Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique

2021 ◽  
pp. 155335062110576
Author(s):  
Islam A. Elzahaby ◽  
Mosab Shetiwy ◽  
Amr Hossam ◽  
Amr Elafy
Keyword(s):  
Head And Neck ◽  
Neck Dissection ◽  
Chest Wall ◽  
Anterior Chest Wall ◽  
Selective Neck Dissection ◽  
Open Approach ◽  
Primary Tumors ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Neurovascular Structures

Introduction This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic neck dissection (END) through anterior chest wall approach (ACWA) without creation of any neck incisions. Resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Methods From January 2020 to August 2020, 6 patients with a biopsy proven head and neck carcinoma underwent resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Results The selective neck dissection was successfully performed endoscopically in all cases with no conversion to open approach and with good visualization of the major neurovascular structures. The operative time for the END ranged from 120 to 170 minutes, with 10–50 mL estimated blood loss. No significant perioperative complications were encountered. The mean total number of cervical LN retrieved was 13.67 + 2.42, and the mean LNR was .01 + .13. All patients were discharged in the third postoperative day, and they were satisfied with the cosmetic outcome. Conclusion Selective total END through ACWA is technically feasible and safe with satisfactory cosmetic results. The absence of neck scars and magnification of the important neurovascular structures are the most obvious advantages of this innovative technique. It may be a valid alternative to conventional surgery when performed in selected patients. However, further research with longer follow up is needed to clarify the oncological safety and the real benefits of END in head and neck cancer patients.

scholarly journals AB0501 CORRELATION BETWEEN AXIAL AND PERIPHERAL ENTHESIS IN SPONDYLARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1278.1-1278
Author(s):  
H. Ferjani ◽  
M. Yasmine ◽  
K. Maatallah ◽  
E. Labbene ◽  
H. Riahi ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Chest Wall ◽  
Age Of Onset ◽  
Scoring Systems ◽  
Plantar Fascia ◽  
Anterior Chest Wall ◽  
Controlled Study ◽  
Asas Criteria ◽  
The Us ◽  
The Mean

Background:Enthesitis is the clinical hallmark of spondylarthritis. It refers to the inflammation of joint attach in the bone. Several sites enthesitis may be affected, and a wide variety of scoring systems were available.Objectives:We aimed to determine the prevalence of axial enthesitis in the anterior chest wall (ACW), and its correlation with peripheral sites especially, the Achilles tendon (AT).Methods:We conducted a prospective study including patients with SpA according to the ASAS criteria. Sociodemographic data, as well as disease characteristics, were recorded. The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) was used to assess clinical entheses (first and seventh costochondral joints, posterior superior iliac spine, anterior superior iliac spine, iliac crest, and Achilles tendon insertion). The presence of enthesitis on the US was then assessed in the right and left sternoclavicular (SCJ), manubriosternal (MSJ) joints, as well as in the AT, using Esaote My Lab 50.Results:The study included 47 patients with SpA: axial (n=26), axial and peripheral (n=21). There was a female predominance (sex ratio: 0.2). The mean age was 42.2 years ± 12.6 [11-70]. The age of onset of the disease was <40 years in 59.6% of cases. Tenderness in entheseal sites was found in 63.8% of patients, especially in the plantar fascia and AT (32.7%, 6%, respectively). The mean MASES score was 2.9 [0-13]. Clinical ACW involvement (29.1%) was at follows: 1st right chondro-sternal joint (CSJ) (19.1%), 1st left CSJ (25.5%), 7th right CSJ (27.7%) and 7th left CSJ (31.9%).US involvement of the ACW was 14.3%. Enthesitis of the AT was found in 70% of cases on US examination. ACW US involvement was correlated neither to the BMI nor to MASES score (p=0.16, p=0.6 respectively). Similarly, there was no correlation between the presence of US ACW enthesitis and clinical nor the US AT enthesitis (p=0.09, p=0.209, respectively).Conclusion:Our study showed that ACW enthesitis is frequent in SpA, especially by US screening. This axial enthesitis, don’t necessarily reflect a simultaneous clinical or US involvement of the peripheral entheses. Further studies are needed to characterize this subtype of SpA.References:[1]Verhoeven F, Guillot X, Godfrin-Valnet M, Prati C, Wendling D. Ultrasonographic evaluation of the anterior chest wall in spondyloarthritis: a prospective and controlled study. J Rheumatol. 2015;42(1):87-92Disclosure of Interests:None declared.

