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PubMed2006

Limb deficiency and prosthetic management. 1. Decision making in prosthetic prescription and management.

UNLABELLED: This self-directed learning module highlights decision making in prosthetic management in pediatric and adult patients. This chapter reviews classification of congenital limb deficiency and management of congenital pediatric upper-extremity amputees. Differences in management of amputees of various ages from infancy to old age is discussed. Case examples are used to formulate prosthetic prescriptions for transradial limb deficiency as well as knee disarticulation and transtibial level amputations. Common prosthetic gait deviations and anticipated functional levels are evaluated. OVERALL ARTICLE OBJECTIVE: To discuss prosthetic prescription and management in congenital limb deficiency and acquired amputations for patients of various ages.

Adult↗
PubMed2006

Initial biomechanical properties of staple-anchor Achilles tendon allograft and interference screw bone-patellar tendon-bone autograft fixation for anterior cruciate ligament reconstruction in a cadaveric model.

PURPOSE: Anterior cruciate ligament (ACL) reconstruction is a common procedure that has a fairly high success rate. Despite such success, controversy exists with regard to fixation and graft type. The purpose of this study was to quantify the maximum load to failure for staple-anchor freeze-dried Achilles tendon allograft fixation compared with interference screw bone-pattelar tendon-bone autograft fixation at the time of insertion for ACL reconstruction. METHODS: Eleven pairs of cadaveric knees were prepared for ACL reconstruction by disarticulation before graft insertion. The tibia and femur were mounted separately onto an MTS machine and were loaded to failure in line with the tunnels. Femoral fixation for the allograft was provided by a staple anchor; tibial fixation was provided by a suture anchor. Titanium interference screws on the femoral and tibial sides provided autograft fixation. A paired t test was performed to compare mechanical testing results in the 2 groups. RESULTS: Mean maximum load to failure for the allograft was 58.7 N (range, 32.3 to 92.6 N) and 119.6 N (range, 82 to 165.9 N) for the femur and the tibia, respectively, compared with 228.2 N (range, 74.2 to 352 N) and 232.9 N (range, 65.1 to 553.1 N) for the autografts. This difference was statistically significant (P < .001) for femoral fixation, but it was not statistically significant for tibial fixation (P = .186). CONCLUSIONS: Soft tissue Achilles tendon allograft with staple fixation is a significantly weaker fixation construct when compared with autograft bone-patellar tendon-bone with interference screw fixation. CLINICAL RELEVANCE: This study shows significantly weaker fixation in the staple-alograft construct and yet this construct has had at least equivalent results over a 5-year time frame, indicating that rigid femoral fixation may not be a critical factor in long-term results.

Achilles Tendon↗
PubMed2004

Comparative effects of monopolar radiofrequency energy and conservative management of mechanical properties of elongated lateral collateral ligament in rabbits: an experimental study.

OBJECTIVE: We examined the biomechanical effects of shrinkage in elongated rabbit lateral collateral ligament. DESIGN: This study was designed in an attempt to evaluate the energy effects of monopolar radiofrequency on strained but not ruptured ligaments. BACKGROUND: In treatment of ligament injuries difficulty in reducing increased laxity after trauma and recurrence of instability are important factors for failure. METHODS: Ligament elongation and laxity were achieved in operating room by applying varus stress for multiple times. In Group C ( n = 8 ), elongated lateral collateral ligaments were treated only with above-knee cast, while in Group S ( n = 8 ), they were treated with shrinkage and above-knee casts. The un-operated sides were labeled as control groups. At the 12th week after surgery the animals were sacrificed and hind limbs were disarticulated. Removing the other soft tissues around knee, only lateral collateral ligaments were left intact. Biomechanical analyses of the effects of two different treatment methods were compared by performing a pulling-out test. RESULTS: Considering maximum load and stiffness, conservatively treated ligaments were stronger and stiffer than shrunken ligaments ( P < 0.05 ). CONCLUSION: Biomechanical values were altered by both treatment methods. Reflecting an alteration in intra-molecular structure, the main alteration was the decrease of strength in shrunken ligaments. In ligament injuries, we concluded shrinkage not to be superior to conservative treatment.

Animals↗
PubMed2004

Disability can be avoided after open fractures in Africa-results from Malawi.

