Head and Neck and Endocrine Surgery

 

Description:

 

This book addresses a wide range of topics relating to head and neck and endocrine surgery, including: maxillofacial injuries, surgery of the scalp, surgery of the salivary glands, jaw tumors, surgery of the oral cavity (lips, tongue, floor of the mouth, and palate), swellings and ulcers of the face, inflammation in the neck, cervical lymphadenopathy, midline and lateral neck swellings, tumors of the pharynx, and endocrine surgery (thyroid gland, parathyroid glands, suprarenal glands, and neuroendocrine tumors). The aim is to clearly describe and illustrate how to diagnose and treat diverse conditions in accordance with evidence-based practice. The coverage thus extends beyond surgical indications and procedures to encompass aspects such as anatomy, clinical presentation, and imaging diagnosis. The book has been structured in such a way as to facilitate quick reference. While it is primarily intended for practitioners, it will also be suitable for upper graduate students.

Table of Contents:

Preface

Acknowledgments

Contents

Contributors

1: Maxillofacial Injuries

1.1 Introduction

1.1.1 Classification

1.1.2 General Principles of Management

1.1.2.1 First Aid Treatment

1.1.2.2 Hospital Evaluation

1.1.2.3 Primary Care

1.1.2.4 Anesthesia

1.2 Soft Tissue Injuries

1.2.1 General Principles

1.2.1.1 Preoperative Care

1.2.1.2 Anesthesia

1.2.2 Wound Preparation

1.2.3 Principles of Repair

1.2.3.1 Surgical Repair According to the Type of Injury

Abrasions

Contusions and Hematomas

Lacerations

Avulsions

Special Types of Injury

1.2.3.2 According to the Location of Injury

Lip Injuries

Nasal Injuries

Eyebrow Injuries

Eyelid Injuries (Fig. 1.3)

1.2.4 Postoperative Care

1.2.5 Complications

1.3 Injury of Specialized Structures

1.3.1 Parotid Gland and Duct Injury

1.3.1.1 Evaluation

1.3.1.2 Treatment

1.3.1.3 Complications

1.3.2 Facial Nerve Injury

1.3.2.2 Evaluation and Treatment

1.3.3 Ear Injuries

1.4 Fractures of Facial Bones

1.4.1 Surgical Anatomy

1.4.2 Nasal Fractures

1.4.2.1 Assessment of Nasal Fractures

1.4.2.2 Treatment of Nasal Fractures

Closed Reduction

Open Reduction

Postoperative Management and Complications

1.4.3 Mandibular Fractures

1.4.3.1 Anatomical Considerations

1.4.3.2 Assessment of Mandibular Fractures

1.4.3.3 Classification (According to Site)

1.4.3.4 Management of Mandibular Fractures

Fractures of the Ramus

Condylar Fractures

Dislocation of the Temporomandibular Joint (TMJ)

Temporomandibular Ankylosis

Factures of the Body of the Mandible

Dentoalveolar Fracture

1.4.4 Middle Third Fractures

1.4.4.1 Classification

1.4.4.2 Assessment of Midfacial Injuries

1.4.4.3 Treatment

Emergency Management

Definitive Treatment

Preparations and Planning

Anatomical Considerations (Facial Pillars)

Reduction and Fixation

References

2: Surgery of the Scalp

2.1 Scalp Swellings

2.1.1 Etiology

2.2 Congenital Swellings

2.2.1 Inclusion (Sequestration) Dermoid Cyst

2.2.2 Meningocele/Encephalocele

2.2.3 Cirsoid Aneurysm

2.3 Acquired Swellings

2.3.1 Traumatic

2.3.1.1 Caput Succedaneum

2.3.1.2 Cephalhematoma

2.3.2 Inflammatory

2.3.2.1 Infected Granuloma

2.3.2.2 Osteomyelitis of Skull Bones

2.3.2.3 Cock’s Peculiar Tumor

2.3.2.4 Suppuration (Abscess)

2.3.3 Sebaceous Cyst (Trichilemmal or Pilar Cyst)

2.3.4 Neoplastic

2.3.4.1 Soft Tissue Swellings

2.3.4.2 Bony Swellings

Ivory Osteoma of the Skull (Calvaria)

Multiple Myeloma

Secondaries (Metastases)

2.3.5 Pott’s Puffy Tumor

References

3: Surgery of the Salivary Glands

3.1 Introduction

3.2 Embryology and Developmental Disorders

3.3 Histology

3.4 Physiology

3.4.1 Salivary Flow Rates

3.5 Parotid Glands

3.5.1 Surgical Anatomy

3.5.1.1 Parotid Fascia

3.5.1.2 Parotid Duct (Stensen’s Duct)

3.5.1.3 Accessory Parotid Gland

3.5.1.4 Surface Anatomy of the Parotid Gland

3.5.1.5 Nerve Supply

3.5.1.6 Arterial Supply

3.5.1.7 Venous Drainage

3.5.1.8 Lymphatic Drainage

3.5.1.9 Parapharyngeal Space (PPS)

3.5.2 Evaluation of the Parotid Gland

3.5.2.1 Clinical Evaluation

History Taking

Physical Examination

3.5.2.2 Imaging

Sialography

Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)

3.5.2.3 Endoscopic Examination (Sialendoscopy)

3.5.2.4 Biopsy

3.5.3 Parotid Injuries and Fistulae

3.5.3.1 Etiology

3.5.3.2 Clinical Presentation

History

Physical Examination

3.5.3.3 Treatment

Medical Therapy

Surgical Therapy

3.5.3.4 Complications

3.5.4 Parotid Calculus

3.5.5 Inflammatory Disorders (Sialadenitis)

3.5.5.1 Viral Infections

Mumps [49]

