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Background Parapharyngeal lymph node metastasis is very rare in patients with thyroid carcinoma. In this study, we elucidated on the clinical features, diagnosis, surgical treatment, and outcomes for patients with parapharyngeal lymph node metastases from thyroid carcinoma. Methods Patients with thyroid carcinoma who had been subjected to surgery through the transcervical approach at our institution between April 1999 and January 2019 were retrospectively enrolled in this study. Results Parapharyngeal lymph node metastases were successfully resected through the transcervical approach in all the 97 patients. There were 32 treatment-naive patients, while 65 patients had a history of treatment before parapharyngeal lymph node metastases. All 97 cases of parapharyngeal lymph node metastases were detected by enhanced CT scans. Lateral neck lymph nodes metastases were confirmed in 96 patients. Unexpected postoperative neurological side effects were reported in 11 (11%) patients, including dysphagia in 5 (5%) patients, Horner’s syndrome in 2 (2%) patients, glossal deviation in 3 (3%) patients, and asymmetrical mouth in 1 (1%) patient. During the follow-up period, 6 of the 97 patients exhibited parapharyngeal lymph node recurrence (recurrence rate 6.2%). The incidence of distant metastases was 44.3% (43 out of 97). The 5- and 10-year disease-specific survival was 93.4% and 88.9%, respectively. Conclusion Parapharyngeal lymph node metastases should be considered in patients with widespread cervical lymph node metastases. Enhanced CT scan is one of the best methods for diagnosing such metastases. Surgical resection through the transcervical approach is an effective and safe option for patients with parapharyngeal lymph node metastases from thyroid carcinoma. Moreover, parapharyngeal lymph node metastasis is associated with distant metastases that may lead to poor prognosis.

Background Medullary thyroid cancer is a neuroendocrine malignancy that can occur sporadically or as the result of genomic rearranged during transfection mutations. Medullary thyroid cancer has a higher rate of metastasis than well-differentiated thyroid cancer. Lateral neck dissection is often performed, and its prophylactic use is controversial. Methods Single-center, retrospective review (2000–2017) of patients undergoing primary surgical treatment for medullary thyroid cancer who had negative lateral neck imaging preoperatively. Demographics, genetic associations, clinical, and imaging findings were analyzed. Locoregional recurrence, overall recurrence, and overall survival were examined. Results A total of 110 patients were identified, of which 18 underwent prophylactic lateral neck dissection and 92 did not. Age, sex distribution, preoperative calcitonin levels, and follow-up were similar among groups. Overall recurrence was 20% for no prophylactic lateral neck dissection and 39% for prophylactic lateral neck dissection (P = .46). Most recurrences were locoregional recurrence, 7.6% for no prophylactic lateral neck dissection versus 22% for prophylactic lateral neck dissection (P = .08), half of it being to the lateral neck in both groups. A total of 7 patients from the no prophylactic lateral neck dissection group required treatment for recurrences versus 4 patients in prophylactic lateral neck dissection group (P = .57). Overall survival at 5 years was similar, 43% the no prophylactic lateral neck dissection group and 31% for prophylactic lateral neck dissection group (P = .52). Conclusion Lateral neck dissection has no effect in decreasing locoregional or overall recurrences in medullary thyroid cancer and has no effect in overall survival when performed prophylactically at index surgical intervention.

Omohyoid muscle syndrome (OMS) is one of the rare causes of lateral neck swelling during swallowing and it is often a worrisome observation due to the concern of malignancy and cosmetic deformity. Anatomical variation, congenital weakness, or trauma may cause incompetence of the fascial-retaining mechanism and subsequently OMS. Its prevalence is unknown as only a few cases were reported in the past and none in Malaysia. Diagnosing OMS is very challenging. Hence, imaging techniques like real time ultrasound or dynamic computed tomography can be useful in assessing the affected muscles.

