What You Need to Know about Mental Nerve Surgical Anatomy for Transoral Thyroidectomy

Pino, Antonella; Parafioriti, Andrea; Caruso, Ettore; Pasquale, M. De; Río, Paolo Del; Calò, Pietro Giorgio; Dionigi, Gianlorenzo; d’Alcontres, Francesco Stagno

doi:10.16956/jes.2019.19.4.144

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…There are complications specific to TOETVA, the most problematic being mental nerve injury (16). The mental nerve, a branch of the inferior alveolar nerve, is a sensory nerve that provides sensory innervation to the lower lip and chin (25). Mental nerve injury may occur due to stretching of the midline trocar site upon camera movement or during the process of widening the midline incision for specimen removal, and may result in temporary or permanent paresthesia in the lower lip and chin region (26).…”

Section: Discussionmentioning

confidence: 99%

Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

Chai

Lee

et al. 2021

J Endocr Surg

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Purpose: Creating working space while performing thyroid surgery via a transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be technically challenging. We describe our experiences using a balloon dilator for easy and rapid flap dissection during TOETVA. Methods: The medical records of patients who underwent surgery for thyroid diseases via a TOETVA were retrospectively reviewed and divided into two groups: the Routine group included patients who underwent routine flap dissection using conventional laparoscopic instruments without the use of a balloon dilator, and the Spacemaker group included patients who underwent flap dissection using a balloon dilator. The working space formation time, defined as the time from first insertion of an instrument into a trocar until the time of the completion of working space formation, and clinical outcomes were analyzed and compared between groups. Results: A total of 39 patients (6 males and 33 females) were included in the study, with 26 patients in the Routine group and 13 patients in the Spacemaker group. There were no differences in patient demographics between groups. Flap dissection time was significantly longer in the Routine group compared to the Spacemaker group (8.0±2.8 minutes vs. 5.3±2.1 minutes, P=0.004). No excessive bleeding events or conversion to open surgery occurred during surgery in either group. There were also no postoperative bleeding events or infections in either group. Conclusion: Balloon dilators can provide a fast, efficient, and safe flap dissection method for working space formation during thyroid surgery with TOETVA.

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Section: Discussionmentioning

confidence: 99%

Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

Chai

Lee

et al. 2021

J Endocr Surg

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“…The mental nerve and its branches innervate sensory of cutan of the chin and lower lip, the mucous membranes on the buccal of the lower lip. 12 Mental foramina in mandible can be located inferior to the first premolar, second premolar or first molar, or between the first and second premolar or the second premolar and the first molar. The average position of mental foramina is 25.8 mm laterally from the midline and about 13 mm superior to the inferior border of the mandibular body.…”

Section: Discussionmentioning

confidence: 99%

Fixed Dose Combination of Mecobalamin and Pregabalin in the Treatment of Orofacial Neuropathic Pain

Lugito

2024

interdental

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Introduction: orofacial neuropathic pain is extraordinary disease in character with its complicated management. Mecobalamin has been used to provide regeneration of traumatized nerves. Pregabalin with its analgesic activities relieves the clinical signs of neuropathic pain. The aim of this case report is to explain fixed dose combination of Mecobalamin and Pregabalin as the treatment of neuropathic pain caused by inferior alveolar nerve and facial nerve neuropathy. Case: First case was an inferior alveolar nerve neuropathy experienced by 63 years old female with complaints of persistent pain and numbness around the left chin and left lower lip the day following the procedure of surgery for the treatment of dentoalveolar abscess on left second premolar of mandibula. Second case was facial nerve neuropathy experienced by 54 years old female had persistent pain and numbness of the anterior two-thirds of the tongue after total thyroidectomy and 1,100 MBq (30 mCi) activity of Radioactive iodine (RAI) therapy, followed with two 131I whole body scans. Case Management: Mecobalamin 500 µg and Pregabalin 75 mg twice daily for 5 weeks were given with tolerable side effects and improvement symptoms. Discussion: Pregabalin combined with Mecobalamin can reduce orofacial neuropathic pain. Pregabalin possess analgesic property and reduce neuropathy-related pain symptoms while Mecobalamin facilitates myelinogenesis and nerve regeneration. Conclusion: Fixed Dose Combination of Mecobalamin and Pregabalin has the potential analgesic effect, reduced neuropathic orofacial pain at a below than determined dosage in case of inferior alveolar and facial nerve neuropathic pain.

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“…The mental nerve (MN) is a branch of the posterior trunk of the inferior alveolar nerve originating from the mandibular nerve. One of the major concerns in TOETVA is MN injury, which causes numbness and paresthesia in the chin or lower lip, impairing quality of life [ 25 ]. Possible causes of MN injury include (a) incorrect vestibular incision and dissection; (b) imprecise port insertion and removal; (c) over-stretching and longer compression of trocars on the MN; and (d) anatomic variations of MN [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve

Chai

Chae

et al. 2021

JCM

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The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has excellent cosmetic effects and its popularity is increasing worldwide. We present our experience with TOETVA and its short-term outcomes. This study included 110 consecutive patients who underwent TOETVA at a single institution between July 2016 and June 2020. We analyzed clinicopathologic data, short-term postoperative outcomes, and learning curve using cumulative summation (CUSUM) analysis. Of the 110 patients who underwent TOETVA, 101 had malignant disease and 100 (90.9%) underwent lobectomy. The mean age was 39.7 ± 9.7 years, and the mean tumor size was 1.0 ± 0.7 cm (range, 0.3–3.6 cm). Operation time was 168.0 ± 63.4 min for total thyroidectomy, 111.0 ± 27.7 min for lobectomy, and 73.7 ± 18.1 min for isthmusectomy. Five patients (4.5%) experienced transient vocal cord palsy (VCP) and one (0.9%) had permanent VCP. The swallowing impairment index-6 score was 2.18 ± 3.21 at postoperative three months, and 0.97 ± 1.72 at postoperative six months. The learning curve for lobectomy was 58 cases in CUSUM analysis. TOETVA is a safe and feasible approach with an acceptable operation time and a low complication rate. This approach is a surgical option for patients who desire excellent cosmesis.

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What You Need to Know about Mental Nerve Surgical Anatomy for Transoral Thyroidectomy

Cited by 5 publications

References 11 publications

Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

Fixed Dose Combination of Mecobalamin and Pregabalin in the Treatment of Orofacial Neuropathic Pain

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve

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