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Unusual complications following thyroidectomy and parathyroidectomy
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Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
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Unusual complications following thyroidectomy and parathyroidectomy
The use of 3D CT reconstruction in aiding the surgical management of Eagle’s syndrome
L. Cheng ∗ , P. Richards, C. Offiah, J. Makdissi, E. Ali, R. Qureshi
J. Dennis ∗ , I. Siddique, D. Srinivasan
Barts Health and Homerton University Hospitals, London, United Kingdom Introduction: Well known postoperative complications after thyroidectomy are haemorrhage, recurrent laryngeal nerve palsy and hypoparathyroidism when total thyroidectomy is the preferred treatment for thyroid cancer, multinodular goitre and Graves disease. Hence surgeons choose to perform hemithyroidectomy for benign thyroid disease to reduce the incidence of these complications. Nowadays thyroidectomy and parathyroidectomy are considered to be low-risk operations. We report cases with unusual complications, namely tracheal and oesophageal perforation, oesophageal-cutaneous fistula, accessory nerve palsy, deep seated haematoma, tracheomalacia and Horner’s syndrome. Case 1 Thyroid squamous cell carcinoma eroded into trachea and oesophagus. After total thyroidectomy and neck dissection, the trachea-oesphageal defects were repaired with local muscle flap. Case 2 The removal of suspected parathyroid carcinoma led to oesophageal-cutaneous fistula which was managed conservatively with nasogastric feeding. Case 3 Persistent shoulder and neck pain after total thyroidectomy and neck dissection for extensive neck metastasis of papillary carcinoma of thyroid. It was treated with ultrasound guided Botox intramuscular injections. Case 4 Intermittent neck discomfort post hemithyroidectomy and ultrasound showed small collection blood behind remaining thyroid. The patient was treated conservatively. Case 5 Emergency total thyroidectomy for repeated acute airway obstruction caused by multiple haemorrhagic thyroid cysts. Postoperative tracheomalacia required tracheostomy to fix the trachea for airway maintenance. Case 6 Transient unilateral Horner’s syndrome after total thyroidectomy for retrosternal goitre. Discussion: We will discuss other unusual complications reported in the literature. Conclusions: Although thyroidectomy and parathyroidectomy have become safe surgical procedures, surgeons must be aware of unusual complications and their multidisciplinary management. http://dx.doi.org/10.1016/j.bjoms.2015.08.115
Leicester Medical School/Nottingham University Hospital Trust, United Kingdom Introduction: Eagle’s (or stylohyoid) syndrome describes a series of symptoms resulting from the elongation of the styloid process. For surgical management, a styloidectomy can be performed using either the intraoral transpharyngeal) or extraoral approach. Eagle introduced the intraoral transpharyngeal approach which has the advantage of avoiding an external scar and damage to the facial nerve. However, this method was discouraged due to poor visualisation and the risk of injury to major vessels. Case presentation: A 45 year old female was referred by her General Medical Practitioner due to left sided facial and neck pain exacerbated by turning her head along with a pharyngeal foreign body sensation. The left palatine tonsillar bed was firm and tender on palpation. An orthopantomogram confirmed the diagnosis of Eagle’s syndrome. 3D Computer Tomography (CT) reconstruction imaging was used to delineate the course of major vessels and aid in the safe planning for a styloidectomy using an intraoral approach. Patient recovery was uneventful. Discussion: Management of Eagle’s syndrome can be either medical or surgical. The appropriate treatment is chosen based on the severity of the symptoms and the pathogenesis of the syndrome. Surgical management can be accomplished using either the intraoral or extraoral approach. Both of these methods have advantages and disadvantages. The intraoral approach has been further assisted by endoscopy. Conclusion: Intraoral resection of the styloid process can be safely carried out with the aid of 3D CT reconstruction planning. Each surgical case requires planning on an individual basis. http://dx.doi.org/10.1016/j.bjoms.2015.08.116 P 109 An unusual anatomical relationship between spinal accessory nerve and the internal jugular vein C. Ennis ∗ , F. Knight Northampton General Hospital, United Kingdom The spinal accessory nerve (SAN) provides motor innervation to the trapezius and sternocleidomastoid muscles. Damage to the SAN during surgical procedures represents a significant cause of long-term morbidity, which frequently results in diminished function of the innervated muscles. When the trapezius muscle is affected the condition is known as sloping shoulder.
