An American Head and Neck Society Consensus Statement
ML Shindo, SM Caruana, E Kandil, JC McCaffrey, LA Orloff, JR Porterfield, A Shaha, J Shin, DJ Terris, GW Randolph
An American Head and Neck Society Consensus Statement
Sinclair CF, Bumpous JM, Haugen BR, Chala A, Meltzer D, Miller BS, Tolley NS, Shin JJ, Woodson G, Randolph GW
Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons
BC Stack, NS Tolley, TB Bartel, JP Bilezikian, D Bodenner, P Camacho, J P.D.T. Cox, H Dralle, JE Jackson, JC Morris, LA Orloff, F Palazzo, JA Ridge, D Scot-Coombes, DL Steward, DJ Terris, G Thompson, GW Randolph
RL Ferris, Y Nikiforov, DJ Terris, RR Seethala, JA Ridge,
P Angelos, QY Duh, R Wong, MM Sabra, JA Fagin, B McIver, VJ Bernet, RM Harrell, N Busaidy, ES Cibas, WC Faquin,
P Sadow, Z Baloch, M Shindo, L Orloff, L Davies, G Randolph
C. Fundakowski, N. Hales, N. Agrawal, M. Barcynski, P. Camacho, D. Hartl, E. Kandil, W. Liddy, T. McKenzie, J. Morris, J. Ridge, R. Schneider, J. Serpell, C. Sinclair, S. Snyder, D. Terris, R. Tuttle, CW. Wu, R. Wong, M. Zafereo, G. Randolph
Care for patients with thyroid nodules is complex and multidisciplinary. Has been shown to vary significantly between institutions and providers. Goal was to reduce unwarranted variation and improve quality of care
External beam radiotherapy (EBRT) for differentiated thyroid cancer (DTC) is debated due to lack of prospective studies. Surgery and radioactive iodine usually effective for locoregional control. Recent retrospective studies report benefit in select patients. Goal of EBRT is to improve locoregional control while limiting treatment toxicity
An American Head and Neck Society Consensus Statement
Sinclair CF, Bumpous JM, Haugen BR, Chala A, Meltzer D, Miller BS, Tolley NS, Shin JJ, Woodson G, Randolph GW
Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons
BC Stack, NS Tolley, TB Bartel, JP Bilezikian, D Bodenner, P Camacho, J P.D.T. Cox, H Dralle, JE Jackson, JC Morris, LA Orloff, F Palazzo, JA Ridge, D Scot-Coombes, DL Steward, DJ Terris, G Thompson, GW Randolph
RL Ferris, Y Nikiforov, DJ Terris, RR Seethala, JA Ridge,
P Angelos, QY Duh, R Wong, MM Sabra, JA Fagin, B McIver, VJ Bernet, RM Harrell, N Busaidy, ES Cibas, WC Faquin,
P Sadow, Z Baloch, M Shindo, L Orloff, L Davies, G Randolph
C. Fundakowski, N. Hales, N. Agrawal, M. Barcynski, P. Camacho, D. Hartl, E. Kandil, W. Liddy, T. McKenzie, J. Morris, J. Ridge, R. Schneider, J. Serpell, C. Sinclair, S. Snyder, D. Terris, R. Tuttle, CW. Wu, R. Wong, M. Zafereo, G. Randolph
Care for patients with thyroid nodules is complex and multidisciplinary. Has been shown to vary significantly between institutions and providers. Goal was to reduce unwarranted variation and improve quality of care
External beam radiotherapy (EBRT) for differentiated thyroid cancer (DTC) is debated due to lack of prospective studies. Surgery and radioactive iodine usually effective for locoregional control. Recent retrospective studies report benefit in select patients. Goal of EBRT is to improve locoregional control while limiting treatment toxicity
Recurrent Laryngeal Nerve and thyroid surgeryMTD Lakshan
This presentation discusses the recurrent laryngeal nerve (RLN) and its relevance to thyroid surgery. It covers the surgical anatomy of the RLN, including its origin, relationship to surrounding structures like the inferior thyroid artery, and anatomical variations. Risks of injury to the RLN during thyroid surgery are reviewed. The presentation emphasizes identifying the RLN to reduce risks of temporary or permanent paralysis, with identification allowing average permanent paralysis rates of 0.9% with localization only versus 0.1% with complete dissection. Factors like anatomical variations, branching patterns, scarring, and extent of disease must be considered during dissection to prevent mechanical, thermal, or severing injuries to the nerve.
Perinatal airway management haemangiomas and vascular malformationsArul Lakshmanaperumal
This document summarizes the presentation, diagnosis, and management of various congenital vascular anomalies seen in fetal and pediatric patients. It discusses lymphatic malformations, teratomas, congenital high airway obstruction syndrome (CHAOS), and various vascular malformations. Prenatal screening and fetal imaging are important for diagnosis. After birth, a multidisciplinary team approach is needed for further evaluation and treatment, which may include sclerotherapy, laser therapy, surgery, or other interventions depending on the specific condition. Close monitoring is also required.
Robotic cardiac surgery involves performing cardiac surgery using robotic arms controlled by a surgeon seated at a console. Key steps include creating a capnothorax by insufflating CO2 into the chest cavity and using one lung ventilation. This causes physiological perturbations from reduced venous return and increased airway pressures that require careful management to prevent hypoxia, hypercarbia, and hemodynamic instability. The anesthetic plan must consider patient positioning, prolonged surgery times, hypothermia, and effects of one lung ventilation.
