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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.

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.

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

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.

Ganglioneuroma is a rare benign neurogenic tumour arising from the sympathetic system. Ganglioneuromas are most commonly seen in posterior mediastinum, retroperitoneum, adrenal gland and rarely seen in cervical region. GNs tend to occur in older children at the age of 5 to 7 years. Here, we present a case of cervical ganglioneuroma in a 4 year old male child who presented with slow growing painless lateral neck swelling since birth.

Extrapulmonary tuberculosis in the head and neck region accounts for 10% of all tuberculosis cases. Cervical lymph nodes are the most common sites of head and neck tuberculosis and often mimics neck metastasis leading to overstaging and overtreatment. Fine needle aspiration has proven effective in diagnosing cervical tuberculosis. If a diagnosis of tuberculosis is confirmed, then the first-line treatment is oral antituberculosis medication.

Lateral neck ectopic thyroid tissue remains a rare entity that can be affected by any lesion involving the gland. The origin of lateral neck ectopic thyroid carcinomas still debated between a metastatic disease secondary to thyroid primary tumor and primary malignancy on the ectopic tissue. Anyway, it should indicate an exploration of the gland. We report the case of a 36 years old female with one year history of hyperthyroidism who was admitted for multinodular grade II goiter with a firm mass in the left level II of the lateral neck. The thyroid scintigraphy demonstrated multiple functioning nodules corresponding to toxic multinodular goiter; in addition to two cold hypofunctional nodules. The cervical ultrasound showed a voluminous multinodular goiter classified as EU TIRADS 5. The surgical procedure exposed a multinodular mass, lateral to the internal jugular vein, with the appearance and structure of the thyroid gland and no connection to it. The thyroid gland was exposed next through a collar incision. Each mass was dissected and removed individually. The histopathology examination of the thyroid gland found papillary carcinoma extracapsular extension. The pathology results of the other mass reported multiple colloid nodules with cystic component, papillary in appearance, with the same cancer proliferation, compatible with ectopic thyroid tissue with papillary carcinoma. No lymph node tissue was found. The patient was sent for complementary RAItherapy. We report a rare case of lateral neck ectopic thyroid papillary carcinoma that supplements and supports the lacking literature data concerning the management of this rare entity., Highlights • Lateral neck ectopic thyroid tissue is a rare entity that can possibly be affected by any lesion involving the gland. • Metastasis from thyroid primary carcinoma are difficult to distinguish from primary malignancy of the ectopic tissues. • The discovery of papillary carcinoma on ectopic thyroid tissue should indicate an exploration of the gland.

Simple Summary The indication for performing a neck dissection in patients with differentiated thyroid cancers is metastatic involvement of the cervical nodes. Potential complications from lateral neck dissection include injury to the thoracic duct, cervical major vessels and nerves. There is a lack of review reporting the incidence of these complications and their diagnostic and therapeutic approach. Our review may help endocrine surgeons and clinicians to recognize and face up to these challenging problems. Abstract Neck dissection is a surgical procedure reserved for thyroid cancer cases with clinically evident lymphatic invasion. Although neck dissection is a reliable and safe procedure, it can determine a significant morbidity involving a variety of structures of nervous, vascular and endocrine typology. A careful pre-operative study is therefore essential to better plan surgery. Surgical experience, combined with accurate surgical preparation and merged with adequate and specific techniques, can certainly help reduce the percentage of complications. In recent years, however, technology has also proved to be useful. Its crucial role was already recognized in the safeguard of the integrity of the laryngeal nerve through neuro-monitoring, but new technologies are emerging to help the preservation also of the parathyroid glands and other structures, such as the thoracic duct. These surgical skills combined with the latest technological advancements, that allow us to reduce the incidence of complications after neck dissection for thyroid cancer, will be reported in the present article. This topic is of significant interest for the endocrine and metabolic surgeons’ community.

