Endoscopically-Assisted Scar-Free Midline Neck Mass Excision

Traditional open surgery is indicated for the treatment of selected tumor subsites in the head and neck. However, it can cause major cosmetic problems and functional pathologies. The endoscopically-assisted transoral approach is increasingly preferred in some surgical fields due to its superior cosmetic and functional outcomes. Nonetheless, endoscopically-assisted transoral approach is not yet standard in the head and neck due to their anatomical complexity. The transoral surgical approach has been used for head and neck masses since the 1960s, and its application continues to evolve with changing disease conditions and recent innovations in surgical instruments. The potential for wide application of transoral surgery continues to be investigated, with a focus on minimizing occurrence of the complications. This review presents details of the surgical procedure and postoperative clinical outcomes, as well as endoscopically-assisted scar-free techniques for the resection of midline neck masses.

Potential implications of slim modiolar electrodes for severely malformed cochlea: A comparison with the straight array with circumferential electrodes

Objectives: Malformations of the inner ear account for approximately 20% of congenital deafness. In current practice, the straight arrays with circumferential electrodes (i.e., full-banded electrodes) are widely used in severely malformed cochlea. However, the unpredictability of the location of residual spiral ganglion neurons in such malformations argues against obligatorily pursuing the full-banded electrode in all cases. Here, we present an experience of electrically evoked compound action potential (ECAP) and radiography-based selection of an appropriate electrode for severely malformed cochlea. Methods: Three patients with the severely malformed cochlea, showing cochlear hypoplasia type II (CH-II), incomplete partition type I (IP-I), and cochlear aplasia with a dilated vestibule (CADV), were included, and the cochlear nerve deficiency (CND) was evaluated. Full-banded electrode (CI24RE(ST)) and slim modiolar electrode (CI632) were alternately inserted to compare ECAP responses and electrode position. Results: In patient 1 (CH-II with CND) who had initially undergone cochlear implantation (CI) using the lateral wall electrode (CI422), a revision CI was performed due to incomplete insertion of CI422 and resultant unsatisfactory performance, thus explanting the CI422 and re-inserting the CI24RE(ST) and CI632 sequentially. Although both electrodes elicited reliable ECAP responses with correct positioning, CI24RE(ST) showed overall lower ECAP thresholds compared to CI632; thus, CI24RE(ST) was selected. In patient 2 (IP-I with CND), CI632 elicited superior ECAP responses relative to CI24RE(ST), with correct positioning of the electrode; CI632 was chosen. In patient 3 (CADV), CI632 did not elicit an ECAP response while meaningful ECAP responses were obtained with the CI24RE(ST) array once correct positioning was achieved. All patients markedly improved auditory performance postoperatively. Conclusion: ECAP and radiography-based strategy for an appropriate electrode may be useful for severely malformed cochlea, leading to enhanced functional outcomes. Additionally, the practice of sticking to the full-banded straight electrode may not always be the best for IP-I and CH-II.

Care and Management of Voice Change for Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

Voice change is a common complaint after thyroid surgery and has significant impacts on quality of life. The Korean Society of Laryngology, Phoniatrics, and Logopedics set up a task force team to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations include preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, including in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQ) in three categories: preoperative (KQ1–2), intraoperative (KQ 3–8), and postoperative (KQ 9–14) management and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. Detailed evidence profiles are presented for each recommendation. The level of evidence for each recommendation is classified into high, moderate, and low-quality. The recommendation