Lung transplantation involves surgically removing one or both diseased lungs and replacing them with healthy donor lungs. The first successful lung transplant was performed in 1983. Lung transplantation is indicated for end-stage lung diseases like COPD, pulmonary fibrosis, cystic fibrosis, and pulmonary hypertension. Candidates undergo evaluation of their cardiopulmonary status and must be otherwise healthy. Donor lungs must meet criteria like age under 55, clear chest x-ray, and no history of smoking. Surgery involves removing the recipient's lungs and suturing in the donor lungs. Post-operative care focuses on lung expansion, secretion clearance, and early mobilization under physiotherapy.
VATS is a minimally invasive surgical procedure used to diagnose and treat lung and chest conditions. It involves 1-inch incisions between the ribs rather than large incisions. The surgeon inserts surgical instruments and a camera to view internal organs on a monitor. VATS has advantages over open thoracotomy such as less pain, shorter recovery time, and lower costs. It is used for lung biopsies, cancer staging, lung resection, and other procedures. Patients are positioned laterally for access and proper positioning of instruments is important for effective surgery. VATS has reduced risks compared to open thoracotomy.
This document discusses anaesthesia considerations for robotic surgery. Key points include:
- Robotic surgery allows for improved precision, control and visualization compared to laparoscopic surgery.
- Patient positioning is critical and cannot be adjusted once the robot is docked, so optimal positioning is important.
- Physiologic perturbations like increased CO2 absorption and changes to ventilation and perfusion during pneumoperitoneum or one-lung ventilation must be managed.
- Access to the patient can be challenging with the robot in place, so airway management and monitoring require planning.
1) Focused Assessment with Sonography for Trauma (FAST) exam is useful for rapidly detecting fluid in trauma patients. Studies have found FAST to be more sensitive than chest X-ray or clinical exam alone in detecting hemothorax and pneumothorax.
2) Research has shown ultrasound to have higher sensitivity (88%) and specificity (100%) compared to chest X-ray (52% sensitivity, 99% specificity) for diagnosing pneumothorax.
3) Ultrasound signs like the sliding lung sign and seashore sign can help identify pneumothorax with reported sensitivities of 81-93% and specificities around 90%. FAST scanning takes less than a minute and
Emergency nurses who underwent training in focused assessment with sonography for trauma (FAST) scanning showed comparable accuracy to radiologists in identifying free fluid in trauma patients, with a sensitivity of 90% for both groups. While FAST scanning provides a rapid, portable, and inexpensive option for initial trauma evaluation, it does not identify the source of bleeding and has limitations in detecting certain injuries.
The document provides information about FAST (Focused Assessment with Sonography in Trauma) scans. It begins with an overview of what a FAST scan is used for - to identify fluid in the abdomen or pelvis where it is not normally found, which can indicate injury. It then details the anatomy visualized in a standard FAST scan and describes the technique. Examples are provided of free fluid appearing in different locations like Morrison's pouch or the pelvis. The document discusses interpreting FAST scans and explores limitations and advantages of the procedure. In under 3 sentences, the document provides an overview of the FAST scan for trauma patients to quickly identify free fluid that could indicate internal injury.
This document provides an overview of ultrasound and the Focused Assessment with Sonography in Trauma (FAST) exam. It describes how ultrasound uses piezoelectric crystals in the probe to transmit sound waves and generate images. The FAST exam is used to quickly identify fluid, particularly in trauma patients, by scanning four areas without radiation: the subxiphoid/subcostal area, right upper quadrant, left upper quadrant, and suprapubic region. By viewing these areas, ultrasound can detect fluid such as blood in the pericardial sac or abdominal cavity that would indicate internal bleeding or injury.
Diagnostic test for respiratory system disorder and nursing responsibilityRakhiYadav53
The document discusses various diagnostic tests for respiratory system disorders and nursing responsibilities related to those tests. It describes tests such as pulse oximetry, sputum examination, pulmonary function tests, chest x-rays, computed tomography, magnetic resonance imaging, and positron emission tomography. For each test, it provides details about the purpose, procedure, and nursing responsibilities before, during, and after the test.
Focused Assessment with Sonography in Trauma (FAST) in 2017Dr Varun Bansal
FAST , its definition, its modifications, its extensions in various other situations such as pregnancy, in pediatric populations, use in triage of patients. Described extended FAST which include evaulation for pneumothorax, pleural effusion, pericardial effusion. other extensions of FAST such as RUSH, RADIUS.
Ultrasound has become a versatile modality for diagnosing and guiding treatment of critically ill patients. It is useful in resource-limited settings as it is non-invasive, economical, repeatable and can be done at the bedside. As an ultrasound nurse in critical care, key roles include using ultrasound to detect head injuries, monitor intracranial pressure, assess lung conditions and volume status, guide procedures like central line insertion, and enable early detection of issues that may otherwise require more invasive diagnostic tests.
The document provides an overview of preoperative evaluation and surgical planning for various neurosurgical procedures. It discusses evaluating the patient history and examination, ordering relevant labs and imaging, reviewing the procedure with anesthesia, selecting the appropriate surgical approach, and ensuring necessary equipment and staff are available. The goal is to thoroughly prepare for any scenario that may occur during surgery.
