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The treatment of head and neck cancer with radiotherapy and radical neck dissection has many recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a disruption of normally balanced forces acting on the clavicle.
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An unusual case of clavicle fracture which is considered to have resulted from an interaction of the effects of these therapies is discussed. An approach for recognizing and distinguishing this entity by its time course, and radiographic and nuclide bone scan appearance is presented. Development of comprehensive nomograms for evaluating overall and cancer-specific survival of laryngeal squamous cell carcinoma patients treated with neck dissection. The aim of this study was to develop effective nomograms to better predict survival for LSCC patients treated with neck dissection.
The 3- and 5-year probabilities of cancer-specific mortality CSM were Concordance index as a commonly used indicator of predictive performance, showed the nomograms had superiority over the no-LNR models and TNM classification Training-cohort: OS: 0. All calibration plots revealed good agreement between nomogram prediction and actual survival. Public Figure. Unofficial Page. Posts about arulalan guruji. There are no stories. Optimal cutoff points were determined by X-tile program.
Significant predictive factors were used to establish nomograms estimating overall OS and cancer-specific survival CSS. The nomograms were bootstrapped validated both internally and externally. These patients were at high risk for LN metastasis and the rate of cervical LN metastasis was recorded. Results In all, lateral neck dissections were performed in patients. Intraoperative pathological data revealed LN metastasis from 55 cases, for which Level II and V dissection were performed. Ninety SSNDs were performed in the other 83 patients without metastasis identified in frozen sections.
Anatomical study of phrenic nerve course in relation to neck dissection.
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The present study sought to clarify the course of the phrenic nerve and its correlation with anatomical landmarks in the neck region. We examined 17 cadavers 30 sides. In each, the phrenic nerves was dissected from the lateral side of the neck , and its position within the triangle formed by the mastoid process and sternal and acromial ends of the clavicle was determined. The point where the phrenic nerve arises in the posterior triangle was found to be similar to the point where the cutaneous blanches of the cervical plexus emerge at the middle of the posterior border of the sternocleidomastoid muscle.
In the supraclavian triangle, the phrenic nerve crosses the anterior border of the anterior scalene muscle near Erb's point where the superficial point is cm superior from the clavicle and posterior border of the sternocleidomastoid muscle. The phrenic nerve arises in the posterior triangle near the nerve point, then descends to the anterior surface of the anterior scalene muscle in the supraclavian triangle.
It is necessary to be aware of the supraclavian triangle below Erb's point during neck dissection procedures. Stroke without dissection from a neck holding manoeuvre in martial arts. Carotid artery trauma is a known cause of stroke in young people. The vessel may occlude, dissect or shower thrombotic emboli into intracranial vessels.
This paper reports the use of single photon emission computed tomography SPECT imaging in a 29 year old man who developed an embolic stroke after neck holding manoeuvres at a martial arts class. Awareness of the potential consequences of these procedures is matched by the need for rapid and accurate diagnosis of stroke now that thrombolytic and neuroprotective treatments are emerging, which are effective only within a short time window.
Evaluation of perception performance in neck dissection planning using eye tracking and attention landscapes. Neck dissection is a surgical intervention at which cervical lymph node metastases are removed. Accurate surgical planning is of high importance because wrong judgment of the situation causes severe harm for the patient. Diagnostic perception of radiological images by a surgeon is an acquired skill that can be enhanced by training and experience.
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To improve accuracy in detecting pathological lymph nodes by newcomers and less experienced professionals, it is essential to understand how surgical experts solve relevant visual and recognition tasks. By using eye tracking and especially the newly-developed attention landscapes visualizations, it could be determined whether visualization options, for example 3D models instead of CT data, help in increasing accuracy and speed of neck dissection planning.
Thirteen ORL surgeons with different levels of expertise participated in this study. They inspected different visualizations of 3D models and original CT datasets of patients. Among others, we used scanpath analysis and attention landscapes to interpret the inspection strategies. It was possible to distinguish different patterns of visual exploratory activity.
The experienced surgeons exhibited a higher concentration of attention on the limited number of areas of interest and demonstrated less saccadic eye movements indicating a better orientation.
Maximizing shoulder function after accessory nerve injury and neck dissection surgery: A multicenter randomized controlled trial. Shoulder pain and dysfunction after neck dissection may result from injury to the accessory nerve. The effect of early physical therapy in the form of intensive scapular strengthening exercises is unknown. A total of 59 neck dissection participants were prospectively recruited for this study.
