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Thyroid Lobectomy

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  • Unilateral toxic nodule.
  • Solitary adenoma or cyst.

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Total Thyroidectomy

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  • Thyroid carcinoma.
  • Graves' disease.
  • Hashimoto thyroiditis.
  • Multinodular goiter.
  • Substernal goiter.

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Neck Dissection

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  • Locally advanced head and neck carcinoma demonstrated by presence of nodal disease clinically, by preoperative imaging, or by sentinel node biopsy.

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  • Few contraindications exist for thyroidectomy or neck dissection.

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Absolute (Neck Dissection)

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  • Randomly scattered dermal metastases precluding a full-thickness dissection.
  • Intracranial extension of tumor from the neck.
  • Tumor fixation to the skull base or the cervical spine.

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Relative (Neck Dissection)

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  • Tumor fixation to the internal carotid artery.
  • Locally advanced disease in the root of the neck.
  • Periosteal invasion of the skull base.

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  • The patient should be supine.
  • Airway management is of particular concern. Preoperative anesthesiology consultation should alleviate positioning concerns while ensuring proper airway safety during the procedure.
  • A towel roll can be placed beneath the shoulder blades to facilitate neck extension.
  • Arms may be tucked.

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  • For benign thyroid disease, thyroid hormone replacement is initiated if total thyroidectomy has been performed.
  • For malignant disease, thyroid hormone replacement is deferred until after postoperative radioactive iodine scan.
  • Postoperative calcium levels are monitored and calcium replacement is given empirically.
  • Pain control should be initiated with intravenous agents initially; once swallowing is adequate, the patient can be transitioned to oral narcotics.
  • Diet should be advanced progressively.
  • Drains should be inspected for lymphatic leak, and patients instructed on drain care.
  • Drains should be removed once output decreases to 30 mL or less per day.

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  • Nerve injury: spinal accessory nerve; recurrent laryngeal nerve injury (if central neck dissection is included in the procedure); brachial plexus.
  • Vascular injury: internal jugular vein; carotid artery causing neck hematoma, which could potentially progress to airway compromise.
  • Thoracic duct injury leading to lymphatic leak, possibly requiring operative intervention and thoracic duct ligation.
  • Tracheal injury.
  • Esophageal injury.
  • Local disease recurrence.

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