Medialization thyroplasty for unilateral vocal cord paralysis secondary to advanced extralaryngeal malignant disease: review of operative morbidity and patient life expectancy.

OBJECTIVE: To review the operative morbidity and the overall length of survival following medialization thyroplasty for unilateral vocal cord paralysis (UVCP) due to advanced extralaryngeal malignancy. DESIGN: Retrospective review. SETTING: Tertiary care laryngology practice. METHOD: All cases of medialization thyroplasty over a 3-year period were reviewed. Only patients who had UVCP due to advanced extralaryngeal malignancy were included. Any cases from iatrogenic causes or for any other reason were excluded. Survival days were calculated from the date of the thyroplasty. MAIN OUTCOME MEASURE: Survival days postmedialization thyroplasty. RESULTS: Twenty-one patients met the inclusion criteria. Two distinct groups within this cohort were identified: (1) those suffering from advanced lung cancer and (2) those with metastatic cancer of another origin (ie, breast, renal cell, esophageal). There were 11 patients in the lung cancer group and 10 in the other group. Average survival was 538 days in the lung cancer group and 668 days in the other group. The procedure was well tolerated, with only one postoperative complication, which was a minor wound infection. CONCLUSION: For patients suffering from advanced malignancy, medialization thyroplasty is a safe procedure and an excellent modality for voice palliation.

Trends in level of evidence in facial plastic surgery research.

BACKGROUND: Evidence-based medicine has increasingly become an integral part of clinical research and practice. The purpose of this study was to assess the trends in the level of evidence in leading facial plastic surgery journals in recent years. METHODS: All scientific articles within the field of facial plastic surgery published in The Laryngoscope, Archives of Facial Plastic Surgery, Otolaryngology-Head and Neck Surgery, Journal of Plastic Surgery, and Plastic and Reconstructive Surgery from 1999, 2002, 2005, and 2008 were rated for level of evidence. The presence of p values and confidence intervals was also noted. RESULTS: Of 975 articles reviewed, 88 percent were clinical and 88 percent were therapy articles. Overall, there was an increase in the average level of evidence of articles published from 1999 to 2008. There was also a significant increase in the proportion of articles reporting p values and confidence intervals. However, the number of articles containing level 1 or 2 evidence remains low. CONCLUSIONS: With the increased demand for evidence-based medicine, facial plastic surgery literature has seen an overall increase in the quantity of higher level evidence research published. However, articles representing level 1 and 2 evidence remain rare.

Radial forearm versus anterolateral thigh free flaps for laryngopharyngectomy defects: prospective, randomized trial.

OBJECTIVE: To investigate the use of anterolateral thigh flaps versus radial forearm free flaps for the reconstruction of laryngopharyngectomy defects in a prospective, randomized study. METHODS: Nineteen patients who were to undergo laryngopharyngectomy were randomized into either anterolateral thigh or radial forearm groups. The primary outcome measure was complication rate (eg, flap failure, fistula formation, pharyngeal stenosis). Secondary outcome measures included donor-site morbidity (limb function, cosmesis, pain). RESULTS: There was a significant (p = .04) increase in reconstructive complications in the anterolateral thigh group, including esophageal stenosis and pharyngeal fistulae. There was no significant difference in donor-site complications. CONCLUSION: There is an increased free flap complication rate without decreased flap donor-site morbidity when using the anterolateral thigh flap to reconstruct laryngopharyngectomy defects. As such, we recommend the radial forearm free flap as the preferred flap for reconstruction of laryngopharyngectomy defects.

Comparison of drain versus no drain thyroidectomy: randomized prospective clinical trial.

OBJECTIVE: To evaluate the use of surgical drains in thyroid surgery. DESIGN: Randomized, prospective, clinical trial. METHODS: Patients were randomized into drain and no drain groups by a blinded observer. Inclusion criteria included all patients presenting for total, hemi-, or completion thyroidectomies. Those with massive goitres or nodules greater than 6 cm were excluded. Fifty-five patients were enrolled in the study. Complications, length of hospital stay, and overall cost were evaluated. RESULTS: In the no drain group, there was a 1.12-day reduction in hospital stay (p < .01), with no increase in postoperative complications. This translated into a cost savings of $2177 per patient. CONCLUSIONS: Thyroid surgery without the use of a drain decreases the length of hospital stay, with no increase in patient morbidity. The overall cost is significantly reduced.