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Although there has been increasing interest in aesthetical approaches for treating patients with papillary thyroid carcinoma (PTC), there have been no studies comparing the safety and effectiveness of gasless endoscopic selective lateral neck dissection (SLND) via the anterior chest approach (ACA) with that of conventional open surgery (OPEN) for papillary thyroid carcinoma. A total of 91 patients with PTC who underwent either gasless endoscopic thyroidectomy, central compartment neck dissection and SLND via the ACA or conventional open surgery between Nov. 2008 to Dec. 2018 were included. Primary outcomes and demographic data were compared between the two groups. Thirty-one patients were in the ACA group and 60 were in the OPEN group. The ACA group was younger and had a longer operative time but less intraoperative hemorrhage (P

Transoral endoscopic thyroid surgery via the vestibular approach (TOETVA) has been gradually accepted worldwide due to its scar-free effect on the neck. Even central cervical lymphadenectomy has been performed in some cases of papillary thyroid carcinoma (PTC). However, there are few reports involving lateral neck dissection with TOETVA. In this study, we attempted to perform selective lateral neck dissection (SLND) for PTC via a transoral vestibular approach. This prospective study was conducted from January 2016 to December 2018 in twenty PTC patients with unilateral T1 tumors without capsular invasion and patients with abnormal level III and IV lymph nodes who underwent SLND via a transoral vestibular approach. Endoscopic surgery was successfully accomplished in all 20 PTC patients. The mean age was 29.2 ± 5.5 (20–41) years. The mean operation time was 146.0 ± 18.7 (114–193) min. The average postoperative hospital stay was 6.8 ± 1.3 (5–10) days. The mean number of removed nodes was 7.4 ± 2.5 (4–12) in the central neck and 10.9 ± 2.8 (6–16) in the lateral neck, and the positive yield amounts were 2.0 ± 1.2 (0–4) and 2.7 ± 1.9 (0–6), respectively. No major complications occurred except for 1 case of transient unilateral recurrent laryngeal nerve palsy and two cases of effusion in the operative area. No evidence of persistent or recurrent disease was observed in these patients during a mean follow-up of 24.3 ± 9.1 (6–36) months. The cosmetic results and protection of personal privacy of this procedure were excellent. Endoscopic SLND via the transoral vestibular approach is feasible, safe, and effective for selected PTCs. A multicenter large comparative study is necessary.

Background Impaction of foreign body is a common condition presented to ear, nose, and throat department among Asian population. The commonest foreign body seen among this population has been documented as fish bone. Fish bone can migrate to lateral neck space or related organs around the neck and chest. By presenting this case report, we aim to emphasize the importance of taking proper history and make clinicians aware of the possibility of a fish bone migrating into different spaces. This will help to prevent diagnosis delay leading to complications due to migrated fish bone. Case presentation A 50-year-old female Sinhalese patient presented to ear, nose, and throat department with right-sided neck pain for 2 days, who had a history of suspected fish bone impaction a few days ago that subsided without any investigations or treatments. She did not have any symptoms related to throat, and neck examination showed mild swelling and tenderness. Computer tomography revealed a migrated fish bone into the lateral neck close to carotid artery, and the fish bone was removed by neck exploration under general anesthesia without any complications. Conclusion In conclusion, migrated fish bone should be suspected if patient is having persistent symptoms mainly in the neck without having difficulty swallowing and who gives a history of fish bone impaction and having negative laryngoscopic examination. Proper history taking is very important in the assessment of these patients to prevent misdiagnosis of the condition. Clinicians should aware that migrated fish bones are not uncommon and that early suspicion can prevent later diagnosis and complications.