Introduction Cavernous hemangioma is a venous malformation that occurs throughout the entire body but is rarely localized in internal jugular vein, to the best of our knowledge our case is the first case reported in the literature. Case report We report a case of internal jugular vein cavernous hemangioma in a 62-year-old woman and review the literature concerning the clinical features, radiological appearance, histopathological findings and treatment options. Discussion Internal jugular vein cavernous hemangioma, is a very rare tumor composed of large dilated blood vessels and containing large blood-filled spaces. It can occur as lateral neck mass, in our case neither the scanner nor the ultrasound made the diagnosis. Given the rarity of the condition, therapeutic strategies remain unclear. However, according to the published literature, complete resection is considered the most successful and effective treatment., Highlights • Cavernous hemangioma is a venous malformation that occurs throughout the entire body. • Rarely localized in internal jugular vein. • To the best of our knowledge our case is the first case reported in the literature.

Objective: Foreign body swallowing is a common pediatric problem. A foreign body in the pharynx is a medical emergency that requires urgent intervention. Evaluation and treatment of pharyngeal foreign bodies is much more difficult in children than in adults and sometimes requires hospitalization and removal of the foreign bodies under general anesthesia due to children’s lack of cooperation. Fish and chicken bones are the most common swallowed foreign bodies, but an interesting case of a piece of dishwashing steel wool stuck in a child’s pharynx is reported in this article. Case Presentation: A 10-year old boy was presented with a history of dysphagia from five weeks ago. Oral examination did not reveal anything significant. In lateral neck radiographs of the patient, a metal wire was observed in the hypopharyngeal region opposite the 4th and 5th cervical vertebrae. Endoscopic attempts to remove the foreign body were not successful. Therefore, the foreign body was removed from the patient’s pharynx in the operating room under general anesthesia. No complications were observed. Conclusion: Despite the prevalence of swallowing foreign bodies in children, ingestion of a piece of dishwashing steel wool not diagnosed for three weeks was considered interesting to report. Pharyngeal foreign bodies are medical emergencies; therefore, it is particularly important to suspect the presence of a foreign body and perform diagnostic procedures.

Pediatric Obstructive Sleep Apnea (OSA) is a condition that may lead to a variety of comorbidities in adolescence and adulthood. The gold standard of diagnosing OSA is polysomnography (PSG). Over the past fifteen years numerous publications have explored how to better visualize the upper airway to further assess OSA in the pediatric population, and eventually institute personalized treatment. Lateral neck radiograph, cephalometry, computed axial tomography, and magnetic resonance imaging are all unique imaging techniques that are used in the diagnosis of OSA. Drug Induced Sleep Endoscopy is a direct visualization technique that is gathering momentum in pediatrics. Each approach has respective benefits and weaknesses. However, none of them at this time can replace PSG, They are a helpful supplement in those patients with complicated upper airway anatomy and in those with residual OSA.

BACKGROUND Patients presenting with a cystic lateral neck lesion may present diagnostic challenges against a backdrop of varied non-malignant and malignant etiologies. PATIENTS A total of 133 consecutive cases who underwent cystic neck tumor removal were evaluated for etiology and diagnostic procedure in order to develop an algorithm for therapeutic efficiency. RESULTS In 92 of 133 cases, a non-malignant tumor was diagnosed. In 41 cases, malignant lymphadenopathy was found. In cases with malignancy, males (p=0.001) and the elderly (p=0.001) were affected more frequently. Primary tumors were discovered by pan-endoscopy before neck surgery or in a second pan-endoscopy (with tonsillectomy and mapping biopsies) in cases with histologically confirmed squamous cell carcinoma. During intraoperative frozen-section evaluation (40 cases), a total of 30 patients underwent neck dissection during the first neck operation. CONCLUSION In patients older than 40 years who present with cystic neck lesions, we recommend pan-endoscopy and intraoperative frozen section in cases where malignancy is suspected in order to avoid secondary neck dissections and delays in therapy.