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
P 107
P 108
Unusual complications following thyroidectomy and parathyroidectomy
The use of 3D CT reconstruction in aiding the surgical management of Eagle’s syndrome
L. Cheng ∗ , P. Richards, C. Offiah, J. Makdissi, E. Ali, R. Qureshi
J. Dennis ∗ , I. Siddique, D. Srinivasan
Barts Health and Homerton University Hospitals, London, United Kingdom Introduction: Well known postoperative complications after thyroidectomy are haemorrhage, recurrent laryngeal nerve palsy and hypoparathyroidism when total thyroidectomy is the preferred treatment for thyroid cancer, multinodular goitre and Graves disease. Hence surgeons choose to perform hemithyroidectomy for benign thyroid disease to reduce the incidence of these complications. Nowadays thyroidectomy and parathyroidectomy are considered to be low-risk operations. We report cases with unusual complications, namely tracheal and oesophageal perforation, oesophageal-cutaneous fistula, accessory nerve palsy, deep seated haematoma, tracheomalacia and Horner’s syndrome. Case 1 Thyroid squamous cell carcinoma eroded into trachea and oesophagus. After total thyroidectomy and neck dissection, the trachea-oesphageal defects were repaired with local muscle flap. Case 2 The removal of suspected parathyroid carcinoma led to oesophageal-cutaneous fistula which was managed conservatively with nasogastric feeding. Case 3 Persistent shoulder and neck pain after total thyroidectomy and neck dissection for extensive neck metastasis of papillary carcinoma of thyroid. It was treated with ultrasound guided Botox intramuscular injections. Case 4 Intermittent neck discomfort post hemithyroidectomy and ultrasound showed small collection blood behind remaining thyroid. The patient was treated conservatively. Case 5 Emergency total thyroidectomy for repeated acute airway obstruction caused by multiple haemorrhagic thyroid cysts. Postoperative tracheomalacia required tracheostomy to fix the trachea for airway maintenance. Case 6 Transient unilateral Horner’s syndrome after total thyroidectomy for retrosternal goitre. Discussion: We will discuss other unusual complications reported in the literature. Conclusions: Although thyroidectomy and parathyroidectomy have become safe surgical procedures, surgeons must be aware of unusual complications and their multidisciplinary management. http://dx.doi.org/10.1016/j.bjoms.2015.08.115
Leicester Medical School/Nottingham University Hospital Trust, United Kingdom Introduction: Eagle’s (or stylohyoid) syndrome describes a series of symptoms resulting from the elongation of the styloid process. For surgical management, a styloidectomy can be performed using either the intraoral transpharyngeal) or extraoral approach. Eagle introduced the intraoral transpharyngeal approach which has the advantage of avoiding an external scar and damage to the facial nerve. However, this method was discouraged due to poor visualisation and the risk of injury to major vessels. Case presentation: A 45 year old female was referred by her General Medical Practitioner due to left sided facial and neck pain exacerbated by turning her head along with a pharyngeal foreign body sensation. The left palatine tonsillar bed was firm and tender on palpation. An orthopantomogram confirmed the diagnosis of Eagle’s syndrome. 3D Computer Tomography (CT) reconstruction imaging was used to delineate the course of major vessels and aid in the safe planning for a styloidectomy using an intraoral approach. Patient recovery was uneventful. Discussion: Management of Eagle’s syndrome can be either medical or surgical. The appropriate treatment is chosen based on the severity of the symptoms and the pathogenesis of the syndrome. Surgical management can be accomplished using either the intraoral or extraoral approach. Both of these methods have advantages and disadvantages. The intraoral approach has been further assisted by endoscopy. Conclusion: Intraoral resection of the styloid process can be safely carried out with the aid of 3D CT reconstruction planning. Each surgical case requires planning on an individual basis. http://dx.doi.org/10.1016/j.bjoms.2015.08.116 P 109 An unusual anatomical relationship between spinal accessory nerve and the internal jugular vein C. Ennis ∗ , F. Knight Northampton General Hospital, United Kingdom The spinal accessory nerve (SAN) provides motor innervation to the trapezius and sternocleidomastoid muscles. Damage to the SAN during surgical procedures represents a significant cause of long-term morbidity, which frequently results in diminished function of the innervated muscles. When the trapezius muscle is affected the condition is known as sloping shoulder.