Head and Neck Surgery - Science topic

No preoperative antibiotic is needed for minor surgery. For semi major surgery for patients with active habits, due exercise and diet, no need of antibiotic. In post-operative period if sign of aggravation of inflammation occurs, consider anti-inflammatory drugs with antibiotic. This helps body immunity to be activated and there will be non-development of resistance to antibiotics.

W. Jerry Oakes has published a study on this question years ago in Pediatric Neurosurgery literature.

Hemangioma

Thanks..

The best evidence for nexk management is a minimum of level II to IV neck dissection.

If nose positive neck and/Or oropharyngeal disease extending anteriorly to oral cavity then neck dissection (I to V).

The key differences as I believe are:

1. Laterality of the diseases: unilateral in Meniere's disease while bilateral in Autoimmune disease

2. Middle age group affection in Meniere's disease while there is all age groups might be affected in Autoimmune disease

3. Other autoimmune diseases in Autoimmune disease

4. Low frequency SNHL in Meniere's disease while high frequency hearing loss in Autoimmune disease on pure tone audiogram

5. Autoimmune antibodies were found in Autoimmune disease

6. SP/AP>0.5 on cochleography in Meniere's disease

7. Steroid is an effective treatment for Autoimmune disease

Hi,

Good luck

Enlarged adenoid should be removed even if  it does not have perceptible  symptoms. 

 In this case Two Ducts emerge from anterior border of Parotid gland instead one one. These ducts pass over masseter muscle and unite near its anterior border to form a single duct which after piercing buccinator  opens into vestibule. we found this Y- shaped pattern during dissection of a cadaver on Right side. on the left side of same cadaver the antaomy of parotid duct was normal. we published this article in International journal of Basic and Applied Sciences (Sciencepubco) and named this duct as Itoo's duct after the  Sir name of  our first author.  Anotomical Knowlege of this duct is important for surgeons operating on parotid  because leakage from this duct can lead to delayed wound healing and fistula formation in this region.

Hi Karthik, 

The post op voice change due to cutting of strap muscles is a controversial area in thyroid surgeries. Personally I have heard from senior thyroid surgeons that, cutting strap muscles affect post op voice especially in low pitch vocalization, although its a subtle change. 

Many books says strap muscle injury as a non-neural cause for thyroid and parathyroid surgery related dysphonia (Surgery of thyroid and parathyroid glands, Textbook of endocrine surgery, Recurrent and SLN, Controversies in thyroid surgery and Atlas of endocrine surgical techniques etc.). But, there is one study available, which concluded strap muscle division is not associated with any voice change.

The landmark articles by Atkinson & Erikson reported strap muscles are important for lowering the fundamental frequencies especially from a mid to low range.

Offhand I don't remember any clinical test for strap muscles alone. Will let you know if I can find one.

No it does not,

Reason: the tongue is anchored by the genio-glossus muscle to the mandible anteriorly and supplied by hypoglossal nerve (motor),  therefore, a inferior alveolar nerve block that deposits the local anesthetic solution in the pterygoid space does not lead to transient paralysis of the hypoglossal nerve (as the space houses the inferior alveolar and the lingual nerves, both sensory nerves) and eventual swallowing of the tongue and airway obstruction. However an inadvertent inferior alveolar nerve block could lead to transient facial nerve paralysis due to the proximity of the parotid gland, the facial nerve and its branches to the pterygoid space.

I tried all methods of tonsillectomy , to summarize that , I personally think that the conventional cold steel tonsillectomy is the golden method of tonsillectomy.

Hi,

As Myriam said: We need more information: When "degeneration" means no voluntary EMG activity plus pathological spontaneous activity, then the probability for full recovery is low BUT does NOT predict NO recovery: This might result in spontaneous but misdirected reinnervation with defective healing.

You have to wait for 6 months after onset of the lesion. No progress, than I would recommend like Myriam  reconstruction surgery (you can also use part of the hypoglossal nerve). If spontaneous recovery occurs, the final results will not be worse than reconstruction surgery, so in such a case there is no need for reconstructive surgery 6 months postop. In such a case you should wait for the final outcome to see if then adjuvant surgery is needed.

EMG and outcome prediction:

Prognostic value of electroneurography and electromyography in facial palsy.

Grosheva M, Wittekindt C, Guntinas-Lichius O.

Laryngoscope. 2008 Mar;118(3):394-7.

Recent review on facial nerve reconstruction:

Facial Reconstruction and Rehabilitation.

Guntinas-Lichius O, Genther DJ, Byrne PJ.

Adv Otorhinolaryngol. 2016;78:120-31. doi: 10.1159/000442132. Epub 2016 Apr 12.

Regards

Orlando

I agree absolutely with Prof. Galli that most of the reports on experiences with salvage supracricoid laryngectomies have come from European groups.

