Nonendemic rhinoscleroma: An unusual manifestation of the trachea.

Objectives: Rhinoscleroma is classically described as a chronic granulomatous disease caused by Klebsiella rhinoscleromatis which primarily affects the nose and nasopharynx. When present, tracheal manifestations will be seen late in the disease course rather than on initial presentation. We describe a rare case of nonendemic rhinoscleroma that presented with tracheal lesions as an initial manifestation of disease. Methods: Case report and literature review. Results: An 88-year-old male presented with longstanding dysphonia. Flexible laryngoscopy demonstrated a septal perforation and diffuse glottic lesions. CT neck demonstrated a nonobstructive polypoid tracheal lesion and mucosal thickening of the paranasal sinuses. Biopsy confirmed an atypical lympho-histiocytic proliferation and microorganisms within macrophages on Grocott methenamine silver and Steiner stains consistent with rhinoscleroma. He was referred for rheumatology and pulmonology consultation. Conclusion: Systemic diseases rarely affect the trachea, and even less frequently is a tracheal lesion identified as the initial manifestation of disease. The most common systemic diseases that affect the trachea include relapsing polychondritis, granulomatosis with polyangiitis, amyloidosis, and inflammatory bowel disease. The literature surrounding nasolaryngotracheal rhinoscleroma is limited, especially in nonendemic areas. It is necessary to include unusual etiologies of airway lesions in the differential diagnosis, which warrants comprehensive airway evaluation including biopsy. Level of Evidence: 4.

The TMEM16A channel as a potential therapeutic target in vascular disease.

PURPOSE OF REVIEW: The transmembrane protein 16A (TMEM16A) Ca 2+ -activated Cl - channel constitutes a key depolarising mechanism in vascular smooth muscle and contractile pericytes, while in endothelial cells the channel is implicated in angiogenesis and in the response to vasoactive stimuli. Here, we offer a critical analysis of recent physiological investigations and consider the potential for targeting TMEM16A channels in vascular disease. RECENT FINDINGS: Genetic deletion or pharmacological inhibition of TMEM16A channels in vascular smooth muscle decreases artery tone and lowers systemic blood pressure in rodent models. Inhibition of TMEM16A channels in cerebral cortical pericytes protects against ischemia-induced tissue damage and improves microvascular blood flow in rodent stroke models. In endothelial cells, the TMEM16A channel plays varied roles including modulation of cell division and control of vessel tone through spread of hyperpolarisation to the smooth muscle cells. Genetic studies implicate TMEM16A channels in human disease including systemic and pulmonary hypertension, stroke and Moyamoya disease. SUMMARY: The TMEM16A channel regulates vascular function by controlling artery tone and capillary diameter as well as vessel formation and histology. Preclinical and clinical investigations are highlighting the potential for therapeutic exploitation of the channel in a range of maladaptive states of the (micro)circulation.

Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes.

INTRODUCTION: Glottic obstruction may arise secondary to bilateral vocal fold immobility (BVFI). Treatment options include a tracheostomy to bypass the site of obstruction as well as unilateral transverse cordotomy to alleviate the obstruction. The objective of this review is to determine the efficacy, adverse event profile, and long-term outcomes, including the need for tracheostomy, in patients undergoing unilateral cordotomy. METHODS: The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for this systematic review. A literature search of unilateral cordotomy was performed by searching PubMed, Cochrane Library, and Embase. Articles presenting cases of BVFI treated with unilateral cordotomy were included. Review articles, animal studies, non-English-language articles, and abstracts were excluded. Articles presenting cases of bilateral cordotomy or cordotomy with arytenoidectomy were excluded. RESULTS: We identified 14 studies and 291 patients undergoing unilateral cordotomy. Sixty-eight patients had a prior tracheostomy in place at the time of cordotomy. The most common post-operative complication was granulation tissue formation (n = 39). Thirty-one patients developed glottic edema with subsequent dyspnea. Three patients developed scarring of the primary cordotomy site with the return to an obstructed airway. Nine patients required a post-cordotomy tracheostomy due to these complications. Five patients required a long-term tracheostomy and were unable to be decannulated. CONCLUSION: Unilateral cordotomy is an effective treatment for glottic obstruction with high post-operative decannulation rates. Adverse events including worsening glottic obstruction are uncommon, although edema and granulation tissue may develop in the post-operative period and necessitate close post-operative monitoring. Laryngoscope, 133:6-14, 2023.

An Ex Vivo Model of Posterior Tracheomalacia With Evaluation of Potential Treatment Modalities.

