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Suh PS, Lee JH, Roh YH, Moon HH, Chung SR, Kwon MS, Choi YJ, Lee YS, Baek JH, Choi SH. Ethanol Ablation of Ranulas and Risk Factor Analysis for Recurrence. JAMA Otolaryngol Head Neck Surg 2024; 150:502-508. [PMID: 38696210 PMCID: PMC11066768 DOI: 10.1001/jamaoto.2024.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/09/2024] [Indexed: 05/05/2024]
Abstract
Importance Ethanol ablation (EA) was shown to be safe and effective for treating ranula, but few studies have assessed long-term outcomes and recurrence of ranula after EA. Objective To evaluate the long-term outcomes and the risk factors for recurrence and receipt of subsequent surgery in patients who underwent treatment with EA for ranula. Design, Setting, and Participants This case-series study was conducted at a single tertiary hospital and assessed patients who were treated with EA between July 2009 and March 2021. Among 70 consecutive patients, those with follow-up loss or who were followed up for less than 24 months were excluded. Exposures EA for ranula. Main Outcomes and Measures The primary outcome was recurrence at last follow-up after single or multiple EA sessions. Secondary outcomes included receipt of subsequent surgery and the recurrence-free survival (RFS) rate after initial EA. Factors possibly associated with outcomes included patient age and sex; ranula site, type, diameter, volume, and echogenicity; the presentation-to-EA interval; parapharyngeal space extension; and sublingual gland herniation. Risk factors were identified on logistic regression analyses. Two-year RFS rates were analyzed for the initial cohort using the Kaplan-Meier method and compared by log-rank tests. Results A total of 57 patients (mean [SD] age, 26.4 [12.1] years; 24 female individuals [42%]) who were followed up for a median of 57 months (range, 24-167 months) were included. The recurrence rate was 33% (n = 19), and 11 (19%) underwent subsequent surgery. Among patients with recurrence, 86% (31 of 36) experienced first recurrence within 12 months after initial EA. A presentation-to-EA interval of 12 months or longer was associated with an increased risk of recurrence (adjusted odds ratio [OR], 3.74; 95% CI, 1.01-13.82). No risk factors were significantly associated with subsequent surgery (highest OR in parapharyngeal space extension: adjusted OR, 4.96; 95% CI, 0.94-26.35). Among the initial cohort of 70 patients, 2-year RFS was lower in a maximum diameter of ranula of 5 cm or greater than less than 5 cm (24% [95% CI, 7%-41%] vs 50% [95% CI, 34%-66%]; difference, 26% [95% CI, -4% to 56%]; log-rank test, P = .02). Conclusions and Relevance This case-series study found that the recurrence rate of ranula after EA was 33%. A presentation-to-EA interval of 12 months or longer may be a risk factor for recurrence, suggesting that early intervention with EA might minimize recurrence. Most first recurrences occurred within 12 months after EA, with a maximum diameter of ranula of 5 cm or greater being a possible risk factor.
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Affiliation(s)
- Pae Sun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yun Hwa Roh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye Hyun Moon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min Su Kwon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Paul I, Mohiyuddin SMA, A S, Mohammadi K, Babu P. The Outcome of Treatment in Second Branchial Cleft Anomalies: A Case Series. Cureus 2023; 15:e40164. [PMID: 37431352 PMCID: PMC10329747 DOI: 10.7759/cureus.40164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Background Branchial-cleft anomalies are second only to thyroglossal duct anomalies among congenital malformations of the neck, and second branchial-cleft anomalies are the most common. These include branchial cysts, branchial sinuses, and branchial fistulas. Clinical symptoms include neck swelling and a discharging sinus or fistula opening. In a small number of cases, they can lead to major complications like abscesses or malignant changes. Surgical resection is the treatment of choice. Various approaches to resection and sclerotherapy have been tried. In this study, we present our treatment outcome with branchial cleft anomalies at a rural tertiary medical care hospital. Objectives To document the various presentations, clinical features, and outcomes of treatment with second branchial cleft anomalies. Methods This retrospective observational study included 16 patients operated on for second branchial-cleft anomalies. A detailed medical history was elicited, and an accurate clinical examination was done. A contrast-enhanced computed tomography (CECT) scan was done in all cases. A few cases required a fistulogram. The cysts, sinuses, or fistulas were resected en bloc by a single neck crease incision. Primary closure was done in all cases. A recurrence or pharyngocutaneous fistula required axial flap reconstruction. The complications and recurrences were documented. Result There were six children and 10 adults in our study. Seven cysts, five sinuses, and four fistulas were present, of which four were iatrogenic. In seven patients, imaging could not show the entire tract. There were four fistulas from the oropharynx to a cutaneous opening in the neck. A complete resection was done for all. Two pharyngocutaneous fistulas were treated with a pectoralis major myocutaneous (PMMC) flap. Three patients had wound dehiscence postoperatively. None of the patients had neurological or vascular injuries. Conclusion Second branchial cleft anomalies can be completely excised by a single neck crease incision. Meticulous surgery results in a low recurrence or complication rate. Following complete excision, in type IV anomalies, a purse-string suture at the pharyngeal opening ensures good closure and no recurrences.
