Objectives/Hypothesis: Overnight hospitalization is routinely advocated following type I thyroplasty (TP) because of concerns for airway compromise. Hospitalization increases cost and patient inconvenience, and may not necessarily be appropriate. This study evaluated complications following surgery and identified predictors for same to assess which patients benefit most from hospitalization.Study Design: Retrospective chart review.Methods: A study was conducted on patients who underwent TP with or without arytenoid repositioning procedures between June 2008 and March 2017. The demographic data of the subjects, characteristics, etiology of glottic insufficiency, interventions performed, and subsequent complications were evaluated.Results: Of 147 patients reviewed, 100 underwent TP alone, 41 underwent TP with arytenoid adduction, and six patients underwent TP with adduction arytenopexy. Iatrogenic vocal fold paralysis was the most common indication. Major complications, which included transient airway compromise and hematoma requiring reoperation, occurred in 7% of patients. Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications.Conclusions: In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy. Overnight hospitalization should be considered in patients undergoing revision surgery and in those requiring concurrent arytenoid repositioning procedures.

Objectives: To systematically review the success rate and safety profile of the available endoscopic surgical options for radiation-induced dysphagia in head and neck cancer patients following organ preservation treatment, including upper esophageal sphincter (UES) dilation, cricopharyngeus (CP) myotomy (CPM), and CP intramuscular botulinum toxin (Botox) injection. Methods: A search of MEDLINE, Scopus, Google Scholar, and Cochrane databases was done to identify articles published between January 1980 and December 2017. Pediatric series, foreign language articles, series with Zenker’s diverticulum or following primary surgical treatment including laryngectomy, open UES/CP surgery, or samples with fewer than 5 patients were excluded. Results: An initial search identified 539 articles. All titles and abstracts were reviewed. One hundred and sixteen potentially relevant articles were inspected in more detail, and 14 retrospective studies met eligibility criteria. Dilation group included 10 studies on anterograde and/or retrograde dilation, with an overall 208 patients. Success rate ranged from 42% to 100%. The endoscopic CPM group included 3 studies with a total of 36 patients, and the success rate ranged from 27% to 90%. In the Botox group, 1 one study with 20 patients met our inclusion criteria, with an overall 65% success rate (13/20). Major complications were only reported in the dilation group, which included esophageal perforation and death. Conclusions: The lack of consistency across trials indicates insufficient evidence for guiding clinical practice. This systematic review suggests the need for greater standardization of outcomes and instruments. Future prospective evaluation should use validated patient-rated and clinician-rated assessment tools to optimally measure postoperative swallowing outcomes of head and neck cancer dysphagic patients following organ preservation therapy.

Among snoring patients seeking medical consultation, male gender and WHtR of ≥ 0.55 were good predictors for moderate to severe OSA. No single head and neck finding reliably predicted this condition. In a situation with limited facilities, these data along with medical history may be helpful for prioritizing patients in order to achieve the optimal use of sleep investigation and treatment.

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Background: Endoscopic stapling of Zenker's diverticulum is associated with a lower complication rate than open resection, but has been associated with a higher recurrence rate, likely owing to the incomplete resection of the cricopharyngeus muscle and preservation of a remnant diverticulum. Transoral resection of the diverticulum (TORD) has been reported, but no studies have evaluated long term outcomes and efficacy beyond this initial report. We describe a modified version of the technique (MTORD) which has proven safe and efficacious in our institution. Methods:The technique is performed endoscopically. A mucosal incision is created, through which the cricopharyngeus muscle is widely excised. The apex of the diverticulum is mobilized and advanced, and redundant mucosa excised. The mucosa is then repaired primarily.Results: Eighteen patients have undergone surgery to date. There have been no complications.Postoperative esophagram can confirm complete sack excision.Conclusions: MTORD is a safe and effective option for the endoscopic resection of Zenker's diverticuli.

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