Post-thyroidectomy hypocalcemia: Impact on length of stay

July 20, 2015     Joe Grainger, FRCS; Mohammed Ahmed, MRCP; Rousseau Gama, FRCPath; Leonard Liew, FRCS; Harit Buch, FRCP; Ronald J. Cullen, FRCS


Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.

Nasal myiasis: A case report

July 20, 2015     Zrria L. White, MD; Michael W. Chu, MD; Richard J. Hood, MD


Nasal myiasis is a rare condition, with only a few reported cases and no treatment consensus. We propose a conservative treatment approach with saline irrigation and debridement. Two patients in the ICU of Norfolk General Hospital, a tertiary academic referral center, presented simultaneously with nasal myiasis. Both patients were negative for necrotic masses or tumors, and neither patient had any contributory medical comorbidities. Both patients were treated conservatively with a single dose of pyrantel pamoate, daily sinus irrigation with saline, and daily bedside endoscopic debridement. After 2 days, the nasal myiasis resolved, and both patients recovered without sequelae. We conclude that this conservative, nonsurgical approach to management is both safe and effective.

Introduction Human myiasis is often seen in the tropics and subtropics but is extremely rare in the Northern Hemisphere.1 Myiasis is a parasitic infestation of live human or vertebrate animal tissues by dipterous larvae of nonbiting flies, which feed on host tissues or fluids.1

Upper aerodigestive amyloidosis

July 20, 2015     Jaime Eaglin Moore, MD; Amanda Hu, MD; Al Hillel, MD

As the patient was asymptomatic, close observation and only laser excision were recommended if the patient's condition progressed.

Diplopia: An uncommon presentation of silent sinus syndrome

July 20, 2015     Juan Gomez, MD; David Liu, MD; Enrique Palacios, MD; Jeremy Nguyen, MD

The etiology of the disease is based on the primary predisposing factor, which is an obstruction of the ostiomeatal complex that results in hypoventilation of the maxillary sinus gases

A 53-year-old woman presented to our institution with a 2-month history of diplopia, followed by bouts of intermittent vertical diplopia that were more pronounced later in the day. She also reported drooping of her left eyelid, occasional gait instability, and headaches that were possibly indicative of myasthenia gravis.

Intratympanic membrane congenital cholesteatoma

July 20, 2015     Hiroshi Sakaida, MD, PhD; Kazuhiko Takeuchi, MD, PhD

Cholesteatoma should be differentiated from other conditions with similar otoscopic findings, such as myringosclerosis.

The ostium of the posterior ethmoid sinus seen in the superior meatus

July 20, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

The division of the anterior from the posterior ethmoid cells is determined by the basal lamella of the middle turbinate.

The ethmoid sinus is divided into two anatomic sections, the anterior and the posterior sections. The division of the anterior ethmoid cells from the posterior ethmoid cells is determined by the basal lamella of the middle turbinate. The anterior ethmoid cells drain into the middle meatus, and the posterior ethmoid cells usually drain into the...

Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report

July 20, 2015     Rajesh Babu Gollapalli, MBBS, MS(ENT), DORL; Ana Nusa Naiman, FRACS; David Merry, FRACS


Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

Oncocytic mucoepidermoid carcinoma of the parotid gland: A case report and review of the literature

July 20, 2015     Deepali Jain, MD; Nabeen C. Nayak, MD


Oncocytic metaplasia rarely has been reported in mucoepidermoid carcinomas. Most salivary gland lesions with oncocytic change are benign; therefore, it is important to distinguish mucoepidermoid carcinoma from other entities that may show prominent oncocytic change. We report a rare case of oncocytic mucoepidermoid carcinoma in a 65-year-old woman.

Two cases of thyroid rupture after blunt cervical trauma

July 20, 2015     Ji Hoon Shin, MD; Yong Bae Ji, MD; Jin Hyeok Jeong, MD; Seung Hwan Lee, MD; Kyung Tae, MD


The consequences of thyroid gland rupture following blunt cervical trauma can be quite grave. Almost all of these cases are associated with preexisting thyroid lesions; the traumatic rupture of a previously normal thyroid gland is very rare. Both surgical and nonsurgical management techniques have been advocated for thyroid injuries, but there is still no consensus on treatment. We report cases of thyroid gland rupture following blunt cervical trauma in 2 patients: a 24-year-old man with a previously normal thyroid and an 8-year-old boy with a preexisting thyroid nodule. The man was treated surgically and the boy was treated conservatively. Based on our experience with these cases and our review of the literature, we propose treatment guidelines for thyroid injuries.

Salivary gland adenoid cystic carcinoma

July 20, 2015     Lester D.R. Thompson, MD

Tumors are poorly circumscribed with an infiltrative border, including extracapsular extension beyond the salivary gland.

Adenoid cystic carcinoma (ACC) is a malignant epithelial salivary gland tumor with myoepithelial and ductal differentiation. Salivary gland tumors account for only about 5% of all head and neck carcinomas, with ACC the fourth most common salivary gland malignancy. ACC has a 3:2 female-to-male ratio. Patients tend to be adults, with a peak...
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