Non-Mumps

Human Immunodeficiency Virus (HIV)-Associated Sialadenitis [50, 51]

3.5.5.2 Bacterial Infections

Acute Suppurative Parotitis (Abscess) [52]

Chronic Pyogenic Parotitis

Actinomycosis

Cat-Scratch Disease

3.5.5.3 Recurrent Parotitis of Childhood

3.5.5.4 Papillary Obstructive Parotitis

3.5.5.5 Granulomatous Sialadenitis

Tuberculosis (TB)

Sarcoidosis

3.5.5.6 Autoimmune Sialadenitis

Mikulicz Disease (MD)

Sjogren’s Syndrome (SS)

3.5.5.7 Benign Lymphoepithelial Lesion (Myoepithelial Sialadenitis, MESA)

3.5.5.8 Other Autoimmune Sialadenitis

3.5.6 Sialadenosis (Sialosis)

3.5.6.1 Clinical Presentation

3.5.6.2 Etiology

3.5.6.3 Pathogenesis

3.5.6.4 Pathology

3.5.6.5 Treatment

3.5.7 Cystic Parotid Lesions

3.5.8 Tumors of the Parotid Glands

3.5.8.1 WHO Histological Classification of Tumors of Salivary Glands

Benign Epithelial Tumors

Malignant Epithelial Tumors

Soft Tissue Tumors

Hematolymphoid Tumors

Secondary Tumors

3.5.8.2 Benign Tumors (BTs)

Pleomorphic Adenoma (PA)

Warthin’s Tumor (Adenolymphoma)

Basal Cell Adenoma (BCA)

Canalicular Adenoma

Myoepithelioma

Cystadenoma

3.5.8.3 Malignant Tumors

Mucoepidermoid Carcinoma (MEC)

Adenoid Cystic Carcinoma (ACC)

Carcinoma Ex-pleomorphic Adenoma (CEPA)

True Malignant Mixed Tumor (TMMT)

Acinic Cell Carcinoma

Basal Cell Adenocarcinoma

Myoepithelial Carcinoma (Malignant Myoepithelioma)

Cystadenocarcinoma

3.5.9 Parotidectomy

3.5.9.1 Superficial Parotidectomy

Complications

Frey’s Syndrome (Gustatory Sweating)

3.5.9.2 Total Parotidectomy

3.5.9.3 Extended Total Parotidectomy

3.6 Submandibular Glands

3.6.1 Surgical Anatomy

3.6.1.1 Fascia

3.6.1.2 Submandibular Duct (Wharton’s Duct)

3.6.1.3 Lingual Nerve

3.6.1.4 Facial Artery

3.6.1.5 Venous Drainage

3.6.1.6 Lymphatic Drainage

3.6.2 Evaluation of the Submandibular Gland

3.6.2.1 Clinical Evaluation

History Taking

Physical Examination

Extraoral Examination

Intraoral Examination

Bimanual Examination

3.6.2.2 Imaging

Plain-Film Radiographs

Sialography

Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)

3.6.2.3 Endoscopic Examination (Sialendoscopy)

3.6.2.4 Biopsy

3.6.3 Submandibular Sialadenitis/Sialadenosis

3.6.3.1 Acute Submandibular Sialadenitis

Etiology

Clinical Picture

Investigations (Workup of the Patient)