Background:A lymph node yield (LNY) over 20 is considered a quality metric for lateral neck dissection to ensure an oncologic representative sample. Anecdotally, however, LNY in patients undergoing neck dissection after radiation therapy (RT) is lower due to atrophy and fibrosis.Objective:To determine whether preoperative RT decreases LNY in patients with laryngeal cancers undergoing surgery.Methods:Medical record database was queried for patients presenting between 2006 and 2015 with laryngeal cancer. Tabulation was made for location (glottic/supraglottic), stage, and side for the total number of lymph nodes between primary surgery and RT (salvage surgery) groups. Descriptive analysis and a paired Student t test were used for statistical analysis.Results:Fifty-nine patients were included in the study for a total of 98 neck dissections. Twenty-six (44%) patients had primary surgery, and 33 (56%) patients had salvage surgery. The mean left and right total LNY in the salvage surgery group was 27.6 and 29.5, respectively, and 32.2 and 33.7 for the primary surgery group. A difference of 4.5 (left) and 4.3 (right) in LNY between the salvage surgery and primary surgery group was found. A Student t test showed no statistically significant difference in LNY between both groups when analyzed per site (glottic and supraglottic), side, and stage (III-IV).Conclusion:Although patients with prior RT had a lower mean of LNY, our results did not demonstrate a statistically significant difference. Further studies with a larger number of patients are recommended.

Introduction The term “carotidynia” has been used to describe a symptom or a nosologic entity characterized by pain in the lateral neck region and over the carotid bifurcation. Recent advances in diagnostic imaging and the introduction of diagnostic criteria have led to the adoption of term “Transient perivascular inflammation of the carotid artery” (TIPIC) syndrome. Method A retrospective analysis of the Radiology Department’s database was performed to identify cases with the diagnosis of TIPIC syndrome. The purpose was to identify ultrasound images including B-mode technique, colour, power Doppler technique and contrast-enhanced ultrasound (CEUS). Findings In total, five patients with the diagnosis of TIPIC syndrome are presented in this review. TIPIC syndrome is a clinic-radiologic entity characterized by pain over the carotid area, a symptom referring to a wide differential diagnosis where imaging plays a crucial role for proper diagnosis and treatment. Characteristic imaging findings on conventional ultrasound and CEUS are presented in this review. Discussion TIPIC syndrome can be investigated with virtually any imaging modality. Ultrasound typically reveals perivascular infiltration and a hypoechoic intimal plaque, while no significant luminal narrowing is appreciated. Computed tomography angiography and magnetic resonance angiography also demonstrate these vascular wall changes primarily affecting the distal common carotid artery, the carotid bulb and possibly the internal carotid artery proximal part. Contrast enhancement is a very characteristic and constant finding of TIPIC lesions, suggestive of the inflammatory nature of the disease and can be appreciated on computed tomography angiography and magnetic resonance angiography. CEUS has been recently used and successfully observed contrast enhancement of the lesions, similar to computed tomography angiography and magnetic resonance angiography. Conclusion Ultrasound remains the first-line modality for the evaluation of TIPIC syndrome, capable of providing all the information needed, especially if supplemented with the administration of microbubbles so that the enhancement of lesions can be evaluated.

Background: Childhood obstructive sleep apnea (OSA) has important implications for growth, learning, behavior, cognition and cardiovascular health as well as snoring and OSA in adulthood. In this study, we elucidated the sex differences in polysomnographic (PSG) findings and pharyngeal radiographic data in pediatric OSA patients. Methods: Sixty three children (age between 3 and 15 years old) with OSA [defined as apnea-hypopnea index (AHI) ≥1/h by polysomnography] were enrolled. Lateral neck radiographs were obtained from the patients. All subjects were separated by age: pre-adolescent group (3–8 years old) and adolescent group (9–15 years old). Results: Overall, 45 patients in the pre-adolescent group (33 boys and 12 girls) and 18 patients in the adolescent group (10 boys and 8 girls) were enrolled, and sex differences were compared in each group. We found sex differences in craniofacial features and severity of OSA in the adolescent group, in which girls with OSA had more upper airway space, in addition to lower AHI, lower 3% oxygen desaturation index (ODI), higher minimum SO 2 and better sleep efficiency than the boys. Conclusions: The present study found revealed sex differences in pediatric OSA patients in the adolescent group. Girls in the adolescent group had more upper airway space in addition to lower AHI, lower 3% ODI, higher minimum SO 2 and better sleep efficiency than boys.

Objective: The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable. Methods: All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database. Results: A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk. Conclusion: There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study’s findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients.