OBJECTIVE: Posterior tracheomalacia (TM) is characterized by excessive intraluminal displacement of the tracheal membranous wall. Recently, novel surgical strategies for repair of posterior TM have been introduced. To our knowledge, these strategies have not been evaluated in a model of posterior TM. Thus, we sought to design an ex vivo mechanical model of posterior TM to evaluate potential repair interventions. METHODS: A model for posterior TM was created with partial thickness longitudinal incisions to the posterior aspect of ex vivo porcine trachea. Three groups of tracheas were tested: (1) control (unmanipulated), (2) posterior TM (injury), and (3) intervention (repair). Interventions included external splinting with 0.3 and 0.5 mm bioresorbable plates, posterior tracheopexy, and injection tracheoplasty with calcium hydroxylapatite. An airtight tracheal system was created to measure tracheal wall collapse with changes in negative pressure. A bronchoscope and pressure transducer were connected to either end. Cross-sectional area of the tracheal lumen was analyzed using ImageJ software (National Institutes of Health, Bethesda, MD). RESULTS: Average percent reduction in cross-sectional area of the tracheal lumen was compared using a two-tailed paired t-test. Significant differences were found between control and TM groups (p < 0.019). There was no significant difference between control and external splinting and posterior tracheopexy groups (p > 0.14). CONCLUSION: We describe an ex vivo model for posterior TM that replicates airway collapse. External splinting and tracheopexy interventions showed recovery of the injured tracheal segment. Injection tracheoplasty did not improve the TM. LEVEL OF EVIDENCE: N/A Laryngoscope, 133:2000-2006, 2023.

Aduhelm, a novel anti-amyloid monoclonal antibody, for the treatment of Alzheimer's Disease: A comprehensive review.

Alzheimer's disease (AD) is the most common form of dementia affecting millions of individuals, including family members who often take on the role of caregivers. This debilitating disease reportedly consumes 8% of the total United States healthcare expenditure, with medical and nursing outlays accounting for an estimated $290 billion. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists have historically been the most widely used pharmacologic therapies for patients with AD; however, these drugs are not curative. The present investigation describes the epidemiology, pathophysiology, risk factors, presentation, and current treatment of AD followed by the role of the novel monoclonal antibody, Adulhelm, in the treatment of AD. Currently, Adulhelm is the only Food and Drug Administration (FDA) approved drug that acts to slow the progression of this disease. Adulhelm is an anti-amyloid drug that functions by selectively binding amyloid aggregates in both the oligomeric and fibrillar states. Studies show Adulhelm may help to restore neurological function in patients with AD by reducing beta-amyloid plaques and reestablishing neuronal calcium permeability. At present, there is concern the magnitude of this drug's benefit may only be statistically significant, although not clinically significant. Despite skepticism, Adulhelm has proven to significantly decrease amyloid in all cortical brain regions examined. With such high stakes and potential, further research into Adulhelm's clinical efficacy is warranted in the treatment of AD.

Opicapone, a Novel Catechol-O-methyl Transferase Inhibitor, for Treatment of Parkinson's Disease "Off" Episodes.

Parkinson's Disease (PD) is a common neurodegenerative disorder and the leading cause of disability. It causes significant morbidity and disability through a plethora of symptoms, including movement disorders, sleep disturbances, and cognitive and psychiatric symptoms. The traditional pathogenesis theory of PD involves the loss of dopaminergic neurons in the substantia nigra (SN). Classically, treatment is pursued with an assortment of medications that are directed at overcoming this deficiency with levodopa being central to most treatment plans. Patients taking levodopa tend to experience "off episodes" with decreasing medication levels, causing large fluctuations in their symptoms. These off episodes are disturbing and a source of morbidity for these patients. Opicapone is a novel, peripherally acting Catechol-O-methyl transferase (COMT) inhibitor that is used as adjunctive therapy to carbidopa/levodopa for treatment and prevention of "off episodes." It has been approved for use as an adjunct to levodopa since 2016 in Europe and has recently (April 2020) gained FDA approval for use in the USA. By inhibiting COMT, opicapone slows levodopa metabolism and increases its availability. Several clinical studies demonstrated significant improvement in treatment efficacy and reduction in duration of "off episodes." The main side effect demonstrated was dyskinesia, mostly with the 100mg dose, which is higher than the approved, effective dose of 50mg. Post-marketing surveillance and analysis are required to further elucidate its safety profile and contribute to patient selection. This paper reviews the seminal and latest evidence in the treatment of PD "off episodes" with the novel drug Opicapone, including efficacy, safety, and clinical indications.

