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The transoral endoscopic thyroidectomy by vestibular approach (TOETVA) has been developed for early-stage thyroid cancer treatment as well as benign thyroid nodules worldwide including Viet Nam, with low rate of complications and excellent results. However, there has not been any comprehensive studies with a large number of patients and long-term follow-up in our country. Therefore, we conducted this study to evaluate the results of treatment by TOETVA for benign and malignant lesions of thyroid gland in Viet Nam. A prospective study was performed on 326 eligible patients who underwent TOETVA due to thyroid cancer and benign thyroid nodules in Department of Oncology and Palliative Care, Hanoi Medical University Hospital from July 2018 to April 2021. The clinical, surgical, and pathological characteristics, postoperative complications, and visual analog scale (VAS, 0–10 cm) score in day 1, 4, and 7 after surgery, long-term oncological and surgical outcomes were recorded. The mean age was 36.9 ± 9.8 years. 231 patients (70.9%) were diagnosed with differentiated cancer and 95 patients (29.1%) were diagnosed benign tumors of thyroid gland. In the cancer group, 12 patients (5.2%) undergone TOETVA had T3b-intraoperative-stage diagnosis, 219 patients (92.2%) were diagnosed T1 according to AJCC 8th. After 1 month of surgery, among thyroid cancer patients, there was no abnormality reported by thyroid scintigraphy and neck ultrasound as well as in unstimulated-Tg and anti-Tg values. The mean number lymph-node dissected in the cancer group was 6.1 ± 4.1 (range 0–21 nodes). However, only 2.6 ± 1.8 metastasis nodes were discovered (range 1–8 nodes), and the maximum size of these nodes was less than 2 mm. 81 patients presented occult lymph-node metastasis among thyroid cancer patients with cN0 stage (account for 35%). The occult lymph-node metastasis was 34.2% and 50% in patients diagnosed with T1 and T3b groups, respectively. The median postoperative hospital stay was 5.4 ± 0.7 days. Postoperatively, transient hypoparathyroidism was recorded in 12 patients (4.8%), transient hoarse was noted in 9 patients (3.6%), and numb chin was identified in 7 patients (2.8%). No permanent complication was noted. VAS score on first postoperative day was 4.5 ± 0.8. Median follow-up time was 12 (3–25) months. No recurrence was recorded. TOETVA is an innovative and revolutionary technique in the treatment of benign thyroid nodules, as well as early-stage differentiated thyroid cancer. The results of oncology, postoperative complications, and satisfied outcomes supported the wide application of TOETVA in Viet Nam.

Background: The transoral endoscopic thyroidectomy by vestibular approach (TOETVA) has been developed for thyroid microcarcinoma (TMC) treatment worldwide, with low rate of complications and excell...

Multiple osteolytic lesions are usually associated with bone metastasis. However, brown tumor should also be included in the differential diagnosis. Brown tumor is a rare benign lesions in skeletal system, encountered in patients with uncontrolled primary or secondary hyperparathyroidism. In our case report, we present a 35 - year - old female with multifocal brown tumor that difficultiy in differential diagnosis of metastasis of malignant parathyroid. Additionally, the treatment and follow up after parathyroidectomy are also emphasized. Methods The SCARE 2020 Guideline [ 1 ]

PURPOSE To evaluate a screening tool for identifying which patients admitted to the oncology ward of a Vietnamese hospital should be referred to specialist palliative care (PC). METHODS We performed a cross-sectional survey of consecutive patients hospitalized in the Department of Oncology and Palliative Care at Hanoi Medical University Hospital between June 2019 and September 2019. We translated a validated 11-item screening tool into Vietnamese and used a total score of ≥ 5 as a positive screen. RESULTS One hundred participants were recruited. Forty-four patients (44%) screened positive. Of these, 37 (84%) had locally advanced or metastatic disease, 31 (70%) had uncontrolled symptoms, and 43 (98%) requested a PC consultation. A score ≥ 5 was significantly more common in patients with stage IV disease versus earlier stage, performance status of Eastern Cooperative Oncology Group (ECOG) 2 versus ECOG 0, and when life-limiting complications of cancer were present. Screening identified four patients overlooked by oncologists as needing referral, and 34% of patients requesting a referral had scores < 5. CONCLUSION This screening tool provided oncologists with easy-to-use criteria for referring patients for PC. At the same time, it relieved the work load for under-resourced PC physicians by screening out requests with low-level need. This tool should be part of routine assessment on admission in all oncology units in Vietnam.

