To maintain the nasal dorsal sidewall unit, superior, central dorsal, and nasal sidewall defects have traditionally been reconstructed using a variety of techniques, including skin grafts and regional flaps, such as glabellar flaps and frontal flaps. We demonstrate that creation of the nasal dorsal sidewall unit is often not necessary, and excellent results can be achieved through the expanded use of cheek advancement flaps.
Background
In this paper, we present three cases where a novel transoral robotic surgery (TORS) approach was used to resect clival chordomas extending into the nasopharynx to demonstrate progress in the evolution of robotic surgery of the head and neck.
Methods
The first patient had a history of metastatic chordoma resection and presented with trismus and dysphagia; the second and third patients had first presentation with nasal congestion and facial numbness, respectively. All patients underwent a novel transpalatal‐TORS resection.
Results
Total resection was achieved in the first patient and near‐total resections were achieved in the second and third patients. All patients had minimal postoperative morbidity and no patients experienced significant adverse events.
Conclusion
Clival chordomas are rare, potentially dangerous lesions with a high rate of recurrence. The novel transpalatal‐TORS approach to these tumors presented in this series represents advancement in the realm of minimally invasive surgery of the head and neck. This approach offers patients total or near‐total control of these lesions with minimal intraoperative and postoperative side effects.
Objective
In this article, we present a series of 28 patients who underwent thyroid surgery using local anesthesia. We describe our technique, report outcomes, and assess how well the procedure was tolerated from a patient perspective.
Methods
Three surgeons performed awake thyroidectomies and recorded data, including the patient's age and gender, surgery being performed, operative time, weight of the surgical specimen, quantity and type of local anesthetic used, additional medications, patient‐reported pain assessment, and any complications.
Results
Twenty‐seven of 28 patients (96%) successfully underwent awake thyroidectomy. One patient had to be converted to general anesthesia due to airway concerns. There were no complications; however, one patient had a panic attack. Based on a 0 to 10 scaled pain score, the average amount of pain reported was 3.4. The amount of pain the patient reported was significantly dependent on the amount of experience the operating surgeon had with this technique. Seventy‐one percent of patients tolerated surgery with local anesthesia only and did not require additional medications.
Conclusion
Awake thyroidectomy is a well‐tolerated and safe procedure in appropriately selected patients, with many potential benefits over general anesthesia. In most cases, only local anesthesia is required. Increased experience with this technique may be associated with increased patient comfort.
Level of Evidence
4
Laryngoscope, 130:685–690, 2020
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