Intraoperative accident and associated factors in Carotid Body Tumor surgery at tertiary Hospital in Addis Ababa ,Ethiopia
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Date
2023-09
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Addis Ababa University
Abstract
Background – Carotid body tumors (CBTs) are the rare tumors of the head and neck region,
accounting for 60% of the cervical paragangliomas. CBTs classified etiologically into sporadic,
hyperplastic and familial type. Anatomic classification designed by shamblin describes how
CBTs envelope carotid vessel and grouped into 3 according to degree of encasement. Patients
commonly present with slowly growing painless mass at carotid triangle. They may have local
compressive symptoms like dysphagia or dysphonia.Surgical excision is safe and main
treatment option for resectable CBTs. However, complication like bleeding, cranial nerve injury,
and stroke continue to be major concerns even in the hands of experienced surgeon. Therefore,
the study aimed to assess intraoperative accident during carotid body tumor excision at tertiary
hospital in Ethiopia.
Method: A retrospective cross-sectional study was conducted among 153 patient operated
over the past 10 years period by reviewing medical record at tertiary hospital in Ethiopia. Data
was collected through structured questionnaire. The data was summarized using frequency
(percentage) table and graph. To identify significant factor associated with intraoperative
accident, mulitvariable binary logistic regression model was used, where Adjusted Odds Ratio
(AOR), 95% CIs for AOR and p-value were used for interpretation.
Result: Among 153 cases patient operated 132(86.3%) were female and mean age was 39.42±
11.161. . Almost all patient presented with neck mass (98.7%) which were painless in 58.8% of
cases. Most patient presented more than 3 years after onset of symptoms (61.5%).Tumor size
more 5 cm was found in 72.1% of cases. Patients were mostly investigated with neck
ultrasound(97.4%) and neck CT(71.22%). Overall, 14.45% were Shamblin I CBTs; 54.2% were
Shamblin II; and 31.4% were ShamblinIII. There were Intra operative accident in 24.8 % of
patient. Hypoglossal nerve (9.2%) and ECA (9.2%) were commonly injured structure. shamblin
class of the tumor was found to be significant exposure for the development of intraoperative
accident for those shamblin III as compared to shamablin I with odds increasing with shamblin
class (AOR=6.6067, 95% CI=1.07,34.4, p=0.018 for shamblin III).
Conclusion : The prevalence of intraoperative accident during CBT excision in our setup
comparable with the current literature from different country which implies CBT excision can
be done safely in our institution with acceptable level complication with available resource.
major factor associated with intraoperative accident was shamblin class of the tumour.
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Keywords
Intraoperative accident, Carotid Body Tumor, surgery