Highlights • The temporo-mandibular joint chondrosarcoma is extremely rare, and can be misdiagnosed as parotid gland tumor. • Surgery is standard treatment with the aim of preserving the temporo-mandibular joint function. • Adjuvant radiation is used in certain cases to improve local control., Introduction Chondrosarcoma is a malignant tumor originated from cartilage cells. The most common sites of chondrosarcoma are pelvis, femur and ribs. The temporo-mandibular joint (TMJ) chondrosarcoma is extremely rare, with approximately 30 cases reported in worldwide. Presentation of case In this report, we present a case of chondrosarcoma in the left TMJ, which was successfully treated with surgery and radiation therapy. A 47 year-old women was admitted to our hospital with a mass in left pre-auricular region. On examination and para-clinical test results, the initial diagnosis was parotid gland cancer. In operation, the lesion was a mass originating from the left TMJ. Tumor resection was performed with close margin. The post-operative pathological result was well-differentiated chondrosarcoma. She was indicated adjuvant radiation therapy due to inadequate surgical therapy. There was no evidence of recurrence after 6 months follow-up. Conclusion The TMJ chondrosarcoma is needed to distinguish from other diseases especially parotid gland tumor. Surgery and adjuvant radiation therapy are standard care with the aim of preserving joint function.

Mucoepidermoid carcinomas (MECs) are generally found in salivary gland, but they have also been mentioned in other organs such as the larynx, esophagus, breast. MECs are considered to be a low-grade carcinoma and their occurrence in the thyroid is extremely rare. We present a 54-year-old male patient admitted to our clinic, complaining about having back pains for approximately three months. A lumbosacral spine MRI and a PET/CT scan revealed multiple lesions in the L4, L5, S1 vertebra bodies, sacral bone and left pelvis bone, suggesting of a metastatic disease. The result of thyroid FNA was carcinoma and a biopsy of the vertebra bone confirmed the presence of a metastatic carcinoma. A total thyroidectomy and level VI neck dissection was conducted followed by palliative external beam radiotherapy (30 Gy) to the vertebra bodies, sacral bone and left pelvis bone. In pathological studies, the diagnosis of thyroid mucoepidermoid carcinoma was confirmed. Six months after treatment, the patient died due to severe pain and fatigue caused by the disease. Here, we report a rare case with bone metastasis as the first symptom of MEC and a brief review of published literature on the subject.

Highlights • Total nasal defect after chemoradiation was complex and difficult to rebuild. • The surgery was divided into 3 stages with each stage to prepare for the next stage. • With the multiple facial unit defects, reconstruction is based on aesthetic unit. • After using multiple local flaps to reconstruct the defect, the result was improved., Introduction Nasal-type extranodal natural killer (NK)/T-cell lymphomas are a rare type of clinical condition. Reconstruction of the complex nasal defect after chemoradiation is extremely challenging for plastic surgeons. Presentation of case Here we present the case of a 56-year old female with the condition of a nasal-type NK/T-cell lymphoma which had caused complex nasal disfigurement. The patient had undergone chemoradiotherapy. Lesions after treatment were present all over the nasal defect (nasal septum, mucosa, support frame and skin) and the left cheek medial subunit. The surgery was subdivided into 3 stages. First, we removed the infectious tissue and restored the wall of nasal cavity by the left forehead – scalp flap. Second, we used the pedicle of the left forehead flap to rebuild the nasal mucosa defect, the rotational flap to rebuild the cheek defect, and the right forehead flap to recovered skin defect of the nose. Finally, we divided the pedicle of right forehead flap. Discussion The complex nasal defect is difficult to reconstruct and has a higher risk of failure in patient who received chemoradiotherapy. It is crucial to choose the right materials and have a confident plan in order to achieve successful results for the sake of the patient. Conclusion Our case report shows that the nasal defect caused by a nasal-type NK/T-cell lymphoma is complex. After our 3 stages plan for the surgery, as well as using multiple flaps for reconstruction from the forehead skin, the result was significant reduction in the disfiguration of the patient’s nose.