A 29-year-old women presents with primary intrathyroidal papillary thyroid carcinoma (BRAF VE1 positive) with morphologically recognizable metastases to cervical lymph nodes (BRAF VE1 positive) as well as a focus of bland-appearing thyroid follicles within the capsule of a level II lymph node (BRAF VE1 negative). There exist various theories regarding the possible developmental origins of “benign” intranodal thyroid tissue in the lateral neck. While the true nature of the bland follicles may not be definitively resolved in this case, these findings are suggestive that they do not represent metastasis from the main papillary thyroid carcinoma. Additional insight into this unusual phenomenon may be gathered by more specific clonal analysis of these microscopic foci.

Cervical cystic vagal schwannomas sometimes mimic lateral neck cysts because of their extremely rare cystic appearance. Accurate diagnosis of this tumor and preservation of neural function are important because permanent neural injury may occur in patients with cervical schwannomas. During surgery, tumor enucleation of the true capsule of the tumor protects the nerve of origin. In this report, we discuss the case of a 27-year-old woman with cervical cystic vagal schwannoma mimicking a lateral neck cyst, who underwent successful tumor enucleation without suffering permanent neurological deficits. This case report aimed to present the extremely rare cystic changes that may occur in cervical schwannomas, and to improve diagnostic accuracy in relation to this disease. Herein, we discuss the details of enucleation, the methodology of which has not been standardized, and advocate the need for surgery in accordance with the pathogenesis of schwannoma.

Basal cell carcinoma is a malignant epithelial neoplasm of the skin and the most common human skin cancer. It is generally associated with a good prognosis. In this case report, a giant basal cell carcinoma of the nodulo-ulcerative type showing wide ulceration with marginal multiple small nodules, is presented. It was trapezoidal in shape, having dimensions of 7 cm at the greatest basal width, 6 cm vertically with different anterior and posterior margin dimensions, and 5 cm horizontally at the top margin. After wide excision of the lesion including 5–10 mm safety margins, the wound was reconstructed with a local skin flap and split-thickness skin graft. The reconstructed wound healed well without recurrence for 1 year.

Pediatric tumors in the apex of the thoracic cavity are often diagnosed late due to the absence of symptoms. These tumors can be quite large at presentation with involvement of the chest wall, sympathetic chain, spine, and aortic arch. The tumors can also extend into the thoracic inlet and encircle the brachial plexus. Depending on the diagnosis, treatment may involve chemotherapy with subsequent surgery or require primary resection. Optimal exposure to resect large apical tumors with thoracic inlet extension is a surgical challenge. To date, several surgical techniques have been described to resect these tumors - including both anterior and posterior thoracic approaches. Each of these techniques can be limited by inadequate exposure of the mass. We describe an alternative approach to surgical resection of these masses that employs an extended sternotomy with a lateral neck incision. This report details two successful resections of large left apical masses with thoracic inlet involvement in children using this technique (Level of evidence 4).

The inherent variable anatomy of the neonate and the uniquely-shaped maternal birth canal that is associated with the evolution of human bipedalism constitute risk factors for neonatal brachial plexus palsy (NBPP). For example, those neonates with a prefixed brachial plexus (BP) are at greater risk of trauma due to lateral neck traction during delivery than those with a normal or postfixed BP. Compared to adults, neonates also have extremely large and heavy heads (high head: body ratio) set upon necks with muscles and ligaments that are weak and poorly developed. Accordingly, insufficient cranial stability can place large torques on the cervical spinal nerves. In addition, the pelvic changes necessary for habitual bipedal posture resulted in a uniquely-shaped, obstruction-filled, sinusoidal birth canal, requiring the human fetus to complete a complicated series of rotations to successfully traverse it. Furthermore, although there are many risk factors that are known to contribute to NBPP, the specific anatomy and physiology of the neonate, except for macrosomia, is not considered to be one of them. In fact, currently, the amount of lateral traction applied to the neck during delivery is the overwhelming legal factor that is used to evaluate whether a birth attendant is liable in cases of permanent NBPP. Here, we suggest that the specific anatomy and physiology of the neonate and mother, which are clearly not within the control of the birth attendant, should also be considered when assessing liability in cases of NBPP.

