Although the thyroid gland is located in the neck it is not a matter of fact that it is a clinical issue for the otorhinolaryngologist in Germany. Probably due to historic reasons general surgeons usually perform operations on the thyroid. As at our department this kind of treatment is an established procedure we prospectively evaluated our thyroid cases in order to present our results.The prospective study started in the year of 2014. So far 231 patients were enrolled with an average age of 53,5 years (16-89). The sex ratio showed a preponderance of the female patients with 187 and 64 males. In 155 cases we didn't insert a Redon-drainage. The mean operation time was 133 min. The preoperative concentration of calcium was 2.44 mg/ml with a postoperative decrease to 2.21 mg/ml. In cases of malignancies revealed in histology a second procedure with complete thyroidectomy and neck dissection took place immediately afterwards.Many symptoms of disorders of the thyroid become manifest in a genuine region of our speciality. Therefore we cannot detect any convincing reason why head and neck surgeons should not perform thyroidectomies. Skills like the specific clinical examination, the preoperative diagnostic work flow including sonography, the precise surgical management of soft tissue and neural structures and the postoperative care are typical features of our discipline. However, besides the surgeon's expertise a close collaboration with the colleagues of nuclear medicine and the general practitioner respectively the endocrinologist is mandatory in order to achieve a high quality of treatment.
This study confirms the high diversity of the surgical anatomy of the CTN. According to the proposed classification the A1-H1-D2/3-situation belongs to the CTN-constellations observed most frequently. It is this very anatomical situation, that apparently tends to be associated with postoperative taste deficits quite regularly due to inevitable intraoperative manipulations. Taking into account the results of this study an otosurgeon might be able to anticipate the potential risk for the CTN by judging the AHD-status intraoperatively and - therefore - reduce taste disorders postoperatively. Additionally, the probability of a postoperative gustatory dysfunction depends upon the kind of underlying middle ear disease as well.
Zusammenfassung Einleitung Die Zahl der Schilddrüsenmalignome zeigt eine deutliche Zunahme. Da die Schilddrüse an der HNO-Klinik Bad Hersfeld im Fokus steht, war dies für uns Anlass, unsere Behandlungsresultate zu untersuchen und Erfahrungen darzustellen. Material und Methoden Es handelt sich um eine Untersuchung beginnend im Jahre 2014 bis zum Juli 2020. Es wurden alle Patienten mit Schilddrüsenmalignomen erfasst und wichtige demografische und medizinische Parameter wie Alter, Geschlecht, Histologie, Calcium, OP-Dauer, Rekurrensparese etc. registriert. Ergebnisse Es wurden insgesamt 63 Patienten mit malignen Schilddrüsenerkrankungen eingeschlossen. Davon waren 42 weiblichen und 21 männlichen Geschlechts. Die Altersspanne reichte von 11 bis zu 95 Jahren. Patienten mit differenzierten Schilddrüsenkarzinomen waren im Schnitt jünger als diejenigen mit anaplastischen Malignomen. Histologisch dominierten die papillären Schilddrüsenkarzinome mit 65 % (n = 41) gegenüber anderen Varianten wie dem follikulären (n = 6), medullären (n = 5) und entdifferenzierten Karzinom (n = 6). Alle Patienten wurden einer operativen Behandlung unterzogen; postoperativ erhielten die Betroffenen mit fortgeschrittenen, differenzierten Karzinomen eine Radiojodtherapie. Von den Patienten mit einem entdifferenzierten Karzinom sind alle ihrem Leiden erlegen, während nach unserer Kenntnis nur eine Betroffene mit einem differenzierten Malignom tumorbedingt verstorben ist. Schlussfolgerung In die Behandlung von malignen Schilddrüsenerkrankungen ist der HNO-Arzt eingebunden. Wie bei den benignen Erkrankungen der endokrinen Halsorgane ist eine interdisziplinäre Zusammenarbeit entscheidend.
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