Schmorl's Node: An Uncommon Case of Back Pain and Radiculopathy.

Background: Schmorl's nodes are herniations of nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra. Schmorl's nodes are extremely common and are typically seen as incidental findings on radiographic imaging. In postmortem studies, it has been estimated that greater than 70% of the population has Schmorl's nodes. Rarely, however, Schmorl's nodes can be a cause of acute back pain and, even less often, radiculopathy. Case Presentation: In the present case, an elderly male presented with an acute onset of lower back pain and radiculopathy. MRI demonstrated a large L3 vertebral body inferior endplate Schmorl's node with posterior extension through the vertebral body cortex and into the ventral epidural space superiorly. This resulted in severe effacement of the right L2-L3 subarticular recess, as well as the right L3-L4 neural foramen, impinging on the right L3 nerve root. Surrounding cortical edema and enhancement on MRI further suggested an acute Schmorl's node. Conclusion: Although rare, Schmorl's nodes can be a cause of acute back pain and, even less commonly, radiculopathy. The imaging modality of choice for the diagnosis of a Schmorl's node is MRI as it has a greater capability to detect edema, neovascularization, and in this case, extruded disc material. In both asymptomatic and symptomatic cases, the mainstay of treatment for Schmorl's nodes is conservative therapy. Surgical removal of disc material has been successful in cases of persistent radiculopathy from compression by a tunneling Schmorl's node.

Pediatric breast lymphatic malformation with recurrent presentation in an adolescent female.

This case report summarizes a rare case of left chest wall/breast lymphatic malformation or cystic lymphangioma in a female child of 18 months with multiple late recurrences in adolescence. By maternal history, the mass was excised initially, but the patient presented at age 15 and 17 years for recurrences and associated symptoms. Comments focus on a complex clinical history and treatment management of patient symptoms and concerns. Breast sparing treatments were employed with sclerotherapy and the T lymphocyte inhibitor, Sirolimus (Rapamune).

Nasal valve repair (NVR) utilization and economic impact in the U.S. medicare population: 18-year trends.

PURPOSE: Nasal valve repair (NVR) is an otolaryngological procedure indicated for the surgical correction of airway obstruction or collapse. Despite its growing popularity, the deployment and financial impact for NVR have not been well-described. Here, we evaluate trends in NVR utilization in the U.S. Medicare population on the state and national levels from 2001 to 2018. MATERIALS AND METHODS: Historical utilization and reimbursement databases compiled by the U.S. Centers for Medicare & Medicaid Services (CMS) were queried for current procedural terminology (CPT) code 30465. Analyses were performed using Microsoft Excel v16. RESULTS: Nationally, we observed a 989.60% increase in the total number of NVRs performed annually (611.07% adjusted to growing enrollment). Concomitantly, total reimbursement increased by 2025.52% (878.29% adjusted), though the average cost per procedure only rose moderately (37.58%). From 2013 to 2018, the majority of providers were male (74.79%), with an M.D. (71.37%), practicing as individuals (76.5%), operating in a facility setting (93.59%), and classified as otolaryngologists (63.25%). In 2018, Indiana had the highest utilization rate, whereas Oregon received the largest reimbursement. Connecticut had the lowest values in both categories. CONCLUSIONS: The utilization and financial impact of NVR have increased substantially among the U.S. Medicare population over the last two decades.

Patterns of Care and Outcomes of Primary Adenoid Cystic Carcinoma of the Trachea.

OBJECTIVE: Primary tracheal malignancies are relatively rare cancers, representing 0.1% to 0.4% of all malignancies. Adenoid cystic carcinoma (ACC) is the second most common histology of primary tracheal malignancy, after squamous cell carcinoma. This study aims to analyze demographic characteristics and potential influencing factors on survival of tracheal ACC (TACC). METHODS: This was a retrospective cohort study utilizing the National Cancer Database (NCDB). The NCDB was queried for all cases of TACC diagnosed from 2004 to 2016 (n = 394). Kaplan-Meier (KM) and Cox proportional-hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes. RESULTS: Median age of diagnosis was 56 (IQR: 44.75-66.00). Females were affected slightly more than males (53.8% vs 46.2%). The most prevalent tumor diameter range was 20 to 39 mm (34.8%) followed by greater than 40 mm in diameter (17.8%). Median overall survival (OS) was 9.72 years with a 5- and 10-year OS of 70% and 47.5%, respectively. Localized disease was not associated with a survival benefit over invasive disease (P = .388). The most common intervention was surgery combined with radiation therapy (RT) at 46.2%, followed by surgery alone (16.8%), and standalone RT (8.9%). When adjusting for confounders, surgical resection was independently associated with improved OS (HR 0.461, 95% CI 0.225-0.946). Tumor size greater than 40 mm was independently associated with worse OS (HR 2.808; 95% CI 1.096-7.194). CONCLUSION: Our data suggests that surgical resection, possibly in conjunction with radiation therapy, is associated with improved survival, and tumor larger than 40 mm are associated with worse survival.