Objective To assess the accuracy of preoperative ultrasound‐guided multilevel fine‐needle aspiration (FNA) cytology and thyroglobulin (Tg) estimation in mapping metastatic levels in the lateral neck, in patients with papillary thyroid carcinoma (PTC). Methods Patients with PTC clinically metastasizing to the lateral neck who were initially treated at the Peking University Cancer Hospital from June 2018 to September 2020 were included. FNA was performed preoperatively in each suspicious neck level; cytological examination (FNA‐C) and Tg measurement of the needle‐washout fluid (FNA‐Tg) were combined to determine metastasis. FNA‐Tg cutoff value was calculated, and the accuracy of FNA at different levels were evaluated. Results In total, 111 patients underwent 124 lymph node dissections. The best cutoff value of FNA‐Tg for the diagnosis of metastatic level was 1.0 ng/mL. Multilevel FNA showed sensitivity, specificity, positive predictive value, and negative predictive value in predicting single‐level metastasis of 100%, 61.0%, 43.9%, and 100%, respectively. In 64 (51.6%) cases, the involved levels diagnosed by FNA were consistent with that diagnosed by postoperative pathology. Conclusion FNA‐Tg improves the diagnostic performance of FNA‐C in lateral neck lymph node metastases. However, limited accuracy was obtained for preoperative multilevel FNA in predicting the extent of metastasis in the lateral compartment.

OBJECTIVE Neck lymph node (LN) metastasis is a common feature of paediatric papillary thyroid cancer, and LN ratio (LNR) is defined as the ratio of the number of positive LNs excised to the total number of removed. Unlike in adults, few data are available regarding the clinical implication of LNR in the paediatric population. Our purpose was to investigate the association of LNR with clinical outcomes in paediatric papillary thyroid cancer. DESIGN & METHODS The study retrospectively reviewed 136 consecutive children and adolescents with papillary thyroid cancer and LN involvement but no initial distant metastasis. Initial treatment, included in all patients a total thyroidectomy with central and/or lateral neck dissection followed by radioactive iodine ablation. Within the neck dissections, total number of LNs removed, total positive LNs and LN ratios were determined. The effect of clinicopathologic characteristics and intraoperative findings on persistent and recurrent diseases were analysed by univariate and multivariate analyses. RESULTS Median number of positive LNs was 9, and median LNR was 0.4. During a median follow-up of 49 months (range, 12.0-139 months), persistent disease occurred in 43 (31.6%) patients. The multivariable analysis showed that age and LNR were the independent factors predictive of persistent disease. Patients with a LNR >0.34 exhibited a threefold higher risk of persistent disease after initial therapy than the counterparts (P = .02). CONCLUSION Our findings suggest that LNR was an independent determinant predictive of persistent disease after initial therapy in children and adolescents with papillary thyroid cancer.

Large cystic mass is an unusual presentation of papillary thyroid carcinoma, accounting for less than 10% of cases. To make a diagnosis of papillary thyroid carcinoma is challenging since the tumour can mimic a benign lateral neck mass. Therefore, a systematical approach to a patient with neck lump is required so that accurate diagnosis and appropriate treatment can be made. We present a case of a 25-year-old female presenting with an asymptomatic left neck cystic mass diagnosed as a metastatic lymph node of papillary thyroid carcinoma only after surgery. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 92-95