This study aimed to evaluate long-term prognosis of contralateral central neck dissection in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We aimed to produce clinical evidence to help determine the extent of central neck dissection (CND) focusing on the separation between the ipsilateral and contralateral sides. A total of 708 PTC patients who underwent total thyroidectomy and concomitant ipsilateral or bilateral CND with ipsilateral lateral neck dissection (LND) were retrospectively included between January 1997 and December 2015 at a single institution. The median follow-up time was 89.7 months, the mean age was 44.7 years and the mean tumor size was 1.5 cm. Among the study population, 507 were female (71.5%) and 201 (28.5%) were male. Locoregional recurrence (LRR) was observed in 26 (7.9%) patients and 30 (7.9%) patients in the ipsilateral and bilateral CND groups, respectively. There were 6 (1.8%) contralateral recurrence cases in the ipsilateral CND group and 5 (1.3%) cases in the bilateral CND group. Male sex (adjusted HR = 1.857, p = 0.034), larger tumor size (adjusted HR = 4.298, p = 0.006), and more metastatic ipsilateral central lymph nodes (adjusted HR = 1.078, p = 0.014) significantly increased the risk of LRR. Ipsilateral CND only did not significantly increase the risk of LRR (adjusted HR = 1.110, p = 0.712). There were no significant differences in recurrence according to contralateral central neck dissection status after propensity score matching (p = 0.424), either. The incidence of hypocalcemia (p = 0.007) was higher in the bilateral CND group compared to the ipsilateral CND group. Surgeons may consider performing contralateral CND only for therapeutic purposes to reduce unnecessary complications.

Lemierre's syndrome is a condition in which an oropharyngeal infection progresses to sepsis and thrombophlebitis of the internal jugular vein. Although the incidence of this syndrome has fallen dramatically since the widespread use of antibiotic therapy to treat streptococcal pharyngitis, it should still be suspected in otherwise healthy young patients presenting with the triad of prolonged pharyngitis, lateral neck pain, and septic symptoms. In this report, we explore a unique case of Lemierre's syndrome complicated by hypercoagulability and ineffective initial antibiotic therapy.

Introduction Plexiform cervical neurofibromas are benign neoplasm, extremely rare, difficult to diagnose and to manage. Only some cases have been reported in the literature. Case presentation We report the case of a 60-year-old man admitted for a lateral neck mass, for which the surgical indication was the increase in volume of this mass, as well as the aesthetical impairment, the surgical exploration found the tumor attached to the cervical plexus. The excision of the mass was performed without damaging nerve. The pathological study was in favor of a plexiform neurofibroma. Discussion Even though Plexiform cervical neurofibroma are extremely rare, and their diagnosis are not often primary evoked in front of any growing mass of this region, the surgeon must keep in mind the existence of these neoplasms as a differential diagnosis of a neck tumor. Conclusion Surgery remains the gold standard in the treatment of these locally invasive tumors. It is essential that the surgeon keep in mind the possibility of these tumors as a differential diagnosis of a neck tumor., Highlights • Plexiform cervical neurofibromas are benign neoplasm, extremely rare. • Difficult to diagnose and to manage. • Their symptomatology is variable and depends on their topography. • The clinical aspect is not specific, and the diagnosis is confirmed after a biopsy with anatomopathological examination. • Surgery remains the gold standard in the treatment of these locally invasive tumors.

Described is an atypical presentation of a rare condition. It highlights the importance of thorough algorithm of medical and family history, physical examination, appropriate investigations and perioperative workup and for surgery. This case raises the awareness that a lateral neck mass (or lateral ectopic thyroid mass) can be benign.

Venous aneurysm of the head and neck is a rare clinical entity due to its asymptomatic nature and tendency of clinicians to report only surgical results. Whereas the primary aneurysm of internal jugular vein (IJV) in children is being increasingly recognized, secondary aneurysms of veins of the head and neck in adults, notably the external jugular vein (EJV) aneurysm remains only in anecdotal case reports. We present the case of a 63-year-old previously healthy woman who presented with a gradually progressive right lateral neck swelling over the last 18 months. Following the evaluation, she was diagnosed as a case of isolated spontaneous right-sided EJV aneurysm and was managed by surgical excision of the aneurysm.

