Damage to the cervical sympathetic system during operations on the thyroid gland

Smith, Ivo; Murley, R. S.

doi:10.1002/bjs.1800520909

Cited by 16 publications

(8 citation statements)

References 6 publications

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“…Few cases have been reported since, and the majority of cases are associated with conventional thyroidectomy (8). To the best of our knowledge, there have been only 18 cases involving the development of HS as a complication of conventional thyroid surgery since 1993 (Table II) that have been reported in the literature (3,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Meng¹,

Tian²,

Lv³

et al. 2015

Oncology Letters

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Abstract. Horner's syndrome (HS), characterized by a combination of ptosis and miosis, is an uncommon complication of thyroid surgery, particularly in minimally invasive thyroid surgery. Two cases of HS were observed secondary to minimally invasive video-assisted thyroidectomy in the Department of Thyroid Breast Surgery of Zhejiang Provincial People's Hospital between August 2012 and July 2014. The two patients developed miosis and ptosis following total thyroidectomy; all symptoms had resolved at 1 and 11 months subsequent to surgery, respectively. HS has currently been reported secondary to numerous types of minimally invasive thyroid procedures. The literature was reviewed to identify cases of this iatrogenic complication secondary to each type of thyroidectomy and the possible injury mechanisms underlying the syndrome were summarized in the present study. In addition, factors that were associated with minimally invasive thyroidectomy, such as the limited endoscopic vision during the procedure, the retraction effect and the occurrence of thermal damage from the use of the harmonic scalpel, were emphasized. The present study concluded that close attention is required during minimally invasive thyroid surgery in order to avoid HS as a complication of the procedure.

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Section: Discussionmentioning

confidence: 99%

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Meng¹,

Tian²,

Lv³

et al. 2015

Oncology Letters

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“…According to our search of the literature, a cervical sympathetic lesion associated with thyroid surgery was described by Kaelin in 1915, 6 who referred to six patients from his own experience, and two others described (unpublished) by Kappeler between 1865 and 1870. We found only 26 cases of HS after thyroidectomy reported in the literature [6][7][8][9][10][11][12][13] and only one report after 1965. 13 Nine of these patients were left with a permanent syndrome, nine had an incomplete recovery, seven recovered completely after periods ranging from 20 days to 15 months, and one was lost to follow-up.…”

Section: Discussionmentioning

confidence: 76%

“…17 The case we described has some characteristics in common with previous cases, such as the onset of HS on postoperative day 2 10,13 and the lack of symptoms related to vascular or sweating problems. 12 For a more accurate study of these last aspects of HS, a quantitative sudomotor axon refl ex test (QSART) 18 could be done to identify a partial lesion of the sympathetic chain, 19 as reported for damage during carotid surgery or for dissecting aortic aneurysms. 20 To the best of our knowledge, our case report is the fi rst to describe HS lasting only 3 days, with total recovery.…”

Section: Discussionmentioning

confidence: 99%

Horner’s syndrome as a complication of thyroidectomy: Report of a case

et al. 2008

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We report a case of Horner's syndrome (HS) occurring as a complication after total thyroidectomy. Horner's syndrome is characterized by myosis, eyelid ptosis, enophthalmos, and lack of sweating, with vascular dilatation of the lateral part of the face, caused by damage of the cervical sympathetic chain. We found only 28 other reports of HS developing after thyroidectomy, and only seven of these patients recovered completely. Of the 495 thyroidectomies performed at our hospital between 1997 and 2007, only one (0.2%) was complicated by the development of HS. The patient was a 35-year-old woman who underwent total thyroidectomy for Basedow-Graves' disease. Horner's syndrome manifested on postoperative day 2, but without anhydrosis or vascular dilatation of the face, and the symptoms resolved spontaneously 3 days later. The possible causes of HS after thyroidectomy include postoperative hematoma, ischemia-induced neural damage, and stretching of the cervical sympathetic chain by the retractor. The prompt and complete recovery of this patient suggests that the cervical sympathetic chain was damaged by retractor stretching.

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“…Smith and Murley [14] reported 25 cases involving patients with iatrogenic injures following either partial or total thyroidectomy. Buhr et al [15] also reported three cases of HS following modified radical neck dissection for medullary thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

Horner Syndrome Secondary to Thyroid Surgery

Demiral

Binay

Şimşek

et al. 2017

Case Reports in Endocrinology

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Horner syndrome (HS), caused by an interruption in the oculosympathetic pathway, is characterised by myosis, ipsilateral blepharoptosis, enophthalmos, facial anhydrosis, and vascular dilation of the lateral part of the face. HS is a rare complication of thyroidectomy. A 15-year-old female patient presented with solitary solid and large nodule in the right thyroid lobe. Ultrasound-guided fine-needle aspiration was performed and the cytological examination results were undefined. The patient underwent a total thyroidectomy. On postoperative day 2, she developed right-sided myosis and upper eyelid ptosis. HS was diagnosed. Interestingly, the patient exhibited an incomplete clinical syndrome with the absence of vasomotor symptoms. We herein report a case of HS in a 15-year-old female patient after total thyroidectomy. The possible causes of HS were ischaemia-induced nerve damage and stretching of the cervical sympathetic chain by the retractor during thyroidectomy. Clinicians should be aware of the possibility of this rare but important surgical complication.

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Damage to the cervical sympathetic system during operations on the thyroid gland

Cited by 16 publications

References 6 publications

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Horner’s syndrome as a complication of thyroidectomy: Report of a case

Horner Syndrome Secondary to Thyroid Surgery

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