Biomechanical properties of the ex vivo porcine trachea: A benchmark for three-dimensional bioprinted airway replacements.

PURPOSE: Combining tissue engineering and three-dimensional (3D) printing may allow for the introduction of a living functional tracheal replacement graft. However, defining the biomechanical properties of the native trachea is a key prerequisite to clinical translation. To achieve this, we set out to define the rotation, axial stretch capacity, and positive intraluminal pressure capabilities for ex vivo porcine tracheas. STUDY DESIGN: Animal study. MATERIALS AND METHODS: Six full-length ex vivo porcine tracheas were bisected into 5.5 cm segments. Maximal positive intraluminal pressure was measured by sealing segment ends with custom designed 3D printed caps through which a pressure transducer was introduced. Axial stretch capacity and rotation were evaluated by stretching and rotating the segments along their axis between two clamps, respectively. RESULTS: Six segments were tested for axial lengthening and the average post-stretch length percentage was 148.92% (range 136.81-163.48%, 95% CI 153-143%). The mean amount of length gain achieved per cartilaginous ring was 7.82% (range 4.71-10.95%, 95% CI 6.3-9.35%). Four tracheal segments were tested for maximal positive intraluminal pressure, which was over 400 mmHg. Degree of rotation testing found that the tracheal segments easily transformed 180° in anterior-posterior bending, lateral bending, and axial rotational twisting. CONCLUSIONS: We define several biomechanical properties of the ex vivo porcine trachea by reporting the rotation, axial stretch capacity, and positive intraluminal pressure capabilities. We hope that this will aid future work in the clinical translation of 3D bioprinted airway replacement grafts and ensure their compatibility with native tracheal properties.

Oromandibular Dystonia: A Clinical Examination of 2,020 Cases.

Objective: The goal of this study is to better characterize the phenotypic heterogeneity of oromandibular dystonia (OMD) for the purpose of facilitating early diagnosis. Methods: First, we provide a comprehensive summary of the literature encompassing 1,121 cases. Next, we describe the clinical features of 727 OMD subjects enrolled by the Dystonia Coalition (DC), an international multicenter cohort. Finally, we summarize clinical features and treatment outcomes from cross-sectional analysis of 172 OMD subjects from two expert centers. Results: In all cohorts, typical age at onset was in the 50s and 70% of cases were female. The Dystonia Coalition cohort revealed perioral musculature was involved most commonly (85%), followed by jaw (61%) and tongue (17%). OMD more commonly appeared as part of a segmental dystonia (43%), and less commonly focal (39%) or generalized (10%). OMD was found to be associated with impaired quality of life, independent of disease severity. On average, social anxiety (LSA score: 33 ± 28) was more common than depression (BDI II score: 9.7 ± 7.8). In the expert center cohorts, botulinum toxin injections improved symptom severity by more than 50% in ~80% of subjects, regardless of etiology. Conclusions: This comprehensive description of OMD cases has revealed novel insights into the most common OMD phenotypes, pattern of dystonia distribution, associated psychiatric disturbances, and effect on QoL. We hope these findings will improve clinical recognition to aid in timely diagnosis and inform treatment strategies.

Principles of supply chain management in the time of crisis.

Hospitals face catastrophic financial challenges in light of the coronavirus disease 2019 (COVID-19) pandemic. Acute shortages in materials such as masks, ventilators, intensive care unit capacity, and personal protective equipment (PPE) are a significant concern. The future success of supply chain management involves increasing the transparency of where our raw materials are sourced, diversifying of our product resources, and improving our technology that is able to predict potential shortages. It is also important to develop a proactive budgeting strategy to meet supply demands through early designation of dependable roles to support organizations and through the education of healthcare staff. In this paper, we discuss supply chain management, governance and financing, emergency protocols, including emergency procurement and supply chain, supply chain gaps and how to address them, and the importance of communication in the times of crisis.