Lateral neck masses (LNM) often present a diagnostic challenge in the practice of pediatric plastic surgeon. The aim of this study is to investigate the clinical and ultrasound (US) characteristics of pediatric LNM in order to make mutual comparison between their entities and enable the most accurate preoperative diagnosis. A cross-sectional study was conducted among 250 pediatric patients treated by surgical excision or sclerotherapy in our institution in the period from July 2009 to June 2019. Lymphatic malformation was the most frequent congenital LNM (60.9%), while reactive or granulomatous lymphadenitis was the most frequent acquired LNM (47%). Congenital anomalies were significantly more often localized in the upper half of the sternocleidomastoid (SCM) muscle region, and had more often soft consistency than acquired ones. Congenital LNM had a 32.37 (3.44–304.63) times higher likelihood of incorrect (p = 0.002) and 5.86 (1.35–25.48) times higher likelihood of undetermined (p = 0.018) than correct US findings, respectively. Acquired LNM were significantly more often localized in the region behind the SCM muscle and more often had solid US appearance in comparison to the congenital ones. Association of the clinical and US findings is very important in determining the most accurate preoperative diagnosis without exposing the children to unnecessary utilizing ionizing radiation or anesthesia. Although they are mostly benign, extreme caution is necessary due to malignancies which were found in 16.4% of all our patients.

BACKGROUND: Although therapeutic lateral neck dissection (LND) may be indicated in thyroid carcinoma, the cervical lymph node groups IIA and IIB, according to Robbins classification, are often not removed. The aim of our study was to determine the relevance of complete comprehensive LND in thyroid carcinoma. METHODS: We conducted a retrospective study between January 2011 and August 2018 in a university teaching hospital. Histopathological analysis of LND performed during total thyroidectomy in thyroid carcinoma was reviewed according to lymph node level. To demonstrate that neck dissection of upper groups, IIA/IIB, is necessary when therapeutic LND is indicated in thyroid carcinoma, we compared histopathological involvement in complete comprehensive LND of the upper groups IIA/IIB to the lower groups III/IV/V. RESULTS: A total of 30 LND (24 patients) were suitable for analysis. Analysis by neck side revealed that comprehensive LND dissection samples were negative in 3 cases, and positive in 27. In those 27 positive LND, 15 demonstrated involvement of the groups IIA/IIB, and 12 were positive for involvement of the III/IV/V groups only. The combined presence of positive IIA/IIB and positive III/IV/V was observed in 15 of the 27 neck sides. There was no positive IIA/IIB without positive involvement of III/IV/V groups. CONCLUSIONS: The high rate of positive cervical lymph nodes in the upper groups IIA/IIB supports complete comprehensive LND rather than selective III/IV/V LND in thyroid carcinoma surgery. However, impact on survival and whether postoperative radioactive iodine treatment may be modulated remain to be studied.

Chyle leak is a well-known complication that can occur after a thyroidectomy with neck dissection; however, it rarely occurs after thyroidectomy alone. Here, we report a case of chyle leak following a left hemithyroidectomy for a benign solitary thyroid nodule. Based on the literature search, this is only the second reported case of a chyle leak after a simple hemithyroidectomy without any central or lateral neck dissection. Amongst the possible causes, we hypothesize that the use of intraoperative nerve monitor may be a contributing factor. Treatment options are explored and the patient was treated successfully with nonoperative management.

Objective: Lateral neck dissection (LND) is important in managing papillary thyroid carcinomas (PTCs). This study aimed to evaluate the relationship between lymph node yield (LNY) for LND and patient outcomes, specifically postoperative serum thyroglobulin levels (sTG) and radioiodine uptake on thyroid scan, and to estimate a threshold LNY to signify adequate LND. Methods: Patients diagnosed with PTC who underwent LND from 2006 to 2015 at a single institution were included. Linear regression with restricted cubic splines was used to characterize the association of LNY with outcomes. Outcomes were log-transformed to achieve a more symmetric distribution prior to regression. For nonlinear associations, a Monte Carlo Markov Chain procedure was used to estimate a threshold LNY associated with postoperative outcome. This threshold was then used to define high LNY versus low LNY in the subsequent analyses. Results: In total, 107 adult patients were included. There was a significant relationship between LNY and postoperative sTG level ( P = .004), but not radioiodine uptake ( P = .64). An LNY of 42.96 was identified, which was associated with the maximum change in sTG level. No association was found between LNY groups (LNY ≥ 43 vs < 43) and radioiodine uptake, risk of complication, or longer operative times (all P > .05). High LNY was associated with a decrease in log(sTG) (estimate = −1.855, P = .03), indicating that adequacy of LND is associated with an 84.4% decrease in sTG. Conclusion: These results suggest an association between LNY and postoperative sTG level, with an estimated threshold of 43 nodes. This has implications for adequate therapeutic LND; additional work is needed to validate thresholds for clinical practice.