Highlights • Giant thyroid tumors are associated with compressive symptoms and surgery is necessary for treatment. • Surgery is primary treatment to quickly relieve compression symptoms. • The risk of surgical complications is higher as well as the duration of operation is longer than small thyroid tumor., Introduction Giant thyroid tumors can be associated with severely compressive symptoms and surgery is inevitable for treatment strategy. However, the risk of surgical complications is higher as well as the duration of operation may be longer than those of small thyroid tumors. Presentation of cases Two patients with large neck tumors were admitted with history of thyroid goiters for more than 10 years. Recently, the patients have complained of worsening compressive symptoms including dyspnea and dysphagia. Imaging work-up indicated a deviation and compression of trachea. Both patients underwent either lobectomy or thyroidectomy and were discharged without any complications. Final histological results were thyroid adenoma in both cases. Conclusion Surgical management is considered as primary treatment for most patients with giant thyroid tumors. It is necessary to be aware of complications and careful dissection to archive a good outcome.

Background The transoral endoscopic vestibular approach (TOETVA) for thyroidectomy is gaining popularity (Russell et al. in Thyroid 28(7):825-829, 2018; Le et al. in Surg Laparosc Endosc Percutan Tech 30(3):209-213, 2020; Liao et al. in Laryngoscope 130(6):1603-1608, 2020). TOETVA has been utilized successfully in performing thyroidectomy, parathyroidectomy, and neck dissection, via both endoscopic and robotic techniques (Razavi et al. in Head Neck 40(10):2246-2253, 2018; Otolaryngol Head Neck Surg 159(4):625-629, 2018; Ngo et al. in J ENT, 2020. https://doi.org/10.1177/0145561320943358 ; Ann Surg Oncol 28(5):2766, 2021). In this video, we show bilateral central neck dissection via transoral approach in papillary thyroid carcinoma. Patient and methods A 37-year-old female with no significant medical history was diagnosed pT3bN0M0 intraoperatively with the tumor having slightly invaded the strap muscle. Thus, we decided to perform total thyroidectomy with bilateral central neck dissection via transoral approach. Methods Prelaryngeal dissection: in the prelaryngeal compartment, soft tissue containing these lymph nodes was intimately associated with the pyramidal lobe. Right paratracheal dissection: fibrofatty tissue was dissected off the prevertebral fascia and the trachea with preservation of right parathyroid glands. Pretracheal lymph nodes were removed with paratracheal dissection. Left paratracheal dissection: the lymphatic tissue was then dissected off the prevertebral and esophageal musculature and the trachea after identifying the left parathyroid glands. Finally, bilateral central neck dissection was finished with preservation of the nerve and parathyroid glands. Results The operation was completed successfully without conversion to open surgery. The operative time for central neck dissection was 20 min. There were nine harvested lymph nodes in the central compartments, while there were two metastatic lymph nodes of papillary thyroid carcinoma with 3 × 3 mm maximal dimension. There were no major postoperative complications. Conclusion Central neck dissection via TOETVA is a safe and feasible method in selected patients.