Focused assessment with sonography for trauma (FAST) is an ultrasound examination used to screen for fluid in trauma patients. It can detect pathologic pericardial or intraperitoneal free fluid which appears dark gray or black. The FAST exam uses four viewing positions to examine the pericardium, Morison's pouch, splenorenal interface, and bladder/retrovesical structures to identify fluid.
This document summarizes the surgical technique and complications of central venous catheters for hemodialysis. It discusses the basic concepts, pre-operative evaluation including imaging of central veins, catheter insertion technique, and perioperative and long-term care and complications. The best site for catheter placement is the right internal jugular vein to minimize risks of kinking and central vein stenosis. Ultrasound and fluoroscopy guidance are recommended for accurate placement and tunneling of cuffed catheters. Major perioperative risks include pneumothorax, hemothorax, and nerve injury, while long-term complications consist of infection, thrombosis, stenosis, and catheter malfunction.
Radiology for Radiation Oncologists provides an overview of various radiological investigations and imaging modalities important for radiation oncologists. It discusses basics of x-rays, CT scans, barium studies, mammograms, ultrasounds, and other techniques. The document explains the principles, procedures, indications, and findings of these different investigations to help radiation oncologists understand radiology.
1) A lobectomy is a type of lung surgery where one lobe of the lung is removed due to conditions like lung cancer, tuberculosis, or trauma. It aims to remove diseased portions while conserving more lung function than a pneumonectomy.
2) Indications for lobectomy include benign conditions like infectious diseases, developmental anomalies, and bleeding; and malignant conditions like non-small cell lung cancer, pulmonary metastases, and certain tumors.
3) Contraindications include poor lung function, recent heart issues, and large tumors over 6cm which make VATS technically challenging. Complications can include prolonged air leaks, pneumonia, and injuries to nearby structures.
Percutaneous nephrostomy involves placing a catheter into the renal pelvis through the skin to relieve urinary obstruction. It is commonly performed under imaging guidance through a posterior calyx. The procedure has a high technical success rate but risks include bleeding, infection, and injury to adjacent organs. Post-procedure, the catheter is secured and connected to a drainage bag to decompress the kidney until the obstruction is resolved.
This document discusses the surgical management of colon and rectal cancers. It covers the surgical anatomy, principles of surgical resection, and pre-operative and intra-operative techniques. The key goals of surgery are cure, local tumor control, and palliation of symptoms. Surgical strategy depends on tumor location, stage, patient factors, and extent of resection. Standard resections include right and left hemicolectomies, sigmoid colectomy, and total proctocolectomy. Pre-operative preparation involves bowel cleansing, antibiotics, and thromboembolism prophylaxis. Intra-operative steps include inspection, mobilization, vascular division, exteriorization of the bowel, anastomosis, and closure.
Radiotherapy techniques, indications and evidences in oral cavity and oropha...Dr.Amrita Rakesh
This document discusses indications, evidence, and radiation therapy techniques for oral cavity and oropharyngeal cancers. It covers:
- Anatomy of the oral cavity and oropharynx.
- Staging principles and indications for surgery vs systemic therapy.
- Principles of surgery including adequate resection margins and neck management.
- Use of adjuvant radiation therapy or chemoradiation to improve local control, especially for high-risk features like positive margins or extracapsular extension.
- Radiation techniques for oral cavity cancers including field design, dose recommendations, and advantages of IMRT for sparing parotid glands.
Recurrent Laryngeal Nerve and thyroid surgeryMTD Lakshan
This presentation discusses the recurrent laryngeal nerve (RLN) and its relevance to thyroid surgery. It covers the surgical anatomy of the RLN, including its origin, relationship to surrounding structures like the inferior thyroid artery, and anatomical variations. Risks of injury to the RLN during thyroid surgery are reviewed. The presentation emphasizes identifying the RLN to reduce risks of temporary or permanent paralysis, with identification allowing average permanent paralysis rates of 0.9% with localization only versus 0.1% with complete dissection. Factors like anatomical variations, branching patterns, scarring, and extent of disease must be considered during dissection to prevent mechanical, thermal, or severing injuries to the nerve.
Perinatal airway management haemangiomas and vascular malformationsArul Lakshmanaperumal
This document summarizes the presentation, diagnosis, and management of various congenital vascular anomalies seen in fetal and pediatric patients. It discusses lymphatic malformations, teratomas, congenital high airway obstruction syndrome (CHAOS), and various vascular malformations. Prenatal screening and fetal imaging are important for diagnosis. After birth, a multidisciplinary team approach is needed for further evaluation and treatment, which may include sclerotherapy, laser therapy, surgery, or other interventions depending on the specific condition. Close monitoring is also required.
Robotic cardiac surgery involves performing cardiac surgery using robotic arms controlled by a surgeon seated at a console. Key steps include creating a capnothorax by insufflating CO2 into the chest cavity and using one lung ventilation. This causes physiological perturbations from reduced venous return and increased airway pressures that require careful management to prevent hypoxia, hypercarbia, and hemodynamic instability. The anesthetic plan must consider patient positioning, prolonged surgery times, hypothermia, and effects of one lung ventilation.