We aimed to evaluate risk factors for local recurrence following lateral neck dissection (LND) for papillary thyroid carcinoma (PTC). Two hundred and nine patients who underwent therapeutic primary or reoperative LND for PTC were included. One hundred eighty-one patients underwent primary LND at our Institution, the remaining 28 were referred for recurrence following LND outside the Institution. Comparing patients who required reoperation for recurrent lateral neck disease with those who did not recur, no significant difference was found concerning sex, tumor size, multifocal disease, extracapsular invasion, histological variant, pT stage (P = NS). At univariate analysis, age, mean number of removed lateral neck nodes at first operation, the extent of initial LND and surgery performed outside the Institution were risk factors for recurrence (P

Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, spreading initially to cervical lymph nodes. The treatment strategy for PTC consists of surgery, selective adjuvant radioiodine ablation, thyroid-stimulating hormone suppression and surveillance. The surgical treatment of the disease and more specifically the management of lateral neck lymphadenectomy is controversial. Many guidelines have been proposed from 2006 until now in order to resolve this controversy. Until 2009, there was general confidence that lateral neck lymphadenectomy must be performed only if lateral cervical lymphadenopathy is biopsy proven, or if there is preoperative clinical suspicion for lateral node metastases. It was in 2012 that the guidelines separated therapeutic from prophylactic lateral lymphadenectomy and associations adopted a more aggressive surgical tactic based on the histological staging and size of the positive nodes. Although it is an undeniable fact that major advances have been seen in the management of lateral neck lymphadenectomy for papillary thyroid cancer from 2006 until now, it is absolutely necessary to reanalyze the already existing data, in order to restate the latest, most commonly accepted and most practical guidelines.

Bronchogenic cysts are rare congenital malformations originating from budding of the tracheobronchial component during foregut development. Most cy sts are located in the mediastinum and the intrapulmonary region. Localization in the cervical area is unusual. The majority of cases have been reported in the pediatric population and few cases in adults. We report an unusual case of bronchogenic cyst presenting as a deep lateral neck mass with dysphagia in an adult female. This case presented with three unusual elements: adult female, lateral cervical location, and presence of symptoms.

Despite an excellent prognosis, cervical lymph node (LN) metastases are common in patients with papillary thyroid cancer (PTC). The presence of metastasis is associated with an increased risk of locoregional recurrence, which significantly impairs quality of life and may decrease survival. Therefore, it has been an important determinant of the extent of lateral LN dissection in the initial treatment of PTC patients with lateral cervical metastasis. However, the optimal extent of therapeutic lateral neck dissection (ND) remains controversial. Optimizing the surgical extent of LN dissection is fundamental for balancing the surgical morbidity and oncological benefits of ND in PTC patients with lateral neck metastasis. We reviewed the currently available literature regarding the optimal extent of lateral LN dissection in PTC patients with lateral neck metastasis. Even in cases with suspicion of metastatic LN at the single lateral level or isolated metastatic lateral LN, the application of ND including all sublevels from IIa and IIb to Va and Vb may be overtreatment, due to the surgical morbidity. When there is no suspicion of LN metastasis at levels II and V, or when multilevel aggressive neck metastasis is not found, sublevel IIb and Va dissection may not be necessary in PTC patients with lateral neck metastasis. Thus consideration of the individualized optimal surgical extent of lateral ND is important when treating PTC patients with lateral cervical metastasis.

Several endoscopic modified radical neck dissections (MRND) have been conducted since the introduction of the endoscopic technique to thyroid surgery with the aim of avoiding a long cervical scar. Furthermore, the recent introduction of surgical robotic systems has increased the precision of endoscopic techniques. The aim of this study was to evaluate and compare the early surgical outcomes of robotic and conventional open MRND for papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM).From January 2009 to May 2010, 165 patients with PTC underwent bilateral total thyroidectomy with central compartment neck dissection and ipsilateral MRND. Of these patients, 56 formed the robotic procedure group (RG) and 109 the conventional open procedure group. These two groups were retrospectively compared with respect to their clinicopathological characteristics, early surgical outcomes, and surgical completeness.The operative time was longer, mean tumor size was smaller, mean age was lower, and disease stage was earlier in the RG. However, mean numbers of retrieved lymph nodes were similar in the two groups, and mean hospital stay after surgery was shorter in the RG. Furthermore, complication rates were similar in the two groups, and there was no statistical difference in postoperative Tg levels between the groups.Robotic MRND was found to be similar to conventional open MRND in terms of early surgical outcomes and surgical completeness but leaves no scar on the neck area. Robotic MRND can be viewed as an acceptable alternative method in low-risk PTC with LNM.

