Removal of thyroid remnant for cancer in the previously operated central neck

Publication date: Available online 22 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Vaninder K Dhillon, Ralph P Tufano
Reoperative central neck dissection requires a concise set of steps to complete a comprehensive dissection of recurrent lymphadenopathy seen in thyroid cancer. The main considerations take into account the recurrent laryngeal nerve and the parathyroid glands. This chapter specifies those steps from a preoperative evaluation to the pearls during dissection to ensure a complete reoperative dissection that removes all residual thyroid tissue and lymphadenopathy while ensuring the best outcomes.



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Recurrent laryngeal nerve preservation in thyroid cancer involving the ligament of berry

Publication date: Available online 22 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Nathan W. Hales, Dipti Kamani, GregoryW. Randolph
The ligament of Berry is a dense consolidation of pretracheal vascular fascia or suspensory ligament which anchors the thyroid to the trachea and is located medial and deep to the tubercle of Zuckerkandl. The ligament of Berry is closely related to the distal 2cm of the extralaryngeal course of the recurrent laryngeal nerve and to the superior parathyroid gland. When thyroid cancer is present in the ligament of Berry, proper preoperative imaging, meticulous dissection with extra caution in the area of the ligament of Berry and use of intraoperative nerve monitoring are helpful tools in preservation of recurrent laryngeal nerve. Additionally, when thyroid cancer is preoperatively suspected to involve ligament of Berry, proper preoperative counseling, detailed consent, as well as communication regarding accurate patient expectations are essential.



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A rare cause of neonatal persistent jaundice

Description

A 22-year-old gravida 2, para 1 (G2P1) woman with immunoglobulin anti-D prophylaxis, insulin-treated gestational diabetes and first-trimester cytomegalovirus (CMV) infection vaginally delivered a 39-week boy weighing 3720 g (90th centile) and with Apgar scores of 8 and 10 at 1 and 5 min. Prenatal ultrasonographic assessment throughout gestation was normal. Nursery stay was uneventful. He was discharged on day 2, with a normal examination, except for the appearance of jaundice, with a transcutaneous bilirubin of 248 µmol/L (cut-off 250 µmol/L), not meeting the criteria for phototherapy. A follow-up clinic on day 4, arranged for bilirubin measurement and CMV testing, surprisingly revealed poor general appearance, lethargy, very icteric skin and a minor weight loss (9% of birth weight). Both liver and splenic edges were palpable. Vital signs were normal. Blood routine showed haemoglobin of 19 g/dL, haematocrit of 58%, white blood cells 11.6x10⁹/L and platelet count 128x10⁹/L. Biochemistry revealed total serum bilirubin...

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Maxillary chondrosarcoma mimicking torus palatinus

Description 

An 88-year-old man was referred to the head and neck surgery clinic for investigation of a painless hard palate lesion. The mass had been present for several months and was identified incidentally by the general practitioner. There were no oral or sinonasal symptoms. On examination, a 3x2 cm hard palatal swelling, covered by normal mucosa and resembling a torus palatinus was identified (figure 1). Flexible nasal endoscopy revealed the tumour to involve the floor of the nasal cavity bilaterally, displacing the inferior nasal turbinates. Examination of the neck was normal.

Figure 1

Midline palatal swelling covered by mucosa.

A biopsy was taken, and histological analysis described a welldifferentiated cartilaginous lesion consistent with a grade 1 chondrosarcoma. A CT scan was performed (figure 2). The regional head and neck and regional sarcoma multidisciplinary team meetings recommended surgical management. The patient underwent...

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Intractable hyperemesis gravidarum in a patient with type 1 diabetes

Hyperemesis gravidarum is not uncommon. Its pathogenies is multifactorial but not fully understood. We present a case of a middle class, Caucasian pregnant woman aged 24 years with coexisting type 1 diabetes, who had severe hyperemesis gravidarum from the sixth week of pregnancy and was resistant to all standard and off-the-label treatments raising questions about the pathogenesis of hyperemesis gravidarum. She was managed with a multidisciplinary approach and was supported with total parenteral nutrition till she had an emergency caesarean section in the 29th week of pregnancy. Her vomiting stopped as soon as a small for gestational age but otherwise healthy male baby was delivered.

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Intradural lumbar disc herniation detected by 3D CISS MRI

A 73-year-old man who presented with right lumbosciatic pain underwent a neurosurgical operation for a voluminous L2–L3 disc herniation, seen on conventional MRI images. No disc herniation was identified in the epidural space during the surgery. Just after the operation, the patient started to present pain in the left L3 territory and was not able to walk any more. A second MRI including three-dimensional (3D) high-resolution constructive interference in steady state (CISS) sequence showed that the voluminous L2–L3 disc split the posterior longitudinal ligament and the anterior dura mater, extended intradurally and compressed the cauda equina to the right. The patient underwent a second surgery, which permitted to cure the symptoms. 3D high-resolution CISS should be considered to accurately depict intradural disc herniation in order to optimally guide the surgical approach.

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Shah-Waardenburg syndrome: a case highlighting the importance of a holistic approach to assessing a child

We present the case of a 45-day-old child with the chief complaint of failure to pass stools for 10 days. After initial investigation, the patient was found to have Hirschsprung's disease. However, with further examination and analysis, the extremely rare diagnosis of type 4 Waardenburg syndrome was made (also known as Shah-Waardenburg syndrome or Waardenburg-Hirschsprung's disease).

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