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Mediastinal goiters
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Yamil Castillo Beauchamp, Ashok R. Shaha
The main complications are related to recurrent laryngeal nerve injury, generally less than 1%, which is low, but may be higher than the incidence in nonsubsternal thyroidectomies. Important consideration should be given intraoperatively to localization of the parathyroid glands and careful preservation. As mentioned above, parathyroid autotransplantation may be necessary if the parathyroids are rendered avascular. Postoperative hematoma is a well-known complication and occurs in approximately 3% of the patients. Other complications, such as pneumothorax and pneumonia, are quite rare. Tracheomalacia may be the result of long-standing tracheal compression by the goiter; however, it appears to be an overstated condition. In his review of substernal goiters, White et al. [28] published an incidence ranging from 0% to 10%, depending on the varying definitions of tracheomalacia. True tracheomalacia with disintegration of the tracheal rings is quite rare [40, 41]. A majority of the time—even with considerable deviation and compression of the trachea—the cartilage and rings of the trachea generally are intact, and in most cases, the trachea returns to an almost normal position within 24–48 hours of surgery. If the trachea appears to be weak, a trachelopexy may occasionally be performed by suturing the tracheal wall to the surrounding musculature or sternal periosteum. Techniques such as support with silastic rings or a Gortex graft are well described in the literature. However, the clinical experience is limited to only a few patients. Most of the time, the patients may be left intubated for 24–48 hours and extubated under close observation without any major problems related to tracheomalacia. Cattel and Hare [41] noted that compression of tracheal rings was rapidly reversed after removal of substernal goiters, but deviation of the trachea took months to return. Airway obstruction is more likely from kinking of an elongated trachea or injury on intubation. In rare instances (reported from 0%–4%), a patient may require temporary tracheostomy. A long-standing (5 years) history of tracheal compression has been reported to predict the possible need for tracheostomy.
Impact of preoperative antibiotic use in preventing complications of cochlear implantation surgery
Published in Cochlear Implants International, 2022
A. Košec, J. Živko, S. Marković, V. Bedeković, M. Ries, J. Ajduk
Four patients developed transient facial palsy which resolved spontaneously. Two additional patients who developed postoperative hematoma were successfully treated with needle aspiration and compression without the need for revision surgery.