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To establish the prevalence of hypocalcaemia following laryngectomy and demonstrate that total thyroidectomy is a risk factor.
A retrospective cohort study was conducted that included all patients who underwent total laryngectomy from 1st January 2006 to 1st August 2017. Exclusion criteria were: pre-operative calcium derangement, previous thyroid or parathyroid surgery, concurrent glossectomy, pharyngectomy, or oesophagectomy.
Ninety patients were included. Sixteen patients had early hypocalcaemia (18 per cent), seven had protracted hypocalcaemia (8 per cent) and six had permanent hypocalcaemia (10 per cent). Exact logistic regression values for hypocalcaemia following total thyroidectomy compared to other patients were: early hypocalcaemia, odds ratio = 15.5 (95 per cent confidence interval = 2.2–181.9; model p = 0.002); protracted hypocalcaemia, odds ratio = 13.3 (95 per cent confidence interval = 1.5–117.1; model p = 0.01); and permanent hypocalcaemia, odds ratio = 22.7 (95 per cent confidence interval = 1.9–376.5; model p = 0.005).
This is the largest study to investigate the prevalence of hypocalcaemia following laryngectomy and the first to include follow up of longer than three months. Total thyroidectomy significantly increased the risk of hypocalcaemia at all time frames and independent of other variables.
Oropharyngeal squamous cell carcinoma is thought to rarely metastasise to bone. This study hypothesised that in p16-positive disease there is a significant incidence of bony metastasis.
This was an ambispective cohort review. All patients with oropharyngeal squamous cell carcinoma diagnosed and treated at one centre were included.
A total of 180 consecutive patients were identified over 5 years. Fifteen patients were excluded because of lack of p16 status, none of whom had bony metastasis. The final analysis included 165 patients: 48 (29.09 per cent) in the p16-negative group and 117 (70.91 per cent) in the p16-positive group. Ten patients (8.55 per cent) in the p16-positive group developed bony metastasis, compared with zero in the p16-negative group; this difference was statistically significant (p = 0.036).
Expression of p16 was associated with an increased incidence in bony metastasis in this cohort. This is the first study to explore this specific question.
We present a case of bilateral chylothorax, a rare but life-threatening complication, which developed following a left-sided neck dissection.
Case report and literature review.
Chylous leakage fistula is a known complication following neck dissection and occurs in 1 to 2 per cent of patients. After left-sided neck dissection, chylothorax is uncommon and bilateral chylothorax is even rarer. Chylothorax is encountered following certain thoracic procedures, especially superior mediastinal dissection for thyroid cancer treatment. We discuss in detail the successful management of a complicated case.
We discuss various management options for this condition, and we summarise its successful management within our department.
In this case a secondarily infected pseudoaneurysm of the common carotid artery presented with clinical features suggestive of a parapharyngeal abscess. The causative organism was identified as community-acquired methicillin-resistant Staphylococcus aureus. To the authors’ knowledge this condition not previously been reported.
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