UNLABELLED: In a free-at source hospital in Malawi, East Africa, 55 open fractures were treated within a 3-year period. The majority (33/55) involved fractures of the lower leg. The treatment regimen contained the following: primary external fixation; scheduled sequential debridement; immediate coverage of any bone devoid of periosteum using local muscle or fasciocutaneous flaps, alternatively limb shortening; no skin closure; controlled secondary healing under moist dressings; dynamisation and/or removal of the external fixator followed by functional treatment (Sarmiento and Latta) as soon as the soft tissues permitted. The first 34 consecutive cases were monitored from the time of treatment; 24 of them attended for clinical review at 36 (+/-16) weeks after injury. Only 72% (13/22) patients had reached the hospital within 24h after sustaining the fracture; 80% (18/22) had developed a septic wound infection, which healed in all cases after 20 weeks. At the time of follow-up, recovery of function was found in 20 (80%) of the injured extremities. Only three patients (12%) remained disabled due to the open fracture, one other patient died during treatment from tuberculosis secondary to AIDS and one patient required knee disarticulation. CONCLUSION: If the biological principles guiding the contemporary treatment of open fractures in the first world are respected, results under third world conditions do not differ as much as the differences in setting might suggest. The application of recent advances of global knowledge in trauma surgery into methods of treatment appropriate to the health care systems of highly resource constraint countries remains a rewarding task for modern trauma surgeons and their scientific community.

Developing Countries↗
PubMed2006

Skeletal changes after experimentally displaced condylar process fracture in growing rats.

INTRODUCTION: Fractures of the mandibular condyle are common. A potential for growth disturbances in young individuals has been reported; however, there are few experiments studying such consequences. Skeletal changes after fracture of the condyle in the growing period were analysed in this study. MATERIAL: Fifty young Wistar rats weighing 100g were used. Under general anaesthesia unilateral fracture dislocations of the condylar process were induced surgically in the experimental group (n=25), while only surgical access was performed in the sham-operated group. The animals were sacrificed at 3 months of age. The mandibles were disarticulated, and radiographs were taken (axial skulls and lateral hemimandibles). Cephalometric evaluations were made using a computer system. Statistical tests were applied between groups and contralateral sides in each group. RESULTS: There were atrophy and degenerative change of the fractured condylar process. There was also a significant difference in the height of the mandibular body and in the length of anterior and posterior maxilla. CONCLUSION: It was concluded that an experimental fracture of the mandibular condyle during the growing period in rats induced degenerative changes of the condyle as well as an asymmetry of the mandible, affecting height of the body, also leading to consequences in the maxilla.

Animals↗
PubMed2005

Evidence of early butchery of giant lemurs in Madagascar.

We report here definitive evidence of butchery, most probably associated with hunting, of giant extinct lemurs by early human settlers in Madagascar. Specimens of Palaeopropithecus ingens and Pachylemur insignis from two sites in southwestern Madagascar, Taolambiby and Tsirave, show classic signs of butchering. We compared these to the bones (also from Taolambiby) of butchered Propithecus verreauxi, a lemur still living in the region. The characteristics of the tool-induced extinct-lemur bone alterations (sharp cuts and chop marks near joints, oblique cuts along the shafts, spiral fractures, and percussion striae) suggest skinning, disarticulation, and filleting. Conclusive evidence of megafaunal modification by humans in Madagascar was limited previously to a few hippo and elephant bird bones and one extinct aye-aye tooth. New evidence comes not from archaeological sites, but from specimens collected in the early 1900s, without stratigraphic records, at "subfossil" sites (i.e., sites renowned for their late Pleistocene or Holocene fossils, often lacking human artifacts). Whereas these are hardly the most ideal samples for analysis of this kind, careful scrutiny of the characteristics of the cut marks has allowed us to document butchery beyond any reasonable doubt. One bone with definitive cut marks has been dated to the very earliest part of the human period in Madagascar. Continued, careful research on the bones in subfossil collections is warranted.

Animals↗
PubMed2006

Anatomy of the coronoid process.