PURPOSE: To develop and validate a deep learning (DL) algorithm to identify poor-quality lateral airway radiographs. MATERIALS AND METHODS: A total of 1200 lateral airway radiographs obtained in emergency department patients between January 1, 2000, and July 1, 2019, were retrospectively queried from the picture archiving and communication system. Two radiologists classified each radiograph as adequate or inadequate. Disagreements were adjudicated by a third radiologist. The radiographs were used to train and test the DL classifiers. Three technologists and three different radiologists classified the images in the test dataset, and their performance was compared with that of the DL classifiers. RESULTS: The training set had 961 radiographs and the test set had 239. The best DL classifier (ResNet-50) achieved sensitivity, specificity, and area under the receiver operating characteristic curve of 0.90 (95% confidence interval [CI]: 0.86, 0.94), 0.82 (95% CI: 0.76, 0.90), and 0.86 (95% CI: 0.81, 0.91), respectively. Interrater agreement for technologists was fair (Fleiss κ, 0.36 [95% CI: 0.29, 0.43]), while that for radiologists was moderate (Fleiss κ, 0.59 [95% CI: 0.52, 0.66]). Cohen κ value comparing the consensus rating of ResNet-50 iterations from fivefold cross-validation, consensus technologists’ rating, and consensus radiologists’ rating to the ground truth were 0.76 (95% CI: 0.63, 0.89), 0.49 (95% CI: 0.37, 0.61), and 0.66 (95% CI: 0.54, 0.78), respectively. CONCLUSION: The development and validation of DL classifiers to distinguish between adequate and inadequate lateral airway radiographs is reported. The classifiers performed significantly better than a group of technologists and as well as the radiologists. © RSNA, 2020

Introduction: Lateral neck metastases occur in ~15% of papillary thyroid cancer and in ~40% of medullary thyroid cancer. We present herein a systematic approach to a standard comprehensive lateral neck dissection, with attention to specific areas where thyroid cancer lymph node metastases may be missed during surgery. Materials and Methods: Video demonstration of a comprehensive levels 2a, 3, 4, and 5b lateral neck dissection for thyroid cancer. Results: A systematic step-wise approach to a standard comprehensive lateral neck dissection for thyroid cancer, inclusive of levels 2a, 3, 4, and 5b, is demonstrated. Areas where thyroid cancer lateral neck lymph nodes can be missed are noted, including low level 4 nodes and carotid-vertebral nodes, level 5B nodes, and subdigastric level 2 nodes medial to the carotid artery. Conclusion: A step-wise systematic approach to a comprehensive lateral neck dissection for thyroid cancer may lower the risk for missed thyroid cancer lateral neck lymph node metastases. No competing financial interests exist. Runtime of video: 8 mins 35 secs

Objectives The objectives of this study are to describe the incidence and age range of presentation of lateral neck cysts, to evaluate a management algorithm for adults presenting with lateral neck cystic lesions and to report the age incidence at which malignant cystic lesions in the neck have clinically presented as lateral neck cysts. Design A retrospective review of histologically diagnosed branchial cysts between 1995 and 2014 at a single centre. Setting Oxford University Hospitals NHS Foundation Trust. Participants A single senior head and neck pathologist and the ENT head and neck team. Main outcome measures Does a dedicated pathway help to identify malignancy in lateral neck cysts earlier in the diagnostic pathway? Results When using a random investigative pathway the sensitivity in distinguishing malignant from non-malignant was 93%, specificity 12% with a PPV of 83% and NPV 28%. When using a defined investigative protocol, the sensitivity was 94%, specificity 67%, PPV of 85% and NPV 86%. Conclusions This study conveys that using a structed pathway when working up patients with a lateral neck cyst results in a greater sensitivity, specificity, PPV and NPV in distinguishing malignancy compared to an unstructured workup. Key points 1) Establishing a lateral neck cyst as a benign structure is a diagnosis of exclusion 2) There is no established protocol for this pathway. 3) The need for a diagnostic pathway is important given the impact of COVID-19 4) The diagnostic challenge is differentiating benign from malignant 5) For lateral neck cysts a cut off age of 35 may not be appropriate