Introduction. Tracheal invasion in thyroid cancer occurs in one-third of locally advanced cases and is the third most common site of infiltration following strap muscles and recurrent laryngeal nerves. Surgical resection plays an important role in the management strategy followed by either radioactive iodine or external beam radiotherapy. Nonetheless, there has been still controversy about the optimal extension of the surgery. Case Presentation. Total thyroidectomy, airway resection and bilateral neck dissection were performed in two cases diagnosed as advanced thyroid cancer with tracheal invasion (stage IV according to McCaffrey). The first case underwent partial tracheal resection and direct anastomosis by the V-shape technique, while the latter one required tracheal resection and permanent tracheotomy. After one-year follow-up, no evidence of tumor recurrence or any postoperative complications were found. Conclusion. Surgical resection still remains the mainstay of management for advanced thyroid cancer in general and for tracheal invasion cases in particular. The decision of surgical resection and tracheal reconstruction methods mostly depends on the extent of tracheal invasion.

Introduction: Recently, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has widely been applied thanks to its promising advantages.1–4 Nevertheless, from our prospectiv...

Objectives: The objective of this study was to report the feasibility and safety of a novel 4-trocar approach for transoral endoscopic thyroidectomy via the vestibular. Methods: In this study, we first used 4 trocars via vestibular area to perform transoral endoscopic thyroidectomy. We reported the safety and surgical feasibility of transoral endoscopic thyroidectomy using a 4-trocar technique in our institute from February 1, 2020, to May 10, 2020. Results: Transoral endoscopic thyroidectomy via the vestibular approach using 4 trocars was carried out in 5 patients. No complications such as bleeding, mental nerve injury, recurrent laryngeal nerve injury, or hypoparathyroidism were reported. All patients were completely satisfied with the cosmetic results. Conclusions: Transoral endoscopic thyroidectomy with 4 trocars via vestibular approach is an effective and feasible method. Markedly, this technique can assist surgeons to expose and preserve both parathyroid glands and recurrent laryngeal nerve easily when performing transoral endoscopic thyroidectomy.

Background: Various approaches for endoscopic thyroidectomy have been developed recently that improve the cosmetic outcome, and some are even scar free. In this study, we compared the safety and su...

Highlights • Many risk factors including age, sex, chronic exposure to solar radiation, tobacco, alcohol consumption, viral factors autoimmune diseases and using immunosuppressant drugs are associated with developing lip cancer. • Treatment with tumor excision, lymph node dissection and reconstruction by local flap is primary treatment for patients with lower lip cancer. • Bilateral V-Y advancement flap can be utilized in the reconstruction of lip cancer in case of large defect, as well as guarantee safety and adequate cosmetic and function for low-income patients., Introduction Squamous cell carcinoma (SCC) of lower lip comprises over 25% of oral cancer. Surgical treatment plan for SCC patients includes tumor excision, lymph node dissection and reconstruction. Case presentation A 68-year-old patient was admitted with 1-year history of tumor in his lower lip. Examination revealed a large lower lip tumor with expansion to the upper lip and a 2 cm submental lymph node. Biopsy result of the tumor was SCC and fine needle aspiration result of the lymph node was metastasis SCC. He underwent a complete removal of the lower lip and 1/3 external of the upper lip plus dissection of bilateral cervical lymph node plus reconstruction with local flap. After a 4-hour operation and 14-day hospitalization, patient recovered with flap in excellent condition and without any complications. Conclusion Treatment with tumor excision, lymph node dissection and reconstruction by local flap is primary treatment for patients with lower lip cancer. Choice of reconstruction method depends on various factors, whereas V-Y advancement flap presents dominant advantage in lower lip cancer treatment.