Association of Laryngeal Botulinum Neurotoxin Injection With Work Productivity for Patients With Spasmodic Dysphonia.

Importance: A disordered voice can affect an individual across both work and non-work-related life domains. There is insufficient research on the effect of spasmodic dysphonia or its treatment with botulinum neurotoxin (BoNT) injections on work productivity. Objective: To assess whether employed patients with spasmodic dysphonia experience voice-related work productivity impairment before BoNT injection, and had a 10% or greater improvement in productivity 1 month after treatment with BoNT injection. Design, Setting, and Particpants: This prospective case series carried out in 2 laryngology outpatient clinics from November 1, 2015, to August 30, 2018 included a consecutive sample of adult employed patients diagnosed with spasmodic dysphonia. Analysis was conducted between November 1, 2015, to July 31, 2018. Exposures: Treatment with BoNT injection into the intrinsic laryngeal musculature. Main Outcomes and Measures: Eligible participants completed the following validated outcomes instruments immediately before and 1 month after outpatient laryngeal BoNT injection: the Work Productivity and Activity Impairment instrument (WPAI), Voice Handicap Index (VHI), and WorkHoarse. Demographic, comorbidity, and occupational voice use data were also collected at baseline. The changes in outcome measures (primary, WPAI Work Productivity Impairment domain) were tested using a paired 2-tailed t test. Exploratory subgroup analyses were analyzed with multivariable linear regression, adjusting for demographic, comorbidity, and voice use variables. Results: Of the 101 patients enrolled, 75 completed the study. The mean (SD) age of the 75 completing participants was 55.7 (11.8) years and 53 (71%) were women. The participants who completed the study had mean (SD) voice-related work productivity impairment of 43% (27%) at baseline and 22% (23%) at 1 month after BoNT injection (difference, 20% [27%] improvement; 95% CI, 14%-27%; effect size, 0.74). Conclusions and Relevance: This case series study found that employed patients with spasmodic dysphonia reported voice-related work productivity impairment, which improved significantly 1 month after treatment with BoNT injection. The association of spasmodic dysphonia with voice-related work productivity appeared greater in women than men with comparable outcomes with BoNT treatment, but this exploratory sex-associated difference requires independent validation.

Impairments in odour detection and hedonic ratings of unpleasant smells in asymptomatic university students as SARS-Cov-2 emerged locally.

Sudden olfactory loss in the absence of concurrent nasal congestion is now a well-recognized symptom of COVID-19. We examined olfaction using standardized objective tests of odour detection, identification and hedonics collected from asymptomatic university students before and as SARS-CoV-2 emerged locally. Olfactory performance of students who were tested when the virus is known to be endemic (n = 22) was compared to students tested in the month prior to viral circulation (n = 25), a normative sample assessed during the previous 4 years (n = 272) and those tested in prior years during the same time period. Analyses showed significantly reduced odour detection for the virus exposed cohort compared to students tested before (t = 2.60; P = .01; d = 0.77; CI 0.17, 1.36) and to the normative sample (D = 0.38; P = .005). Odour identification scores were similar, but the exposed cohort rated odours as less unpleasant (P < .001, CLES = 0.77). Hyposmia increased 4.4-fold for students tested 2 weeks before school closure (N = 22) and increased 13.6-fold for students tested in the final week (N = 11). While the unavailability of COVID-19 testing is a limitation, this naturalistic study demonstrates week-by-week increase in hyposmia in asymptomatic students as a virus was circulating on campus, consistent with increasing airborne viral loads. The specific hedonic deficit in unpleasantness appraisal suggests a deficit in the TAAR olfactory receptor class, which conveys the social salience of odours. Assessment of odour detection and hedonic ratings may aid in early detection of SARS-CoV-2 exposure in asymptomatic and pre-symptomatic persons.

Adverse events following injection laryngoplasty: An analysis of the MAUDE database.

