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Thyroid surgery
Published in Pallavi Iyer, Herbert Chen, Thyroid and Parathyroid Disorders in Children, 2020
Jessica Fazendin, Brenessa Lindeman
A transverse curvilinear cervical incision is made 1–2 fingerbreadths above the sternal notch and at least 1 fingerbreadth below the cricoid cartilage. Every effort is made to limit the incision to 3–5 cm in length; however, this is dependent on the size of the gland and the extent of surgery to be performed. Care is taken to hide the incision within a natural crease within the skin. The incision is carried down through the skin, subcutaneous tissue, and platysma transversely, and skin flaps are raised superiorly and inferiorly in the sub-platysmal plane. Care is taken to separate the anterior jugular veins from the flaps, allowing them to remain lying on the strap muscles. The sternohyoid and sternothyroid muscles are then divided in the midline and the sternothyroid fibers lifted off of the thyroid parenchyma. At this point, if a nerve monitor is utilized, a signal from the vagus nerve can be obtained to test that the circuit is intact prior to initiation of dissection in the paratracheal space. As the paratracheal space is developed, the middle thyroid vein is routinely encountered, ligated, and divided (Figure 8.1).
Surgical Anatomy of the Thyroid
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Ashutosh Mangalgiri, Deven Mahore
Anterior jugular veins are paired veins running parallel upwards from the jugular venous arch. The midline avascular plane is identified between these anterior jugular veins. Usually the anterior jugular veins are paired but you may get single or multiple veins also. The anterior jugular veins are now exposed.
Acute airway assessment and management
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
In an emergency situation this is best performed via a vertical incision with a number 11 blade from the skin into the trachea. This vertical incision avoids damage to the anterior jugular veins and problematic bleeding.
Single versus dual venous anastomosis in radial forearm free flaps in head and neck reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2023
We also analyzed the relationship between venous compromise and recipient venous systems. The external jugular vein (EJV) system of the head and neck includes the anterior jugular vein and the EJV, while the internal jugular vein (IJV) system includes the tongue vein, the superior thyroid vein, the IJV, the anterior facial vein, the common facial vein and the concomitant venae of facial artery. When applying one vein anastomosis, the IJV system (N = 53) was more commonly used than the EJV system (N = 27). When two veins were used during the operation, attaching both the EJV and IJV systems was the most favored option (N = 161), followed by two IJV system veins (N = 10) and two EJV system veins (N = 2) (Figure 1). Venous compromise occurred the most when using one IJV system vein (N = 4, 7.5%), followed by one EJV system (N = 1, 3.7%), and both the EJV and IJV systems (N = 1, 0.6%). No venous compromise was observed when two IJV or EJV system veins were used. There was not a significant difference in the incidence of venous compromise between recipient venous systems (p=0.051).
Learning curve for radiofrequency ablation of benign thyroid nodules
Published in International Journal of Hyperthermia, 2021
Gilles Russ, Adrien Ben Hamou, Sylvain Poirée, Cécile Ghander, Fabrice Ménégaux, Laurence Leenhardt, Camille Buffet
All examinations were performed with an Esaote MyLab and a LA533 linear 3-13 MHz probe. All nodules were measured in three dimensions, at least twice and the volume was calculated by the following formula: d1xd2xd3xπ/6. In case of discrepancy between the two measures, the maximum volume was retained and this was applied to all subsequent examinations during follow-up. Nodules were subdivided into small to medium ones (≤30 ml) and large ones (>30 ml). The size cutoff of 30 ml was in accordance with what was suggested by Mauri et al. [21] and already applied by other authors [2]. All nodules were scored according to the EU-TIRADS classification [22]. The position of the vagus nerve, middle cervical sympathetic ganglion (if visible), anterior jugular vein(s) and the relation of the nodule and the theoretical location of the recurrent laryngeal nerve region (so-called ‘danger triangle’) were assessed. Vascularity was categorized by color flow Doppler and microvascular imaging (MicroV, Esaote) as absent, perinodular only, mild intranodular or intense intranodular. Stiffness was assessed with strain elastography as low, focally increased or diffusely increased.