Treatment

Prognosis

3.6.3.2 Chronic Submandibular Sialadenitis/Sialolithiasis

Chronic Sialadenitis

Papillary Stenosis

Sialolithiasis

Clinical Picture

Investigations

Treatment

3.6.3.3 Autoimmune Sialadenitis

Sjogren’s Syndrome

Mikulicz’s Disease/Syndrome

3.6.3.4 Sialadenosis

3.6.4 Tumors of the Submandibular Gland

3.6.4.1 Benign Tumors (BTs)

3.6.4.2 Malignant Tumors (MTs)

3.6.4.3 Clinical Presentation

3.6.4.4 Differential Diagnosis

3.6.4.5 Diagnostic Imaging

3.6.4.6 Cytopathologic Diagnosis

3.6.4.7 Patterns of Spread

3.6.4.8 Management

Benign Tumors

Malignant Tumors

Factors Influencing Selection of Therapy

Resectable Tumors

Advanced Non-resectable Tumors

Management of the Neck

Chemotherapy

3.6.5 Surgical Technique: Submandibular Sialoadenectomy

3.6.5.1 Steps of the Procedure

3.6.5.2 Postoperative Complications

3.7 Sublingual Glands

3.7.1 Surgical Anatomy

3.7.2 Tumors of the Sublingual Glands

3.7.2.1 Ranula

3.7.2.2 Treatment of Sublingual Malignant Neoplasms

3.8 Minor Salivary Glands

3.8.1 Surgical Anatomy

3.8.2 Tumors of Minor Salivary Glands

3.8.2.1 Clinical Presentation

3.8.2.2 Diagnosis

3.8.2.3 Benign Tumors

3.8.2.4 Malignant Tumors

3.8.2.5 Treatment

3.8.2.6 Prognosis

References

4: Swellings of the Jaw

4.1 Introduction

4.2 Classification of Jaw Swellings

4.3 Epulides

4.3.1 Fibrous Epulides

4.3.2 Myelomatous Epulides (Giant Cell Epulides)

4.3.3 Granulomatous Epulides

4.3.4 Carcinomatous Epulides

4.3.5 Sarcomatous Epulides

4.3.6 Epulides Associated with Pregnancy

4.4 Odontomas

4.4.1 Dental (Radicular or Subapical) and Dentigerous (Follicular) Cysts

4.4.2 Ameloblastoma (Adamantinoma)

4.5 Bony Swellings

4.5.1 Inflammatory Lesions

4.5.1.1 Dental Granuloma

4.5.1.2 Alveolar (Dental) Abscess

4.5.1.3 Osteomyelitis

4.5.1.4 Cervicofacial Actinomycosis

4.5.2 Neoplastic Lesions

4.5.2.1 Carcinoma of the Maxilla

4.5.2.2 Sarcoma of the Maxilla

4.5.2.3 Burkitt’s Lymphoma

4.5.2.4 Osteoclastoma (Giant Cell Tumor)

4.6 Reconstruction of the Mandible

4.6.1 Reconstructive Stepladder

4.6.1.1 Alloplastic Devices

4.6.1.2 Corticocancellous Bone Grafts

4.6.1.3 Pedicled Soft Tissue Flaps

4.6.1.4 Free Vascularized Flaps

4.6.1.5 Tissue Engineering and Regenerative Medicine

4.6.2 Vascularization: The Key for Regeneration

4.6.2.1 Vascularization Concerns in the Mandible After Cancer Ablation

Vascular Pattern

Radiotherapy

Defect Size

4.6.2.2 Types of Vascularization

Vasculogenesis

Angiogenesis (Fig. 4.9)

Inosculation

4.6.3 Summary

References

5: Surgery of the Oral Cavity

5.1 Surgical Anatomy

5.2 Swellings of the Oral Cavity

5.2.1 Ranula

5.2.2 Sublingual Dermoid Cyst

5.2.3 Stone in Wharton’s Duct

5.2.4 Vascular Malformations

5.2.4.1 Classification

5.2.4.2 Venous Malformations

Pathology

Clinical Presentation

Treatment

5.2.4.3 Arteriovenous Fistulae

Pathology

Clinical Presentation

Treatment

5.2.4.4 Lymphatic Malformations

Pathology

Clinical Presentation

Treatment

5.3 Ulcers of the Oral Cavity

5.3.1 Etiological Classification

5.3.2 Traumatic Ulcers

5.3.2.1 Dental Ulcers

5.3.2.2 Frenular (Pertussis) Ulcer

5.3.3 Inflammatory Ulcers

5.3.3.1 Herpetic Ulcers

5.3.3.2 Tuberculous (TB) Ulcers

5.3.3.3 Syphilitic Ulcers

5.3.3.4 Chronic Superficial Glossitis

5.3.4 Dyspeptic (Aphthous) Ulcers

5.3.5 Malignant Ulcers

5.4 Neoplastic Lesions of the Oral Cavity

5.4.1 Classification

5.4.2 Benign Tumors

5.4.2.1 Fibro-epithelial Polyp

5.4.2.2 Papilloma of the Oral Cavity

5.4.2.3 Mixed Salivary Tumors of Minor Salivary Glands

5.4.2.4 Lingual Thyroid

5.4.2.5 Hemangioma

Pathology

Clinical Presentation

Treatment

5.4.2.6 Pyogenic Granuloma

5.4.3 Malignant Tumors of the Oral Cavity

5.4.3.1 Predisposing Factors

5.4.3.2 Sites in the Tongue

Anterior Two Thirds (80 %)

Posterior Third (20 %)

5.4.3.3 Pathology

Macroscopic Picture

Microscopic Picture

Spread

5.4.3.4 Clinical Presentation

5.4.3.5 Complications (Terminal Events)

5.4.3.6 Staging

Primary Tumor (T)

Regional Lymph Nodes (N)

Distant Metastasis (M)

5.4.3.7 Histological Grade (G)

5.4.3.8 Investigations

5.4.3.9 Treatment

Surgical Treatment

Radiotherapy (RT)

Chemotherapy

Management of Recurrences

5.4.3.10 Follow-Up

5.4.3.11 Prognosis

References

6: Surgery of the Face

6.1 Swellings of the Face

6.1.1 Classification

6.2 Diffuse Swellings

6.2.1 Acute Diffuse Swellings

6.2.2 Chronic Diffuse Swellings

6.2.2.1 Diffuse Hemangioma

6.2.2.2 Plexiform Neurofibromas (PNF)

6.3 Localized Swellings

6.3.1 Cystic Swellings

6.3.1.1 Sebaceous Cyst

6.3.1.2 Dermoid Cyst

6.3.1.3 Hemangioma

6.3.1.4 Lymphangioma

6.3.1.5 Cystic Swellings of the Parotid Gland

6.3.1.6 Cystic Swellings Around the Orbit

6.3.2 Solid Swellings

6.3.2.1 Keloid (Greek Crab’s Claw)

6.3.2.2 Lipoma

6.3.2.3 Neurofibroma

6.3.2.4 Other Solid Swellings

6.4 Ulcers of the Face

6.4.1 Classification

6.5 Ulcerating Infective Lesions

6.5.1 Nonspecific Ulcers

6.5.1.1 Chronic Nonspecific Ulcer

6.5.1.2 Infected Sebaceous Cyst

6.5.2 Specific Ulcers

6.5.2.1 Tuberculous (TB) Ulcers

6.5.2.2 Syphilitic ($) Ulcer

6.5.2.3 Leishmaniasis (Oriental Sore)

6.5.2.4 Actinomycosis

6.5.2.5 Anthrax

6.6 Ulcerating Tumors

6.6.1 Molluscum Sebaceum (Keratoacanthoma, KA)

6.6.2 Basal Cell Carcinoma (BCC)

6.6.2.1 Incidence

6.6.2.2 Body (Anatomic) Distribution

6.6.2.3 Etiology

6.6.2.4 Related Syndromes

Nevoid BCC Syndrome (Gorlin’s Syndrome)