To determine whether annual surgeon volume of lateral neck dissections for squamous cell carcinoma is associated with complication rates.Retrospective review.Two US databases spanning 2000 to 2014.Neck dissections for squamous cell carcinoma from the National Inpatient Sample and State Inpatient Databases were analyzed. The primary outcome was any in-hospital complication common to neck dissection. The principal independent variable was surgeon volume. A multivariable logistic generalized estimating equation with a piecewise linear spline for surgeon volume was fit to assess its association with complication.The National Inpatient Sample had 3517 discharges fitting criteria, a median surgeon volume of 12, and an 11.1% complication rate. A 1-unit increase in surgeon volume was associated with a 7% increase in the odds of complication when volume ranged between 4 and 19 (adjusted odds ratio [AOR], 1.07; 95% CI, 1.04-1.11) and with a 3% decrease in the odds of complication when volume ranged between 19 and 51 (AOR, 0.97; 95% CI, 0.96-0.99). The State Inpatient Databases had 2876 discharges fitting criteria, a median surgeon volume of 30, and a 13.5% complication rate. Surgeon volume was not associated with complication when27 (AOR, 1.01; 95% CI, 0.99-1.02), but a 5-unit increase in volume was associated with a 7% decrease in the odds of complication with volume ≥27 (AOR, 0.93; 95% CI, 0.88-0.98).Surgeon volume was associated with complications for most volume ranges and with lower odds of complication for high-volume surgeons.

Objective: Omohyoid muscle syndrome (OMS) is a condition that causes a X-shaped lateral neck lump on swallowing, caused by the failure of the central tendon of the omohyoid muscle to restrict movement of the muscle during swallowing. We aim to review the etiology, pathophysiology, diagnostic tests, and management options for this condition. Data Sources: Pubmed, MEDLINE, EMBASE, and Cochrane databases were searched for all articles and abstracts related to OMS up to 29th July 2020. Review Methods: A systematic review was performed, data extracted from relevant full text articles. Both quantitative data and qualitative data were analyzed. Results: Twenty cases of OMS were reported. Patients presented at a mean age of 36.0. All cases were Asian. There is a 7:3 ratio of males to females. The most common symptom was a transient neck mass. Most cases were managed conservatively with good prognosis. Open or endoscopic transection of the muscle and ultrasound-guided botulinum toxin injection were 3 treatment options, with no recurrence at 4 years, 6 months, and 6 months respectively. Conclusion: OMS could be genetic as all cases were Asian in ethnicity. The deep cervical fascia which usually envelopes the omohyoid muscle may be weakened by stress as 20% of cases had a preceding traumatic event. Real-time ultrasonography establishes the diagnosis, demonstrating the anterolateral displacement of the sternocleidomastoid muscle by a thickened omohyoid muscle during swallowing. Surgical transection can achieve cure, but due to limited studies available, they should be reserved for patients who are extremely bothered. Intramuscular injection of botulinum toxin is an effective alternative, but recurrence is expected.

Spinal osteochondroma are basically of two forms, these are spinal osteochondromas in patients with multiple osteochondromas and solitary osteochondromas occurring in the spine. Osteochondromas are more prevalent among the male gender and has an age of onset between 20-30 years. This is a 27-year-old lady that was referred for plain radiograph of the cervical region on account of a hard mass on the left aspect of the neck that was slowly growing for two years duration. He patient also complained of occasional left shoulder, forearm, wrist and hand pain with occasional numbness. The plain radiography was done in both anterior-posterior and lateral projection, showed a soft tissue density fullness and an expansile missed sclerotic and lucent lesion/mass involving the spinous processes of the second to sixth cervical vertebrae. The expansile, and mixed sclerotic and lucent appearance of this area proffered the differential of a solitary cervical spinal osteochondroma. The patient had surgical excision of the tumor, and histopathologic assessment of the tumor confirmed osteochondroma. We report the radiologic finding of a case of Solitary cervical spine osteochondroma in a 27-year-old lady due to its rare nature and presentation