Lung transplantation involves surgically removing one or both diseased lungs and replacing them with healthy donor lungs. The first successful lung transplant was performed in 1983. Lung transplantation is indicated for end-stage lung diseases like COPD, pulmonary fibrosis, cystic fibrosis, and pulmonary hypertension. Candidates undergo evaluation of their cardiopulmonary status and must be otherwise healthy. Donor lungs must meet criteria like age under 55, clear chest x-ray, and no history of smoking. Surgery involves removing the recipient's lungs and suturing in the donor lungs. Post-operative care focuses on lung expansion, secretion clearance, and early mobilization under physiotherapy.
VATS is a minimally invasive surgical procedure used to diagnose and treat lung and chest conditions. It involves 1-inch incisions between the ribs rather than large incisions. The surgeon inserts surgical instruments and a camera to view internal organs on a monitor. VATS has advantages over open thoracotomy such as less pain, shorter recovery time, and lower costs. It is used for lung biopsies, cancer staging, lung resection, and other procedures. Patients are positioned laterally for access and proper positioning of instruments is important for effective surgery. VATS has reduced risks compared to open thoracotomy.
This document discusses anaesthesia considerations for robotic surgery. Key points include:
- Robotic surgery allows for improved precision, control and visualization compared to laparoscopic surgery.
- Patient positioning is critical and cannot be adjusted once the robot is docked, so optimal positioning is important.
- Physiologic perturbations like increased CO2 absorption and changes to ventilation and perfusion during pneumoperitoneum or one-lung ventilation must be managed.
- Access to the patient can be challenging with the robot in place, so airway management and monitoring require planning.
1) Focused Assessment with Sonography for Trauma (FAST) exam is useful for rapidly detecting fluid in trauma patients. Studies have found FAST to be more sensitive than chest X-ray or clinical exam alone in detecting hemothorax and pneumothorax.
2) Research has shown ultrasound to have higher sensitivity (88%) and specificity (100%) compared to chest X-ray (52% sensitivity, 99% specificity) for diagnosing pneumothorax.
3) Ultrasound signs like the sliding lung sign and seashore sign can help identify pneumothorax with reported sensitivities of 81-93% and specificities around 90%. FAST scanning takes less than a minute and
Emergency nurses who underwent training in focused assessment with sonography for trauma (FAST) scanning showed comparable accuracy to radiologists in identifying free fluid in trauma patients, with a sensitivity of 90% for both groups. While FAST scanning provides a rapid, portable, and inexpensive option for initial trauma evaluation, it does not identify the source of bleeding and has limitations in detecting certain injuries.
The document provides information about FAST (Focused Assessment with Sonography in Trauma) scans. It begins with an overview of what a FAST scan is used for - to identify fluid in the abdomen or pelvis where it is not normally found, which can indicate injury. It then details the anatomy visualized in a standard FAST scan and describes the technique. Examples are provided of free fluid appearing in different locations like Morrison's pouch or the pelvis. The document discusses interpreting FAST scans and explores limitations and advantages of the procedure. In under 3 sentences, the document provides an overview of the FAST scan for trauma patients to quickly identify free fluid that could indicate internal injury.
This document provides an overview of ultrasound and the Focused Assessment with Sonography in Trauma (FAST) exam. It describes how ultrasound uses piezoelectric crystals in the probe to transmit sound waves and generate images. The FAST exam is used to quickly identify fluid, particularly in trauma patients, by scanning four areas without radiation: the subxiphoid/subcostal area, right upper quadrant, left upper quadrant, and suprapubic region. By viewing these areas, ultrasound can detect fluid such as blood in the pericardial sac or abdominal cavity that would indicate internal bleeding or injury.
Diagnostic test for respiratory system disorder and nursing responsibilityRakhiYadav53
The document discusses various diagnostic tests for respiratory system disorders and nursing responsibilities related to those tests. It describes tests such as pulse oximetry, sputum examination, pulmonary function tests, chest x-rays, computed tomography, magnetic resonance imaging, and positron emission tomography. For each test, it provides details about the purpose, procedure, and nursing responsibilities before, during, and after the test.
Focused Assessment with Sonography in Trauma (FAST) in 2017Dr Varun Bansal
FAST , its definition, its modifications, its extensions in various other situations such as pregnancy, in pediatric populations, use in triage of patients. Described extended FAST which include evaulation for pneumothorax, pleural effusion, pericardial effusion. other extensions of FAST such as RUSH, RADIUS.
Ultrasound has become a versatile modality for diagnosing and guiding treatment of critically ill patients. It is useful in resource-limited settings as it is non-invasive, economical, repeatable and can be done at the bedside. As an ultrasound nurse in critical care, key roles include using ultrasound to detect head injuries, monitor intracranial pressure, assess lung conditions and volume status, guide procedures like central line insertion, and enable early detection of issues that may otherwise require more invasive diagnostic tests.
The document provides an overview of preoperative evaluation and surgical planning for various neurosurgical procedures. It discusses evaluating the patient history and examination, ordering relevant labs and imaging, reviewing the procedure with anesthesia, selecting the appropriate surgical approach, and ensuring necessary equipment and staff are available. The goal is to thoroughly prepare for any scenario that may occur during surgery.
Focused assessment with sonography for trauma (FAST) is an ultrasound examination used to screen for fluid in trauma patients. It can detect pathologic pericardial or intraperitoneal free fluid which appears dark gray or black. The FAST exam uses four viewing positions to examine the pericardium, Morison's pouch, splenorenal interface, and bladder/retrovesical structures to identify fluid.
