Monday, August 31, 2009

You will be viewing a online photo show of various radiological findings in otolaryngology.

Saturday, August 15, 2009

Total Laryngectomy

History credits Patrick Watson for having performed total Laryngectomy. This happened way back in 1866. Careful study of Patrick Watson’s description of the case has revealed that he performed a tracheostomy on a live patient and performed an autopsy Laryngectomy on the same patient. Ironically the patient died of syphilitic laryngitis. It was Billroth from Vienna who performed the first total Laryngectomy on a patient with growth larynx. This happened on December 31 1873.
Bottini of Turin documented a long surviving patient following total Laryngectomy (10 years).
Gluck critically evaluated total Laryngectomy patients and found that there were significantly high mortality rates (about 50%) during early post operative phases. This prompted him to perform total Laryngectomy in two stages. In the first stage he performed tracheal separation, followed by total Laryngectomy surgery two weeks later. This staging of procedure allowed for healing of tracheocutaneous fistula before the actual Laryngectomy procedure.
In 1890’s Sorenson one of the students of Gluck developed a single staged Laryngectomy procedure. He also envisaged the current popular incision Gluck Sorenson’s incision for total Laryngectomy.

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Tuesday, August 04, 2009

Role of ultrasound in recurrent thyroid disease

Number of patients undergo total thyroidectomy for malignant lesions of thyroid. Recurrences can be identified easily and accurately by performing ultrasound examination of the thyroid bed area in the neck. The widespread availability of ultrasound guided fine needle aspiration cytology has added to the diagnostic armamentorium. Even after performing total thryroidectomy, recurrences are common in thyroid malignancies.

Role of ultrasound neck in post operative evaluation of thyroid cancer patients:
1. To identify tumor recurrence
2. To perform fine needle aspiration cytology

Usually sonographic evaluation is performed in post thyroidectomy patients using a high frequency probe 10 - 15 MHz. Since thyroid is absent in these patients, a valuable landmark in the neck is lost to the sonologist. Moreover the normal anatomy is also distorted. Hence it is imperative that in the absence of thyroid tissue, imaging should be performed in two planes i.e. transverse and longitudinal. Any visible mass in the thyroid bed should be considered to be a recurrent mass unless proved otherwise.
In the postthyroidectomy patient, the carotid artery and jugular vien slide medially into the space previously occupied by thyroid gland. The right carotid artery ideally is pulled medially and lies immediatly adjacent to the trachea, whereas the left carotid is at the lateral edge of oesophagus.

Recurrence in thyroid bed is typically seen as:
1. Round and hypoechoic mass situated between carotid and trachea
2. May have well defined margins
3. Microcalcifications may be seen within the mass
4. Abnormal vascularity
5. Loss of normal echogenic hilum seen in normal lymph nodes

Abnormal internal jugular chain of nodes should be searched on both sides.