Forestier disease or diffuse idiopathic skeletal hyperostosis (DISH) is an uncommon cause of dysphagia. Due to rarity of this condition there is neither any demographic data nor any consensus about the investigation and treatment modalities. Here an effort is made in the present article to compile the information regarding the demographic and clinical features, investigation modalities and different methods of treatment from all the available case reports of dysphagia due to Forestier disease in the English literature till date. Three cases of the same condition are also reported in the present paper. Three cases of dysphagia due to Forestier disease treated in the ENT department of R.G. Kar Medical College and Hospital are reported herewith. A systematic review of literature is also done. All the case reports of dysphagia due to Forestier disease are obtained by World Wide Web search (WWWS) using ‘Forestier Disease’, ‘DISH’ and ‘dysphagia’ as the key words. Data regarding age, sex, duration of the symptom, associated symptoms, investigations done, level of vertebrae involved and different modalities of treatment with result are collected and analyzed systematically. We found total 73 cases of dysphagia due to Forestier disease. The condition commonly affects males (M:F 5.64:1) in older age group (94.52% cases are 60 years or above), often presented to the treatment facility after a long time of initiation of the symptom. Barium swallow X-rays and lateral neck X-ray were the most common investigations done to arrive at a diagnosis as per result of systematic review. Surgical removal of the causative osteophytes were the definitive treatment, but if surgery is contraindicated, conservative measures like switchover to liquid and semisolid food and proper swallow training also improve the condition to some extent. Dysphagia due to Forestier disease mostly affects older male, often has a chronic course. It can be diagnosed with simple investigations like neck X-ray or barium swallow X-rays. The definitive treatment is surgical, but if contraindicated the problem can be palliated with simple measures like swallow training and change of food.

This paper suggests basic information for the improvement of the fit of cloth patterns by lateral body type by comparing the surface patterns of the upper lateral body. The surface patterns were created by projecting three-dimensional figure data onto flattened patterns with a purpose-built software, Patternmaker2008. The resulting surface patterns were compared to explain the differences among lateral body types. Depending on the upper lateral body type, there were significant differences in the parameters related to neck width, lateral neck height, shoulder-dart angle, shoulder angle, back-center angle, and waist-dart ratio. These surface pattern parameters can provide a quantitative basis for the use of lateral shape features in the production of garment patterns and the improvement of upper lateral shape fit.

Omohyoid muscle syndrome (OMS) is a rare clinical condition that has the pathognomonic feature of the appearance of a lateral neck mass when swallowing due to dysfunction of the omohyoid muscle (OH). We present two cases of typical OMS with electrophysiologic and dynamic imaging studies. The study results indicate that OMS is caused mainly by the loosening of the fascial attachment to the intermediate tendon of the OH. The characteristic clinical features and pathomechanism underlying OMS are also discussed.

Radical neck dissection is a standard procedure carried out for the teatment of palpable nodes in the neck but if carried out electively in cases where there are no palpable nodes in the neck it is considered to be an overtreatment with its associated morbity. Lateral neck dissection was carried out on twenty patients who had T31 T4 lesion of the larynx and hypophar-vnx with NO neck. The dissection entails removal of Level II. III and IV nodes. Occult metastasis 80% and 85% respectively. The mean follow up was 13 monts. It appears from our study that elective lateral neck dissection is a promising and safe procedure and may be useful as an important prognostic tool in sampling the lymph nodes and predicting recurrences in the neck.

Cervical neuroblastoma is relatively uncommon. It present, most often as a firm mass in the lateral neck. Primary neuroblastomas of the neck usually arise in the cervical sympathetic ganglia. They are the sixth most common head and neck extracranial neoplasms. Neuroblastoma is the most common malignancy in children under 1 year of age. No known cause of Neuroblastoma has been reported.

The early development of the brachial plexus shows that it is formed of a dorsal branch supplying the extensor muscles and a ventral branch for the flexor muscles. Although the network becomes more and more complex, a basic pattern is generally preserved. This basic pattern, as well as variants and the topography of the lateral neck triangle, is described.

