology measurements (thickness and cross-sectional area) during different shoulder position (0°, 90° abduction and elevation) in rest and during isomteric contraction were evaluated. The omohyoid muscle was activated when the shoulder was isometrically abducted at 90° abduction. Thickness and the cross-sectional area of the lower belly increased during contractions at 90° abduction compared with a resting position at 90° (p value < 0.01). No changes occurred at 0° isometric abduction. The CSA of the muscle was found to be significantly larger (p < 0.001) during contraction at 90° abduction compared with contraction at 0° abduction. Omohyoid muscle was most contracted during abduction position with abduction shoulder muscles isometric contraction. Changes of the scapula position might influence omohyoid muscle function.

Completion thyroidectomy and lateral neck dissection revealed adhesions in the lateral neck compartment after gasless transaxillary endoscopic thyroidectomy: a case report

Endoscopic thyroidectomy is effective and safe surgical option for thyroid surgery while providing satisfactory cosmetic results. Gasless transaxillary endoscopic approaches have been reported to achieve endoscopic thyroidectomy in our center. We present a patient who previously underwent gasless transaxillary endoscopic lobectomy with ipsilateral central neck dissection who underwent open completion thyroidectomy and lateral neck dissection (LND) (reoperation) in our center. The ultrasound test before the first treatment did not reveal abnormal lymph nodes in the central and lateral neck compartments. Further evaluation of the neck lymph nodes was not performed. Meanwhile, this patient did not participate in the originally planned follow-up at the 3- and 6-month visits. At the one-year visit, imaging tests revealed enlarged and suspicious malignant lymph nodes in levels III and IV of the lateral neck compartments. We believed that reoperation was performed for persistent, rather than truly recurrent disease for this patient. During the second surgery, we found that the surface of internal jugular vein (IJV) was significantly adhered to the surrounding fibroadipose tissue and the omohyoid muscle was adhered to the IJV. After carefully dissected the IJV, the dissection of the lateral neck compartment had been performed successfully. Exposure of the lateral neck compartment in the gasless transaxillary procedure, especially exposure of the IJV, causes adhesions of the lateral neck compartment and brings difficulties for possible future LND. Gasless transaxillary endoscopic thyroid surgery should be performed in strictly selected patients with adequate preoperative assessment. The IJV should be carefully dissected to avoid IJV injury, and the lateral neck compartment could be dissected successfully during reoperation.

Targeted Muscle Reinnervation of the Supraclavicular Nerve to the Motor Branch of the Omohyoid Muscle in Patients Undergoing Thoracic Outlet Syndrome Procedures.

Summary:Transection of the supraclavicular nerve (SCN) through supraclavicular incisions can lead to debilitating neuroma formation. Targeted muscle reinnervation (TMR) proved to be an effective technique for the prevention and treatment of neuroma. In this case series, we propose the TMR of the SCN to the motor branch of the omohyoid muscle (OM) to prevent the formation of neuroma and avoid chronic pain at the supraclavicular area after thoracic outlet syndrome (TOS) procedures. A total of 10 patients underwent the procedure. Dissection of the SCN and its branches was performed through a supraclavicular incision. The branches were transected close to the clavicle. The inferior belly of the OM was identified and its motor branch isolated. Coaptation of the SCN branches with the motor branch of the OM was performed under the microscope and the wound was closed in layers. All the patients denied pain or hypersensitivity at the supraclavicular area on follow-up. In summary, the motor branch of the OM is a viable recipient for the TMR of the SCN and can prevent and treat painful neuromas at the supraclavicular area with minimal morbidity.