Capstone: Radical Neck Dissection by Mackenzie Henning

Cheif Complaint

mhenning18 — 2024-03-11 20:31:37 UTC

Patient seen on 2/14/24 at 9:30am experiencing pain/sore throat, pain in neck, physical weakness over last 3 months.

Present symptoms

mhenning18 — 2024-03-11 20:32:46 UTC

Sore, raspy voice/throat, showing progressive weight loss and large lump in neck. Temperature 97.6, blood pressure measured at 160/100 showing signs of hypertension.

Expected Comorbidities

mhenning18 — 2024-03-11 20:33:52 UTC

Diabetes, COPD.

Expected Medications

mhenning18 — 2024-03-11 20:34:23 UTC

Metformin: oral tablet for type 2 diabetes and lowering risk of reoccurring tumors in head and neck. Takes 1 in morning with breakfast, 1 at night with dinner.

Fluticasone: Treatment for COPD. Inhaler used twice daily.

References

mhenning18 — 2024-03-11 20:35:22 UTC

322: Radical neck dissection. (n.d.-a). https://www.ast.org/articles/2010/2010-10-322.pdf

Gogna, S. (2023, August 8). Neck cancer resection and Dissection. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK536998/

Gottlieb, M., Anders Mellemgaard, Kristoffer Marsaa, & Godtfredsen, N. (2020). Optimizing COPD treatment in patients with lung- or head and neck cancer does not improve quality of life – a randomized, pilot, clinical trial. European Clinical Respiratory Journal, 7(1), 1731277–1731277. https://doi.org/10.1080/20018525.2020.1731277

Head and neck surgery, 2018 - sage journals. (n.d.-b). https://journals.sagepub.com/doi/full/10.1177/0194599818788083d

Wang, X., Wang, H., Zhang, T., Cai, L., Dai, E., & He, J. (2020). Diabetes and its Potential Impact on Head and Neck Oncogenesis. Journal of Cancer, 11(3), 583–591. https://doi.org/10.7150/jca.35607

Radical Neck Dissection

mhenning18 — 2024-03-12 00:09:45 UTC

CT scan +Biopsy

mhenning18 — 2024-03-26 22:42:05 UTC

CT scan performed on 2/28/24 9:35am. CT scan was performed to show 3 dimensional results and size of any abnormalities regarding tumors at different angles. Results showing a 5mm circular tumor in anterior neck. 3/5/24 9:30 am Biopsy of lump neck mass. Pathology results 3/11/24 5mm Follicular Thyroid Carcinoma.

Pre Operative Diagnosis:

mhenning18 — 2024-03-26 23:03:04 UTC

Preoperative Diagnosis: Follicular Thyroid Carcinoma

Care Plan:

mhenning18 — 2024-03-26 23:09:46 UTC

Based on CT scan the patient will be scheduled for an open radical neck dissection. Studies show that 30-50% of patients with Thyroid cancer, cancer cells spread to other areas of the neck. The surrounding lymph nodes, structures & mass will be removed for further prevention of spread. Open Surgery and sentinel lymph node biopsy scheduled for 3/15/24 8:30am at Virginia Beach General main hospital OR.

Pathophysiology of Thyroid Carcinoma

mhenning18 — 2024-03-26 23:25:42 UTC

The process of a Thyroid carcinoma begins in the follicular cells along with the supporting "C" cells. 85% of Follicular thyroid cancers are differentiated thyroid carcinomas. Usually, they have a positive prognosis following treatment. Factors contributing to thyroid cancer include obesity, enlarged thyroid or thyroiditis.

Pertinent Surgery Requirments:

mhenning18 — 2024-03-26 23:33:17 UTC

Surgical Assistant needed for severity/complexity of procedure.
Shoulder roll in room, patient supine, head elevated to 30 degrees
Neck hyperextended with shoulder roll, rotated to opposite side
Standard head and neck tray
McCabe neck dissectors
Munion right angle clamps
Harmonic Scapel
Expected blood loss: Maximum 200ml based on type of incision
Specimen will be sent frozen to pathology

References:

mhenning18 — 2024-03-26 23:42:10 UTC

“Head and Neck Cancer - Diagnosis.” Cancer.Net, 15 Dec. 2022, www.cancer.net/cancer-types/head-and-neck-cancer/diagnosis.

Shah, Jatin P. “Thyroid Carcinoma: Epidemiology, Histology, and Diagnosis.” Clinical Advances in Hematology & Oncology : H&O, U.S. National Library of Medicine, Apr. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC5526593/.

“Surgery.” University of Colorado School of Medicine, medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/gites/patient-care/endocrine-surgery/neck-dissection/about. Accessed 26 Mar. 2024.

“Surgery to Remove the Lymph Nodes in Your Neck.” Laryngeal Cancer | Cancer Research UK, 15 Feb. 2022, www.cancerresearchuk.org/about-cancer/laryngeal-cancer/treatment/surgery/remove-lymph-nodes.

Antonio Riera March, MD. “Radical Neck Dissection Treatment & Management.” Surgical Therapy, Preoperative Details, Intraoperative Details, Medscape, 28 Nov. 2023, emedicine.medscape.com/article/849895-treatment?form=fpf.

professional, C. C. medical. (n.d.). Thyroid cancer: Types, symptoms, causes & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12210-thyroid-cancer

mhenning18 — 2024-04-07 17:12:39 UTC

Lymph node levels l-V

mhenning18 — 2024-04-19 19:27:34 UTC

Post Operative instructions

mhenning18 — 2024-04-19 19:41:08 UTC

Post Operative Prescription

mhenning18 — 2024-04-19 19:41:43 UTC

mhenning18 — 2024-04-19 20:06:57 UTC