Objective
We performed a systematic review and meta‐analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy ...(TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node‐negative (cN0) papillary thyroid cancer (PTC) patients.
Methods
We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI).
Results
Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco‐regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI 0.19, 1.27, P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI 0.73, 2.97, P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI 0.59, 3.03, P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI 0.42, 7.26, P = .44) did not significantly differ between both groups.
Conclusion
For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco‐regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events.
Level of Evidence
1 Laryngoscope, 132:1320–1328, 2022
and Objectives: Hypocalcemia is a commonly reported complication after thyroid surgery. Many possible risk factors have been identified. The purpose of this study is to analyze various risk factors ...possibly associated with development of postoperative hypocalcemia after thyroid surgery by dividing the sample population into postoperative hypocalcemia and normal calcium groups.
Retrospective.
Multiple centers in the Makkah region of Saudi Arabia.
Risk factors for postoperative hypocalcemia that were obtained for analysis include patient factors, perioperative blood parameters factors, disease-related factors, and surgical factors. Postoperative hypocalcemia was defined as a reduction of the total calcium level to <8.0 mg/dL. Hypocalcemic and normocalcemic patients were compared by multivariate logistic regression.
Distinguish independent risk factors for postoperative hypocalcemia after thyroidectomy.
215 patients.
The incidence of hypocalcemia was 52.1% (112 of 215 patients). According to multivariate analysis, statistically significant risk factors for predicting postoperative hypocalcemia included postoperative parathyroid hormone level <10 pg/dL, inadvertent parathyroid gland resection, and neck dissection surgeries.
The causes of postoperative hypocalcemia are multi-factorial. Because many of these factors are modifiable, they should be identified postoperatively to distinguish high-risk groups and implement early preventive measures.
Retrospective with a relatively small size. We encourage additional prospective studies with a larger sample size in multiple regions of the country, which might reveal further significant results.
Dysphagia is a common adverse event among head and neck (H&N) cancer patients. We aimed, for the first time, to validate the Arabic version of the MD Anderson Dysphagia Inventory (MDADI) among 82 ...Saudi Arabian patients with H&N cancer. We followed established validation guidelines and translated the 20-item MDADI using the forward–backward method. Our results revealed 100% feasibility. Test–retest reliability demonstrated acceptable interclass correlation coefficients (ICC) for the subscale domains (emotional = 0.973, physical = 0.971, and functional = 0.956) and composite score (ICC = 0.984). The Cronbach’s alpha coefficients for the emotional, functional, and physical subscales were 0.937, 0.825, and 0.945, respectively (composite score = 0.975). We confirmed concurrent validity by demonstrating significant correlations between the domains of the Arabic MDADI and European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Head and Neck Module (QLQ-H&N35). Our study validated the Arabic version of the MDADI among H&N cancer patients from Saudi Arabia.
Plasma cell neoplasms rarely manifest as a solitary extramedullary plasmacytoma. Oropharyngeal involvement had been already reported in the literature. The most common malignancy of the oropharynx is ...squamous cell carcinoma, while soft tissue malignancy is extremely rare. In our present case report, the patient presented with a huge oropharyngeal mass which developed in a short duration. His family’s concerns were mostly about his survival and quality of life. After complete checkup, a diagnosis for solitary extramedullary plasmacytoma of the oropharynx was concluded. The patient received neo-adjuvant chemotherapy and radiotherapy. The mass markedly decreased in size with complete regression as seen both clinically and radiologically. Our main aim for reporting this present case of pathology in oropharyngeal malignant masses is to increase the awareness and draw attention of Otolaryngology, the Head and Neck surgeons.