Bazex Syndrome

Rombo Syndrome

6.6.2.5 Symptoms

6.6.2.6 Physical Examination

6.6.2.7 Complications

6.6.2.8 Clinic-pathological Types of BCC

Nodular (Noduloulcerative) BCC

Variants of Nodular BCC

Infiltrative BCC

Micronodular BCC

Morphea-Like (Fibrosing, or Sclerosing) BCC

Superficial BCC

Gorlin Syndrome (Basal Cell Nevus Syndrome)

Other Types of BCC

6.6.2.9 Diagnosis

Skin Biopsy

Imaging

6.6.2.10 Differential Diagnoses

6.6.2.11 Staging

High-Risk Tumors

6.6.2.12 Treatment

Approach Considerations

Surgical Modalities

Electrodesiccation and Curettage (E&C) [55]

Curettage Without Dessication [54]

Curettage with Er:YAG Laser Ablation

Laser Ablation Without Curettage

Surgical Excision

Mohs Micrographically Controlled Surgery

Cryosurgery

Immuno-cryosurgery

Radiation Therapy (RT)

Photodynamic Therapy (PDT)

Topical Medications

Oral Medications

6.6.2.13 Prognosis

6.6.3 Squamous Cell Carcinoma (SCC)

6.6.3.1 Incidence

6.6.3.2 Etiology

6.6.3.3 Symptoms

6.6.3.4 Physical Examination

6.6.3.5 Pathology

Variants (Subtypes) of SCC

6.6.3.6 Diagnosis

6.6.3.7 Marjolin Ulcer

6.6.3.8 Management

Treatment of the Primary Tumor

Treatment of Lymph Nodes

6.6.3.9 Prognosis

6.6.4 Malignant Melanoma (MM)

6.6.4.1 Embryology of Melanocytes

6.6.4.2 Incidence

6.6.4.3 Etiology and Risk Factors

6.6.4.4 Pathophysiology

6.6.4.5 Symptoms

6.6.4.6 Physical Examination

Local Examination

General Examination

6.6.4.7 Spread

6.6.4.8 Classification (Clinic-�pathological Types)

6.6.4.9 Staging of Melanoma

The Clark Scale

The Breslow Scale

The Day Scale (Modification of Breslow)

TNM and AJC (American Joint Committee) Staging System

Clinical Staging System (Number Stages of Melanoma)

6.6.4.10 Investigations

6.6.4.11 Differential Diagnosis

6.6.4.12 Prevention

6.6.4.13 Treatment

Treatment of the Primary Lesion

Local Excision

Reconstruction

Management of Regional LNs [100]

Treatment of Disseminated Disease

Palliative Surgery

Radiotherapy (RT)

Immunotherapy

Chemotherapy

6.6.4.14 Prognosis of Melanoma

6.7 Cavernous Sinus Thrombosis (CST)

6.7.1 Etiology

6.7.2 Clinical Presentation

6.7.3 Diagnosis

6.7.4 Complications

6.7.5 Treatment

6.7.5.1 Acute General Treatment

6.7.5.2 Long-Term Treatment

6.7.6 Prognosis

References

7: Deep Neck Space Infections

7.1 Introduction

7.2 Ludwig’s Angina

7.2.1 Surgical Anatomy

7.2.2 Etiology

7.2.3 Clinical Manifestations

7.2.4 Diagnosis

7.2.5 Treatment

7.2.5.1 Medical Treatment

7.2.5.2 Surgical Therapy

7.2.6 Prognosis

7.3 Peritonsillar Abscess (PTA)

7.3.1 Etiology

7.3.2 Clinical Presentation

7.3.3 Diagnosis

7.3.4 Treatment

7.3.4.1 Medical Therapy

7.3.4.2 Surgical Treatment

7.3.5 Prognosis

7.4 Parapharyngeal Abscess

7.4.1 Surgical Anatomy

7.4.2 Etiology

7.4.3 Clinical Presentation

7.4.4 Diagnosis

7.4.5 Treatment

7.5 Retropharyngeal Abscess (RPA)

7.5.1 Surgical Anatomy

7.5.2 Etiology

7.5.3 Clinical Presentation

7.5.4 Diagnosis

7.5.5 Treatment

7.5.6 Prognosis

References

8: Cervical: Lymphadenopathy

8.1 Anatomical Considerations

8.1.1 Delineation of the Levels of Cervical Lymph Nodes [3] (Fig. 8.1)

8.1.2 Neck Dissection

8.1.2.1 Historical Overview

8.1.2.2 Classification of Neck Dissection (AAO-HNS and American Head and Neck Society) [3]

Radical Neck Dissection (RND)

Modified Radical Neck Dissection (MRND) (Figs. 8.3 and 8.4)

Selective Neck Dissection (SND)

Extended Radical Neck Dissection (ERND)

8.2 Cervical Lymphadenopathy: Pathology and Clinical Pattern

8.2.1 Definition

8.2.2 Classification

8.2.2.1 Etiological

8.2.2.2 Pathological

8.2.2.3 Clinical

8.2.3 Etiology

8.2.3.1 Infections

Tuberculosis (TB)

Syphilis

Cat-Scratch Disease

Toxoplasmosis

8.2.3.2 Malignancy

8.2.3.3 Autoimmune Disease

8.2.3.4 Endocrine Disease

8.2.3.5 Drug-Induced Lymphadenopathy

8.2.3.6 Miscellaneous Causes of Cervical Lymphadenopathy

Kawasaki Disease (KD)

