The transoral endoscopic thyroidectomy vestibular approach (TOETVA) can lead to abnormal sensorimotor changes in the lower lip and chin because of its incision design. This study aimed to explore the surgical outcomes of these changes after TOETVA. A total of 122 patients who underwent TOETVA were reviewed. The original incision design was used for the 39 patients in group A and a modified incision design was used for the 83 patients in group B. The sensorimotor changes in the lower lip and chin were compared. Varying degrees of paresthesia of the lower lip and chin (PoLC) were noted in all group A patients. Approximately 20.5% of group B patients did not suffer from PoLC, and the degree of PoLC in group B was significantly lower (P < 0.001). Abnormal motor function of the lower lip was noted for 23.1% of the patients in group A and 2.4% of those in group B. The incision design plays an important role in the morbidity of sensorimotor changes in the lower lip and chin. Our modified incision design seems minimally invasive and feasible for patients who undergo TOETVA.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Availability of data and material
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
Anuwong A (2016) Endoscopic thyroidectomy vestibular approach a series of the first 60 human cases. World J Surg 40:491–497
Dionigi G, Bacuzzi A, Lavazza M, Inversini D, Boni L, Rausei S, Kim HY, Anuwong A (2017) Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg 69:225–234
Zheng G, Ma C, Sun H, Wu G, Guo Y, Wu G, Zheng H (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
Bakkar S, Al Hyari M, Naghawi M, Corsini C, Miccoli P (2017) Transoral thyroidectomy: a viable surgical option with unprecedented complications—a case series. J Endocrinol Invest 41:809–813
Peng X, Li Z, Li H, Peng W, Zhou X, Song D, Zhou B, Lv C (2020) The clinical application of mental nerve dissection in transoral endoscopic thyroidectomy via an oral vestibular approach. Surg Endosc 34:153–158
Park JO, Sun DI (2017) Transoral endoscopic thyroidectomy our initial experience using a new endoscopic technique. Surg Endosc 31:5436–5443
Bian C, Liu H, Yao XY, Wu SP, Wu Y, Liu C, Huang TS (2018) Complete endoscopic radical resection of thyroid cancer via an oral vestibule approach. Oncol Lett 16:5599–5606
Zheng G, Xu J, Wu G, Ma C, Sun H, Ge M, Zheng H, Zheng C (2021) Transoral versus gasless transaxillary endoscopic thyroidectomy: a comparative study. Updates Surg. https://doi.org/10.1007/s13304-021-01062-y (Epub ahead of print)
Zhang D, Caruso E, Sun H, Anuwong A, Tufano R, Materazzi G, Dionigi G, Kim HY (2019) Classifying pain in transoral endoscopic thyroidectomy. J Endocrinol Invest 42:1345–1351
Zhang D, Famá F, Caruso E, Pinto G, Pontin A, Pino A, Mandolfino T, Gagliano E, Siniscalchi EN, De Ponte FS, Sun H, Dionigi G (2019) How to avoid and manage mental nerve injury in transoral thyroidectomy. Surg Technol Int 35:101–106
Zhang D, Fu Y, Dionigi G, Pontin A, Caruso E, Antonella P, Sun H (2020) Human cadaveric model for studying the preservation of mental nerve during transoral endoscopic thyroidectomy. Surg Radiol Anat 42:55–62
Zhang D, Fu Y, Zhou L, Wang T, Liang N, Zhang J, Xue G, Dionigi G, Sun H (2021) Pictorial essay of vestibular incision outcomes from transoral endoscopic thyroidectomy. Langenbecks Arch Surg. https://doi.org/10.1007/s00423-021-02124-w (Epub ahead of print)
Celik S, Makay O, Yoruk MD, Bayzit Kocer I, Ozdemir M, Kilic KD, Tomruk C, Bilge O, Uyanikgil Y, Dionigi G (2019) A surgical and anatomo-histological study on transoral endoscopic thyroidectomy vestibular approach (TOETVA). Surg Endosc 34:1088–1102
Chen Y, Chomsky-Higgins K, Nwaogu I, Seib CD, Gosnell JE, Shen WT, Duh QY, Suh I (2018) Hidden in plain sight: transoral and submental thyroidectomy as a compelling alternative to “Scarless” thyroidectomy. J Laparoendosc Adv Surg Tech A 28:1374–1377
Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim HY, Dionigi G, Richmon JD (2018) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 32:456–465
Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2017) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27
Kim HY, Chai YJ, Dionigi G, Anuwong A, Richmon JD (2018) Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 32:688–694
Russell JO, Clark J, Noureldine SI, Anuwong A, Al Khadem MG, Yub Kim H, Dhillon VK, Dionigi G, Tufano RP, Richmon JD (2017) Transoral thyroidectomy and parathyroidectomy—a North American series of robotic and endoscopic transoral approaches to the central neck. Oral Oncol 71:75–80
Chen HK, Chen CL, Wen KS, Lin YF, Lin KY, Uen YH (2017) Application of transoral continuous intraoperative neuromonitoring in natural orifice transluminal endoscopic surgery for thyroid disease a preliminary study. Surg Endosc 32:517–525
Nakajo A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Mori S, Ishigami S, Ueno S, Yoshinaka H, Natsugoe S (2013) Trans-oral video-assisted neck surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 27:1105–1110
Wilhelm T, Metzig A (2011) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35:543–551
Alsaad K, Lee TC, McCartan B (2013) An anatomical study of the cutaneous branches of the mental nerve. Int J Oral Maxillofac Surg 32:325–333
Zhang D, Park D, Sun H, Anuwong A, Tufano R, Kim HY, Dionigi G (2019) Indications, benefits and risks of transoral thyroidectomy. Best Pract Res Clin Endocrinol Metab 33:101280
We would like to thank Editage (http://www.editage.cn) for English language editing.
This work was funded by the Taishan Scholars Program of Shandong Province (No. ts20190991).
Conflict of interest
The authors have no financial or proprietary interests in any material discussed in this article.
Research involving Human Participants and/or animals
The authors declare under their responsibility that all the procedures followed in this study were in accordance with the ethical standards issued by the national health and family planning commission and with the Helsinki Declaration. The ethics committee of the affiliated Yantai Yuhuangding Hospital of Qingdao University approved this study (Approval No.: 2020-012). This article does not contain any studies with animals performed by any of the authors.
Consent to participate
Informed consents were obtained from all patients involved in this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Zheng, G., Wang, X., Wu, G. et al. The sensorimotor changes of the lower lip and chin after transoral endoscopic thyroidectomy vestibular approach. Updates Surg (2021). https://doi.org/10.1007/s13304-021-01133-0
- Vestibular incisions design
- Minimally invasive
- Mental nerve injury
- Abnormal sensorimotor function