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Multimodal Assessments of Altered Sensation after Transoral Endoscopic Thyroidectomy

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Abstract

Background

Transoral endoscopic thyroidectomy, a novel technique, uses oral vestibule as the entry point and leaves no scar on the body surface. However, because the incisions are close to the mental nerve, nerve damage and the associated sensory impairment are concerning. Herein, we evaluated sensory alteration after transoral endoscopic thyroidectomy and determined factors associated with the prolonged sensory alteration.

Methods

Patients who underwent transoral endoscopic thyroidectomy were enrolled. Sensation over the lower lip, chin, and neck was evaluated before and after the surgery. A self-assessment questionnaire, Semmes–Weinstein monofilament test, and two-point discrimination test were used to subjectively and objectively evaluate sensory changes.

Results

Fifty-one patients were enrolled; most of them reported altered sensation, with chin (72.5%) being the most common site, followed by lower lip (52.9%), upper neck (33.3%), and lower neck (5.9%) on postoperative day 2. The sensory disturbance resolved within 3 months. Factors associated with prolonged sensory alteration are male sex and old age. Fourteen patients (27.5%) experienced mild drooling from the mouth, which was usually self-limiting in 1 month. Sensory impairments in light touch pressure threshold and two-point discrimination were significant in the chin and neck on postoperative day 2 and at 1 week. The ability to discern two-point was also compromised in the lower lip on postoperative day 2. All these significant changes normalized to preoperative baseline at 1 month.

Conclusions

There was an altered sensation after transoral endoscopic thyroidectomy with the most common and disturbed in the chin. Sensory impairment was usually transient and recovered in 3 months.

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References

  1. Anuwong A, Sasanakietkul T, Jitpratoom P et al (2018) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 32:456–465

    Article  Google Scholar 

  2. Anuwong A, Ketwong K, Jitpratoom P et al (2018) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27

    Article  Google Scholar 

  3. Zhang D, Park D, Sun H et al (2019) Indications benefits and risks of transoral thyroidectomy. Best Pract Res Clin Endocrinol Metab 33:101280

    Article  Google Scholar 

  4. Zhang D, Fama F, Caruso E et al (2019) How to avoid and manage mental nerve injury in transoral thyroidectomy. Surg Technol Int 35:101–106

    CAS  PubMed  Google Scholar 

  5. Cohen O, Tufano RP, Anuwong A et al (2021) Transoral endoscopic vestibular approach for thyroidectomy and parathyroidectomy - From promise to practice. Am J Otolaryngol 42:103022

    Article  Google Scholar 

  6. Park D, Kim HY, Kim HK et al (2020) Institutional experience of 200 consecutive papillary thyroid carcinoma patients in transoral robotic thyroidectomy surgeries. Head Neck 42:2106–2114

    Article  Google Scholar 

  7. Chen YH, Kim HY, Anuwong A et al (2020) Transoral robotic thyroidectomy versus transoral endoscopic thyroidectomy: a propensity-score-matched analysis of surgical outcomes. Surg Endosc. https://doi.org/10.1007/s00464-020-08114-1

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chai YJ, Chae S, Oh MY et al (2021) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): Surgical outcomes and learning curve. J Clin Med 10(4):863

    Article  Google Scholar 

  9. Zheng G, Ma C, Sun H et al (2021) Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: a two-centre study. Eur J Surg Oncol 47:1346–1351

    Article  Google Scholar 

  10. Fernandez-Ranvier G, Meknat A, Guevara D et al (2020) Transoral endoscopic thyroidectomy vestibular approach: a single-institution experience of the first 50 cases. Surg Innov 27:439–444

    Article  Google Scholar 

  11. Karakas E, Klein G, Schopf S (2020) Transoral thyroid surgery vestibular approach: does size matter anymore? J Endocrinol Invest 43:615–622

    Article  CAS  Google Scholar 

  12. Fernandez Ranvier G, Meknat A, Guevara DE et al (2020) International multi-institutional experience with the transoral endoscopic thyroidectomy vestibular approach. J Laparoendosc Adv Surg Tech A 30:278–283