Sarcoidosis

Histiocytosis X

Kikuchi-Fujimoto Disease (KFD)

Castleman’s Disease

8.2.4 Neck Staging Under the “TNM Staging System” for Head and Neck Tumors

8.2.4.1 Regional Lymph Nodes (N)

8.2.4.2 Nasopharynx

8.2.4.3 Thyroid Gland

8.2.4.4 Mucosal Melanoma

8.2.4.5 Carcinoma of Unknown Primary (CUP)

8.3 Diagnostic Approach

8.3.1 History Taking

8.3.2 Physical Examination

8.3.3 Investigations

8.3.3.1 Imaging Modalities

Ultrasonography (US)

Reactive LNs

Tuberculous LNs

Lymphomatous LNs

Metastatic LNs

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)

Other Imaging Modalities

8.3.3.2 Biopsy

Excisional Biopsy

Core Needle Biopsy

8.4 Technique of Modified Radical Neck Dissection (MRND) [94, 95]

References

9: Swellings of the Neck

9.1 Surgical Anatomy

9.1.1 Triangles of the Neck

9.1.1.1 Anterior Triangle

9.1.1.2 Posterior Triangle

9.2 Introduction

9.2.1 Diagnosis of a Neck Mass

9.3 Midline Neck Swellings

9.3.1 Neck Dermoid Cysts

9.3.2 Abscess in Relation to the Mandible

9.3.3 Subhyoid Bursitis

9.3.4 Median Ectopic Thyroid Tissue

9.3.5 Tuberculous Thyroid Chondritis

9.3.6 Cyst/Nodule of the Thyroid Gland Isthmus

9.3.7 Thyroglossal Cyst

9.3.7.1 Embryology and Pathogenesis

9.3.7.2 Sites

9.3.7.3 Incidence

9.3.7.4 Pathology

9.3.7.5 Clinical Picture

9.3.7.6 Complications

9.3.7.7 Differential Diagnosis

9.3.7.8 Treatment (Sistrunk Operation, 1928)

9.3.7.9 Thyroglossal Fistula

9.4 Lateral Neck Swellings

9.4.1 Solid Swellings of the Anterior Triangle

9.4.1.1 Lymphadenopathy

9.4.1.2 Thyroid Swelling

9.4.1.3 Swelling of the Lower Pole of Parotid Gland

9.4.1.4 Paragangliomas (Glomus Tumors: Chemodectomas)

Carotid Body Tumor

Pathology

Symptoms

Clinical Examination

Investigations

Treatment

Excision of a Carotid Body Tumor

Glomus Vagale

Glomus Jugulare

Glomus Tympanicum

9.4.1.5 Schwannoma

9.4.1.6 Ganglioneuroma

9.4.1.7 Sternocleidomastoid (SCM) Tumor

Pathology

Clinical Picture

Treatment

9.4.2 Cystic Swellings of the Anterior Triangle

9.4.2.1 Pyogenic Abscess

9.4.2.2 Cold Abscess (TB Abscess)

9.4.2.3 Branchial Cyst

Embryology and Pathogenesis

Incidence

Pathology

Clinical Picture of the Second Branchial Arch Cyst

Differential Diagnosis

Complications

Treatment

Branchial Fistula

Congenital Type

Acquired Type

First Branchial Arch Anomaly (FBAA)

Third/Fourth Branchial Arch Anomaly

9.4.2.4 Laryngocele

9.4.2.5 Carotid Artery Aneurysm

9.4.3 Solid Swellings of the Posterior Triangle

9.4.3.1 Cervical Rib Syndrome

Scalene Syndrome: Superior Thoracic Aperture Syndrome

Varieties of Cervical Rib

Pathology

Symptoms

Local Examination

Investigations

Differential Diagnosis

Treatment

9.4.4 Cystic Swellings of the Posterior Triangle

9.4.4.1 Cystic Hygroma

Etiology

Pathology

Clinical Picture

Diagnosis

Complications

Treatment

Surgical Treatment

Sclerosing Therapy

Other Less Popular Methods

9.4.4.2 Pharyngeal Pouch (Zenker’s Diverticulum)

Pathogenesis

Clinical Presentation

Complications

Treatment

9.4.4.3 Pneumatocele

Pathophysiology

Epidemiology

Etiology

Clinical Picture

Complications

Investigations

Laboratory Studies

Imaging Studies

Procedures

Differential Diagnoses

Treatment

Prognosis

References

10: Tumors of the Pharynx

10.1 Tumors of the Nasopharynx

10.1.1 Benign Tumors (Nasopharyngeal Fibroma/Angiofibroma)

10.1.2 Malignant Tumors

10.2 Tumors of the Oropharynx

10.3 Tumors of the Hypopharynx

References

11: Surgery of the Thyroid Glands

11.1 Embryology

11.2 Surgical Anatomy

11.2.1 Fascia and Ligaments

11.2.2 Relation with Strap Muscles

11.2.3 Arterial Supply

11.2.3.1 Superior Thyroid Artery (STA)

11.2.3.2 Inferior Thyroid Artery (ITA)

11.2.3.3 Thyroidea Ima Artery

11.2.4 Venous Drainage

11.2.5 Lymphatics of the Thyroid Gland

11.2.6 Innervation of the Thyroid Gland

11.2.6.1 Nerves Related to the Thyroid Gland

11.2.7 The Parathyroid Glands

11.3 Histology

11.4 Physiology

11.5 Investigating the Enlarged Thyroid

11.5.1 Serological Investigations

11.5.1.1 Thyroid Function Tests

11.5.2 Imaging

11.5.2.1 Ultrasonography (US)

11.5.2.2 Magnetic Resonance Imaging (MRI) and Computed Tomography (CT)

11.5.2.3 Thyroid Scintigraphy

11.5.3 Biopsy

11.5.3.1 Fine-Needle Aspiration Cytology (FNAC): Freehand or US Guided

Indications and Aims of FNAC

Limitations of FNAC

Cytology Results of FNAC

The Nondiagnostic Smears

Accuracy of FNA in Exploring Cervical LNs in the Presence of a Thyroid Carcinoma

Core Biopsy (With or Without US Guidance)

