The use of robot-assisted transaxillary surgery (RATS) for the management of thyroid nodes is increasing. It has the advantage of the absence of scar, but specific complications such as injury to the brachial plexus, and risk of thyroid cells seeding along the transaxillary approach. We report the second case of benign thyroid cells seeding along the transaxillary approach and the first mimicking malignant spreading on imaging. The patient was treated for a 20 mm right follicular adenoma by RATS. Eight years later, she presented with multiple subcutaneous nodules in the supraclavicular, axillary, pectoral areas, and in the right thyroid compartment, with internal jugular vein and sternocleidomastoid muscle invasion on CT-scan. The patient was treated by open surgery. Histologically, benign thyroid tissue displacement within muscular and connective tissues was identified in all masses. Considering the multiple disseminated lesions, adjuvant treatment by radioactive iodine ablation was recommended. Surgeons performing RATS should be aware that thyroid cell seeding may occur even with benign nodes and lead to the need of secondary open surgery with scars.
Key points: (no abstract required) • Cochlear implant effectiveness in
asymmetric hearing loss and single-sided deafness is well established,
but rarely covered by health care systems. • Continuation of wearing the
implant beyond the first year could be considered as an indirect
indicator of subjective benefit. • Percentage of cochlear implant
abandon at 5-years post-implantation was very low in patients with
asymmetric hearing loss and single-sided deafness. • High education
level, low audibility and good unaided speech perceptions scores of the
contralateral acoustic-hearing ear were positive prognostic factors of
CI use. • The low percentage of non-users is an additional strong
argument to recommend cochlear implantation in patients with asymmetric
hearing loss and single-sided deafness, on the ear with a profound
hearing loss, especially in case of frail contralateral acoustic-hearing
ear.
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