Yu Xing, Jiang Yuancong, Li Yujun, He Qionghua, Pan Lei, Zhu Peifeng, Wang Yong, Wang Ping
Department of Thyroid Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
College of Medicine, Zhejiang University, Hangzhou, China.
Front Endocrinol (Lausanne). 2022 Feb 17;13:842148. doi: 10.3389/fendo.2022.842148. eCollection 2022.
The influences of patients' different mandibular jawlines on transoral endoscopic thyroidectomy vestibular approach (TOETVA) have not been described before. The objective of this study was to introduce a new classification to assess different mandibular jawlines, and to evaluate the effects on TOETVA in terms of safety, feasibility, and postoperative feelings in the treatment of papillary thyroid carcinoma (PTC).
The crossing angle of esthetic plane and mandibular plane was defined as Wang Angle, used to assess patients' different mandibular jawlines. Mandibular classifications of A (angle: 80° ~ 110°), B (angle > 110°), and C (angle < 80°) types were compared to evaluate the surgical outcomes of TOETVA by a retrospective study. 690 patients of PTC who received TOETVA were included in this study, which were divided into three groups according to mandibular classifications.
Clinicopathological characteristics of the patients including age, gender, body mass index, tumor size, Hashimoto thyroiditis were similar in the three groups. Patients' length of jay in group C was significantly longer than group A and group B ( < 0.01). The ratios of using suspension system in group C were significantly higher than group A and group B ( < 0.01). The scores of postoperative visual analogue scale (VAS) and ratios of mandibular swell in group C were significantly higher than group A and group B ( < 0.01). There was no significant difference in the three groups regarding surgical outcomes, including postoperative vocal cord paralysis, hypocalcemia, serum white blood cells and C-reactive protein levels.
The Wang angle and mandibular jawline classifications were firstly introduced in TOETVA. All the patients of class A, B, and C mandibular jawline can achieve safe and effective surgical outcomes in the treatment of PTC with TOETVA. Patients of class C need more assistance of suspension system, would experience higher scores of VAS, and higher ratios of mandibular swell compared with class A and B.
患者不同的下颌轮廓对经口内镜甲状腺手术前庭入路（TOETVA）的影响此前尚未见报道。本研究的目的是引入一种新的分类方法来评估不同的下颌轮廓，并从安全性、可行性和治疗甲状腺乳头状癌（PTC）的术后感受方面评估其对TOETVA的影响。
将审美平面与下颌平面的交叉角定义为王角，用于评估患者不同的下颌轮廓。通过回顾性研究比较A（角度：80°~110°）、B（角度>110°）和C（角度<80°）型下颌分类，以评估TOETVA的手术效果。本研究纳入690例行TOETVA的PTC患者，根据下颌分类分为三组。
三组患者的临床病理特征，包括年龄、性别、体重指数、肿瘤大小、桥本甲状腺炎等相似。C组患者的颏长度明显长于A组和B组（<0.01）。C组使用悬吊系统的比例明显高于A组和B组（<0.01）。C组术后视觉模拟评分（VAS）得分和下颌肿胀比例明显高于A组和B组（<0.01）。三组在手术效果方面无显著差异，包括术后声带麻痹、低钙血症、血清白细胞和C反应蛋白水平。
王角和下颌轮廓分类首次在TOETVA中引入。A、B、C型下颌轮廓的所有患者在采用TOETVA治疗PTC时均可获得安全有效的手术效果。与A组和B组相比，C组患者需要更多的悬吊系统辅助，VAS得分更高，下颌肿胀比例更高。
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