Ulrich Wirth

Traumatische Schilddrüsenruptur: Fallbericht und Literaturübersicht

BACKGROUND Traumatic rupture of the thyroid gland is rare. A common approach does not exist. Surgical and nonsurgical management have been advocated. METHOD This work summarizes the publications in PubMed including an own case. This study will analyse the accident mechanism, the underlying thyroid pathologies, possible pathogenetic mechanisms of airway obstruction and the therapeutic options. A present classification is revised in order to develop it into a treatment proposal. RESULTS A total of 34 case reports were analysed. The first half had to be performed a surgery on, the other half was observed without surgical treatment. None of the patients died of his injury. 59% of the patients, that had to be performed a surgery on had thyroid pathology before rupture. 50% of all patients had a road accident as a cause for the rupture. CONCLUSION The revised classification and treatment proposal developed here presents a clinically-viable approach.ZusammenfassungHintergrundTraumatische Rupturen der Schilddrüse sind eine Seltenheit. Ein einheitliches therapeutisches Vorgehen gibt es nicht. Es liegen konservative und operative Behandlungstrategien vor.MethodeDiese Arbeit beschreibt den Fall einer Schilddrüsenruptur unter Berücksichtigung der aktuellen Literatur. Anschließend wird der aktuelle Fall in die Datenlage eingearbeitet. Eine vorliegende Klassifikation wird überarbeitet, um daraus einen Behandlungsvorschlag zu entwickeln.ErgebnisseInsgesamt sind bisher 34 beschriebene Schilddrüsenrupturen veröffentlicht, die je zur Hälfte operiert oder konservativ überwacht wurden. Keiner der Patienten verstarb an seiner Verletzung. Bei 59 % der Fälle lag eine Schilddrüsenpathologie vor. Die Ursache von 17 der beschriebenen Rupturen war ein Verkehrsunfall.SchlussfolgerungDie überarbeitete Klassifikation und der hier entwickelte Behandlungsvorschlag stellt einen klinisch-praktikablen Ansatz vor.SummaryBackgroundTraumatic rupture of the thyroid gland is rare. A common approach does not exist. Surgical and nonsurgical management have been advocated.MethodThis work summarizes the publications in PubMed including an own case. This study will analyse the accident mechanism, the underlying thyroid pathologies, possible pathogenetic mechanisms of airway obstruction and the therapeutic options. A present classification is revised in order to develop it into a treatment proposal.ResultsA total of 34 case reports were analysed. The first half had to be performed a surgery on, the other half was observed without surgical treatment. None of the patients died of his injury. 59 % of the patients, that had to be performed a surgery on had thyroid pathology before rupture. 50 % of all patients had a road accident as a cause for the rupture.ConclusionThe revised classification and treatment proposal developed here presents a clinically-viable approach.

Invisible scar endoscopic thyroid surgery by the dorsal approach: importance of the spinal accessory nerve

PurposeWith about 100,000 surgeries per year in Germany, thyroid operations count among the most common procedures performed in general and endocrine visceral surgery. Twentieth century technological development gives the opportunity to perform thyroid surgery without leaving visible scar like conventional approaches do. This study is part of the work on the videoendoscopic retro-auricular access to the thyroid gland using the EndoCATS method by Schardey and Schopf. To avoid possible complications with the spinal accessory nerve (SAN), like irritation or injury of the nerve as happened during a feasibility study, a systematic study of the surgical anatomy at the nerve’s entry to the posterior cervical triangle is performed especially in relation to the EndoCATS operation method.MethodsSixty-one neck regions in fifty-three specimens were examined at the anatomical institute of Munich to investigate the course of the SAN relative to the anatomic landmarks tip of mastoid bone, sternal notch, and posterior border of the sternocleidomastoid muscle together with the SAN’s course variants at its entry to the posterior cervical triangle. The results were then statistically analyzed.ResultsFrom this analysis, we derived a simple method to predict the course of the SAN preoperatively and offer a new approach to protect the SAN during EndoCATS surgery. Additionally, we found a significant difference of the SAN’s course between male and female specimens.ConclusionThe EndoCATS method can be a safe alternative to conventional thyroid surgery, but the SAN is at risk during the surgery procedure. Here we give feasible solutions to eliminate the SAN-problem performing EndoCATS thyroid surgery.

