Management algorithm for ectopic lingual thyroid including TORS lingual thyroidectomy
✍ Scribed by Kathryn M. Van Abel; Matthew L. Carlson; Nicole L. Boettcher; Jonathan W. Hafner; Eric J. Moore
- Book ID
- 102452364
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 441 KB
- Volume
- 121
- Category
- Article
- ISSN
- 0023-852X
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✦ Synopsis
Ectopic thyroid is a rare congenital anomaly that arises from aberrant embryogenesis during thyroid migration. Ectopic lingual thyroid (ELT) represents the most frequent site of ectopy with a reported incidence of 10% 1 . While only 0.01% of this group present with symptoms, approximately 33-62% do so with hypothyroidism 1,2 . Mechanical symptoms caused by gland hypertrophy or inflammation may manifest with dysphagia, dysphonia, dyspnea and rarely, hemorrhage 1,2 . Initial diagnostic evaluation includes a variety of imaging techniques, including I 123 or I 131 scans, ultrasonography of the neck to confirm absence of cervical thyroid, magnetic resonance imaging, or an iodine-contrasted computed tomography (CT) scan 3 .
An initial trial of thyroid suppression has been successful in some cases and is generally agreed to be the first step in treatment 4 . For symptomatic patients who fail conservative therapy, surgery is recommended. Traditional surgical approaches to ELT include external techniques which provide excellent visualization and vascular control at the cost of a high rate of tracheotomy, lingual nerve injury, fistula, infection and visible scar formation 2,3 . With improved technology, transoral approaches have decreased the morbidity associated with surgical management, resulting in fewer complications, improved functional outcome and decreased hospital stay 1,2,3 . Transoral approaches utilizing monopolar coagulation, transoral laser microsurgery (TLM), and recently transoral ultrasonic resection have all been shown to be effective 2,3,4 with decreased overall morbidity 5 . However, these techniques may be inadequate for large base of tongue (BOT) lesions due to line of site limitations, insufficient visualization, and space restrictions 6 . Transoral robotic surgery (TORS) has recently emerged as a minimally invasive option, which overcomes these limitations by offering non-linear exposure, wristed instrumentation, three dimensional field of view, and tremor reduction 6 .
With the introduction of TORS, we propose that transoral total excision (TOTE) is a viable option for large, inferoposteriorly located ELT and offers a safe and effective surgical option. To the authors' knowledge, there has been no published report describing the use of TORS for lingual thyroidectomy. Herein, we present our experience and suggest a management algorithm for the adult patient presenting with ELT.