Browsing by Author "Viljoen, Gerrit"

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    Does thyroid sparing total laryngectomy decrease the risk of hypothyroidism?
    (2022) Viljoen, Gerrit; McGuire, Jessica K; Fagan, Johannes J
    Introduction Thyroid lobectomy is recommended with total laryngectomy for laryngeal cancer in the National Comprehensive Cancer Network (NCCN) guidelines. However, it is associated with a 32-89% risk of hypothyroidism, which represents a problem especially for patients without access to thyroid hormone monitoring and replacement. Sparing the thyroid gland does not compromise oncological control if thyroid lobectomy is reserved for intraoperative evidence of extra laryngeal tumor extension abutting or invading the thyroid gland, or when there is need to resect level 6 lymph nodes with subglottic and pyriform fossa involvement. However, there is limited evidence about to what extent hypothyroidism is avoided if the thyroid gland is completely spared compared to hemithyroidectomy in the setting of a total laryngectomy. Aims The aims of the study were to determine whether preserving the whole thyroid, compared to a single lobe, does indeed significantly lower the incidence of hypothyroidism in the setting of a total laryngectomy with or without adjuvant radiotherapy. Method A retrospective study was done at Groote Schuur Hospital in Cape Town, South Africa. The thyroid function of patients who had undergone thyroid sparing total laryngectomy with or without radiotherapy was determined and compared to those who underwent hemithyroidectomy. Results Eighty-four patients met the inclusion criteria. The overall incidence of hypothyroidism was 45.2%. The incidence of hypothyroidism was significantly reduced in patients who underwent thyroid sparing total laryngectomy compared to hemithyroidectomy (p=0.037). Adjuvant radiotherapy was associated with a higher incidence of hypothyroidism (p=0.001). Conclusion Thyroid preserving laryngectomy should be advocated in carefully selected patients with advanced laryngeal carcinoma as it reduces the incidence of hypothyroidism.
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    口底癌切除术
    (University of Cape Town, 2012) Fagan, Johan; Viljoen, Gerrit; Fagan , Johan
    本章节介绍口底癌的外科切除原则与重建策略，重点阐述口底的相关外科解剖、术前评估、下颌骨受累的判断、肿瘤切除技术及功能性重建方法。内容涵盖不同手术入路、下颌骨切除术的适应证，以及多种局部和游离皮瓣重建选择。该资源旨在帮助头颈外科医生和相关医疗专业人员在确保肿瘤学安全切除的同时，最大限度地保留患者的言语、吞咽和口腔功能。