This document summarizes the surgical technique and complications of central venous catheters for hemodialysis. It discusses the basic concepts, pre-operative evaluation including imaging of central veins, catheter insertion technique, and perioperative and long-term care and complications. The best site for catheter placement is the right internal jugular vein to minimize risks of kinking and central vein stenosis. Ultrasound and fluoroscopy guidance are recommended for accurate placement and tunneling of cuffed catheters. Major perioperative risks include pneumothorax, hemothorax, and nerve injury, while long-term complications consist of infection, thrombosis, stenosis, and catheter malfunction.
Radiology for Radiation Oncologists provides an overview of various radiological investigations and imaging modalities important for radiation oncologists. It discusses basics of x-rays, CT scans, barium studies, mammograms, ultrasounds, and other techniques. The document explains the principles, procedures, indications, and findings of these different investigations to help radiation oncologists understand radiology.
1) A lobectomy is a type of lung surgery where one lobe of the lung is removed due to conditions like lung cancer, tuberculosis, or trauma. It aims to remove diseased portions while conserving more lung function than a pneumonectomy.
2) Indications for lobectomy include benign conditions like infectious diseases, developmental anomalies, and bleeding; and malignant conditions like non-small cell lung cancer, pulmonary metastases, and certain tumors.
3) Contraindications include poor lung function, recent heart issues, and large tumors over 6cm which make VATS technically challenging. Complications can include prolonged air leaks, pneumonia, and injuries to nearby structures.
Percutaneous nephrostomy involves placing a catheter into the renal pelvis through the skin to relieve urinary obstruction. It is commonly performed under imaging guidance through a posterior calyx. The procedure has a high technical success rate but risks include bleeding, infection, and injury to adjacent organs. Post-procedure, the catheter is secured and connected to a drainage bag to decompress the kidney until the obstruction is resolved.
This document discusses the surgical management of colon and rectal cancers. It covers the surgical anatomy, principles of surgical resection, and pre-operative and intra-operative techniques. The key goals of surgery are cure, local tumor control, and palliation of symptoms. Surgical strategy depends on tumor location, stage, patient factors, and extent of resection. Standard resections include right and left hemicolectomies, sigmoid colectomy, and total proctocolectomy. Pre-operative preparation involves bowel cleansing, antibiotics, and thromboembolism prophylaxis. Intra-operative steps include inspection, mobilization, vascular division, exteriorization of the bowel, anastomosis, and closure.
Radiotherapy techniques, indications and evidences in oral cavity and oropha...Dr.Amrita Rakesh
This document discusses indications, evidence, and radiation therapy techniques for oral cavity and oropharyngeal cancers. It covers:
- Anatomy of the oral cavity and oropharynx.
- Staging principles and indications for surgery vs systemic therapy.
- Principles of surgery including adequate resection margins and neck management.
- Use of adjuvant radiation therapy or chemoradiation to improve local control, especially for high-risk features like positive margins or extracapsular extension.
- Radiation techniques for oral cavity cancers including field design, dose recommendations, and advantages of IMRT for sparing parotid glands.
This document discusses the management of laryngeal cancer. It covers treatment options for different stages of glottic and supraglottic cancers including endoscopic resection, radiation therapy, and open partial laryngectomies like vertical partial laryngectomy and supracricoid partial laryngectomy. It describes the surgical techniques and principles of various open partial laryngectomy procedures and their indications. Post-operative care and expected outcomes are also summarized.
This document discusses the anesthetic challenges and management of a patient undergoing thyroidectomy for a large thyroid swelling with retrosterneal extension. Key points include:
1) Such cases pose airway management challenges such as difficult intubation and potential for airway obstruction or cardiovascular compromise.
2) Thorough preoperative evaluation and optimization is important including imaging to assess tracheal compression and deviation.
3) A multidisciplinary team approach is needed and various techniques may be used to secure the airway including awake fiberoptic intubation or potential for emergency tracheostomy.
4) Close perioperative monitoring is required and postoperative complications like tracheomalacia must be watched for.
This document discusses the management of neck nodes in head and neck cancer. It covers lymph node levels, risk factors for metastasis, diagnostic workup, staging, surgical and radiation treatment options. For clinically negative nodes, elective neck irradiation or dissection are equally effective at controlling subclinical disease. For clinically positive nodes, factors like number of positive nodes and size influence treatment planning. Combined modality treatment with surgery and radiation provides better control than either alone for more advanced neck disease.
This document discusses the anesthetic challenges of performing thyroidectomy for a patient with a large retrosternal goiter. It outlines the preoperative evaluation and planning required, including airway assessment, optimization of thyroid function, and involvement of a multidisciplinary team. Specific challenges addressed are potential for difficult intubation, intraoperative blood loss and cardiovascular compromise, postoperative tracheomalacia, and recurrent laryngeal nerve injury. Careful preparation and perioperative management are needed for a successful outcome in these high-risk cases.
Papillary carcinoma of the thyroid gland is the most common, accounting for 75% of all thyroid malignancies, and the most indolent with a survival rate of 98%. Usually it presents as hypoechoic nodules in the thyroid gland. It is very rare for papillary carcinoma to present with large neck mass compromising airway and invading surrounding tissues. These features are more characteristic of anaplastic thyroid carcinoma.
There are many challenges in treating such patients.
1) Airway access to overcome obstruction.
2) Anesthesia concerns.
3) Surgical clearance (as there is soft tissue invasion).
