ABSTRACT
OBJECTIVE: Congenital lymphatic malformations are a challenging clinical problem. There is currently no universally accepted treatment for the management of microcystic disease. We describe the novel use of an existing technology (radiofrequency ablation, also termed Coblation) for the debulking of paediatric microcystic lymphatic malformations involving the upper aerodigestive tract. METHODS: Five children with microcystic or mixed-type lymphatic malformations were included in this retrospective case series. RESULTS: Each child had a satisfactory outcome following radiofrequency debulking, with improved oral intake and airway symptoms. No serious complications were reported. These findings constitute level IV evidence. CONCLUSION: We recommend radiofrequency ablation as a safe, viable alternative to existing techniques for the treatment of paediatric microcystic lymphatic malformations of the upper aerodigestive tract. Radiofrequency ablation achieves effective debulking of microcysts whilst avoiding excessive bleeding and thermal damage to surrounding tissues. This paper constitutes the first report of successful treatment of airway obstruction due to paediatric laryngopharyngeal microcystic disease, using radiofrequency ablation.
Subject(s)
Catheter Ablation/methods , Head and Neck Neoplasms/surgery , Lymphatic Abnormalities/surgery , Catheter Ablation/instrumentation , Child , Child, Preschool , Congenital Abnormalities/surgery , Female , Humans , Lymphangioma, Cystic , Lymphatic Abnormalities/complications , Otorhinolaryngologic Surgical Procedures , Retrospective Studies , Treatment Outcome , Vascular Malformations/surgeryABSTRACT
BACKGROUND: Thyroid lymphomas are relatively uncommon. This study aimed to analyse our experience of thyroid lymphoma management and outcome. MATERIALS AND METHODS: A retrospective case note analysis of 63 patients treated in the previous 13 years was conducted. RESULTS: The five-year survival rate was 68 per cent, with most patients dying of their lymphoma. This is at odds with the British Thyroid Association statement that the prognosis of this condition is 'generally excellent'. The only presenting symptom found to be significantly associated with prognosis was dysphagia (p = 0.001). Dual modality treatment provided a significantly better outcome than single modality treatment (p = 0.014). Thyroid lymphoma can present to the head and neck surgeon 'in extremis'; however, it can respond rapidly to appropriate treatment. CONCLUSION: The outcome of thyroid lymphoma seems unrelated to the acuteness of its presentation. Thyroid surgery has no role other than for diagnosis. However, 51 per cent of the study patients underwent some form of thyroidectomy, indicating the need to implement better diagnostic pathways.
Subject(s)
Airway Obstruction/etiology , Lymphoma, B-Cell/mortality , Thyroid Neoplasms/mortality , Acute Disease , Adult , Age Factors , Aged , Aged, 80 and over , Airway Obstruction/surgery , Biopsy , Combined Modality Therapy , Deglutition Disorders/epidemiology , Diagnosis, Differential , Female , Hashimoto Disease/epidemiology , Humans , Kaplan-Meier Estimate , Lymphoma, B-Cell/complications , Lymphoma, B-Cell/diagnosis , Lymphoma, B-Cell/therapy , Male , Middle Aged , Neoplasm Staging , Practice Guidelines as Topic , Prognosis , Recurrence , Retrospective Studies , Sex Distribution , Survival Rate , Thyroid Neoplasms/complications , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/therapy , Thyroidectomy/statistics & numerical data , Tracheostomy/statistics & numerical data , Treatment Outcome , United KingdomABSTRACT
Palatal tremor (formerly palatal myoclonus) is an extremely rare, but potentially treatable cause, of objective tinnitus. The tinnitus is thought to be secondary to rhythmic involuntary movements of the soft palate. Its aetiology is variable and it remains difficult to treat. Many different medical and surgical remedies have been tried but none have demonstrated reproducible success. Botulinum toxin has been used in sporadic cases and seems to produce good results. Ten patients with palatal tremor have presented to this department over the last three years. After discussion with the patients with regard to the management of this condition and possible complications, five opted for botulinum toxin therapy and five declined further intervention. Clinical diagnosis was made on the confirmation of soft palate movements synchronous with an audible clicking noise. Five patients underwent botulinum toxin injection into the insertion of the levator and tensor veli palatini muscles. Of the five that were treated with toxin, four showed complete resolution of symptoms after a course of treatment. Only one patient reported transient side effects. This would suggest that botulinum toxin is a safe and effective first line treatment for palatal tremor.
