Thyroid hemiagenesis

BACKGROUND AND OBJECTIVES

Thyroid hemiagenesis is a rare embryological condition, predominantly in females (3:1) with a left lobe being absent. The associated diseases in the remaining thyroid lobe include benign adenoma, multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. Presence of carcinoma in a patient with hemiagenesis is quite rare and very few cases are reported in the world literature.

METHODS

We report a 30-year-old female who presented with left thyroid mass gradually increasing in size over a period of 3 months. The patient's pre-operative workup included a thyroid scan, which revealed a cold nodule in the left lobe with absent right lobe. A fine-needle aspiration biopsy was suspicious for papillary thyroid carcinoma. The patient underwent thyroid exploration and left thyroid lobectomy.

RESULTS

The operative findings confirmed hemiagenesis of the right lobe and papillary carcinoma in the left lobe. All four parathyroids were in normal position.

CONCLUSIONS

The purpose of this presentation is to discuss and review the literature on thyroid hemiagenesis and present a rare case of absent right thyroid lobe with carcinoma in the remaining left thyroid lobe.

Folded free radial forearm flap for reconstruction of full-thickness defects of the cheek

BACKGROUND

Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. We report a modified technique of folding the radial forearm flap for reconstruction of full-thickness defects of the cheek.

METHODS

The free radial forearm flap is a type C fasciocutaneous flap based on the radial artery along with its vena commitans and superficial forearm vein. The size and shape of the flap are determined according to the dimensions of the surgical defect. The flap is then lifted off with the fascia of the forearm making it a fasciocutaneous flap, in which the radial artery lies deep to the fascia and gives numerous branches. The flap is disconnected from the donor site only after the recipient vessels have been prepared for anastomosis. Vascular anastomosis is then performed using the operating microscope. This technique was used in 13 patients with carcinoma of the buccal mucosa who underwent fill-thickness excision of the cheek.

RESULTS

Flap edema was observed in 4 patients in the immediate post-operative period. Necrosis of the outer paddle was seen in 1 patient. Donor site morbidity was seen in 4 patients who required dressings on an outpatient basis for up to 3 weeks.

CONCLUSION

Single-stage reconstruction of full-thickness defects of the cheek with the folded free radial forearm flap is reliable and produces excellent cosmesis with minimal donor site morbidity.