Objective To determine whether the use of fibrin sealant tissue adhesives during lateral neck dissections is associated with a change in postoperative outcomes. Study Design Retrospective cohort. Setting Institutionally affiliated tertiary care center. Methods Various demographic, disease, and surgical data were collected for patients who underwent lateral neck dissections. Univariate regression analysis was performed with the following outcomes: total drain output and duration of drain placement, as well as incidence of postoperative infection, hematoma, seroma, chyle leak, and salivary leak. Results A total of 133 patients underwent lateral neck dissections. Fibrin sealant was used in 35% of cases (n = 46). Its use was not associated with differences in total drain output ( P = .77) or the number of days that the drains were in place ( P = .83). On secondary analysis, the use of fibrin sealant was not associated with a difference in postoperative incidence of hematoma ( P = .65), seroma ( P = .68), chyle leak ( P = .42), or salivary leak ( P = .73). These results were consistent when stratified by the presence of intraoperative complications. Its use accompanied an average cost of $674 per case. Conclusions Fibrin sealant use during lateral neck dissections was not associated with a reduction in drain output or days that the drains remained in situ. Although the current study was limited by sample size, fibrin sealant use was not associated with a decreased risk of postoperative adverse events. The evidence in this report suggests that the routine use of these products adds cost without clear benefit.

Background: The optimal extent of therapeutic lateral neck dissection (LND) in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice. In this light, our study aims to explore the incidence, patterns, and predictive factors of the lateral multiple-level metastasis in N1b PTMC patients. Methods: The clinical records of 142 patients diagnosed with N1b PTMC who underwent therapeutic LND from July 2015 to November 2018 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to examine the predictive factors associated with lateral multiple-level metastasis. The recurrence-free survival was analyzed and confirmed by Kaplan–Meier plots and log-rank test. Results: The overall frequency of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, and two-level to four-level simultaneous metastasis were present in 26.8, 17.6, and 6.3% patients, respectively. Extrathyroidal extension (ETE) (OR = 5.79, 95% CI, 1.36–24.59; P = 0.017) and the central metastatic lymph node ratio (CLNR) with values equal or higher than 0.61 (OR = 6.18, 95% CI, 2.53–15.09; P < 0.001) served as independent predictors of multiple-level metastasis in N1b PTMC patients. Moreover, locoregional recurrence was significantly higher in the selective neck dissection (SND) group compared to the modified radical neck dissection (MRND) one (HR = 3.65, 95% CI, 1.11–12.00; P = 0.03). Conclusion: Our results show that the lateral multiple-level metastasis was relatively common, and we suggest MRND to be considered for N1b PTMC patients with ETE or CLNR equal or higher than 0.61.

Objective Nasogastric tube (NGT) insertion in anesthetized and intubated patients can be challenging, even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between GlideScope™ visualization and neck flexion, with lateral neck pressure techniques. Material and methods This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery, under relaxant general anesthesia, who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope™ group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of the first and second attempts, duration of insertion, and complications were recorded. Results The total success rate was 79.1% in group G, compared with 76.7% in group F (P = 1). The median time required for NGT insertion was significantly longer in group G, for both first and second attempts (97 vs 42 s P P = 0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications for both techniques. Conclusion Using GlideScope™ visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique, in the degree of success rates of insertion. Although complications were not statistically significant between groups, neck flexion with lateral neck pressure technique was significantly less time-consuming for both first and second attempts. Trial registration Retrospectively registered: Thai Clinical Trial Registry (TCTR)20171229003. Registered on 19 December 2017