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Submental liposuction improves the appearance and quality of life for head and neck cancer patients suffering from posttreatment lymphedema by way of improving their self-perception and self-confidence.

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S ubmental lymphedema is a common problem encountered by patients following treatment of head and neck cancer. Radiotherapy alone may disrupt lymphatic channels, but the addition of neck dissection further compounds the problem. Lymphedema results in the interstitial deposition of protein-rich fluid, which causes a cycle of inflammation, adipose tissue hypertrophy, and fibrosis, resulting in persistent and often fluctuating swelling and induration of the cervical soft tissues, causing disfigurement and functional deficits. 1 Liposuction has been well described for the management of lymphedema of the upper extremities following the treatment of breast cancer. 2 To our knowledge, the use of liposuction for submental and cervical lymphedema has not been previously described. We obtained full approval through our local research ethics board for the study. The purpose of this article is to introduce the otolaryngologisthead and neck surgeon to this management option and to describe our surgical technique, which is exceedingly simple and well tolerated by patients suffering from this condition. Surgical TechniqueAfter obtaining informed consent, patients are examined in the sitting position, and the area to be treated is marked with a surgical marking pen. Patients are then placed supine on the operating table. A 1-cm submental incision is marked in a suitable skin crease, and the angle of the mandible is marked bilaterally to landmark the position of both marginal mandibular nerves (Figure 1). The submental incision and the outlined areas to be treated are then infiltrated in a subcutaneous plane with approximately 30 cc of 1% lidocaine with epinephrine. The area is then prepped and draped in a sterile fashion.A # 15 blade is used to open the incision, and small tenotomy scissors are used to raise a limited inferior flap to free the skin from the underlying tissue. A 3-mm blunt-tipped Accelerator 3 (Mentor, Irving, Texas) cannuale is introduced without suction, and tunneling is performed using the nondominant hand to pinch the underlying tissue as the cannulae is passed through the treatment area. All areas to be treated are broken down using a fanning technique to facilitate subsequent suction lipectomy. At this point, the cannuale is connected to wall suction, and the sterile suction tubing is kinked to prevent trauma to the incision while the cannuale is reintroduced. The area is then treated on suction using a similar fanning technique in the plane of the previous dissection. Great care is taken to keep the suction ports of the cannuale down facing the deep tissue to avoid suctioning of the overlying skin. Increased resistance will be encountered based on the amount of suction employed. We pay particular attention to treating the submentum and neck evenly and symmetrically. A simple way to ensure this is to make a similar

BackgroundBilateral vocal fold immobility (BVFI) is a rare diagnosis causing dyspnea, dysphonia and dysphagia. Management depends on respiratory performance, airway patency, vocal ability, and quality-of-life priorities. The authors review the presentation, management and outcome in patients diagnosed with BVFI. The utility and efficacy of the Empey index (EI) and the Expiratory Disproportion Index (EDI) are evaluated as an objective monitoring tools for BVFI patients.MethodsA 13-year retrospective review was performed of BVFI patients at St. Michael’s Hospital, University of Toronto, a tertiary referral centre for laryngology.ResultsForty-eight patients were included; 46 presented with airway obstruction symptoms. Tracheotomy was required for airway management in 40 % of patients throughout the course of their treatment, which was reduced to 19 % at the end of the study period. Twenty-one patients underwent endoscopic arytenoidectomy/cordotomy. Non-operative management included continuous positive airway pressure devices. Pulmonary function testing was carried out in 29 patients. Only a portion of the BVFI patients met the defined upper airway obstruction criteria (45 % EI and 52 % EDI). Seven patients had complete pre- and post-operative PFTs for comparison and all seven had ratios that significantly improved post-operatively which correlated clinically.ConclusionThe EI and EDI have limited use in evaluating patients with who have variable upper airway obstruction, but may be helpful in monitoring within subject airway function changes.