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.

Misdiagnosis of Vocal Fold Nodules.

INTRODUCTION: Benign vocal fold masses (BVMs) include nodules, polyps, cysts, and other pathology. Nevertheless, some otolaryngologists and other physicians utilize "vocal fold nodules" as an umbrella diagnosis for vocal fold masses. Patients subsequently evaluated by a laryngologist are found to have a different vocal fold mass, which often has a different prognosis and treatment plan compared to nodules. OBJECTIVE: The purpose of this study was to investigate the rate at which vocal fold nodules are misdiagnosed. METHODS: Adult voice patients who presented to our voice center having been evaluated elsewhere by an otolaryngologist and diagnosed with vocal fold nodules, or prenodules, were included in this retrospective study. Strobovideolaryngoscopy (SVL) footage from each patient's first visit or prior to any treatment at our center was compiled and de-identified. Three blinded physician raters evaluated the videos to determine if the mass(es) was/were nodules on a binary scale, with 1 indicating a nodule. If the mass was not a nodule (0), the raters were asked to identify it based on a list of five different mass types. RESULTS: There were 56 cases (11 male and 45 female) included in the retrospective cohort. The average age was 38 ± 14.8 with a range of 11-65. Reliability between all raters was fair (κ = 0.3). Individually raters 1 and 2 had very good reliability (κ = 1) and rater 3 had good reliability (κ = 0.6). In 100% of cases, two raters agreed that none of the masses were nodules. Only one rater identified two masses as vocal fold nodules, indicating that at least 97% of cases were not vocal fold nodules and had been misdiagnosed. The most frequently identified mass and the most frequently agreed upon mass by all raters was vocal fold cyst or pseudocyst, followed by fibrous mass. Only one rater was unable to identify the mass type in some cases (n = 7). CONCLUSION: Vocal fold nodules are frequently misdiagnosed. Proper identification of vocal fold masses requires high levels of expertise and SVL. Since treatment of BVMs varies with mass type, accurate diagnosis is essential.

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.

The Influence of Photo Editing Applications on Patients Seeking Facial Plastic Surgery Services.

BACKGROUND: The utilization of the smartphone and social media have introduced paradigm shifts to cosmetic surgery. Much has been studied regarding social media and its influences in plastic surgery; however, little is known about facial editing applications and how these relate to plastic surgery practices. OBJECTIVES: The authors sought to discover if face-editing applications influence patients' pursuit of plastic surgery, who utilizes these applications, and why. METHODS: An anonymous survey was administered between September and December 2019, including questions about demographics, familiarity, and utilization of face-editing applications, motivations in utilization and influences towards pursuing cosmetic procedures, and attitudes towards applications. RESULTS: Seventy patients completed the survey and 32.9% admitted to utilizing face-editing applications. Patients utilizing applications were significantly younger (36.9 years) than those who did not (54 years [P < 0.001]). Among those familiar with applications, women were significantly more likely than men to utilize them (100% vs 78.6%, respectively [P = 0.047]). Social media was the most common influence for utilizing apps (87%). The majority confirmed that these applications played a role in pursuing cosmetic procedures (56.5%). Most patients did not regret their utilization of these applications (87%). CONCLUSIONS: Face-editing applications serve a role regarding patient decision-making to pursue cosmetic surgery. Several motivators exist for application utilization, the largest of which is social media. Younger females are the most likely demographic to utilize applications and generally do not express regret in doing so. Plastic surgeons would benefit by understanding patient motivations and expectations created by utilizing these applications.