NAL Neck Artificial Ligament Lifting: Neck Rejuvenation with Polytetrafuotoethylene (PTFE) Bands

Background: The current surgical method allows a short recovery and minimally invasive technique with polytetrafluotoethylene (PTFE) bands application, minimal skin excision for a fallen platysma muscle and skin laxity in facelift surgery; the clinical advantage of this method is a short recovery and an anatomic less invasive dissection, ideal for also younger patients who want more and more short healing times. Methods: Retrospective analysis of a 294 cases series of patients seeking platysma and skin laxity increase of neck-face region were included in the study. All of them were primary neck-face lift performed with PTFE bands of dual mesh that are customized for suture to the platysma and anchored to the mastoid, creating a neck artificial ligament (NAL) that is buried into the muscle and tightened, without modifying the superficial musculoaponeurotic system and platysma. Result: Data collection on surgery time, implant dimension selection, and postoperative complications were included. The most frequent complications were rare and include 5 case of superficial epidermolysis (healed within 21 days) and 1 case of mild band infection (treated with antibiotics). The surgical results are still stable over time, like those of a normal facelift after 6 months. Conclusion: minimally invasive NAL application avoids a large dissection and deep modifications of the superficial musculoaponeurotic system and platysma getting a strong upward tension that lasts over time with stable results. Keywords: Cervicoplasty, Neck, Rejuvenation, Aging, Mandible, Platysma Muscle.

Role of Tracheostomy in Dealing with Penetrating Neck Trauma: A Double Edged Sword

Background Penetrating neck trauma is an injury in which platysma muscle in neck is breached. It is a life threatening emergency and it requires urgent management by securing airway and neck exploration. Tracheostomy is one of the important procedures as it secures the airway though associated with complications and morbidity in the patients. Case Presentation We present 3 cases of penetrating neck trauma. Each patient is managed by different means of securing airway depending on the site of trauma and associated laryngeal injury. Conclusion Tracheostomy in penetrating neck trauma helps in securing the airway and paves way for safe neck exploration. Minor laryngeal injuries are managed conservatively in order to avoid complications associated with tracheostomy. Tracheostomy and other means of airway management in penetrating neck trauma depend mainly on individualised approach though tracheostomy at a lower site to that of wound should be preferred in major laryngeal injuries. Keywords: Penetrating Neck Trauma; Tracheostomy; Laryngeal Injuries; Airway Management.

Comparative effects of suture and non-suture surgical techniques on platysma after Thyroid surgery

Background: Thyroidectomy is a routine general surgical procedure and pain after thyroidectomy is responsible for prolongation of hospital stay and increased risk of respiratory complications. Platysma is routinely sutured at the end of thyroidectomy before wound closure. This randomized controlled trial was conducted to compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Aim: To compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Place and duration of study: Dept. of Surgery at Sh. Zayed Hospital, Lahore from 26-12-2019 to 25-06-2020. Methodology: It is a randomized controlled trial study which consists of 92 patients, between 18 to 70 years of age in both gender and planned for thyroidectomy for nodular thyroid enlargement. Patients were randomly allocated into two treatment groups. After excision of thyroid, platysma was sutured as per conventional practice in one group while in the other group platysma was not sutured. For pain assessment Visual Analogue Scale (VAS) was used to 24 hours after surgery. Results: The mean age was 36.4±13.4 years. The mean VAS score for post-operative pain measured 24 hours after the surgery was significantly lower in patients undergoing thyroidectomy without platysmal suture as compared to those with conventional suturing of platysma during thyroidectomy (2.37±0.97 vs. 3.67±1.28; p <0.001). Similar significant difference was also noted between groups and subgroups which based on patient’s age, gender, BMI and educational status. Conclusion: Avoiding the suturing of platysma significantly reduced the post-operative pain which advocates a change in current practice and encourages non-suturing of platysma to decrease the morbidity of patients in post-operative period. Keywords: Thyroidectomy, Platysma, Suture, No Suture, Pain

Conservative Neck Rejuvenation

In the field of facial rejuvenation, among the recurrent topics, one of the most discussed is the return to less invasive techniques. Lower face rejuvenation is best achieved acting on the platysma muscle. Many techniques are used and usually include platysma section, redundancy reduction, and redraping. Platysma plication is also used especially in secondary cases because of the increased risk of nerve injury due to possible anatomical damage caused by previous operations. A technique that preserves the deep planes based on a new plication method is proposed (conservative neck rejuvenation). In this technique, the dissection plane is only subcutaneous to reduce the risk of nerve injuries. An effective neck contouring is possible using a simpler technique with very good results and a lower rate of morbidity.

Application of platysma muscle suture after thyroidectomy

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

Thyroid

The thyroid gland forms from endoderm beginning at gestational week 5. The butterfly-shaped thyroid gland wraps around the trachea, cricoid, and thyroid cartilages. Excess thyroxine causes hyperthyroidism and suppression of the sensitive thyroid-stimulating hormone value. Hyperthyroidism may cause sweating, irritability, weight loss, and atrial fibrillation. US, nuclear imaging, and CT are useful. Collar incisions of the neck with transection of the platysma muscle, opening the median raphe, and exposing the thyroid isthmus are straightforward steps. Possible surgical complications are postoperative hematoma, RLN injury, and temporary hypoparathyroidism, and they should be avoided at all costs.