PURPOSE: Coronoid injuries are classified according to the size of the coronoid fracture. The purpose of this study was to provide a detailed anatomic description of the coronoid process, with specific focus on the coronoid height, the coronoid width, and the olecranon-coronoid angle. METHODS: Thirty-five cadaveric arms were dissected. All soft tissue was removed and the ulna was disarticulated from the humerus, radius, and the carpal bones. A 3-dimensional digitizing system was used to locate 19 anatomic landmarks on each specimen. By using the 3-dimensional coordinates of the landmarks, the coronoid heights, proximal ulnar widths, and olecranon-coronoid angles were determined. RESULTS: The coronoid height, with its base defined by the trough of the trochlear notch and the slope change of the distal coronoid process, measured 15 mm and was 42% of the ulnar height. The coronoid height, with its base defined by the transverse groove of the sigmoid notch at the guiding ridge and the distal insertion of the brachialis muscle, measured 15 mm and was 43% of the ulnar height. The olecranon-coronoid angle ranged between 33 degrees and 38 degrees . CONCLUSIONS: For lateral radiographic classification of coronoid fractures, coronoid height is best defined by the trough of the trochlear notch and the slope change of the distal coronoid process. For anatomic studies, coronoid height is best defined by the transverse groove of the sigmoid notch at the guiding ridge and the distal insertion of the brachialis muscle. The olecranon-coronoid angle is best defined by the angle formed by the lines from the olecranon tip through the coronoid tip and through the slope change of the distal coronoid process. The coronoid anatomy measurements reported in this study may help to improve coronoid fracture classification.

Aged↗
PubMed2005

Magnetic resonance imaging characterization of osteochondral defect repair in a goat model at 8 T.

OBJECTIVE: This study was performed to non-invasively visualize and characterize osteochondral (OC) repair in ex vivo goat stifles using an 8 T magnetic resonance imaging (MRI) scanner and to compare the MR morphology with images obtained from 1.5 T, gross morphology and histology. METHODS: Mature, neutered male goats were assigned to an 8-week (n = 4) or 16-week (n = 4) study period. Two cylindrical OC defects (7 mm diameter, full cartilage thickness and 1mm into subchondral bone) were surgically created in the right stifle: one in the medial femoral condyle (MFC) and the other in the trochlear groove (TG). The implant matrices (non-woven or foam) were secured in the defect using a bottom anchored fixation device (FD). The contralateral left stifles served as time zero controls. At the day of necropsy, implants were placed at both defect sites (MFC and TG) on the normal left stifles. Following necropsy, the ex vivo goat stifles (intact and encapsulated) were disarticulated. Within 24 h postnecropsy, MR scans of the stifles along the mid-sagittal plane of the OC defect were acquired at 8 T and 1.5 T. MR relaxation times, T1 and T2, were measured at the region of repair tissue (RT) and adjacent native cartilage. Immediately after MR imaging, the stifles were dissected, grossly examined, and a sagittal OC block corresponding to the MR region of interest was prepared for formalin fixation. RESULTS: The high-resolution MR images enabled visualization of cartilage and bone integrity surrounding the implant as well as delineating the margins of RT/implant matrix and the FD. On spin echo sequence, the RT variably appeared as high, intermediate or low MR signal intensity; whereas, the FD always appeared as low signal intensity. In general, the MR signal intensity of 8-week RT was slightly higher compared to 16-week RT; however, there was no difference in RT morphology of stifles implanted with the non-woven matrix or foam matrix. Subchondral sclerosis appeared as low signal intensity. The 8 T MR images showed better delineation of the stifle tissues compared to the images acquired at 1.5 T. The T2 relaxation time of the RT appears to indicate (inconclusive due to small number of samples) a slight variation in the RT type between 8 weeks and 16 weeks. At both study times, the defects grossly appeared whitish to reddish but did not have the characteristic hyaline appearance typical of articular cartilage (AC). The gross appearance of the MFC and TG RT differed, which was predominantly mottled and recessed with fissuring of adjacent native AC in the MFC. Histologically, the RT of both 8-week and 16-week postsurgical defects predominantly comprised fibrovascular connective tissue with only few samples showing the presence of fibrocartilaginous and/or hypertrophic chondrocytes within the defect RT at 8 weeks. Also, compared to 8-week, the 16-week RT appeared to be more fibrotic. CONCLUSION: Using 8 T scanner, high-resolution MR images of ex vivo encapsulated goat stifles confirmed the capability of high-field MR imaging to distinguish the defect RT from the FD and adjacent joint tissues. The extent of OC repair and adjacent bone lesions (at 8 weeks and 16 weeks) observed in the MR images compared well with those observed on the corresponding histological sections.

Animals↗
PubMed2005

Effects of helium-neon laser on the mucopolysaccharide induction in experimental osteoarthritic cartilage.