Highlights • Endoscopic thyroidectomy is a favorable approach to treat patients with benign nodules and Grave’s disease. • There are direct (cervical-anterior or lateral) and extracervical endoscopic procedures to have the thyroid exposed. • TOETVA is an excellent choice for select patients requiring thyroid surgery who desire to avoid a neck incision., Introduction Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a promising procedure with many advantages such as truly scar free healing, minimally invasive dissection, and accessible approach to both thyroid lobes. Presentation of case A female patient aged 19 presented with a benign thyroid nodule 2 cm in size for a year and the patient decided to proceed with surgery. The operation with a left subtotal thyroidectomy performed by the TOETVA technique was indicated. The surgery was implemented in 110 min, the patient was discharged after three days of postoperative care without any complication except for a mild seroma and swelling in the anterior neck which resolved completely within 10 days. Discussion Endoscopic thyroidectomy is a favorable approach to treat patients with benign nodules, Grave’s disease and thyroid cancer which has 1–2 cm cancer nodule without extrathyroid extension. There are direct (cervical-anterior or lateral) and extracervical endoscopic procedures to have the thyroid exposed but multiple small scars remain. However, TOETVA is an excellent choice for select patients requiring thyroid surgery who desire to avoid a neck incision. Conclusion TOETVA with the potential for scar-free surgery is a safe and effective procedure which provides good cosmetic outcome. The long operative time of this approach will be shortened with experience.

Environmental exposure to dioxins, consumption of a high fat diet, and platelet-derived growth factor receptor β signaling in the brain affect feeding behavior, which is an important determinant of body growth. In the present study, we investigated the effects of prenatal exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin and high fact diet after weaning on body growth and expression of platelet-derived growth factor receptor β in the brain in rat pups. Subjects from the control and dioxin exposure groups were assigned to 1 of 3 different diet groups: standard diet, high fat diet in the juvenile period, or high fat diet in adulthood. Body weight gain rate in the juvenile high fat diet group and the length gain rate in the adult high fat diet group were greater than the corresponding values in the standard diet group only in male offspring, although the effects of dioxin exposure on growth were not significant. Consumption of a high fat diet decreased platelet-derived growth factor receptor β levels in the amygdala and hippocampus in both sexes compared to control groups, while 2,3,7,8-tetrachlorodibenzo-p-dioxin decreased platelet-derived growth factor receptor platelet-derived growth factor receptor β levels in the amygdala and striatum only in females receiving an high fat diet. Furthermore, platelet-derived growth factor receptor β levels in the hippocampus and platelet-derived growth factor receptor β striatum were inversely correlated with increases in body length, while changes in platelet-derived growth factor receptor β in the amygdala and nucleus accumbens were significantly correlated to body weight gain or body mass index. In conclusion, these findings suggest that these 2,3,7,8-tetrachlorodibenzo-p-dioxin and high fat diet-induced changes in body growth and feeding behaviors might be partially mediated by changes in brain platelet-derived growth factor receptor β levels.

Tumors of the parapharyngeal space (PPS) are rare, accounting for less than 1% of all head and neck neoplasms, of which 70–80% are benign and 20–30% are malignant. The main treatment for this condition is surgical excision of the mass via a transcervical or transparotid-transcervical approach, or via a mandibilotomy in the case of large extensive tumors. We report the case of a 57-year-old male with a very large PPS tumor, 102 × 85 × 80 mm in size, and with a 14-month history of breathing difficulty and dysphagia. The clinical manifestations included a mass in the oropharynx, a neck mass and Eustachian tube obstruction. Endoscopy showed a bulging, in the left parapharyngeal space, extending into the oropharynx, and causing a noticeable obstruction of the respiratory tract. The patient was operated on with a minimal invasive transcervical approach, and not via mandibulotomy, which was a challenging technique. This approach allowed us to avoid the complications and significant side effects such as infection, temporomandibular joint dysfunction, non-union of tissues, plate extrusion, and tooth loss that is often associated to mandibulotomy. Histological examination revealed a pleomorphic adenoma from a deep lobe of the parotid. In conclusion, surgery is the mainstay of treatment for tumors of the parapharyngeal space. Here, we describe the removal of a large parapharyngeal pleomorphic adenoma transcervically with a minimally invasive approach without mandibulotomy.