    Article  Google Scholar 

  13. Russell JO, Razavi CR, Shaear M et al (2021) Transoral thyroidectomy: safety and outcomes of 200 consecutive North American cases. World J Surg 45:774–781

    Article  Google Scholar 

  14. Fu J, Luo Y, Chen Q et al (2018) Transoral endoscopic thyroidectomy: review of 81 cases in a single institute. J Laparoendosc Adv Surg Tech A 28:286–291

    Article  Google Scholar 

  15. Yeh YT, Chen JY, Kuo PC et al (2020) Printing a three-dimensional patient-specific safety device for reducing the potential risk of mental nerve injury during transoral thyroidectomy. World J Surg 44:371–377

    Article  Google Scholar 

  16. Peng X, Li Z, Li H et al (2020) The clinical application of mental nerve dissection in transoral endoscopic thyroidectomy via an oral vestibular approach. Surg Endosc 34:153–158

    Article  Google Scholar 

  17. Tae K, Lee DW, Bang HS et al (2020) Sensory change in the chin and neck after transoral thyroidectomy: prospective study of mental nerve injury. Head Neck 42:3111–3117

    Article  Google Scholar 

  18. Liang TJ, Tsai CY, Chen IS (2020) Foley balloon facilitates creation of working space in transoral thyroidectomy. World J Surg 44:1514–1517

    Article  Google Scholar 

  19. Liang TJ, Wang NY, Tsai CY et al (2021) Outcome comparison between endoscopic transoral and bilateral axillo-breast approach thyroidectomy performed by a single surgeon. World J Surg 45:1779–1784

    Article  Google Scholar 

  20. Kim SJ, Lee KE, Myong JP et al (2013) Prospective study of sensation in anterior chest areas before and after a bilateral axillo-breast approach for endoscopic/robotic thyroid surgery. World J Surg 37:1147–1153

    Article  Google Scholar 

  21. Vriens JP, van der Glas HW (2009) Extension of normal values on sensory function for facial areas using clinical tests on touch and two-point discrimination. Int J Oral Maxillofac Surg 38:1154–1158

    Article  CAS  Google Scholar 

  22. Essick GK, Phillips C, Turvey TA et al (2007) Facial altered sensation and sensory impairment after orthognathic surgery. Int J Oral Maxillofac Surg 36:577–582

    Article  CAS  Google Scholar 

  23. Zhang D, Fu Y, Dionigi G et al (2020) Human cadaveric model for studying the preservation of mental nerve during transoral endoscopic thyroidectomy. Surg Radiol Anat 42:55–62

    Article  CAS  Google Scholar 

  24. King SD, Arellano R, Gordon V et al (2020) Anatomic variations from 120 mental nerve dissections: lessons for transoral thyroidectomy. J Surg Res 256:543–548

    Article  Google Scholar 

  25. Zhang D, Li S, Dionigi G et al (2020) Consequences of trocar dynamics on mental nerve in transoral thyroidectomy. Surg Laparosc Endosc Percutan Tech 30:305–311

    Article  Google Scholar 

  26. Bakkar S, Al Hyari M, Naghawi M et al (2018) Transoral thyroidectomy: a viable surgical option with unprecedented complications-a case series. J Endocrinol Invest 41:809–813

    Article  CAS  Google Scholar 

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Author notes

  1. Tsung-Jung Liang and Kuo-Chiang Wang Have contributed equally to this work

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan

    Tsung-Jung Liang, Kuo-Chiang Wang, Shiuh-Inn Liu, I.-Shu Chen & Nai-Yu Wang

  2. School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan

    Tsung-Jung Liang & Shiuh-Inn Liu

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  1. Tsung-Jung Liang
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  2. Kuo-Chiang Wang
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  3. Shiuh-Inn Liu
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  4. I.-Shu Chen
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  5. Nai-Yu Wang
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Correspondence to Nai-Yu Wang.

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Liang, TJ., Wang, KC., Liu, SI. et al. Multimodal Assessments of Altered Sensation after Transoral Endoscopic Thyroidectomy. World J Surg 46, 600–609 (2022). https://doi.org/10.1007/s00268-021-06356-1

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  • DOI: https://doi.org/10.1007/s00268-021-06356-1

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