Transoral Endoscopic Thyroidectomy via Vestibular Approach: A series of the first ten cases in Iraq

Transoral endoscopic thyroidectomy was first described as an experimental sublingual approach. This approach was modified to a vestibular approach to avoid complications. In this report, we describe the results of the first ten cases of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) performed in Iraq. All operations were performed at Al Shifa General Hospital, Basrah, Iraq, in 2017 using three laparoscopic ports inserted at the oral vestibule. One out of ten patients underwent a near total thyroidectomy, the remaining cases underwent thyroid lobectomies. The average operative time was 113.5 minutes and the average duration of hospital stay was 41.9 hours. One case of mild cervical emphysema and one case of temporary mental nerve palsy were reported but both were treated conservatively without permanent sequelae. In conclusion, TOETVA is a safe, feasible procedure with an excellent cosmetic outcome when the patients are selected carefully.Keywords: Thyroidectomy; Endoscopy; Mouth; Robotics; Case Reports; Iraq.

Transoral transvsetibular thyroidectomy: an initial approach and experience

<p class="abstract"><strong>Background:</strong> The objective of the study was to record our intial experience of transoral transvestibular thyroidectomy and to ascertain the problems faced, their possible solutions and further suggestions.</p><p class="abstract"><strong>Methods:</strong> Inclusion criteria were unilateral thyroid swelling, patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 8 cm; (b), USG estimated gland volume ≤40 ml, nodule size ≤50 mm, A benign tumor, such as a thyroid cyst, single-nodular goitre, or multinodular goitre. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and Harmonic. </p><p class="abstract"><strong>Results:</strong> All transoral transvestibular thyroidectomy procedures were performed successfully with no conversions. The mean operative time was 112.5 (90-180) min. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients.</p><p class="abstract"><strong>Conclusions:</strong> Transoral transvestibular thyroidectomy may provide a method for ideal cosmetic results. It also provides a wide and enhanced endoscopic view. Though more study and further instrumental development is required to fully embrace this procedure a preliminary experience show encouraging results.</p>

Oral Manifestations of Osteoarticular Diseases

Human body acts as a whole and this leads to an increased occurrence of oral manifestations during the onset and development of systemic diseases. Therefore, oral pathological manifestations play an important role in the diagnosis, prognosis and treatment of diseases with osteoarticular involvement. General pathology has a strong impact on oral health which in turn is influenced by systemic factors. Oral manifestations can be used for making an early diagnosis of a serious condition that can be cured with appropriate therapy. Oral lesions can be explained by pathological processes and correlated with systemic diseases. When oral symptoms and signs are present, the disease is already in an advanced stage, due to the fact that the oral cavity is usually affected by a generalized disease. The mouth is part of the digestive system, but it has various symptoms caused by diseases located in other regions. 98 patients with oral manifestations of diseases with osteoarticular involvement were followed up in a private dental clinic from Iasi over a period of 3 years between June 2013 and July 2016. 47 patients were male (47.95%) and 51 were female (52.05%), aged between 18 and 65 years old, with a peak incidence between the ages of 45 and 60. The complex structure of the oral cavity was thoroughly explored (lips, lip mucosa, the corners of the mouth, gingival labial sulcus, oral vestibule, the internal face of the cheeks, the outer surface of gums, the floor and the ceiling of the oral cavity or the hard and the soft palate). The health status of the body is reflected by the health of the oral mucosa, which can be seen as a marker of various systemic diseases.

Softening Condition of Impression Compound for Border molding of Removable Dentures

ABSTRACT Objectives To prepare removable dentures, border molding using an impression compound has been employed for a long time to obtain a denture border morphology harmonized with perioral muscle movement. However, border molding using impression compound is performed following practitioner's empirical rule. The objective of this study is to clarify the optimum softening conditions of impression compound for border molding, for which we measured the pressure assumed to be loaded on impression compound during border molding. Materials and methods The pressure assumed to be loaded on an impression compound during border molding was measured using a tongue pressure-measuring device. Based on the measured pressure, appropriate softening conditions were investigated (softening temperature and water immersion time) for three types of impression compound: Red (Impression com- pound Red, Kerr, USA), green (Peri Compound, GC, Japan), and pink (Iso Compound, GC, Japan). Results The measured pressure was significantly different between those in the oral vestibule in the lower anterior tooth region during tugging the mouth corner, and in the gingivobuccal fold of the lower first molar during large mouth opening. Regarding the impression compound softening condition, red was deformed by all measured muscle pressures after immersion in 60°C water for 30 seconds and 65°C water for 20, 25, and 30 seconds. Green was deformed by all measured muscle pressures after immersion in 60°C water for 30 seconds, and 65°C water for 25 and 30 seconds. In contrast, pink was deformed by all measured muscle pressures after immersion in 55°C water for 25 and 30 seconds. Conclusion It was clarified that for border molding, muscle pressures of all regions during the functional movements can be registered using red and green softened by immersion in 60°C water for 30 seconds and pink softened by immersion for 20 seconds. How to cite this article Takano T, Kugimiya Y, Koike T, Ueda T, Sakurai K. Softening Condition of Impression Compound for Border molding of Removable Dentures. Int J Prosthodont Restor Dent 2016;6(2):37-42.