Opioid Prescribing in Patients Undergoing Neck Dissections With Short Hospitalizations

2020 ◽  
pp. 019459982095798
Author(s):  
Grace L. Banik ◽  
Kristen L. Kraimer ◽  
Maisie L. Shindo
Keyword(s):  
Pain Management ◽  
Head And Neck ◽  
Neck Dissection ◽  
Opioid Prescription ◽  
Multidisciplinary Collaboration ◽  
Opioid Prescribing ◽  
The Mean ◽  
Preoperative Counseling ◽  
Group 2 ◽  
Group 1

Objective To evaluate postoperative opioid prescribing in patients undergoing neck dissections with short hospitalizations. Study Design Retrospective cohort study. Setting Tertiary academic hospital. Methods The study population included patients who underwent lateral neck dissections with or without an associated head and neck procedure and required hospitalization for ≤3 days from 2012 to 2019. Interventions to decrease opioid utilization, including preoperative counseling, multimodality pain management, and multidisciplinary collaboration, were implemented in September 2016. Patients were divided into 2 groups: preintervention (group 1) and postintervention (group 2). The mean quantity of opioids prescribed during hospitalization, at discharge, and in refills was calculated in morphine milligram equivalents (MME). Results A total of 407 patients were included in the analysis: 223 patients in group 1 and 184 patients in group 2 (42.3% female, 89.4% white; average age, 55.2 years [95% CI, 53.6-56.9]). The mean opioid quantity prescribed in unilateral neck dissection alone decreased from 353.9 MME (95% CI, 266.7-441.2) in group 1 to 113.3 MME (95% CI, 87.8-138.7) in group 2 ( P < .001; effect size, 1.0). Statistically significant decreases in mean opioid quantity prescribed were also observed in unilateral neck dissection in combination with thyroidectomy, parotidectomy, glossectomy, or tonsillectomy. The percentage of patients requiring opioid prescription refills was not statistically different between the groups. Conclusion This study demonstrates that the quantity of opioids prescribed in patients undergoing neck dissections and associated head and neck procedures with short hospitalizations can be reduced to as low as 100 to 125 MME with preoperative counseling, multimodality pain management, and multidisciplinary collaboration.

Surgical management of lymphangiomas in adults

1996 ◽  
Vol 110 (6) ◽  
pp. 586-589 ◽  
Author(s):  
A. J. Curran ◽  
N. Malik ◽  
D. McShane ◽  
C. V. I. Timon
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Head And Neck ◽  
Neck Dissection ◽  
Surgical Management ◽  
Neck Region ◽  
Selective Neck Dissection ◽  
Older Population ◽  
Head And Neck Region ◽  
Congenital Tumours

AbstractLymphangiomas are uncommon benign congenital tumours. Most occur in the head and neck region and the vast majority present before the age of two. This paper describes the presentation and management of four cases presenting after puberty and involving the parotid gland. The cases are unusual in that all were intimately associated with the facial nerve and in an older population. The value of selective neck dissection and facial nerve exposure as an approach to these lesions is discussed.

scholarly journals Regional Control of Head and Neck Melanoma With Selective Neck Dissection

2014 ◽  
Vol 140 (11) ◽  
pp. 1014 ◽  
Author(s):  
Mathew Geltzeiler ◽  
Marcus Monroe ◽  
Babak Givi ◽  
John Vetto ◽  
Peter Andersen ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Dissection ◽  
Selective Neck Dissection ◽  
Regional Control ◽  
Head And Neck Melanoma
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