Literature Review: A roundup of important recent studies

Reference: Forrest LA, Husein T, Husein O. Paradoxical vocal cord motion: classification and treatment. Laryngoscope. 2012;122(4):844-853.

—Reviewed by Sue Pondrom

 

CND in Differentiated Thyroid Carcinoma

Is total thyroidectomy with central neck dissection (CND) superior to total thyroidectomy alone in decreasing regional recurrence without increasing surgical morbidity in differentiated thyroid carcinoma?

Background: Although differentiated thyroid carcinoma is the fastest growing malignancy worldwide, considerable debate surrounds the question of whether CND is a preferred option with total thyroidectomy. Proponents claim that CND not only decreases regional recurrence and the surgical morbidity of reoperation but also provides information on nodal metastasis. Those who challenge the use of CND argue that total thyroidectomy alone offers an equal survival benefit and that CND is associated with risks.

Study design: Systematic review and meta-analysis.

Setting: Department of General Surgery, Chang Zheng Hospital, affiliated with Second Military Medical University, Shanghai, People’s Republic of China.

Synopsis: Sixteen trials with 3,558 patients were analyzed for surgical morbidities and locoregional recurrence after total thyroidectomy with CND versus total thyroidectomy alone. There was no increased risk of recurrent laryngeal nerve injury (temporary or permanent) or permanent hypocalcemia or locoregional recurrence when CND was performed. (Locoregional recurrence was slightly higher after total thyroidectomy alone.) Post-operative temporary hypocalcemia was more common after total thyroidectomy with CND than after total thyroidectomy alone. The retrospective nature of the study prevented researchers from analyzing the role of radioiodine therapy. An additional limitation was that cohorts were divided into groups based upon surgeon preference or expertise rather than randomization, which would have increased heterogeneity between groups.

Bottom line: The surgical morbidity in patients who received total thyroidectomy with CND was no greater in patients undergoing total thyroidectomy alone. There was a higher risk of temporary hypocalcemia from subsequent CND with additional dissection in the central cervical compartment.

Reference: Shan CX, Zhang W, Jiang DZ, et al. Routine central neck dissection in differentiated thyroid carcinoma: a systemic review and meta-analysis. Laryngoscope. 2012;122(4):797-804.

—Reviewed by Sue Pondrom

 

Clonazepam for Pain in Burning Mouth Syndrome

Is clonazepam, a GABA agonist, effective in treating pain associated with burning mouth syndrome (BMS)?

Background: Treatment has been problematic for burning mouth syndrome (BMS), a complex disorder characterized by painful burning sensations of the oral cavity. Treatments used have included antidepressants, analgesic mouth rinse, alpha-lipoic acid and hormone therapy. No specific therapy has been found. Although clonazepam has been cited as effective in treating BMS patients, there have been no double-blinded, randomized, controlled studies.