11.5.4 Flexible Laryngoscopy

11.6 Multinodular Goiter (MNG)

11.6.1 Introduction

11.6.2 Pathogenesis

11.6.3 Clinical Assessment

11.6.3.1 Patient’s History

11.6.3.2 Physical Examination

11.6.4 Complications of MNG

11.6.5 Investigations

11.6.5.1 Laboratory Findings

11.6.5.2 Imaging Findings

Ultrasonography (US)

Scintigraphy

Radiography and Tomography

11.6.5.3 Fine-Needle Aspiration (FNA)

11.6.5.4 Airway Assessment

11.6.6 Management of MNG

11.6.6.1 Nonoperative Treatment

11.6.6.2 Surgical Treatment

Indications and Extent of Surgery

Multinodular Goiter (Benign/Thy 2)

Thyroid Nodules Associated with Hypo-/Hyperthyroidism

Dominant Nodule in MNG

Thyroid Cystic Swelling

Results of Surgical Treatment of MNG

Prophylaxis of Recurrence

Treatment of Recurrent Goiter

11.7 Retrosternal Goiter (RSG)

11.7.1 Introduction

11.7.2 Incidence

11.7.3 Anatomical Classification

11.7.4 Clinical Manifestations

11.7.4.1 Symptoms

11.7.4.2 Physical Examination

11.7.5 Diagnosis

11.7.5.1 Plain Chest X-Ray (CXR)

11.7.5.2 CT Scan and MRI

11.7.5.3 Scintigraphy

11.7.5.4 US and FNA

11.7.6 Differential Diagnosis

11.7.7 Treatment

11.7.7.1 Pharmacotherapy

11.7.7.2 Radioactive Iodine (RAI) Therapy

11.7.7.3 Surgical Therapy

Approach to RSG

Complications of RSG Surgery

11.8 Solitary Thyroid Nodule (STN)

11.8.1 Pathological Classification

11.8.2 Clinical Considerations

11.8.2.1 History Taking

11.8.2.2 Physical Examination

11.8.3 Laboratory Tests

11.8.4 Imaging Studies

11.8.4.1 Ultrasonography (US)

11.8.4.2 Scintiscan

11.8.5 Fine-Needle Aspiration Biopsy (FNAB)

11.8.6 Management

11.8.6.1 Clinically Non-palpable Incidental Nodule

11.8.6.2 Benign Nodule

11.8.6.3 Indeterminate Lesion

11.8.6.4 Suspicious Nodule

11.8.6.5 Malignant Nodule

Treatment of Differentiated Thyroid Cancer

Principles and Strategies

Treatment: Papillary Thyroid Cancer (PTC)

Treatment: Follicular Thyroid Cancer (FTC)

