Application Of Three-dimensional Reconstruction Of Head And Neck With Neck Extension In Thyroid Surgery

Objective:To evaluate the clinical application of three-dimensional reconstruction of head and neck with neck extension in thyroid surgery.Methods:The CT images which were scan with neck extension of 31 patients proved to be thyroid disease by pathology were collected.The thyroid gland,thyroid nodules,thyroid cartilage,mandible,clavicle,and skin were reconstructed with the software of 3DVWorks.Measuring different angles and diameters for disease evaluation and treatment base on the reconstruction model.Results:In the 3D reconstruction model of head and neck,intersectoral angles and distances between different tracheal planes and anatomic structures of endoscopic thyroidectomy were measured.Based on these 3D data,3 of 11 patients with thyroid nodule<3 cm were not suitable for endoscopic thyroidectomy via a transoral approach.Meantime,3 patient was not suitable for the thoracic and breast approach or axillo-breast approach and 1 patient was only suitable for open surgery.The other 4 of 11 patients were suitable for all surgical approaches.6 patients with thyroid nodule>3cm were not diagnosed with a substernal goiter by the model,which could be accessible via a transcervical approach but not a transstemal operative approach.Through measurement of the length of the blind area in the central lymph node dissection of 14 patients in the cervical extension position,thyroid surgeons can commend if the patient with thyroid carcinoma can select the thoracic and breast approach or not.Furthermore,by comparison of the datum of thoracic and breast approach,transoral approach and central lymph node dissection by thoracic and breast approach in the horizontal and neck extension position,the results of 14 patients indicated there were statistic difference in these evaluations in this two positions(P<0.001).Conclusion:Three-dimensional reconstruction of head and neck with neck extension has unique advantages in choice of operative approach,diagnosis and treatment of substernal goiter and central lymph node dissection by thoracic and breast approach.The writer suggest thyroid surgeon can use neck extension position when there is needed for CT scan and reconstruct the images,which help to make a better surgical decision and benefit physician-patient communication.