Retroauricular hairline approach for excision of second branchial cleft cysts: a preliminary experience.

OBJECTIVE: To report our preliminary experience with a retroauricular hairline incision (RAHI) for excision of second branchial cleft cysts (SBCC) and to present a relevant literature review. STUDY DESIGN: Retrospective case series. METHODS: A retrospective chart review was conducted of two consecutive patients diagnosed with SBCC who underwent surgical removal via a RAHI. Relevant demographic, clinicopathological, and radiological data was recorded. A web-based search was conducted to identify relevant scientific literature on "retroauricular hairline incision /approach" in order to present a systematic review of current literature. RESULT: In both cases, the SBCC (6.0 cm and 3.8 cm) could be safely excised without major complications. One patient developed a temporary hypoesthesia of ear lobe. None of the patients had a postoperative infection, hematoma, spillage of cyst fluid, or necrosis of the skin flap. All patients were satisfied with the cosmetic outcome of the procedure (100%). The incisions healed well without any evidence of hair loss or keloid formation. CONCLUSION: In conclusion, the RAHI offers an excellent surgical outcome and cosmetic result with no proven increased risks to the patients who require surgical excision of a benign SBCC.

Secondary tracheoesophageal puncture with in-office transnasal esophagoscopy.

OBJECTIVE: To evaluate the outcomes of voice restoration using office-based transnasal esophagoscopy (TNE) to guide placement of the secondary tracheoesophageal puncture (TEP). DESIGN: Retrospective chart review. SETTING: Two tertiary care medical centers. PATIENTS: The study included 39 patients who underwent the TNE-TEP procedure from January 2004 to December 2008. MAIN OUTCOME MEASURES: Clinical, demographic, and TE speech-related data were recorded to examine the ease, efficiency, complications, and speech-related outcomes. RESULTS: Among 39 patients identified, the average age was 65 years (age range, 47-83 years), with 32 male (82%) and 7 female (16%) patients. Twenty-five patients (64%) underwent total laryngectomy; 8 (21%) underwent total laryngectomy with partial pharyngectomy; and 14 (36%) underwent microvascular flap reconstruction. The overall success rate of secondary TNE-assisted TEP placement was 97% (n = 38), with 1 unsuccessful attempt. There was no statistically significant correlation found between patients having undergone radiation therapy (either before or after oncologic resection) or a cricopharyngeal myotomy and successful TEP placement, type of reconstruction used to close the pharyngeal defect when compared with the difficulty in the placement of the TEP, development of complications associated with TEP placement, use of the TEP prosthesis, or speech intelligibility at the last follow-up visit. Thirty-one patients (79%) were still using their TEP prosthesis for speech at the last follow-up visit. Of the patients reviewed, 28 (72%) had understandable TE speech. CONCLUSIONS: In-office TNE-assisted TEP placement can safely be performed, with excellent speech outcomes. Reconstruction with musculocutaneous or microvascular free-tissue transfer did not limit our ability to place secondary TEPs with TNE.