Although small papillary thyroid cancer (PTC) patients are considered as low-risk population, approximately 5-20% of these patients relapse after surgery. The objective of this single-center retrospective study was to identify risk factors, which could help to distinguish patients who would need additional treatment after surgery. A total of 268 patients (39 men, 229 women, median age 49 years) underwent surgery between 2007-2015, and fulfilled inclusion criteria: tumor size ≤ 20 mm, absence of metastatic lymph nodes (LN) in the lateral neck compartment (LC), and absence of local invasion. Total thyroidectomy was performed in 252 cases, in 221 cases with central neck compartment (CC) dissection. The outcome - a more aggressive disease - was defined as the presence of metastases in the LNLC or in distant organs found during follow-up. A median follow-up was 117 months. Overall, 41 patients experienced the outcome with a median time-to-event of 18 months. Male gender (OR = 2.2, P = 0.049), extra-thyroidal extension ETE (OR = 2.61, P = 0.015), and metastases in LNCC (OR = 4.21, P < 0.001) were associated with worse outcome. Multivariable analysis and stratification according to ETE revealed an effect modification with a higher effect of the positive LNCC on the outcome among patients without ETE than in those with ETE. Our findings advocate placing greater emphasis on the role of LNCC metastases in the absence of ETE. In clinically node-negative tumors intraoperative examination of CC on the side of the tumor followed by CC dissection if metastatic lymphadenopathy is present could play an important role in the stratification of patients with small-size PTC.

AIM. In this study, we aimed to investigate the effects of Ultrasonic Coagulation (UC), Bipolar Energy Sealing System (BESS), Intra Operative Nerve Monitoring (IONM) and surgical experience on the complications of thyroid surgery. METHOD. The data of 1627 patients who underwent thyroid surgery for various indications in our department between 2009 and 2018 were analyzed retrospectively and the effects of different technological devices on complications were investigated. RESULTS. Transient recurrent laryngeal nerve (RLN) palsy was higher between 2009 and 2013, when IONM was not in routine use (p=0.029). There were no significant differences between two energy devices (UC and BESS) in terms of transient or permanent RLN palsy, bleeding, and transient or permanent hypocalcemia. Multivariate analysis showed that young age (0.006), female gender (0.016), surgery type (p

Masson’s tumor, also known as intravascular papillary endothelial hyperplasia (IPEH), is a rare, benign vascular tumor characterized by the proliferation of endothelial cells with papillary formations. Differential diagnosis between IPEH and angiosarcoma is important because both have microscopic similarity. Herein, we report a rare case of IPEH on the right lateral neck of a 50-year-old female presenting with a neck mass, which was completely removed without complication.

INTRODUCTION In order to avoid large neck scar caused by conventional lateral neck dissection. We have explored and introduced endoscopic lateral neck dissection (IIA, IIB, III, and IV) using a breast approach. Now, we summarized and shared the outcomes of the first 24 cases. MATERIALS AND METHODS All the patients were treated in our institute from January 2017 to May 2018, and followed-up for more than 1 year. The details of patients and this technique have been summarized and analyzed retrospectively. RESULTS A series of first 24 cases were successfully managed with this technique, and no cases were converted to an open approach. Among these 24 patients, levels III + IV dissection had been performed in 6 patients and levels II+III+IV dissection had been performed in 18 patients. The mean age, body mass index, and sex were 39.3±10.5 years old, 24.1±3.5, and 2 male/22 female, respectively. The average operative time of total operation and lateral neck dissection was 238.8±37.2 minutes and 128.8±21.1 minutes, respectively. The mean dissected lateral lymph nodes were 5.9±2.2 (level II) in 18 cases and 15.9±3.9 (levels III+IV) in 24 cases. In addition, with no severe complications to date, such as asphyxia, main nerves injury (cervical plexus, vagus nerve, etc.), and permanent hypoparathyroidism, nor permanent recurrent laryngeal nerve injury, and so on. However, unexpectedly, had some mild and common complications like transient hypocalcemia in 4 cases (16.67%), transient horse 1 case (4.2%), controllable lymphatic leakage in 2 cases (8.3%), and controllable jugular vein injury in 2 cases (8.3%). One year after the operation, 1 case found lung metastasis but no local recurrence. In other 23 patients, no recurrence/metastasis and the average of serum thyroglobulin is 3.2±3.8 ng/mL. CONCLUSIONS This technique can yield adequate oncological dissection for selected patients. Endoscopic thyroidectomy along with lateral neck dissection using a breast approach may provide an option for selected patients who favor avoiding a visible neck incision.