4) Preservation of the recurrent laryngeal nerve.
5) Preserving parathyroids to prevent post-operative hypocalcaemia.
6) Hypopharyngeal and cervical oesophageal integrity and
continuity.
This document discusses the management of the neck and cervical lymph nodes in thyroid cancer. It notes that surgery should aim to completely remove cancer while preserving important structures like the voice, airway, swallowing, and parathyroid function. For differentiated thyroid cancers, lymph node dissection generally includes lymph nodes in levels IIa, III, IV, and Vb of the neck. The risks and benefits of prophylactic central neck dissection for papillary thyroid carcinoma are debated, as it may provide prognostic information but also increase risks of temporary complications like hypocalcemia or nerve paralysis.
The retropharyngeal space is a potential space located posterior to the pharynx that contains areolar fat and lymph nodes. It allows for movement of the pharynx during swallowing and respiration. Lesions and fluid collections like abscesses or hematomas can develop in this space. Imaging like CT scans are useful for evaluating these conditions. Retropharyngeal abscesses require prompt treatment with antibiotics and drainage to prevent airway complications. Lymph nodes in this region can metastasize early from cancers like nasopharyngeal carcinoma.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Nove...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Complicated Diverticulitis
- Pelvic Fracture
- Mesenteric Ischemia
This document discusses the management of periampullary cancers. It covers the role of fine needle aspiration in diagnosis and pre-operative biliary decompression. Staging laparoscopy and clinicopathological staging are discussed. The document outlines curative surgeries like pancreaticoduodenectomy and distal pancreatectomy. It also discusses operative and non-operative palliative options. Adjuvant therapies including chemo-radiation are mentioned. Emerging novel agents for treatment are noted.
Clinical value of the laparoscopic transabdominal preperitoneal techniqueMohamedTag14
Current guidelines recommend that surgical treatment of recurrent inguinal hernia should avoid the anatomical difficulties caused by the primary surgery, and that the recurrence repair should be done via a different surgical approach to that used during the primary repair.
Mr. Sunil, a 72-year-old male, presented with a 3-month history of a left neck swelling. Further examinations revealed metastatic squamous cell carcinoma in the left neck lymph nodes. He was diagnosed with carcinoma of unknown primary (CUP) and underwent radical neck dissection, followed by chemotherapy and radiotherapy. CUP describes metastatic cancers where the primary site cannot be identified despite various examinations and evaluations. Treatment options for CUP include surgery, radiation therapy, chemotherapy, or concurrent chemoradiation depending on the lymph node involvement and other factors. Prognosis depends on the stage and presence of extracapsular extension, with 5-year survival rates ranging from 30% for upper cervical nodes to 5%
This document discusses the challenges of performing thyroid surgery for patients with large thyroid swellings that extend into the chest (retrosternal goiters). Key risks include difficult intubation, blood loss, prolonged surgery, and cardiovascular or airway complications during or after surgery. Thorough preoperative evaluation and planning is required, including assessing airway accessibility and developing primary and backup airway management plans. Careful perioperative management is also needed to address issues like potential airway obstruction, tracheomalacia, nerve injury, hematoma, or edema. Postoperative monitoring and treatment may involve assessing for tracheomalacia, nerve palsies, or the need for tracheostomy or ventilation.
Anesthesia consideration for parotidectomyTayyab_khanoo9
This document summarizes anesthesia considerations for parotidectomy surgery. It discusses the anatomy of the parotid gland and facial nerve. Parotidectomy is usually indicated for parotid tumors and may require facial nerve monitoring. The document presents a case of performing parotidectomy under local anesthesia in a high-risk patient with hypertension. It describes blocking the maxillary and cervical plexus nerves along with local infiltration to anesthetize the area. The surgery was performed successfully without complications under local anesthesia. Advantages of this technique include avoiding risks of general anesthesia and facilitating identification and protection of the facial nerve.
This document summarizes recent advances in surgery presented at a conference in Athens. It discusses various topics including the role of central lymph node dissection for papillary thyroid cancer, intraoperative neuromonitoring during thyroidectomy, breast cancer axillary lymph nodes, minimally invasive pancreatic surgery, laparoscopic adrenalectomy, minimally invasive esophagectomy, and advances in pancreatic and colon cancer surgery. It also discusses the role of virtual and augmented reality in surgical training.
Surgical approach to thalamus explained in details their surgical anatomy and lesion, Preop post op results with different surgical approach for thalamic lesions
Emergency sonography in Pediatrics has evolved to become one of the most versatile
modalities for diagnosing and guiding
treatment of critically ill patients.
1) The document reviews various incision and closure techniques used in obstetrics and gynecology, including transverse (e.g. Pfannenstiel), vertical (e.g. midline), and laparoscopic incisions.
2) It discusses factors to consider when selecting an incision such as patient characteristics, pathology, and risk of adhesions or malignancy. It also reviews various suturing and closure methods like continuous versus interrupted sutures.
3) The ideal closure method provides good approximation with minimal risk of complications like infection, hemorrhage or wound dehiscence while allowing for the best cosmetic outcome. Layered versus mass closure techniques are evaluated.
