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Objective: To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery., Methods: This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study., Results: With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors., Conclusion: Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.

Objective: To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre., Methods: This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia., Results: Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032)., Conclusion: Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

Objective: To evaluate the presence of cardiovascular risk factors and recovery of idiopathic sudden sensorineural hearing loss in hospitalised patients., Methods: A single-centre retrospective study of 80 patients hospitalised for idiopathic sudden sensorineural hearing loss was conducted over a 6-year period. Mean pure tone hearing thresholds were assessed by pure tone audiometry., Results: Twenty-three of 80 patients (28.75 per cent) initially had no cardiovascular risk factors. Forty-five patients had hyperlipidaemia, 22 patients had hypertension, 7 patients had diabetes mellitus and 7 patients were obese. No statistically significant difference was observed between patients with complete versus partial sudden sensorineural hearing loss (p = 0.0708) concerning the cardiovascular risk factors. At long-term follow up, the hearing recovery rate was not significantly different between the two groups of patients (p = 0.7541)., Conclusion: The lack of a clear relationship between idiopathic sudden sensorineural hearing loss and cardiovascular risk factors suggests that sudden sensorineural hearing loss has a predominantly multifactorial disease profile regardless of hearing impairment severity.

Objective: This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre., Methods: A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits., Results: In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups., Conclusion: Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

Objectives: This study was designed to evaluate the efficacy and morbidity of immediate tonsillectomy used to treat peritonsillar abscess (quinsy) and parapharyngeal abscess., Subjects and Method: This four-year, retrospective study was based on 31 patients hospitalised in a university hospital ENT and head and neck surgery department for peritonsillar and/or parapharyngeal abscess. All patients underwent immediate, bilateral tonsillectomy. The length of hospital stay, duration of antibiotic therapy, microbiological findings, complications, and the time to complete recovery and oropharyngeal healing were recorded., Results: The patients' mean post-tonsillectomy hospital stay was 2.84 days (median: 3 days). No post-operative haemorrhage was observed. All patients were considered to be cured at the day 10 follow-up visit, and complete oropharyngeal healing was observed at the day 21 visit. The duration of antibiotic therapy ranged from 10 to 15 days (mean: 11.5 days; median: 10 days)., Discussion and Conclusion: Immediate tonsillectomy appears to be a safe and effective surgical technique for the management of peritonsillar and parapharyngeal abscess; in particular, it markedly reduces patients' hospital stay (when performed early in the course of the disease) and duration of antibiotic therapy. Immediate tonsillectomy has become the first-line treatment for parapharyngeal abscess and several types of peritonsillar abscess in our department.

Objective: To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery., Materials and Methods: We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands., Results: A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side)., Conclusion: The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the 'processus posterior glandulae thyroideae' described by Zuckerkandl.

Purpose of the Study: We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery., Materials and Methods: Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed., Results: Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery., Discussion: Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches., Conclusion: The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.

Objectives: To analyse and compare chest radiographs and cervicothoracic computed tomography scans taken prior to thyroid surgery, in order to locate and predict thoracic extension of substernal goitres., Method: This eight-year, retrospective study included 223 patients who had undergone total thyroidectomy for benign, substernal, multinodular goitres. Chest radiographs and computed tomography scans were reviewed by two physicians (a senior ENT surgeon and a senior radiologist)., Results: The most frequent mode of extension was anterior or prevascular, seen in 76 per cent of cases, especially on the left side. Fifty-nine per cent of goitres did not reach the aortic arch and 11 per cent extended beyond the aortic arch. A cervical surgical approach was performed in approximately 99 per cent of cases., Discussion: Thorough examination of computed tomography scans is essential in order to identify and classify substernal goitres and to decide the best surgical procedure. A cervical surgical procedure is almost always sufficient and safe for the surgical management of substernal goitres., Conclusion: Computed tomography appears to be the best imaging modality for identifying and characterising substernal goitres. Surgical management is almost always via a cervical approach and does not differ from that used for benign cervical goitres. In the future, magnetic resonance imaging may be used; its results would need to be compared with those of computed tomography.

Objectives: To describe the features of an oropharyngeal and hypopharyngeal myxoma., Materials and Methods: Case report of a 34-year-old patient operated upon for a dual-location tumour, and review of the literature., Results: The myxoma is a rare tumour. Various head and neck locations have been described, but not (to our knowledge) a tumour in both the oropharynx and the hypopharynx. Multiple synchronous locations must be searched for, particularly regarding cardiac myxoma., Conclusion: The myxoma is a rare, benign tumour, even rarer in the head and neck. Surgical treatment must be complete in order to avoid recurrences, and should be performed after assessment for cardiac involvement.

Aims: To evaluate the risk of hypocalcaemia (transient or permanent) after total thyroidectomy for bilateral, benign, multinodular goitre, the frequency and impact of unintentional parathyroidectomy, and the value of parathyroid gland autotransplantation during thyroid surgery., Materials and Methods: This was a retrospective study of 351 surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre over a seven-year period. The primary endpoint was serum calcium concentration immediately post-operatively and during follow up. Normal serum calcium concentration was defined as 2 mmol/l. Parathyroid data were collected during surgery and histological examination., Results: In 62 per cent of cases, no hypocalcaemia had been observed after surgery. In 35 per cent of cases, transient hypocalcaemia had been observed after surgery. In 3 per cent of cases, chronic hypocalcaemia had been present six months after surgery. Permanent hypoparathyroidism had been diagnosed two years after surgery in 1.4 per cent of cases. Unintentional parathyroidectomy had been detected in 5.2 per cent of cases. Parathyroid gland autotransplantation had been performed in 7 per cent of cases during surgery., Conclusion: Permanent hypoparathyroidism is rare, although transient hypoparathyroidism occurs relatively frequently. Unintentional parathyroidectomy and parathyroid gland autotransplantation do not affect serum calcium levels.