BACKGROUND Recently, transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) has become popular worldwide.1-3 After controlling for the technique, the authors used the transoral endoscopic approach to modified radical neck dissection (MRND) for papillary thyroid carcinoma with clinically positive lymph nodes in the lateral compartments. To the best of their knowledge, the authors report the first case of TOETVA for MRND. PATIENT A 27-year-old woman had a diagnosis of cT1aN1bM0 right papillary thyroid carcinoma (metastatic to a small right level 4 lymph node). Therefore, total thyroidectomy, bilateral central neck dissection, and MRND of right levels 2, 3, and 4 were performed via the transoral endoscopic approach. METHODS Total thyroidectomy and bilateral central lymph node dissections were performed based on the three-trocar Anuwong technique.4 Then, the fourth incision was made near the sixth teeth in the right oral vestibular area for insertion of the fourth 5-mm trocar, which was used to expose the lateral lymph compartment and to perform right MRND easily. RESULTS The operation was completed successfully without conversion to open surgery. The total operative time was 170 min, and the operating time for MRND was 55 min. The numbers of harvested lymph nodes were 7 and 8 in the central and right lateral compartments, respectively. The numbers of metastatic lymph nodes were 2 and 1 in the central and lateral compartments, respectively. No major postoperative complications occurred. CONCLUSION Transoral endoscopic MRND of levels 2, 3, and 4 can be feasible and safe for highly selected patients.

Introduction Prophylactic central neck node dissection (CND) for pediatric patients with papillary thyroid cancer (PTC) is still controversial. We aimed to identify the incidence and the predictive parameters of the central lymph node metastasis (CLN) in pediatric patients with cN0 PTC. Methods This retrospective study had included 32 pediatric patients with cN0 PTC who underwent total thyroidectomy and prophylactic CND from 2015 to 2019. Results The proportion of CLN metastasis was 75.0%. Univariate logistic regression demonstrated that CLN metastasis was associated with age (≤15 years; p = 0.028), tumour size > 1 cm (p = 0.008), multifocality (p = 0.028) and external extension (p = 0.041) Multivariate logistic regression revealed that age (≤15 years), multifocality, tumour size (>1 cm) and external extension were independent risk factors of CLN metastasis in pediatric patients. Conclusions In summary, central lymph node metastasis occurred in 75% of cN0 pediatric patient and were more common in larger tumour size (>1 cm), multifocal tumours, extrathyroidal extension, and younger age.

Highlights • NRLN is a rare clinically relevant structure. • All four patients with the non-recurrent laryngeal nerve on the right side and arteria lusoria were performed thyroidectomy. • There are 2 types of NRLN in terms of its origin., Introduction The non-recurrent laryngeal nerve (NRLN), which is found in 0.25–0.99 of the patients who undergo thyroid surgery, is a rare embryologically-derived variant of the recurrent laryngeal nerve (RLN). Identification and prevention of injury to the laryngeal nerve is one of the main issues in thyroid surgery; thus, thyroid surgeons should have adequate knowledge of all anatomical variations of the RLN. Presentation of cases All four patients with the non-recurrent laryngeal nerve on the right side were performed thyroidectomy and discharged without any complications. During the procedure the surgeons found that the right laryngeal nerve was not recurrent and originated directly from the vagus nerve. Moreover, the right subclavian artery of these patients arose directly from the aortic arch. Discussion NRLN can be easily damaged during surgery and its presence is closely related to subclavian artery anomaly. There are 2 types of NRLN in terms of its origin, nonetheless, in all variations of the NRLN and RLN, the nerve travels to the larynx at the level of cricothyroid joint, close to berry ligament. Conclusion The NRLN is a rare, but clinically relevant structure and is associated to an increased risk in iatrogenic injury. Thorough anatomical knowledge and cautious dissection are essential to identify variants of RLN in order to minimize the risk of injury to the patient. Additionally, in embryological terms, the presence of NRLN is closely related to subclavian artery anomaly.