MIS Complications: Managing the Emergency ConsultationGeorge S. Ferzli
This document discusses various situations in which an emergency consultation with an expert laparoscopic surgeon may be needed, including: before an operation begins if there are complications entering the abdomen; upon entry into the abdomen if there is a vascular injury; if there are difficulties visualizing structures; upon discovery of an injury to an intra-abdominal structure like the bowel, bladder, or ureter; and in the critical care setting for diagnostic laparoscopy. It provides details on managing different complications like vascular injuries, adhesions, and various organ injuries. The role of a laparoscopic consultant is to prevent injuries, aid in diagnosis and management of injuries, and improve the skills and learning of the consulting surgeon.
Similar to Management of invasive well differentiated thyroid cancer: AHNS Endocrine Surgery Guidelines (20)
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Management of invasive well differentiated thyroid cancer: AHNS Endocrine Surgery Guidelines
1. AHNS Endocrine Surgery Section
Guidelines
https://endocrine.ahns.info
Management of Invasive Well-differentiated Thyroid Cancer:
An American Head and Neck Society Consensus Statement
ML Shindo, SM Caruana, E Kandil, JC McCaffrey, LA Orloff,
JR Porterfield, A Shaha, J Shin, DJ Terris, GW Randolph
2. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
Shindo ML, Caruana SM, Kandil E, et al. Management of invasive well-
differentiated thyroid cancer: an American Head and Neck Society consensus
statement. AHNS consensus statement. Head Neck 2014;36:1379– 1390.
3. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Locally invasive disease present in 13-15% of patients
with WDTC
• Locally invasive disease often seen in those who die of
WDTC
• Incomplete surgical excision of invasive WDTC
associated with higher mortality
• Important to manage local invasion appropriately at
the time of initial surgery
Locally Invasive Thyroid Cancer
4. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Paucity of studies which evaluate management of
locally invasive WDTC
• Insufficient evidence base to develop clinical guidelines
• AHNS Endocrine Surgery Section convened a panel to
formulate expert opinion and clinical consensus
statements (CCS) on management of locally invasive
disease based on available literature
Background
5. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Expert Panel: 9 Members of AHNS, MPH & evidence
based medicine expert
• Extensive review of relevant literature
• Formulation of consensus statements
• Modified Delphi Survey method
• Determine if each statement reached consensus, near
consensus or did not reach consensus
Methods
7. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Most commonly involves strap muscles
• Strap muscle invasion managed with muscle resection
• Involvement of RLN, trachea, larynx, esophagus, and
major blood vessels less common
• Management should be planned preoperatively
• General consensus that macroscopic (gross) tumor
removal is important for locoregional control
• Morbidity of radical resection must be balanced against
tumor control, morbidity of persistent local disease,
survival benefit
Locally Invasive Thyroid Cancer
8. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 1a - Preoperative exam of the larynx
is recommended in the management of DTC
• Preoperative vocal cord paralysis is important
predictor of invasive thyroid malignancy
• Statement 1b - Fiberoptic exam is preferred
method to examine the larynx
Preoperative Examination of Larynx
Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients
undergoing thyroidectomy: voice, vocal cord function, and the pre- operative
detection of invasive thyroid malignancy. Surgery 2006;139: 357–362.
9. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Pro - higher local recurrence with gross residual
disease
• Con - no difference in survival
Recurrent Laryngeal Nerve Invasion
Resect or Preserve?
10. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 2a - If the RLN is encased by tumor, and
ipsilateral vocal fold paresis or paralysis is present
preoperatively, resection of the RLN is indicated
Recurrent Laryngeal Nerve
Intraoperative Management
Tumor
Proximal
RLN
11. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 2b - If the RLN is encased by tumor,
and bilateral vocal fold function is normal
preoperatively, the tumor may be shaved off to
spare the RLN, as long as all gross disease is
removed
• Statement 2c - If the RLN is encased by tumor,
and the contralateral vocal fold is paretic or
paralyzed, the tumor may be shaved off so that
the RLN is spared
Recurrent Laryngeal Nerve
Intraoperative Management
12. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 2d - If the RLN is encased by tumor
and the RLN is spared intraoperatively, then
adjuvant therapy is indicated
• Statement 2e - When only the contralateral
vocal fold is paralyzed, shaving the tumor off
the ipsilateral nerve followed by adjuvant may
be justified to avoid bilateral paralysis and the
need for a tracheostomy
Recurrent Laryngeal Nerve
Intraoperative Management
13. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 2f - If intraoperatively the tumor is
found to be minimally adherent to the RLN (not
encasing it) then the RLN should be preserved
Recurrent Laryngeal Nerve
Intraoperative Management
14. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
Recurrent Laryngeal Nerve
Intraoperative Management
Reprinted with permission of G. W. Randolph, editor. Surgery of the thyroid and
parathyroid glands. 2nd ed. Philadelphia, PA: Elsevier–Saunders, 2012.
15. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 3a - If feasible, immediate
reinnervation should be performed when
the RLN is resected during surgery for
invasive DTC
Recurrent Laryngeal Nerve
Intraoperative Management
16. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 4a - Intraoperative monitoring of the RLN
during thyroidectomy for invasive DTC may provide
prognostic information regarding the functional status of
the nerve during the procedure
• Statement 4b - Intraoperative monitoring of the RLN
during thyroidectomy for invasive DTC provides
prognostic information regarding the functional status of
the nerve at the conclusion of the procedure
• Statement 4c - Laryngeal nerve monitoring may be
considered during the performance of thyroid cancer
surgery, especially when preoperative nerve dysfunction
is observed
Recurrent Laryngeal Nerve Monitoring
18. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 5a - If the clinical presentation raises
concern for tracheal invasion, CT is an
acceptable means to assess for the status of the
trachea, and is superior to ultrasound when
assessing for tracheal invasion
Tracheal Invasion
Preoperative Assessment
19. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 5b - If the clinical presentation or
imaging raises concern for tracheal invasion,
then a bronchoscopy should be performed
before or at the time of the initial tumor
resection and the operative team and patient
should be prepared to proceed with tracheal
resection at the time of the initial resection
Tracheal Invasion
Preoperative Assessment
20. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Shave versus segmental resection:
• Similar survival rates
• Primary tracheal resection 5-9% mortality in some series
• Higher recurrence rate for shave procedure
• Higher morbidity with resection of recurrence
Tracheal Invasion
Intraoperative Management
21. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 6a - If a short segment of the trachea
is invaded and there is minimal cartilage
invasion, a tracheal shave excision is
appropriate
• Technique consists of sharp separation of the tumor from the
wall of the airway, leaving the mucosa intact. Although
possible, complete resection is difficult
• Statement 6b - If there is intraluminal tracheal
invasion or significant cartilage invasion,
circumferential sleeve resection of the trachea
is appropriate
Tracheal Invasion
Intraoperative Management
22. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 6c - If the surgeon performing the
thyroidectomy is not experienced in
performing tracheal resections and a head and
neck or thoracic surgeon with such expertise is
not available, referral to a tertiary center
should be considered and may be preferable to
staging the operation and performing tracheal
resection after thyroid surgery
Tracheal Invasion
Intraoperative Management
24. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 7a - Tumors without intraluminal
esophageal invasion can be managed with
resection of the involved muscularis layer,
avoiding esophageal entry
• Statement 7b - Tumors with full-thickness
involvement should undergo composite tumor
excision
Esophageal Invasion
Intraoperative Management
25. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 7c - If a small full-thickness
esophageal defect is necessary for complete
tumor excision, primary tension-free
multilayer closure may be performed if the
tissue is healthy
• Statement 7d - Extensive defects of the
esophagus should be reconstructed with a
myofascial/myocutaneous pedicled or free flap
Esophageal Invasion
Intraoperative Management
26. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Symptoms suggestive of laryngeal invasion include:
• Severe hoarseness
• Hemoptysis
• Dyspnea
• Signs suggestive of laryngeal invasion include:
• Paraglottic mucosal thickening and discoloration on laryngoscopy
• Vocal cord paralysis
• Tumor may be seen growing along the mucosal surfaces of the true or
false vocal folds or ventricles
• Gross invasion into the pyriform sinus
Laryngeal Invasion
27. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 8a - In cases of partial thickness invasion
of the larynx, shave excision of gross disease is
favored over organ-sacrificing procedures
• Statement 8b - In cases of gross endolaryngeal
invasion of the larynx, partial or total laryngectomy
is indicated, depending on tumor extent
• Statement 8c - If partial or total laryngectomy is
indicated and the thyroid surgeon is not well-versed
in performing the procedure, then the assistance of
an experienced surgeon should be sought
Laryngeal Invasion
Intraoperative Management
28. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Symptoms suggestive of laryngeal invasion include:
• Face or neck swelling
• Facial flushing,
• Venous distension or varicose veins over the upper body
surface
• Globus sensation or dysphagia due to vascular engorgement
Vascular Invasion
29. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
Note markedly enlarged anterior jugular veins
Superior Vena Cava Syndrome
30. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
Superior Vena Cava Syndrome
31. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 9a - When vascular involvement is
suspected, preoperative imaging should be
performed to assess for invasion and
resectability
• Statement 9b - Either CT angiogram or MR
angiogram (MRA) are appropriate means to
evaluate for vascular invasion and provide
adequate information when planning for safe
vascular control and/or resection
Vascular Invasion
Preoperative Assessment
32. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 9c - If carotid resection is planned,
the extent of collateral intracranial blood flow
and integrity of Circle of Willis should be
assessed with MRA or conventional
angiography to determine whether the carotid
is shunted or not
Vascular Invasion
Preoperative Assessment
33. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 10a - One internal jugular vein may be
excised without reconstruction when the
contralateral internal jugular vein is patent
• Statement 10b - In the event that both internal
jugular veins are resected simultaneously, at least
one should be reconstructed, preferably with
autologous vein graft
• Statement 10c - In the case of focal vascular
invasion, the vessel wall may be excised after
appropriate proximal and distal control and
reconstructed with patch angioplasty
Vascular Invasion
Intraoperative Management
34. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
• Statement 11a - EBRT is considered
postoperatively in cases in which DTC has high-
grade histology
• Statement 11b - EBRT is considered
postoperatively in cases in which there is
unresectable gross disease
• Statement 11c - In cases of extensive
extracapsular nodal extension, EBRT may be
considered, balancing the relative effectiveness
and morbidity of the EBRT
External Beam Radiotherapy
35. AHNS Endocrine Surgery Section - https://endocrine.ahns.info
Management of Invasive Well-differentiated Thyroid Cancer:
An American Head and Neck Society Consensus Statement
ML Shindo, SM Caruana, E Kandil, JC McCaffrey, LA Orloff,
JR Porterfield, A Shaha, J Shin, DJ Terris, GW Randolph