BACKGROUND Nasopharyngeal carcinoma (NPC) is a rare malignant tumor that arises from the mucosal lining epithelium of the nasopharynx, most commonly at the lateral nasopharyngeal recess or fossa of ...Rosenmüller. According to global age-standardized incidence rates (ASIRs), in 2018 the incidence rate of nasopharyngeal carcinoma varied from 2.1 to 0.4 per 100 000 in Asia and Europe, respectively. The number of deaths exceeded 50 000. It is one of the few head and neck tumors prone to distant metastasis, most commonly to bones, lung, and liver. CASE REPORT In this case report, we present a rare case in which a 23-year-old male patient presented to our head and neck clinic. The patient presented initially to the orthopedic clinic with a right humeral mass lesion 10 cm with history of pain for the last 7 months. A Tru-Cut biopsy confirmed metastatic NPC. A nasopharyngeal biopsy further revealed his lesion to be an NPC undifferentiated type III. The patient was diagnosed with a T3 N2b M1 stage tumor and he was treated with chemoradiotherapy. CONCLUSIONS NPCs that present with a shoulder/humoral metastasis are very rare clinically. We are presenting this case to increase the awareness of the Otolaryngology - Head & Neck surgery, Orthopedic, and Oncology community of such a rare presentation.
To examine the possible implications of the 2009 H1N1 influenza A (pandemic flu, pH1N1) on this religious gathering and provide a response plan for the Otolaryngology, Head and Neck (ENT) clinic ...during the Hajj pilgrimage.
This study was conducted between November and December 2009. All patients presenting to the ENT clinic at Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia were recorded. Descriptive statistics were used to analyze the data.
A total of 3087 patients were included (mean age 35+/-7.8 years), of which, 2114 were males (68.5%), and 973 females (31.5%, male to female gender ratio=2.17:1). Among them, 1467 patients (47.5%) were Hajji and 1620 patients (52.5%) were non-Hajji. Saudi patients comprised 1602 (51.8%), while non-Saudi's comprised 1485 (48.2%). Upper respiratory tract infections (URTI) including the diagnosis of pharyngitis, viral URTI, pH1N1, and tonsillitis represented (92%) of total diagnoses. Of these, only 77 suspected pH1N1 cases (2.5%) were observed in the ENT clinic. Management of 3045 patients (98.6%) included antimicrobials as part of their main therapy.
The pH1N1 cases presenting to our ENT Hajj clinic had a minimal impact on the clinic operation. The ENT Hajj Clinic helped alleviate pressure from the ER. Excessive use of antibiotic usage should be discouraged.
Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid cancer. It is one of the most common types of malignancy of the thyroid that spreads to cervical lymph nodes. Lymph node ...metastasis (LNM) is an important factor when determining recurrence risk, and determining the extent of lymph node involvement can guide treatment. Our main objective is to evaluate the association between the size of the tumor and the number of lymph node metastases in patients with PTC. Methods: We conducted an electronic retrospective chart review of 125 patients with PTC followed in the Head and Neck Department at KAMC from 2009 to 2020. Twenty-two patients included in our study were pathologically and clinically diagnosed and confirmed to have LNM of PTC. Results: The study included 22 PTC patients who had undergone lymph node dissections. Patients had a median age of 38.8 years (IQR = 32.2–54.5), and the median tumor size was 20.5 mm. The most commonly affected level of the neck was IV (76.2%). Distant metastasis M1 was seen in only two patients (9.1%). Tumors sizes >30mm (75%) had ≥5 LNM. Most cases were the classic subtype PTC. For the site of the tumor, the site had a significant impact on the number of LNM (p = 0.004). Multifocality had a high impact on LNM (p = 0.019). Conclusions: This study showed no association between the size of PTC and the number of LNMs. The bilaterality of PTC was significantly associated with a high number of LNMs.
•Lymph nodes in level IV were the most common metastasis site for PTC.•Bilateral and multifocal PTC were significantly associated with a higher number of lymph nodes metastasis.•The size of the tumor was not significantly related to the number of lymph node metastasis.
Abstract Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a single parathyroid adenoma, which represents the most common cause of chronic hypercalcemia. ...However, in few cases, surgery may be technically difficult or risky. We report the use of percutaneous ultrasound-guided alcohol ablation of a parathyroid adenoma as an alternative to surgery in an 88-year-old male patient with significant medical comorbidities.
Abstract
Introduction
Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral ...nasolacrimal duct obstruction at two stages, rather than in the same setting.
Objective
To evaluate the feasibility and the outcome of simultaneous bilateral Endo-DCR and its impact on the quality of life of the patients.
Methods
We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire.
Results
Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation SD: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37.
Conclusion
Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients.
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