Complications of Modified Radical Neck Dissection in Patients at Tertiary Care Hospital

Objective: To determine frequency of complication of modified radical neck dissection in patients at a tertiary care hospital Karachi, Pakistan Material and Methods: Study design: This is a cross sectional section study, conducted at Department of ENT, for Six months from January 1, 2019 to July 1, 2019. All the patients who fulfilled the inclusion criteria and visited to department of ENT, were included in the study after taking informed consent. Patients were discharged by 48-72 hours postoperatively. Patients were assessed daily till the time of discharge for occurrence of nerve complication, wound complications and vascular complications. Data was entered and analyzed by SPSS 21 software. Mean, Frequency and percentage were given for continuous and discreet data respectively. Chi squire test was applied to detect significance. P value of < o.o5 was taken as significant. Results: Mean ± SD of age was 40.31±9.54 with C.I (38.62.......41.99) years. Out of 126 patients 84 (67%) were male and 42 (33%) were female. Out of 126 cases complication 46(37%) developed nerve complication, 47 (37%) had wound complication and vascular complication was documented in 27(21%) cases. Conclusion: surgical complications after modified radical neck surgery are not uncommon. Wound complication was found to be most common followed by nerve and vascular complication. Therefore proper antiseptic measures before, during and after surgery, patient care and careful surgical steps have a role in preventing these dreadful complications. Keywords: Modified Radical Neck Dissection, Complications, Nerve Complication, Wound Complication, Vascular Complication

A cutaneous representation of parotid adenocarcinoma not otherwise specified

<p class="abstract">Cutaneous manifestations of adenocarcinoma is a very rare entity. The patient reported to our institute with a complain of swelling on right parotid region that would bleed profusely merely on palpation. The hematological values revealed very low Hemoglobin, RBC and PCV counts indicating severe hemolytic anemia. The patient had palpable lymph nodes of level I and IIA which were enlarged. The patient underwent excision of the lesion along with modified radical neck dissection and reconstruction of the skin defect using pectoralis major myocutaneous flap.</p>

Postoperative Chylothorax after Modified Radical Neck Dissection for Thyroid Carcinoma: A Missable Rare Complication of Thyroid Surgery

Background and objectives: Currently, few studies have been conducted on postoperative chylothorax, specifically in total thyroidectomy with modified radical neck dissection (MRND) in papillary thyroid carcinoma patients. This study provides the actual incidence, etiology, and clinical features of postoperative chylothorax and reports the clinical outcomes after treatment, which were dependent upon the severity of the complications. Materials and Methods: The medical charts of 111 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy with modified radical neck dissection from January 2016 to December 2018 were reviewed retrospectively. The results were compared in three groups: the no chylothorax group, the subclinical (asymptomatic) group, and the clinical (symptomatic) group. Results: Chylothorax occurred in 23 patients (20.7%, 23/111). Nineteen (82.6%, 19/23) were subclinical chylothorax cases, which implies a small amount of chyle leakage with no respiratory symptoms. Four (17.4%, 4/23) were clinical, meaning they had either respiratory symptoms, such as dyspnea, desaturation, or a large amount of chylothorax in the images. The incidence was significantly higher in patients who underwent left modified radical neck dissection, and this corresponds to the side in which chylothorax occurred. There were also statistical differences in the drainage color, peak amount, or drain removal time. Conclusions: Postoperative chylothorax is a rare complication following neck dissection. However, it can be fatal if the condition progresses. Therefore, patients who undergo total thyroidectomy with modified radical neck dissection, especially on the left side, should be monitored for respiratory symptoms, and serial chest x-ray images obtained.

Initial Experience with Robotic Modified Radical Neck Dissection Using the da Vinci Xi System through the Bilateral Axillary Breast Approach

Objectives: The bilateral axillo-breast approach (BABA) to robotic thyroidectomy has been extended to modified radical neck dissection (MRND). This study assessed outcomes in patients who underwent robotic MRND through BABA using the da Vinci Xi system. Methods: The medical records of 40 patients who underwent total thyroidectomy, bilateral central neck dissection and MRND from September 2018 to March 2020 were reviewed retrospectively, including 12 who underwent robotic surgery and 28 who underwent open surgery. All operations were performed by a single endocrine surgeon. Results: Operation time was significantly longer in the robotic than in the open group (277.08