11.8.6.6 Treatment of Oncocytic (Hürthle Cell) Thyroid Cancer

11.8.6.7 Treatment of Medullary Thyroid Carcinoma (MTC)

11.8.6.8 Treatment of Anaplastic Carcinoma

11.8.6.9 Nondiagnostic Biopsies

11.9 Thyrotoxicosis

11.9.1 Introduction

11.9.2 Clinical Manifestations

11.9.2.1 Symptoms

11.9.2.2 Local Examination

11.9.2.3 General Examination

11.9.3 Diagnosis

11.9.4 Differential Diagnosis

11.10 Graves’ Disease

11.10.1 Pathogenesis

11.10.2 Pathology

11.10.3 Clinical Presentation

11.10.4 Diagnosis

11.10.5 Management

11.10.5.1 Radioactive Iodine (RAI)

11.10.5.2 Antithyroid Drugs (ATDs)

11.10.5.3 Surgical Treatment

11.11 Toxic Multinodular Goiter (Plummer’s Disease)

11.11.1 Diagnosis

11.11.2 Treatment

11.11.2.1 Solitary Toxic Nodule

11.11.3 Diagnosis

11.11.4 Treatment

11.12 Thyroiditis

11.12.1 Hashimoto’s Thyroiditis

11.12.2 Silent (Painless) Thyroiditis

11.12.3 Subacute Thyroiditis (de Quervain’s, Granulomatous, or Giant Cell Thyroiditis)

11.13 Iodine-Induced Thyrotoxicosis

11.14 Thyroiditis

11.14.1 Introduction

11.15 Autoimmune Thyroiditis

11.15.1 Hashimoto’s Thyroiditis (Chronic Lymphocytic Thyroiditis, Struma Lymphomatosa)

11.15.2 Focal Lymphocytic Thyroiditis (Focal Autoimmune Thyroiditis, Chronic Nonspecific Thyroiditis

11.15.3 Postpartum Thyroiditis

11.15.4 Subacute de Quervain’s Thyroiditis (Granulomatous, Pseudotuberculous, or Giant Cell Thyroi

11.15.5 Painless Thyroiditis (Subacute Lymphocytic Thyroiditis)

11.15.6 Riedel’s Fibrosing Thyroiditis

11.16 Non-autoimmune Thyroiditis

11.16.1 Acute Infectious Thyroiditis (Acute Suppurative Thyroiditis)

11.16.2 Drug-Induced Thyroiditis

11.16.3 Postoperative Necrotizing Thyroiditis

11.16.4 Radiation Thyroiditis

11.16.5 Other Causes of Nonimmune Thyroiditis

11.16.6 Indications of Surgery in Thyroiditis

11.17 Malignant Thyroid Disease: Introduction

11.17.1 Classification

11.17.1.1 World Health Organization (WHO) Classification

11.17.1.2 Pathological Classification

11.17.2 Screening

11.17.3 Risk Factors for Thyroid Carcinoma

11.17.3.1 History Taking

11.17.3.2 Clinical Examination

11.18 Well-Differentiated Thyroid Cancer

11.18.1 Staging (Tables 11.20a, 11.20b, and 11.20c)

11.18.2 Management of DTC

11.18.2.1 Surgical Treatment

11.18.2.2 Radioactive Iodine (RAI) Ablation and Treatment for DTC

Preparation for 131I Ablation or Therapy

Postoperative 131I Ablation

Indications of Remnant Ablation with 131I

Short-Term and Long-Term Side Effects of 131I Ablation Treatment

11.18.2.3 External Beam Radiotherapy (EBRT) for the Treatment of DTC

11.18.3 Follow-Up of WDTC

11.18.3.1 Voice Dysfunction

11.18.3.2 Management of Hypocalcemia

11.18.3.3 Long-Term Suppression of Serum Thyrotropin

11.18.3.4 Measurement of Serum in Long-Term Follow-Up

11.18.3.5 Role of US and Whole-Body 131I Scan (WBS) in Routine Follow-Up

11.18.4 Recurrent/Persistent DTC

11.18.4.1 Recurrence in the Thyroid Bed or Cervical LNs

11.18.4.2 Metastases in the Lungs and Other Soft Tissue Areas

11.18.4.3 Cerebral Metastases

11.18.4.4 Bone Metastases

11.18.4.5 Other Metastatic Sites

11.18.4.6 Palliative Care

11.19 Papillary Thyroid Cancer (PTC)

11.19.1 Risk Factors

11.19.2 Gross Features

11.19.3 Microscopic Features

11.19.3.1 Histological Variants of PTC

Papillary Micro-carcinoma

Encapsulated Variant

Follicular Variant

Tall Cell and Columnar Cell Variants

Diffuse Sclerosing Variant

Other Variants of PTC

11.19.4 Clinical Aspects

11.19.5 Lymphatic Spread

11.19.6 Distant Metastases

11.19.7 Evaluation of the Neck in PTC (Primary Tumor and LNs)

11.19.7.1 Physical Examination

11.19.7.2 Ultrasound (US)

11.19.7.3 Cross-Sectional Imaging (CT and MRI)

11.19.7.4 Cytology

11.19.8 Surgery for DTC

11.19.8.1 Elective Surgical Treatment

Management of the Primary Tumor (Thyroid Surgery)

