Setting: A tertiary care academic medical center. Patients: The study included 90 patients who underwent a hemithyroidectomy from 1999 to 2004. Main Outcome Measures: Hypothyroidism was defined as a serum thyrotropin level greater than 6.0 mIU/L at least 8 weeks after hemithyroidectomy. All patients were analyzed for age, sex, surgical indications, preoperative and postoperative thyrotropin levels, weight of resected specimen, final pathologic analysis, and length of followup. Multivariate analysis was performed to identify multiple risk factors for the development of hypothyroidism. Results: The final pathologic analysis demonstrated 49 follicular adenomas, 17 cases of Hashimoto thyroiditis, 10 multinodular goiters, and 14 other abnormalities. The overall incidence of the development of hypothyroid

Bilateral recurrent laryngeal nerve (RLN) paralysis after thyroidectomy is infrequent, but serious when it occurs. Intraoperative knowledge of the status of the nerve after dissection could potentially provide the surgeon with important decision-making information. The current study examines the sensitivity and specificity of intraoperative stimulation of the RLN during thyroid surgery for predicting postoperative RLN deficits. Eighty-one RLNs in 55 patients were identified to be at risk of injury during thyroidectomy or parathyroidectomy performed between January 1998 and February 2000. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator (Xomed, Jacksonville, Florida) set at 0.5 mA. Injury was assessed by palpating for a contraction of the posterior cricoarytenoid muscle while the stimulus was applied. Postoperative assessment of RLN integrity was determined by using indirect or direct laryngoscopy to visualize vocal fold mobility. Nine RLNs failed to elicit a posterior cricoarytenoid contraction after nerve stimulation, and 4 RLNs were determined to be deficient in the postoperative evaluation. The calculated sensitivity and specificity were 75% and 92.2% with a positive predictive value of 33.3% and negative predictive value of 98.6%. The RLN injury rate was 4.94%. We conclude that intraoperative RLN stimulation is a relatively safe and useful method of determining what RLN function will be after thyroid or parathyroid surgery.

The endoscopic management of ZD is a safe and effective technique. The endoscopic stapling technique appears to have an improved efficacy and safety when compared with the CO2 laser technique. The two techniques are compared and contrasted.

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Objective: To assess the role of positron emission tomography (PET) in the management of unknown primary carcinoma of the head and neck region. Design and Setting: Prospective case series at an academic medical center. Patients: Twenty-six patients with an open excisional biopsyorafine-needleaspirationbiopsyfindingthatconfirmed squamous cell carcinoma of the cervical lymph nodes and no visible primary tumor (as determined by results of a comprehensive physical examination and computed tomography and/or magnetic resonance imaging) underwent PET. The standard evaluation consisted of a comprehensive head andneckexaminationthatincludedfiberopticlaryngoscopy/ nasopharyngoscopy, computed tomography and/or magnetic resonance imaging, and PET followed by panendoscopy with selected biopsies and tonsillectomy. Main Outcome Measures: Sensitivity, specificity, and positive and negative predictive values of PET to detect an occult primary tumor. (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 131, JULY 2005 WWW.ARCHOTO.COM 626