OBJECTIVE: To investigate the effects of mucopolysaccharide induction after treatment by low power laser for experimental osteoarthritis (OA). METHODS: Seventy-two rats with three different degrees of papain induced OA over right knee joints were collected for helium-neon (He-Ne) laser treatment. The severity of induced arthritis was measured by 99mTc bone scan and classified into three groups (I-III) by their radioactivity ratios (right to left knee joints). The rats in each group were further divided into study subgroups (Is, IIs, and IIIs) and control subgroups (Ic, IIc, and IIIc) randomly. The arthritic knees in study subgroups received He-Ne laser treatment, and those in controls received sham laser treatment. The changes of arthritic severity after treatment and follow-up 2 months later were measured. The histopathological changes were evaluated through light microscope after disarticulation of sections (H.E. stain), and the changes of mucopolysaccharide density in cartilage matrix were measured by Optimas scanner analyzer after Alcian blue (AB) stain. The densities of mucopolysaccharide induced after treatment in arthritic cartilage were compared and correlated with their histopathological changes. RESULTS: The density of mucopolysaccharide rose at the initial stage of induced arthritis, and decreased progressively in later stages. The densities of mucopolysaccharide in treated rats increased upon complete laser treatment more than those of the controls, which is closely related with the improvement in histopathological findings, but conversely with the changes in arthritic severity. CONCLUSION: He-Ne laser treatment will enhance the biosynthesis of arthritic cartilage, and results in the improvement of arthritic histopathological changes.

Animals↗
PubMed2006

Quantification of ankle articular cartilage topography and thickness using a high resolution stereophotography system.

OBJECTIVE: To describe the topography and to measure thicknesses, surface areas and volumes in the cartilage layers of the ankle. METHODS: Twelve cadaveric ankle joints were disarticulated and the cartilage surfaces of each bone were imaged with a highly accurate (+/-2 microm) stereophotography system (ATOS). The cartilage was then dissolved and the subchondral bone imaged. The geometric data were then used to measure the quantitative parameters in each cartilage layer. RESULTS: The mean cartilage volume across the 12 specimens ranged from 0.32+/-0.08 ml for the fibula to 2.44+/-0.48 ml for the talus. The mean thickness of both the talar (1.1+/-0.18 mm) and tibial (1.16+/-0.14 mm) cartilage was significantly thicker than the fibula (0.85+/-0.13 mm). The talus had the greatest mean maximum cartilage thickness (2.38+/-0.4 mm). CONCLUSIONS: The reported stereophotographic technique may be used as an independent gold standard for validation of the accuracy of quantitative cartilage measurements made using magnetic resonance imaging. The thickness distribution maps show that the thickest articular cartilage occurs over the talar shoulders where osteochondral lesions commonly occur and not in the centre of the talar dome as commonly believed.

Aged↗
PubMed2005

Withdrawal of life-sustaining low-burden care.

A 90-year-old diabetic man with unreconstructable peripheral vascular disease, end-stage chronic obstructive pulmonary disease, relentless ischemic rest pain, and severe disability returns to your clinic asking you to deactivate his implanted pacemaker. To do so would likely precipitate his demise, and you ask him if he is aware of this. He tells you that he is and that he has been considering this request since he last saw you 3 months ago. Relief of his chronic pain would require bilateral hip-disarticulating amputations, procedures with a prohibitively high operative mortality rate, particularly with his age and comorbidities. He has been evaluated by a psychiatrist and found to be mentally competent. His treatment by a pain specialist, who used his full armamentarium of high-dose narcotics, electronic devices, nerve blocks, and psychological techniques, has been unsuccessful. You do not reside in Oregon. What is your most ethical course of action?

Aged↗
PubMed2004

Customised hinged knee replacements as a salvage procedure for failed total knee arthroplasty.