Management of the Nodal Spread

Surgical Decision for Treatment of PTC

Surgery for Papillary (or Follicular) Micro-carcinoma

11.19.8.2 Emergency Surgery

11.19.8.3 Surgery for Locally Advanced Disease

11.19.9 Prognostic Indicators

11.19.9.1 Prognostic Scales/Scores

11.20 Follicular Thyroid Cancer (FTC)

11.20.1 Gross Features

11.20.2 Microscopic Appearance

11.20.3 Clinical Aspects

11.20.4 Surgical Decision for the Treatment of Follicular Carcinoma

11.20.5 Prognostic Factors

11.21 Hürthle Cell (Oncocytic) Tumors

11.21.1 Introduction

11.21.2 Clinical Presentation

11.21.2.1 Histopathological Features

11.21.3 Diagnosis

11.21.4 Management

11.21.5 Prognosis

11.22 Anaplastic Thyroid Carcinoma (ATC)

11.22.1 Clinical Aspects

11.22.2 Diagnosis

11.22.3 Gross Appearance

11.22.4 Microscopic Appearance

11.22.5 Treatment

11.23 Medullary Thyroid Carcinoma (MTC)

11.23.1 Clinical Presentation

11.23.2 Gross Features

11.23.3 Microscopic Picture

11.23.4 Investigations

11.23.4.1 Preoperative Investigations Should Include

11.23.5 Treatment

11.23.5.1 Surgical Treatment

Investigation of Persistent or Increasing Hypercalcitoninemia

11.23.5.2 Radiotherapy and Chemotherapy

11.23.6 Follow-Up

11.23.7 Molecular Genetics: Genetic Investigation of a Patient with MTC

11.23.7.1 Clinical History

11.23.7.2 Genetic Testing

Before Testing

11.23.7.3 Testing

11.23.7.4 Action Based on Results

If a Mutation Is Found

If No Mutation Is Found

11.23.8 Multiple Endocrine Neoplasia-2B (MEN-2B)

11.23.8.1 Recognition

11.23.8.2 The Child of an MEN-2B Patient

11.24 Other Rare Thyroid Malignancies

11.24.1 Poorly Differentiated Thyroid Carcinoma (PDTC) (Insular Carcinoma)

11.24.1.1 Diagnosis

11.24.2 Biological Behavior

11.24.3 Treatment

11.25 Thyroid Lymphoma

11.25.1 Clinical Presentation

11.25.2 Diagnosis

11.25.3 Treatment

11.25.3.1 Radiation Therapy/Chemotherapy

11.25.3.2 Surgical Role

11.25.4 Prognosis

11.26 Metastatic Lesions to the Thyroid

11.26.1 Clinical Presentation and Diagnosis

11.26.2 Treatment

11.26.3 Prognosis

11.27 Molecular Basis for Thyroid Carcinogenesis

11.27.1 Introduction

11.27.2 Genetic Background for FMTC

11.27.3 Genetic Background for FNMTC

11.27.4 Evolving Molecular Understanding of Sporadic Cases of Thyroid Carcinoma

11.27.5 When to Suspect a Familial Pattern

11.28 Thyroidectomy

11.28.1 Indications

11.28.2 Total Thyroidectomy (TT) for Benign Disorders

11.29 Conventional (Open) Thyroidectomy

11.29.1 Surgical Technique

11.29.1.1 Skin Incision

11.29.1.2 Dissection of Strap Muscles

11.29.1.3 Mobilization of Thyroid Gland and Identification of Upper PTGs

11.29.1.4 Identification of RLNs and Lower PTGs

11.29.1.5 Mobilization of Pyramidal Lobe

11.29.1.6 Thyroid Resection

11.29.1.7 Drainage

11.29.1.8 Closure

11.29.2 Postoperative Care

11.30 Flapless Conventional Thyroidectomy

11.31 Minimal Invasive Thyroid Surgery (MITS)

11.31.1 Introduction

11.31.2 Advantages and Disadvantages of MITS

11.31.3 Direct Access MITS (Mini-incision)

11.31.4 Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)

11.31.5 Pure Endoscopic Techniques of Thyroidectomy

11.32 Complications of Thyroidectomy

11.32.1 Bleeding

11.32.2 Respiratory Distress

11.32.3 Recurrent Laryngeal Nerve (RLN) Injury

11.32.4 External Branch of the Superior Laryngeal Nerve (EBSLN) Injury

11.32.5 Other Nerve Injuries

11.32.6 Hypoparathyroidism

References

12: Surgery of Parathyroid Glands

12.1 Introduction

12.2 Anatomy

12.3 Physiology

12.4 Pathology

12.5 Clinical Presentation

12.6 Investigations

12.7 Treatment

12.7.1 When to Operate and What Benefits to Expect

12.7.2 Surgery

12.7.2.1 Bilateral Neck Exploration (BNE)

12.7.2.2 Minimally Invasive Parathyroidectomy (MIP)

12.7.2.3 Intraoperative Techniques Aiding the Localization and Confirmation of Cure

12.7.3 Special Situations

References

13: Surgery of the Suprarenal Gland

13.1 Surgical Anatomy

13.1.1 Vascular Supply

13.1.2 Lymphatic Drainage

13.1.3 Innervation

13.2 Applied Physiology

13.2.1 Glucocorticoids

13.2.2 Mineralocorticoids

13.2.3 Adrenal Sex Steroids

13.2.4 Catecholamines

13.3 Cortical Tumors (Adenoma-Carcinoma)

13.3.1 Primary Hyperaldosteronism (Conn’s Syndrome)

13.3.2 Cushing’s Syndrome

13.3.3 Adrenocortical Cancer (ACC)

13.4 Pheochromocytoma

13.5 Incidentaloma

13.6 Bilateral Adrenalectomy

13.6.1 Technical Aspects of Adrenalectomy

References

14: Pancreatic Neuroendocrine Tumors

14.1 Introduction

14.2 Insulinoma

14.2.1 Historical and Epidemiological Aspects

14.2.2 Genetic Basis

14.2.3 Pathological Features

14.2.4 Pathophysiology and Clinical Features

14.2.5 Biochemical Diagnosis

14.2.6 Imaging Localization

14.2.7 Management

14.3 Gastrinoma

14.3.1 Historical and Epidemiological Aspects

14.3.2 Genetic Basis

14.3.3 Pathological Features

14.3.4 Pathophysiology and Clinical Features

14.3.5 Biochemical Diagnosis

14.3.6 Imaging Localization

14.3.7 Management

14.4 Glucagonoma

14.4.1 Historical and Epidemiological Aspects

14.4.2 Pathological Features

14.4.3 Pathophysiology and Clinical Features

14.4.4 Biochemical Diagnosis

14.4.5 Imaging Localization

14.4.6 Management

14.5 VIPoma

14.5.1 Historical and Epidemiological Aspects

14.5.2 Pathological Features

14.5.3 Pathophysiology and Clinical Features

14.5.4 Biochemical Diagnosis and Imaging Localization

14.6 Somatostatinoma

14.6.1 Historical and Epidemiological Aspects

14.6.2 Pathological Features

14.6.3 Pathophysiology and Clinical Features

14.6.4 Biochemical Diagnosis and Imaging Localization

14.6.5 Management

14.7 Nonfunctional Pancreatic NETs

References

15: Minimally Invasive Surgery in the Head and Neck

15.1 Introduction

15.2 Classification of Endoscopic Neck Surgery

15.2.1 Gasless Skin Lifting Methods

15.2.2 Carbon Dioxide (CO2) Insufflation Method

15.3 Benefits of Endoscopic Neck Surgery

15.4 Obstacles of Endoscopic Neck Surgery

15.5 Video-Assisted Neck Surgery (VANS)

15.5.1 Surgical Technique

15.5.2 Transcervical Approach

15.5.3 Infraclavicular Approach

15.6 Endoscopic Nodal Neck Dissection

15.7 Assessment of Minimally Invasive Neck Surgery

15.7.1 Operative Time

15.7.2 Blood Loss

15.7.3 Complications

15.8 Conclusions

An aparitie	19 Feb 2016
Autor	Mahmoud Sakr
Dimensiuni	178 x 254 x 31 mm
Editura	Springer
Format	Paperback
ISBN	9783319275307
Limba	Engleza
Nr pag	393