外科學教學課件：Cervical Disease

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1、Anatomy of the neckThyroid enlargementThyroid carcinomaClinical manifestations,pathological typing and treatment of thyroid carcinoma.Differential diagnosis and treatment of thyroid tumors.Complications of thyroid surgery.On either side of the tracheaLateral to the ligament of Berry Entering the lar

2、ynxRight side:separating from the vagus when crossing the subclavian arteryLeft side:separating from the vagus when traversing over the arch of the aortaAnomalous variations in the course of the right recurrent laryngeal nerve.A,A nonrecurrent laryngeal nerve arises from the vagus.B,The normal cours

3、e of the recurrent laryngeal nerve arises from the vagus after it passes beneath the subclavian artery.C,The unusual nonrecurrent nerve and recurrent laryngeal nerve join to form a common distal nerve.separated from the vagus nervetwo branches:The larger internal branch -sensory function and it inne

4、rvates the larynx.The smaller external branch -the cricothyroid muscle喉上神經喉上神經Four main arteries,two superior and two inferior:The superior thyroid arteryThe inferior thyroid arteryThree pairs of venous systems drain the thyroid.Simple goiter(euthyroid):Diffuse hyperplastic/Multinodular goiterToxicN

5、eoplastic:Benign/MalignantInflammatory:Autoimmune/Granulomatous/Fibrosing/InfectiveOtherEndemic GoiterThyroiditis HyperthyroidismEtiology 1/3 of the worlds population,specifically in underdeveloped countries.Cause Iodine deficiency diffuse goiternodular goiter Acute Suppurative ThyroiditisSubacute T

6、hyroiditisDe Quervain s thyroiditis)Chronic thyroiditisHashimotos thyroiditisRiedels thyroiditis(struma)A cause of hypothyroidism in adult Immune complex and complement An exacerbation of immune response.An infiltration of lymphocytesTSH-blocking antibodies.A hypothyroid clinical stateGraves disease

7、 toxic nodular goiter toxic thyroid adenoma Most hyperthyroid states are caused by Graves disease(diffuse toxic goiter).Physical examinationIncreased hyper metabolic stateCardiovascular stressGastrointestinal signPsychiatric signsGenital disordersHematopoietical modificationExtrathyroid Presentation

8、vitiligopretibial myxoedemadigital hippocratismeophtalmopathyT3L,T4L,TSHAnti-thyroglobuline antibody Anti-microsomal antibody Anti-TSH-recepter immunoglobulineAn extensive historyPhysical examination Signs and symptoms of thyrotoxicosis Thyroid function tests Antithyroid medication Radioiodine ablat

9、ionSurgery ORL exam and general examAntithyroid medicationThe lugosThe beta-blockage Benign:Follicular adenoma Malignant:Papillary Follicular Medullary Anaplastic Lymphoma Clinical manifestationTreatmentAhmedin Jemal,Cancer Statistics,2010,CA CANCER J CLIN 2010;60:277-300.Solitary painless massesDys

10、phagiaCervical tendernessPainful neck massSuperior vena cava syndrome(extremely rare)UltrasoundScintigraphy CTLMRIFNAT1 Limited to thyroid,2cm or less T2 Limited to thyroid,2cm but 4cm T4 Extending beyond capsule,any size N0 No regional node metastases N1 Regional node metastases M0 No metastases M1

11、 Metastases present Under 45 years Over 45 years Any T,any N,M0 T1,N0,M0 Any T,any N,M1 T2/3,N0,M0 T4,N0,M0 or any T,N1,M0 Any T,any N,M1 Under 45 yearsOver 45 yearsM1N1N0T1T2T3T4IIIIIIIVM1M0T1T2T3T4IIIIIIIVThe main treatment:surgical ablation.Epidemic the most common of the thyroid neoplasms and us

12、ually associated with an excellent prognosis Second category of well-differentiated thyroid cancersFollicular,and mixed papillaryfollicular cancers(90%of all thyroid cancers)A malignant neoplasm of the thyroid epithelium Solitary painless massThe coexistence of lymph node involvement(extremely rare)

13、Cervical adenopathy(rare)Primarily surgical.Thyroid lobectomy and Isthmectomy 2 cm,(4 cm,the risk for cancer 50%)Lymph node dissection Radioiodine treatment 5%to 10%of thyroid malignancies A biological marker,Calcitonin Presentation:a palpable mass an elevated calcitonin level Single and unilateral

14、MCT:a mass and an elevated calcitonin level Detailed and in-depth family history Signs and symptoms Screening for pheochromocytoma with 24-hour urinary catecholamines Less than 1%of all thyroid malignancies Most aggressive form of thyroid cancer Typical presentations:dysphagiacervical tendernesspain

15、ful neck masssuperior vena cava syndrome Most reports with resection are not optimistic.less than one third of them are resectablechemotherapy adds little to the overall prognosis Prognosis is badBleeding Recurrent laryngeal nerve injurySuperior laryngeal nerve injuryHypoparathyroidismeThyrotoxic stormInfection Hypothyroidism Thank you