BACKGROUND: Failure of knee arthroplasty can lead to significant pain and functional disability. In a small number of patients with fracture, sepsis or massive bone loss they are considered for arthrodesis or above knee amputation. The purpose of this study was to investigate the results and complications of using customised hinged knee replacements in their place. METHODS: Since 1993, 30 of the 280 (10.7%) revision knee replacements in the Avon Orthopaedic Centre, Bristol have used Endo customised hinged knee prostheses (21 rotating, nine fixed) for salvage of limb threatening situations in elderly patients. Surgical indications were 22 low periprosthetic fractures (with or without aseptic loosening), five massive aseptic osteolyses, and three deep infections. RESULTS: The mean length of post-operative hospital stay was just 14.6 days and all patients were discharged walking with aids. At follow up (mean 3.0 years, range 0.5-9.3 years) nine patients had died with their prostheses in situ and functioning. Six patients developed deep sepsis, two of which underwent above knee amputation, and two had received further surgery for septic problems. Two patients required further surgery for prosthetic disarticulation and one patient had successful on table vascular repair. Twenty-five patients had mid- or long- term follow up. Their mean American Knee scores (AKS) were 69.8 for knee and 35.6 for function (maximum 100), with mean total knee flexion 83 degrees. Mean Oxford knee scores (OKS) and WOMAC scores (both scored between 12 and 60 with low score indicating less difficulties) were 34.0 and 30.5, respectively. CONCLUSIONS: Customised hinge revision knee replacements gave rapid rehabilitation and hospital discharge. Complications were high but at mid- and long-term review, no prostheses had failed from an aseptic cause and most of the knees of this challenging group were providing both stability and flexion.

Aged↗
PubMed2006

Development and dehiscence of the cephalothecoid peridium in Aporothielavia leptoderma shows it belongs in Chaetomidium.

The development of the cephalothecoid peridium of Aporothielavia leptoderma was examined using light and electron microscopy. Early stages in ascoma initiation were consistent with previous reports for other species in the Chaetomiaceae. However, as young cleistothecia increased in size, clusters of peridial cells in the outer textura angularis elongated in a radial pattern around a central cell or cell cluster to form rosettes of relatively thick-walled segments that marked the central areas of incipient cephalothecoid plates. The external flank along median portions of the radial cells became thin walled and swelled outwards so that each plate became concave and was separated from adjacent plates by a more or less circular to polygonal ridge of knuckle-shaped swellings. When dry, mature peridia split apart along some of the ridges demarcating individual plates but an internal mechanism for liberating ascospores from the confines of the ascoma was not observed. Physical disturbance of mature cleistothecia by beetles, when enclosed together in a Petri dish, shattered the peridia, liberating the ascospores. Smaller insects were unable to cause disarticulation of the cephalothecoid plates. Because of the presence of an apical germ pore in the ascospores and morphological similarity to Chaetomidium arxii, the new combination Chaetomidium leptoderma (syn. Thielavia leptoderma) comb. nov. is proposed.

Animals↗
PubMed2006

Computed tomographic anatomy of the head of the loggerhead sea turtle (Caretta caretta).

The heads of three loggerhead sea turtles were disarticulated and imaged immediately to minimize postmortem changes and then frozen and sectioned. For computed tomography (CT) imaging, the heads were positioned in ventral recumbency. Transverse CT images with soft-tissue window were obtained from the olfactory sac region to the temporomandibular joint region. After CT imaging, the heads were sectioned and the gross sections were compared to CT images, to assist in the accurate identification of the anatomic structures. Different clinically relevant anatomic structures were identified and labelled in two series of photographs (CT images and anatomic cross-sections). CT images provided good differentiation between the bones and the soft tissues of the head. The information presented in this paper should serve as an initial reference to evaluate CT images of the head of the loggerhead sea turtle and to assist in the interpretation of lesions of this region.

Animals↗
PubMedDate not supplied

Biomechanical evaluation of kyphoplasty with calcium sulfate cement in a cadaveric osteoporotic vertebral compression fracture model.