Blinded assessment occurred at baseline, and at 3, 6, and 12 months. The intervention is a favorable treatment for maximizing shoulder abduction in the short term. The effect of the intervention compared to usual care is uncertain in the longer term. The morbidity of bilateral lateral neck dissection BLND for thyroid cancers has not been described in detail. This study delineates the specific complications arising from BLND for thyroid cancers at a single high-volume center.
To determine the morbidity associated with BLNDs for differentiated thyroid cancers at our institution. This was a retrospective review of medical records performed to identify patients having undergone BLNDs for thyroid cancers by a single surgeon at an academic, tertiary medical center in Toronto, Ontario, Canada, from to Patients who underwent BLND for papillary, follicular, or medullary thyroid cancers were identified through operative procedure codes and review of operative and pathology reports.
The indication for this procedure was suspicious bilateral lateral compartment on imaging and clinical examination. Sixty-two patients who underwent BLND for thyroid cancers, with or without total thyroidectomy and central compartment dissection , were identified. The main outcome measures for this study were unanticipated medical or surgical complications during the operation or in the postoperative period.
Secondary measures were oncologic outcomes, including regional structural or biochemical recurrence.
Their mean age was 46 years range, years. There was 1 case of unanticipated permanent recurrent nerve paralysis and 1 case of temporary nerve paresis. There were 3 readmissions within 30 days of surgery, 1 pulmonary embolism, and 1 perioperative mortality. Fifty percent of patients had pN0 contralateral necks despite preoperative clinical suspicion. Four patients were found to have anaplastic thyroid cancers intraoperatively. Four patients died of their disease within available follow. The utility of intraoperative ultrasound in modified radical neck dissection : a pilot study.
Although the value of surgeon-performed neck ultrasound SPUS for thyroid nodules has been validated, the utility of intraoperative ultrasound US in modified radical neck dissection MRND has not been reported in the literature.
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Between and , a total of 25 patients underwent MRND by 1 surgeon for thyroid cancer. There were 10 male and 15 female patients. Pathology included 23 papillary and 2 medullary carcinomas. Robotic total thyroidectomy with modified radical neck dissection via unilateral retroauricular approach. Traditionally, total thyroidectomy was performed through an open transcervical incision; in cases where there was evident nodal metastasis, the conventional surgical approach was to extend the incision into a large single transverse incision to complete the required neck dissection.
However, recent innovation in the surgical technique of thyroidectomy has offered the opportunity to reduce the patient's burden from these prominent surgical scars in the neck. Minimally invasive surgical techniques have been developed and applied by many institutions worldwide, and more recently, various techniques of remote access surgery have been suggested and actively applied.
The more former and widely acknowledged robotic thyroidectomy technique uses a transaxillary TA approach, which has been developed by Chung et al. Terris et al. However, Chung et al. Oncologic outcomes of selective neck dissection in HPV-related oropharyngeal squamous cell carcinoma.
Multi-institutional retrospective review.
Three hundred and twenty-four patients were identified with a median follow-up of 49 months range months. On univariable analysis, absence of radiation was associated with regional recurrence odds ratio [OR] 9. On multivariable analysis, adjuvant radiation was associated with improved disease-free survival DFS OR 0. Omission of radiotherapy increases the risk of regional recurrence, although it may not significantly impact OS or DSS. It appears unnecessary to routinely perform a comprehensive neck dissection.
The pros and cons of prophylactic central neck dissection in papillary thyroid carcinoma. Compared to many malignancies, PTC has a high overall survival but local recurrence due to lymph node metastases continue to present management challenges. Unlike lateral cervical nodal metastasis metastasis, central neck nodal metastasis are unable to be reliably detected clinically or radiologically at pre-operative assessment.
Residual disease recurrent or persistent typically requires re-operative surgery in the central compartment, which carries a heightened risk of significant morbidity. These nodal groups can be accessed during the index thyroidectomy for PTC. Thus, pCND offers potential to reduce the rates of recurrence and the need for re-operative surgery in the central neck. This benefit needs to be balanced with the potential morbidity risk from pCND itself at the index resection. This review will discuss the advantages and disadvantages of pCND with regard to long-term outcomes and potential morbidity.
The rationale of pCND will be discussed, along with the indications for ipsilateral and contralateral pCND, the role of re-operative surgery for recurrence and the use of selective versus routine pCND. Strategies to select higher risk patients for pCND with the use of molecular markers will be addressed, along with a discussion of quality of life QoL research in PTC. The most frequent recurrence site of papillary thyroid carcinoma PTC is the cervical lymph nodes. The introduction of an electric linear probe for use with ultrasonography in improved preoperative lateral neck evaluations.
Our analysis of the patients aged neck evaluations and clinical feature changes.