Nader M. Albsoul

Neck Dissection of Level IIb: Is it Really Necessary?

Objectives: To determine whether resection of level IIb is necessary in elective or therapeutic neck dissections.

Underlay mesh repair for spontaneous lumbar hernia.

INTRODUCTION Lumbar hernia is a rare condition with fewer than 300 cases reported in the literature. It arises through posterolateral abdominal wall defects, named the inferior triangle (Petit) and superior triangle (Grynfelt). It can be congenital or acquired, primary or secondary, peritoneal or extraperitoneal, reducible or complicated. PRESENTATION OF CASE We report a 63 year old female patient who presented to our hospital with a reducible right superior lumbar hernia. She underwent repair with underlay mesh after inversion of the sac and had a smooth postoperative course. DISCUSSION In contrast to the classical procedure the underlay mesh modification saved us from enlarging the defect, and was quick and associated with minimal tissue injury. CONCLUSION Underlay mesh repair for spontaneous lumbar hernia is feasible when the defect is small.

Salvage vertical partial laryngectomy for radiation failure in early glottic carcinoma.

Background:  Partial laryngectomy after failure of radiotherapy for early glottic cancer is an accepted surgical salvage procedure. However,there have been only a few studies on recurrent disease or long‐term survival.

Recurrent right sublingual ranula, concomitant with ipsilateral submandibular salivary gland aplasia

INTRODUCTION Oral ranula is a retention cyst that arises from the salivary gland with recurrence rate of up to 25% after complete excision of ranula and up to 2% in case of complete excision of ranula and sublingual gland. Major salivary gland aplasia is a rare finding that is usually associated with other developmental anomalies. PRESENTATION OF CASE We report a 15-year-old female patient presented with recurrent intraoral cystic swelling that was documented to be sublingual ranula. CT scan revealed also the absence of right submandibular salivary gland with persistence of its Whartons duct. This combination has never been reported previously. DISCUSSION The combination of recurrent sublingual ranula associated with aplasia of ipsilateral submandibular salivary gland and persistence of Whartons duct has never been reported before in the literature, a finding that may provide the base for future research. CONCLUSION Further research may prove similar associations between oral ranula and salivary gland aplasia, which may have clinical implications on diagnostic and management plan decisions.

A rare case of extracranial meningioma in parapharyngeal space presented as a neck mass

Background Meningiomas are the most common intracranial tumor, but rarely, they can develop extracranially, usually in the neck. There are very few cases of parapharyngeal meningioma reported in literature and little is known about their biological behavior and operative management. We present a patient with a primary parapharyngeal meningioma that presented as an anterior neck mass. Case presentation The patient is a 55-year-old female who presented with neck mass. A CT scan and MRI revealed a large, well defined, mildly enhancing soft tissue mass located in the right carotid sheath extended from the level of the thyroid gland into the skull base jugular foramen superiorly. Cervical exploration with partial excision of the mass was performed. Histological examination revealed meningiothelial cells with intranuclear inclusions, arranged in a syncytial pattern. Mutiple psamoma bodies these findings are consistent with the diagnosis of meningioma. Conclusion Extracranial meningiomas are quite rare. The diagnosis of these types of tumors is challenging due to the non specific nature of the symptoms. The anatomic complexity of the region of parapharyngeal space also makes their detection difficult. Imaging modalities can aid in the diagnosis, but pathological examinations are essential in confirming a definite diagnosis.

Wound infiltration with bupivacaine 0.5% with or without adrenaline does not decrease pain after thyroidectomy. A randomized controlled study

Objectives: To study the effect of local wound infiltration with and without adrenaline on pain perception after thyroidectomy using the visual analog score (VAS). Methods: A prospective randomized controlled double-blinded study was conducted between May 2015 and June 2016 at The University of Jordan Hospital, Amman, Jordan. Eighty-nine patients undergoing planned thyroidectomy were included in the study. Patients were divided randomly into 3 groups: Group A, local wound infiltration with bupivacaine 0.5% was administered; Group B, bupivacaine 0.5% with adrenaline was administered; Group C (control), no infiltration was performed. Standardized thyroidectomies were performed in the 3 groups. Pain perception was measured using VAS at 2, 4, 6, 12, and 24 hours after surgery. A comparison between the 3 groups was carried out. Results: No significant differences among the 3 groups were observed at all time points (p=0.246). Visual analog scores were significantly lower at 12 and 24 hours after operations. Conclusion: Local wound infiltration with bupivacaine 0.5% does not decrease pain perception after thyroidectomy performed under general anesthesia, and adding adrenaline does not enhance its effect.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement

Purpose To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Methods Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. Results During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). Conclusion This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Isolated Multiple Bilateral Thyroid Metastases from Prostatic Adenocarcinoma: Case Report and Literature Review

Solitary metastasis from prostate adenocarcinoma to thyroid gland is very rare and usually associated with other distal metastasis. This report describes for the first time isolated multiple bilateral thyroid metastasis from prostatic adenocarcinoma. A 67-year-old man who is known as a case of prostatic adenocarcinoma was admitted to a hospital as a case of a multinodular goiter on the basis of clinical and CT scan findings. Total thyroidectomy was performed and histopathology result showed adenomatous goiter containing bilateral metastatic prostatic adenocarcinoma. This is the first report of isolated multiple bilateral thyroid gland metastasis from prostatic adenocarcinoma without other distal metastasis. Such lesions are very rare and can be misdiagnosed, so high index of suspicion for thyroid metastasis should be always maintained in all oncology patients with isolated thyroid mass because early resection and thyroidectomy will change the prognosis for patient.