Generally speaking, at the time also the interest of the European groups in respect of salvage transoral laser surgery (TLS) seems greater than that of North American groups . Ramakrishnan et al. (Head Neck 2014;36:280-285) very recently analyzed the oncological results of salvage endolaryngeal laser surgery after RT had failed. Up to July 2011, they found 11 studies that met their inclusion criteria (9 of them European and 2 from the United States). 

The reasons behind why the incidence of thyroid cancer is rising substantially are difficult to account for.  Increased use of diagnostic imaging capable of exposing subclinical disease is considered the most parsimonious explanation for this reported rise. The location of the thyroid gland places it within the window of many diagnostic-imaging studies. In addition, cross-sectional imaging studies have contributed to a 2.4-fold increase in the reported incidence of thyroid nodules over the past 30 years. 

The use of ultrasound for the screening of thyroid cancer has also been considered as a contributing factor.  This is believed to be the key factor in South Korea’s abrupt increase in thyroid cancer incidence.  A study based on the 2009 Korean National Cancer Screening Survey revealed that 13.2% of South Koreans undergo thyroid cancer screening with ultrasound. The link between imaging studies and increased incidence is supported by a correlation with access to healthcare, and the incidence is rising more rapidly in countries where healthcare expenditure is driven by the private sector than the public.

Contrary to the hypothesis that diagnostic imaging is the main cause of the increased incidence of small thyroid cancer, the incidence of large thyroid cancers has not declined, and is also increasing.  Moreover, higher rates of aggressive PTCs are being detected, including those with extrathyroidal extension and distant metastases.

Risk factors, not yet identified, may also be contributing to this increase in incidence.  Studies have also suggested that this may be due to high levels of ionizing radiation exposure. Moreover, hormonal, nutritional, and menstrual and reproductive factors may be causing this surge of incidence. The worldwide rise as well as the differing rates of thyroid cancer between countries suggests multiple factors may have a role in the incidence and warrant further investigation.

Vocal nodules are traction injuries to the vocal folds from prolonged loud speaking or singing. In time, the gaps generated fore and aft of the nodules prevents the vacuum from forming during the glottic cycle and stops the injury from worsening by the growth of the nodule itself. Ulceration can also occur further deteriorating the voice. This is the way surgery can help, NOT AS PRIMARY PREVENTION, but as secondary prevention of worsened disease. If nodules are recalcitrant to speech therapy, removing them will help to avoid worse disease IN SOME PATIENTS.

Branchial fistula/cyst is the most cause for recurrent neck abscess in young people, especially for the one who already had abscess before the present of branchial fistula/cyst.

Our routine is similar to the above. But, in the recent years we found that fungal etiology plays an important role. We have lots of these patients referred to us. After local treatment of external auditory canal and IV antibiotics, if we encounter not a good response we will start systemic anti-fungal drugs before surgery. This algorithm was very successful and in the past 4 years i do not remember any surgical intervention by the indication of poor medical response, and we have one of these patients every week or two.

as NK Ayati said: it depends on patient' risk and also on specific tumor features such as histology and type of PTC ( classic, follicular variant or tall cell variant) as perhaps on Ki-67 (only little data) but also on localisation of the tumor ( capsule or inside the thyroid) and procedures may lead to different numbers of locoregional recurrence but not on different long term survival. This is very good, independent on the surgical procedure. Answers like: "I do it.." are of little help as the guidelines are of little help, since they differ, depending on the group and country, they are coming from. Since we still lack prospective randomized trials and long term results from such trial the answers between hemithyroidectomy up to thyroidectomy plus cetral lymph node dissection will come and have to be weighed between surgical risk and freedom from recurrence - still influenced by experience, individual prevalence and prejudice. Sorry, but this is all we have of realy sound data.

Pain post tonsillectomy particularly reaches a peak in most cases at day 6 post surgery. NSAIDs are the most effective analgesics. Pain control is optimised by education (make patient aware pain and earache worsens rather than improves up to day six), use of the jaw (chewing gum is a useful ajunct, patients need to be educated to avoid living on a soft diet) and possibly steroids.

Opiates are less effective in the days following surgery

In my institution, recently balloon dilatation (new technique) is used with good results.

Unfortunately this is all too common a problem. While positive margins is undoubtedly a major risk factor for LR and death, we commonly see cancers which recur despite widely negative margins and N0 necks. How the specimen is processed and assessed by the Pathologist is undoubtedly important. In-tranit metastases, local lymphovascular spread, tumour implantation during resection, and field cancerization are all possibilities

We had a patient with miliary tberculosis associated with sarcoidosis and B lymphocytopenia. It could be useful sometime to have also a bioptic specimen and not only microbiologic results.

This problem was faced by us in the beginning. To avoid this, we excise semilunar skin to fit the size of the stoma from both the lower and upper flaps. Also, cutting through the tracheal ring is avoided which can cause stenosis in the process of healing.. creating a separate stoma away from the suture line is a good method, as mentioned by Dr Manoharan. however in this process we are creating a small bridge of skin between the stoma and suture line, which has a potential risk (more theoretical) of necrosis.