Impact of age on surgical outcomes and failure rates in patients with thyroglossal duct cysts.

PURPOSE: Thyroglossal duct cyst (TGDC) may appear in all age groups. The impact of age on surgical outcome has been reported with conflicting results. The aim of the study was to evaluate different risk factors for surgical success according to stratified age groups. METHODS: A single center retrospective study. All patients who underwent a Sistrunk procedure between 2004 and 2018 were enrolled. Data included demographics, pre-operative presentation, intra\postoperative complications and surgical failures. Population groups were divided into adults (≥18 years), older children (OC, 3-18 years) and toddlers (<3 years). RESULTS: A total of 109 patients were included: 55 adults (50.5%), 36 OC (33%) and 18 toddlers (16.5%). The adult group demonstrated a significant lower rate of surgical failures when compared to the toddler (3.6%, vs. 38.9%, P < 0.001, respectively) and the OC group (3.6%, vs 16.7%, P = 0.032, respectively). A borderline significance was found when comparing surgical failure rates among toddlers and OC (38.9% vs.16.7%, P = 0.07, respectively). Post-operative complications were associated with surgical failures among toddlers (P = 0.045) and OC (P = 0.016), but not adults. Pre-operative infection and admission were significantly associated with failure in the OC group. CONCLUSIONS: Surgical failures following Sistrunk procedures and their associated risk factors vary between age groups. Familiarity with these rates and associations can contribute to better decision making in managing TGDC patients.

Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes.

OBJECTIVE: There is a debate regarding the durability of fat implants. Our experience and recent publications suggest fat implantation may deliver a long-lasting improvement. This study aims to present the long-term outcomes for vocal fold fat augmentation using strict harvesting, preparing, and implantation protocols. STUDY DESIGN: A prospective cohort conducted between 2014 and 2020 (recruitment 2014-2017). SETTING: An academic tertiary referral center. SUBJECTS AND METHODS: Twenty-two patients with glottic insufficiency were enrolled: 11 had unilateral vocal fold paralysis (UVFP), and 11 had atrophy or scar. Harvested fat was injected unilaterally or bilaterally into multiple sites. Six of these patients also had simultaneous microlaryngoscopic removal of other benign glottic lesions. Outcome measurements included video stroboscopy; Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) score; Voice Handicap Index (VHI); and acoustic analysis, performed preoperatively, 3, 12, 24, and 36 months after surgery. RESULTS: Ten augmentations were unilateral and 12 bilateral. Comparing the preoperative and 36-month postoperative periods, the mean VHI score improved from 73.45 (±22.78) to 44.88 (±28.93), P = .001, and the mean GRBAS decreased from 8.64 (±3.89) to 2.82 (±2.3), P = .001; 24 months postoperatively, the mean fundamental frequency decreased from 163.88 Hz (±41.61) to 150.44 Hz (±41.47), P = .012. Stroboscopic analysis revealed statistically significant improvement in mucosal wave propagation, phase closure, and phase symmetry. Best results were achieved in the UVFP subgroup. Computed tomography scans demonstrated long-term viability of the implanted adipose tissue. CONCLUSION: Fat is an excellent source of autologous graft. With careful patient selection and proper surgical technique, fat is suitable for long-term correction of glottic insufficiency. Fat augmentation should be considered as a long-lasting or even permanent solution, rather than temporary.

Negative-Pressure Vacuum Therapy for High-Output Chyle Leak Following Neck Dissection.

Chyle fistula is a challenging complication following neck dissection carrying a high morbidity and mortality rate. Herein we present a challenging case of successful management of high-output left-sided cervical chyle fistula with negative-pressure vacuum (VAC) therapy in a case where all conservative treatments failed. A 40-year-old man with lymphoma and supraglottic carcinoma underwent endoscopic resection and bilateral neck dissections. He developed high-output chyle fistula, nonresponsive to conservative treatments. Double-layered Vicryl mesh was placed between the sponge and the jugular vein to prevent vascular injury. Immediately after initiation of the VAC therapy, the output decreased, and completely stopped after 3 days. The VAC therapy was continued for additional 5 days to ensure complete seal of the fistula by granulation tissue, by which time the wound was primarily closed. VAC therapy seems to be a safe and effective treatment for high-output cervical chyle fistula following neck dissection, avoiding complex surgical interventions. Thoracic surgeons should be aware of this low-morbidity and potentially effective treatment modality for this challenging complication.