BACKGROUND CONTEXT: Vertebral compression fractures can cause deformity, pain, and disability. Kyphoplasty involves percutaneous insertion of an inflatable balloon tamp into a fractured vertebra followed by injection of polymethylmethacrylate (PMMA) bone cement. PMMA has several disadvantages such as potential thermal necrosis and monomer toxicity. Calcium sulfate cement (CSC) is nontoxic, osteoconductive, and bioabsorbable. PURPOSE: To evaluate the biomechanical performance of CSC for kyphoplasty in cadaveric osteoporotic vertebral bodies. STUDY DESIGN: Destructive biomechanical tests using fresh cadaveric thoracolumbar vertebral bodies. METHODS: Thirty-three vertebral bodies (T9 to L4) from osteoporotic cadaveric spines were disarticulated, stripped of soft tissue, and measured for height and volume. Each vertebral body was compressed at 0.5 mm/s using a hinged plating system on a materials testing machine to create an anterior wedge fracture and reduce the anterior height by 25%. Pretreatment strength and stiffness were measured. Two KyphX inflatable balloon tamps were used to reexpand each vertebral body. After randomization, three groups were created: Group A-no cement; Group B-PMMA; Group C-calcium sulfate cement. Groups B and C were filled with the corresponding cement to 25% of the vertebral body volume. All vertebral bodies were then recompressed by 25% of the post-kyphoplasty anterior height to obtain posttreatment strength and stiffness. RESULTS: Treatment with PMMA restored vertebral strength to 127% of the intact level (4168.2 N+/-2288.7) and stiffness to 70% of the intact level (810.0 N/mm+/-380.6). Treatment with CSC restored strength to 108% of the intact level (3429.6 N+/-2440.7) and stiffness to 46% of the intact level (597.7 N/mm+/-317.5). CSC and PMMA were not significantly different for strength restoration (p=.4). Significantly greater strength restoration was obtained with either PMMA or CSC, compared with the control group (p=.003 and .03, respectively). Stiffness restoration tended to be greater with PMMA than for CSC, but this difference was not statistically significant (p=.1). Both cements had significantly greater stiffness when compared with the control group (p=.001 and p=.04, respectively). CONCLUSIONS: Use of CSC for kyphoplasty yields similar vertebral body strength and stiffness as compared with PMMA. It may be a useful alternative bone cement for kyphoplasty. Further studies are required to assess the bioabsorption of CSCs after kyphoplasty in vivo.

Aged↗
PubMedDate not supplied

Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths.

BACKGROUND CONTEXT: Although successful clinical use of cervical pedicle screws has been reported, anatomical studies have shown the possibility for serious iatrogenic injury. However, there are only a limited number of reports on the biomechanical properties of these screws which evaluate the potential benefits of their application. PURPOSE: To investigate if the pull-out strengths after cyclic uniplanar loading of cervical pedicle screws are superior to lateral mass screws. STUDY DESIGN: An in vitro biomechanical study. METHODS: Twenty fresh-frozen disarticulated human vertebrae (C3-C7) were randomized to receive both a 3.5 mm cervical pedicle screw and lateral mass screw. The screws were cyclically loaded 200 times in the sagittal plane. The amount of displacement was recorded every 50 cycles. After cyclical loading, the screws were pulled and tensile load to failure was recorded. Bone density was measured in each specimen and maximum screw insertion torque was recorded for each screw. RESULTS: During loading the two screw types showed similar stability initially, however the lateral mass screws rapidly loosened compared to the pedicle screws. The rate of loosening in the lateral mass screws was widely variable, while the performance of the pedicle screws was very consistent. The pullout strengths were significantly higher for the cervical pedicle screws (1214 N vs. 332 N) and 40% failed by fracture of the pedicle rather than screw pullout. Pedicle screw pullout strengths correlated with both screw insertion torque and specimen bone density. CONCLUSIONS: Cervical pedicle screws demonstrated a significantly lower rate of loosening at the bone-screw interface, as well as higher strength after fatigue testing. These biomechanical strengths may justify their use in certain limited clinical applications.

Aged↗
PubMed1997

Treatment of conductive hearing loss with ossicular chain reconstruction procedures.

Middle ear infections and ossicular disorders can cause conductive hearing loss. Ossicular disorders include fibrous unions in which scar tissue replaces the long process of the incus; disarticulations caused by previous surgical procedures or cholesteatomas; fixation from otosclerosis, cholesteatomas, or congenital malformations; and dislocations caused by trauma. Surgical reconstruction procedures, with the insertion of partial or total ossicular replacement prostheses, help restore conductive hearing. Patients who undergo these delicate procedures have significant hearing deficits and require sensitive, skilled perioperative nursing care.

Ear↗
PubMed2004

[Recurred hydatid cyst of the thyroid: a case report].

A 21-year-old patient underwent surgery in 1987 for hydatid cyst of segment VIII of the liver. Six years later, the patient developed a cold thyroid nodule. During the thyroid operation, needle aspiration and cytology study confirmed the diagnosis of hydatid cyst. Resection of the prominent dome was performed. In 1996, the patient developed cervical recurrence. Pericytectomy was attempted and during the procedure a wound of the subclavian artery required sternoclavicular disarticulation. Hydatid cyst of the thyroid gland is rare, but should be considered in patients living in endemic zones who develop an anterior neck tumor. Cystectomy, isthmolobectomy or sub-total thyroidectomy may be indicated. Resection of the prominent dome may be required in the event of recurrence.

Adult↗