Safety and Efficacy of Outpatinet Type 1 Thyroplasty Using Gore-Tex for Mobile Vocal Folds.

INTRODUCTION: Type 1 thyroplasty treats glottic insufficiency (GI) through vocal fold medialization. The safety of type 1 thyroplasty and its efficacy in an outpatient setting have not been investigated in patients with mobile vocal folds. OBJECTIVE: The purpose of this study was to investigate efficacy and safety of outpatient type 1 thyroplasty using Gore-Tex for mobile vocal folds. METHODS: Patients from our voice center who had vocal fold paresis, had not had prior thyroplasty, and who underwent type 1 thyroplasty using Gore-Tex implants and were followed for at least 3 months were included in this retrospective study. Strobovideolaryngoscopy footage from each patient's preoperative and postoperative visits was compiled and de-identified. Three blinded physician raters reviewed and evaluated the videos to determine glottic closure and complications. Interrater reliability was moderate and intrarater reliability was good for GI. RESULTS: A total of 108 patients with an average age of 49.6 years were included in the retrospective cohort. GI improved significantly in patients from preoperative to first postoperative visit and from preoperative to second postoperative visit. The GI improvement from the second to third visit was not significant. In total, 33 patients underwent additional Thyroplasty, 12 due to revision from a complication and 25 for further voice improvement. There were no major complications seen. Within 1 month of surgery, the most frequent findings were edema and hemorrhage. Long-term complications evaluated by raters were reported inconsistently with poor interrater and intrarater reliability, and therefore were excluded. CONCLUSION: Overall, outpatient type 1 thyroplasty using a Gore-Tex implant is safe and effective in treating dysphonia due to GI in patients with vocal fold paresis and mobile vocal folds. There were no major complications within 1 week of surgery requiring hospitalization, supporting the literature that type 1 thyroplasty is safe to perform in the outpatient setting.

BCOR-Rearranged Sarcoma of the Tonsil.

A tonsillar mass in a young patient with no medical issues routinely presents as an infectious process. Practitioners must maintain a broad differential if diagnostic testing does not support an infection. Neoplasm must be excluded. Otolaryngologists must consider malignancies other than squamous cell carcinoma, the most common oropharyngeal malignancy, and lymphoma. Rare tumors, such as sarcomas, must also be considered. Otolaryngologists must be familiar with the proper management of rare oropharyngeal malignancies.

Management of Isolated Zygomatic Arch Fractures and a Review of External Fixation Techniques.

INTRODUCTION: Fractures of the zygomatic bone can present with complicated aesthetic and neurological pathology. Specifically, management of isolated zygomatic fracture has been sparsely discussed in the literature, and most studies are based upon older techniques. Here, we compare the results of 2 critical operative techniques as well as review the available literature in the setting of isolated zygomatic fractures. METHODS: A retrospective chart review was performed at our institution from 2010 to 2018 examining for patients who had sustained an isolated zygomatic fracture confirmed by computed tomography scan. Patients were excluded if they sustained additional maxillofacial fractures. Demographical information, symptoms on presentation, fracture management modality, and postoperative course were all collected and examined. RESULTS: A total of 218 patients were identified for inclusion. The average age of this cohort was 45.5 ± 18 years, with 77.5% being male. Assault (55%) was most the frequent cause of injury with accidents being the least common (17.9%). Most patients (78.8%) underwent nonoperative management. Patients who underwent operation more often presented with zygomatic deformity (97.7% vs 18.4%), paresthesia (29.5% vs 2.9%), and trismus (29.5% vs 6.9%) when compared to their nonoperatively managed counterparts. In all, 44 operatively managed patients underwent open reduction with or without eternal fixation (Gillies Approach vs Keen Approach). There were no significant differences in the presence of zygomatic deformity, paresthesia, and trismus between the 2 operative techniques. CONCLUSIONS: Isolated zygomatic arch fractures can present with discerning symptoms. Unfortunately, the literature on appropriate management is not well described. We find external fixation to provide reestablishment of both form and function with minimal required exposure, although the outcomes may be similar without the use of external fixation.

Dangers beyond drowning: craniomaxillofacial trauma in adult water activities.

PURPOSE: Water recreation is one of the most popular activities for both fitness and leisure. The dangers of water activities have mostly been examined in the context of drowning and general bodily injuries. Despite the existing research, little is known about adult maxillofacial injuries in these settings. METHODS: We accessed the National Electronic Injury Surveillance System in order to identify adult patients presenting to emergency departments with traumatic maxillofacial injuries secondary to a water-based sport or activity over the most recent 10-year period (2009-2018). Data collected included demographical information, anatomical location, mechanism of injury, and visit circumstances, as well as visit disposition. RESULTS: A total of 1350 total patients were identified as appropriate for study inclusion. Young, Caucasian male adults were the most common age group to present with maxillofacial injuries secondary to water sport activities. Surfing and water skiing were associated with lacerations, while diving board incidents posed a higher fracture risk. Patients participating in all water activities were more likely to be treated and released rather than admitted. CONCLUSION: There appears to be a distinct pattern profile for individuals who sustain maxillofacial trauma while participating in water sports: young, Caucasian males in particular. Additionally, specific activities may be associated with varying injury types. The results of this study may increase interest in legislature and patient counseling when seeking such activities.

Thyroglossal Duct Cyst Occupying Posterior Hyoid Space with Endolaryngeal Extension Presenting After Neck Trauma.

OBJECTIVE: Thyroglossal duct cysts are the most common congenital neck mass. They typically present as a painless midline neck mass in a child or young adult, but may also present later in adulthood when the cyst becomes symptomatic. Thyroglossal duct cysts are most commonly located inferior to the hyoid bone in close relation with the thyrohyoid membrane. Very rarely, they may extend intralaryngeal, occupy the posterior hyoid space, and present with dysphonia and/or dysphagia. To our knowledge, this is the 24th reported case in the literature. METHODS: Case report with a comprehensive review of the literature. RESULTS: The patient was a 43-year-old male experiencing dysphonia and dysphagia following a motor vehicle accident. He was subsequently found to have a large thyroglossal duct cyst with endolaryngeal extension that was previously asymptomatic and undiagnosed. He underwent successful surgical excision which resulted in resolution of symptoms. CONCLUSION: This is the first reported case of a thyroglossal duct cyst in the posterior hyoid space with endolaryngeal extension being diagnosed following a traumatic event. This case illustrates the need to consider thyroglossal duct cyst in the differential diagnosis when working up a post-traumatic intralaryngeal neck mass. A secondary educational objective in this case is to be diligent to consider and rule out laryngeal fracture in the case of a neck mass presenting after trauma as they can easily be missed and present with many overlapping symptoms.