We report herein the cases of two patients who suffered traumatic tracheal disruption, both of whom under-went successful surgical treatment. The first patient was a 48-year-old truck driver who suffered severe dyspnea after jamming his neck in a truck door. An endotracheal tube was unable to be inserted due to bleeding and thus, an emergency tracheostomy was performed. On admission massive subcutaneous emphysema was noted in the neck and anterior chest, and tracheal disruption was confirmed by a lateral neck X-ray, computed tomography (CT), and fiberscopy. An emergency end-to-end anastomosis of the trachea with insertion of a T-type silicon tube into the lower trachea was performed. The second patient was a 36-year-old man who suffered severe dyspnea after having his neck caught in a chain while driving a motorcycle. On admission, marked subcutaneous emphysema in the neck and paradoxical movement of the trachea were noted. Tracheal disruption was confirmed by a lateral neck X-ray and CT, and a similar operation to that of the first patient was performed. This type of injury is rare; however, lateral neck X-ray, CT, and fiberscopy proved extremely useful for making an accurate diagnosis following which successful emergency surgery was able to be performed, achieving good long-term results.

Lymphangiomas are uncommon lesions of lymphatic channels that are often present at birth and diagnosed mostly (90%) before the age of two years. Lymphangiomas occur exceedingly rarely in adults and few cases are described in the literature. The treatment of choice is complete surgical removal; however, the tumor tends to spread along vital structures therefore sometimes inductive complete surgical removal is impossible. We describe the clinical and pathological features of cystic lymphangioma diagnosed in three adults with lateral neck mass. Clinical examination, ultrasonography, MRI and fine-needle aspiration cytology were performed. We discuss the diagnostic difficulties of this uncommon lesion where in many cases the correct diagnosis is reached only after histopathological investigation of the surgical specimen. Therapeutic options are briefly described. Our cases suggest the need to consider cystic lymphangioma in the differential diagnosis of lateral neck masses in adults, together with adequate imaging and cytological studies to corroborate the preoperative diagnosis.

The Branchial apparatus was first described by Von Baer in 1827. (cited by King. 1949) After five years the cervical fistula was recognised as an anomalie of Branchial apparatus. By 1864 the term “branchial fistulae” had been applied, and soon thereafter cysts of the lateral neck were to be ascribed to branchial origin. Everything appeared to fit nicely into this neat categorization until 1912 when Wenglowski published the results of his dissections of Cadavers and human embryos, which led him to doubt the branchiogenic origin of many lateral cervical cysts. In the ensuing years various theories as to the exact pathogenesis of these anomalies have been proposed with more controversies on the matter of cysts than on fistulas or sinuses. There are four theories of origin of branchial cysts but because of the complicated development of the neck none has been proven by empryological investigation. Most of the theories attempted to correlate clinical findings with known embryological facts and none can stand close scrutiny4. Here a case is reported who presented to us with large lateral cervical cyst extending from angle of jaw to sternoclavicular joint, strengthening the cervical sinus theory. It postulates that branchial cysts represent remains of the cervical sinus of His which is formed by the second arch growing down to meet the fifth.

Evaluation of the retrotracheal soft tissues in infants and children is difficult due to the variation in soft tissue thickness during respiration. It is our purpose to report a simple method for evaluation of the retrotracheal pre-cervical soft tissues. In 1930, Hay [4] noted that on the lateral roentgenogram of the neck in infants and children the trachea buckled forward during expiration. He regarded this buckling as normal and felt it was due to "crowding of the trachea during expiration", due to lax retropharyngeal tissues, and stressed the need to examine the neck in both phases of respiration. He noted that one might be misled into making a diagnosis of retropharyngeal abscess on a lateral roentgenogram of the neck if the film was obtained during the expiratory phase of respiration. One approach to accurate determination of the soft tissues of the neck is fluoroscopy and due roentgenography. Brenner [2] noted that the duration of minimal thickness of the vertebral soft tissues during inspiration ]asted only 0.2 seconds in most cases and during expiration soft tissue thickness increased markedly. This explains why it is often difficult to obtain a good inspiratory film without buckling of the trachea in the infant or young child, Often, several lateral films of the neck are obtained and none is satisfactory.

In 200 patients with uni- or bilateral neck dissection the long range cosmetic results, subjective complaints, and the neurologic status were studied at postoperative time intervals between 3 months and 10 years. The main disorders were related to both the absence of resected, tumorinvolved structures and to hyperesthesia of the lateral neck skin.