Isolated Middle-Third Clavicle Fracture Causing Horner's Syndrome: A Case Report and Literature Review

Lin, Chia‐Yu; Chang, Hao-Wei; Chang, Yu-Hsuan; Lin, I-Hao; Huang, Hung‐Yu; Chang, Cheng-Hsien; Chen, Hsien‐Te; Chen, Yiwen; Lin, Tsung-Li; Hsu, Chin‐Jung

doi:10.3389/fsurg.2021.640900

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…Unusual traumatic entities have been reported. For instance, we mention a case from 2021 concerning a middle-third clavicle fracture which is the most frequent type of fracture of this bone that, yet, exceptionally complicates with HS [ 17 ]. Also, tumours (like osteocondroma), traumas or surgical interventions at the level of first rib might cause the condition [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid–related HS represents an unusual entity underling thyroid nodules/goiter/cancer–HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2–6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.

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Section: Introductionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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Horner syndrome after thyroid-related surgery: a review

Tang

Yin

Yang

et al. 2022

Langenbecks Arch Surg

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A 70-year-old man with a drooping eyelid and distended chest veins

Tyagi,

Kishore,

Chakraborty

et al. 2024

Chest Dis Rep

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Horner’s Syndrome and central venous obstruction are usually seen in patients with superior sulcus tumour, and their presence, especially in elderly patients, is alarming. Benign causes of Horner’s Syndrome and central venous obstruction are rare but well-documented in the literature. A combination of both occurring due to clavicular trauma is extremely rare. We report a case of an elderly male with clavicular trauma who presented with Horner’s Syndrome and central venous obstruction. He was managed conservatively and had a complete resolution of symptoms. This case highlights that even “red flag” clinical signs may represent relatively innocuous etiology, and thorough evaluation is essential before reaching a diagnosis.

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Isolated Middle-Third Clavicle Fracture Causing Horner's Syndrome: A Case Report and Literature Review

Cited by 3 publications

References 22 publications

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Horner syndrome after thyroid-related surgery: a review

A 70-year-old man with a drooping eyelid and distended chest veins

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