New insights into the pathophysiology of postoperative hemorrhage in thyroid surgery: An experimental study in a porcine model

Background: Postoperative cervical hemorrhage is a rare but life‐threatening complication that can cause severe morbidity. Different mechanisms leading to asphyxia have been described based only on clinical observation. Methods: We performed a series of in vivo animal studies simulating post‐thyroidectomy hemorrhage and its effect on respiratory drive. Three series of tests were carried out in 12 German domestic pigs under general anesthesia. The pigs were breathing spontaneously with secured airways. An additional series using functional magnetic resonance imaging of the pigs’ brainstem was also conducted. Results: The first experimental series carried out on 2 animals revealed an obvious difference between the effects of cervical hemorrhage and external bleeding with development of hemorrhagic shock. An experimental setting for the repeated simulation of cervical hemorrhage was established. A pressure‐dependent mechanism was discovered that led to apnea in every animal despite the secured airway. In 8 of 10 animals, relief of cervical pressure led to complete respiratory recovery. The test was repeated up to 6 times per pig. Apnea was induced in 25 of 25 test procedures (100%) and was followed by respiratory recovery in 22 of 25 tests (88%). The threshold pressure at which the respiratory rate started to decrease was 47 ± 14 Torr when blood was used to increase the cervical compartment pressure. When silicone oil was used in a further experimental series, the threshold pressure was similar at 44 ± 21 Torr. The cervical compartment pressure needed to induce apnea was 74 ± 18 Torr using blood and 74 ± 39 Torr using silicone oil, both of which exceeded the mean arterial pressure by 28 Torr during apnea. Functional magnetic resonance imaging revealed a decrease in brainstem activity during phases of increased cervical compartment pressure, which suggests a possible role for cerebral vascular perfusion. Conclusion: Respiratory drive can be suppressed by increased pressure in the cervical compartment, possibly because of a pressure‐dependent impairment in cerebral perfusion through a form of cervical compartment phenomenon or, less likely, a pressure‐dependent reflex (nervous) mechanism.

Traumatische Schilddrüsenruptur: Fallbericht und Literaturübersicht@@@Traumatic thyroid rupture: case report and review of the literature

BACKGROUND Traumatic rupture of the thyroid gland is rare. A common approach does not exist. Surgical and nonsurgical management have been advocated. METHOD This work summarizes the publications in PubMed including an own case. This study will analyse the accident mechanism, the underlying thyroid pathologies, possible pathogenetic mechanisms of airway obstruction and the therapeutic options. A present classification is revised in order to develop it into a treatment proposal. RESULTS A total of 34 case reports were analysed. The first half had to be performed a surgery on, the other half was observed without surgical treatment. None of the patients died of his injury. 59% of the patients, that had to be performed a surgery on had thyroid pathology before rupture. 50% of all patients had a road accident as a cause for the rupture. CONCLUSION The revised classification and treatment proposal developed here presents a clinically-viable approach.ZusammenfassungHintergrundTraumatische Rupturen der Schilddrüse sind eine Seltenheit. Ein einheitliches therapeutisches Vorgehen gibt es nicht. Es liegen konservative und operative Behandlungstrategien vor.MethodeDiese Arbeit beschreibt den Fall einer Schilddrüsenruptur unter Berücksichtigung der aktuellen Literatur. Anschließend wird der aktuelle Fall in die Datenlage eingearbeitet. Eine vorliegende Klassifikation wird überarbeitet, um daraus einen Behandlungsvorschlag zu entwickeln.ErgebnisseInsgesamt sind bisher 34 beschriebene Schilddrüsenrupturen veröffentlicht, die je zur Hälfte operiert oder konservativ überwacht wurden. Keiner der Patienten verstarb an seiner Verletzung. Bei 59 % der Fälle lag eine Schilddrüsenpathologie vor. Die Ursache von 17 der beschriebenen Rupturen war ein Verkehrsunfall.SchlussfolgerungDie überarbeitete Klassifikation und der hier entwickelte Behandlungsvorschlag stellt einen klinisch-praktikablen Ansatz vor.SummaryBackgroundTraumatic rupture of the thyroid gland is rare. A common approach does not exist. Surgical and nonsurgical management have been advocated.MethodThis work summarizes the publications in PubMed including an own case. This study will analyse the accident mechanism, the underlying thyroid pathologies, possible pathogenetic mechanisms of airway obstruction and the therapeutic options. A present classification is revised in order to develop it into a treatment proposal.ResultsA total of 34 case reports were analysed. The first half had to be performed a surgery on, the other half was observed without surgical treatment. None of the patients died of his injury. 59 % of the patients, that had to be performed a surgery on had thyroid pathology before rupture. 50 % of all patients had a road accident as a cause for the rupture.ConclusionThe revised classification and treatment proposal developed here presents a clinically-viable approach.