OBJECTIVE: Injection laryngoplasty (IL) is considered safe in both the operating room and clinical setting. However, safety data is limited to single-institution studies with reduced sample sizes. The objective of this study is to examine a national database for adverse events related to IL in an effort to further confirm the safety of this procedure and better characterize potential complications. MATERIALS AND METHODS: Retrospective analysis of the Manufacturer and User Facility Device Experience (MAUDE) database for reported adverse events of IL procedures utilizing calcium hydroxyapatite (CAHA), hyaluronic acid (HA) and carboxymethylcellulose (CMC) implants from 2009 to 2020. RESULTS AND ANALYSIS: We identified 47 reported adverse events. The average patient age was 54 years old. 59.3% of patients were female. Adverse events more frequently involved the use of CAHA compared to HA or CMC (n = 27, 57.4%, n = 13, 27.7% and n = 7, 14.9%, respectively). The most common adverse events were laryngeal edema (n = 18, 39.1%), improper placement of injected material (n = 12, 26.1%), persistent dysphonia (n = 13, 28.3%), and post-injection dysphagia or odynophagia (n = 11, 23.9%). Major events, defined as requiring emergency room treatment, hospitalization, or surgical intervention accounted for 29 (60.4%) of cases. Four cases of edema required intubation, and one patient necessitated a surgical airway. CONCLUSION: Complications arising from IL range from minor events to airway obstruction and may happen with a variety of injectable materials including CAHA, HA and CMC. Few cases of airway obstruction requiring immediate intervention were identified, confirming the safety of IL in both the operative and office setting.

Lamotrigine and Stevens-Johnson Syndrome Prevention.

Stevens-Johnson Syndrome (SJS) is a rare life-threatening condition characterized by severe mucocutaneous epidermal necrolysis and detachment of the epidermis. The condition centers around a delayed-type hypersensitivity reaction with a complex etiology stemming from a variety of causes. The number one cause is medication-related-common ones including sulfonamides, antiepileptics, allopurinol, and nonsteroidal anti-inflammatory drugs. Genetics also play a role as several human leukocyte antigen (HLA) genotypes within certain ethnic groups have been implicated in adverse reactions to specific drugs. HLAB*15:02 has been identified in the Chinese and others of Southeast Asian origin to increase susceptibility to lamotrigine and carbamazepine-induced SJS. Furthermore, patients of Japanese origin with HLAB*31:01 and Koreans with HLA-B*44:03 are also at increased risk of SJS after receiving the same two drugs. Of the antiepileptics, one most commonly associated with SJS is lamotrigine, a pre-synaptic voltage-gated sodium channel inhibitor. Lamotrigine is an antiepileptic drug of the phenyltriazine class that is indicated for the prevention of focal and generalized seizures in epileptic patients as well as monotherapy or adjunctive maintenance treatment for Bipolar disorder. The occurrence of SJS is not a rigid contraindication to lamotrigine reintroduction in the same patient. To facilitate this, manufacturers have developed a strict re-challenge dosing regimen to facilitate successful reintroduction of lamotrigine. In order to prevent the recurrence of SJS during a re-challenge, timing of re-dose and initial rash severity must be considered. Therefore, to prevent SJS recurrence, prime lamotrigine re-challenge patients are those with mild initial rash that has not occurred within the previous 4 weeks. The Federal Food and Drug Administration recommends the testing HLA subtypes for those associated with SJS prior to starting lamotrigine.

Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 Cases.

OBJECTIVE: The role of sclerotherapy for vascular lesions of the head and neck is well established. However, the efficacy of sclerotherapy for benign cystic lesions of the head and neck is less clear. The objective of this review is to determine the efficacy and safety of sclerotherapy for benign cystic lesions of the head and neck. DATA SOURCES: PubMed/MEDLINE, Cochrane Library, and Embase. REVIEW METHODS: The PRISMA guidelines (Preferred Reporting Systems for Systematic Reviews and Meta-analyses) were followed for this systematic review. Studies of patients with benign head and neck cystic masses treated primarily with sclerotherapy were included. Thirty-two studies met criteria for inclusion. RESULTS: A total of 474 cases of sclerotherapy were reviewed. Agents comprised OK-432, ethanol, doxycycline, tetracycline, and bleomycin. Lesions in the analysis were ranula, thyroglossal duct cyst, branchial cleft cyst, benign lymphoepithelial cyst, parotid cyst, thoracic duct cyst, and unspecified lateral neck cyst. A total of 287 patients (60.5%) had a complete response; 132 (27.9%) had a partial response; and 55 (11.6%) had no response. OK-432 was the most widely utilized agent, with a higher rate of complete response than that of ethanol (62.0% vs 39.4%, P = .015). Fifty-three cases (11.2%) required further surgical management. One case of laryngeal edema was reported and managed nonoperatively. CONCLUSION: Sclerotherapy appears to be a safe and efficacious option for benign cystic lesions if malignancy is reliably excluded. Efficacy rates are comparable to those of sclerotherapy for vascular malformations. The rate of serious complications is low, with 1 incident of airway edema reported in the literature.