There are many treatments for neck laxity and fullness, both invasive and noninvasive. The purpose of this study was to evaluate the effectiveness of combined infrared, radiofrequency, mechanical massage, and suction therapy in performing contour changes in the submental and lateral neck regions. This was a single-center, prospective cohort study in which 30 patients were treated with a session of combined infrared, radiofrequency, mechanical massage, and suction therapy once a week for 4 weeks. Follow-up was performed at posttreatment months 1, 3, and 6. Both subjects and investigators completed submental fat grading scales and lateral neck and jowl linear analog scales. Exclusion criteria included history of soft tissue augmentation, cosmetic injections, ablative or nonablative skin resurfacing, or surgical procedures in the lower facial region, as well as weight gain or loss exceeding 10 pounds during the study period. There was a significant difference between mean ± SD neck and jowl investigator scores at day 0 and month 6, which were 5.6 ± 0.9 and 4.4 ± 1.0, respectively ( P < .05). Mean investigator submental fat score at day 0 was 1.9 ± 0.7 vs 1.5 ± 0.6 ( P = .04) at month 6. Differences between mean patient neck and jowl and submental fat scores were also statistically significant between day 0 and month 6. At day 0, the mean patient neck and jowl score was 4.7 ± 0.8 vs 3.2 ± 1.1 at month 6 ( P < .05), and at day 0, the mean patient submental fat score was 2.2 ± 0.5 vs 1.8 ± 0.6 at month 6 ( P < .05). Combined infrared, radiofrequency, mechanical massage, and suction therapy provides an effective, noninvasive treatment modality for improving contour of the lateral neck and submentum.

Background Unilateral muscular deficits have been identified in individuals with neck pain, although no unilateral clinical tests have been described in the literature. Assessment of lateral neck flexor endurance may allow identification of abnormal unilateral muscle function. The lateral neck flexor (LNF) endurance test, where an individual holds their head parallel to the ground while side-lying, may be a clinical option. We sought to (1) determine inter-rater reliability of the LNF endurance test and (2) establish normative LNF values in healthy individuals. Methods Inter-rater reliability was assessed for four raters, working in pairs to assess a pilot sample of 20 individuals. Normative data was subsequently collected for 60 healthy adults, age 20–40. All participants completed the International Physical Activity Questionnaire to assess physical activity and the LNF endurance test was assessed once per side. Results The LNF endurance test demonstrated excellent inter-rater reliability: ICC(2,1) = 0.972 [0.941–0.987]. Left and right median LNF hold times were 122.0, 133.94 s for males and 97.42, 93.73 s for females, respectively. Individual median hold time ratios were 72.1% for males and 68.7% for females. There were no meaningful correlations between reported physical activity and LNF endurance. Conclusion The LNF endurance test is a reliable measure. Males generally displayed greater LNF endurance than females, although variability within groups was high. Based on the observed values in this healthy population, 120 s for males and 90 s for females with a 70% side:side ratio appear to be useful normative benchmarks although further research is required including clinical populations.

BACKGROUND We report on the feasibility of a novel robotic-assisted extended "Sistrunk" approach (RESA) to the larynx, hypopharynx, and lateral neck lymphatics. METHODS Studies were performed using the da Vinci Xi and SP system on three cadavers comprising of three supraglottic laryngectomies, one partial hypopharyngectomy, and four lateral level II to IV neck dissections. RESULTS In all resections at first a central common working space overlying the hyoid bone was created. The da Vinci Xi system was used with two vestibular and two submental ports for laryngeal/hypopharyngeal resections, and an additional port through a facelift incision for level II to IV neck dissections. The da Vinci SP system was used with only one submental port. CONCLUSIONS We describe herein a novel endoscopic robotic approach to the larynx, hypopharynx, and neck based on the traditional "Sistrunk" procedure. The technique should help improving exposure of the primary lesion and reduce access-related morbidity to the neck.