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Affiliation(s)
- Indranil Paul
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - S M Azeem Mohiyuddin
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Sagayaraj A
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Kouser Mohammadi
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Prashanth Babu
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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3
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Muacevic A, Adler JR, Niermeyer W, Joshi A. The Use of Ethanol Sclerotherapy To Treat a Large Cervical Lymphocele. Cureus 2022; 14:e33043. [PMID: 36721545 PMCID: PMC9881499 DOI: 10.7759/cureus.33043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Cervical lymphoceles are atypical lymphatic accumulations that develop within the subcutaneous tissue of the neck. While these accumulations have traditionally been removed via surgical excision, sclerotherapy has recently emerged as a reasonable option to prevent injury to surrounding vascular, neurologic, and pulmonary structures. The purpose of this case report is to describe the efficacy of ethanol sclerotherapy for a cervical lymphocele refractory to surgical embolization. We present the case of a 70-year-old male with a large cervical lymphocele that was initially treated with surgical embolization. The mass rapidly reaccumulated within two weeks and the patient subsequently underwent ethanol sclerotherapy with no evidence of re-accumulation after 18 months. This case highlights the utility of ethanol due to its better side-effect profile, widespread availability, and cheaper cost when compared to better-described agents.
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Shuaibu IY, Sholadoye TT, Ajiya A, Usman MA, Aliyu HO. Paediatric neck masses in Zaria: A review of clinical profile and treatment outcome. Afr J Paediatr Surg 2021; 18:205-209. [PMID: 34341304 PMCID: PMC8423163 DOI: 10.4103/ajps.ajps_134_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A neck mass is any abnormal lesion in the neck that can be seen, palpated, or identified on imaging. It is one of the most common reasons for presentation to the surgical clinics. AIM the aim is to analyse the clinical presentation and treatment outcome in children who were diagnosed and managed for neck masses in a tertiary centre in Northwestern Nigeria. MATERIALS AND METHODS The records of patients managed for neck masses over 7 years between January 2013 and December 2019 were reviewed. Demographic and clinical data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). RESULTS A total of 99 cases were reviewed and there were 52 (52.5%) males and 47 (47.5%) females with male-to-female ratio of 1.1:1, and mean age ± standard deviation of 4.4 ± 3.9 years, the primary complaints of all the patients were neck swellings. The anterior triangle was the most common region involved in 86 (86.9%) patients. The majority of the neck masses were congenital, accounting for 71 (71.8%) patients. Ultrasound scanning was the most commonly requested radiological investigation done in 87 (87.8%) patients. . Thyroglossal duct cyst was the most common paediatric neck mass seen in 41 (41.4%) patients. The majority of the patients 68 (68.7%) had an excisional biopsy of the lesion. Surgical site infection was the most common complication noted in 7.1% of the study population. CONCLUSION Most of the neck masses were congenital and were managed surgically. Prompt diagnosis with appropriate treatment may result in a good outcome.
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Affiliation(s)
- Iliyasu Yunusa Shuaibu
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Tunde Talib Sholadoye
- Department of Surgery, Division of Pediatric Surgery, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Abdulrazak Ajiya
- Department of Otorhinolaryngology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Mohammed Aminu Usman
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Halima Oziohu Aliyu
- Department of Pathology, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
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Fockens MM, de Bakker BS, van Lienden KP, Dikkers FG, Hoekstra CEL. Endoscopic Cauterization and Sclerotherapy for Airway Obstruction by a Third Branchial Pouch Sinus. Laryngoscope 2020; 131:E1730-E1732. [PMID: 32915997 PMCID: PMC8246521 DOI: 10.1002/lary.29101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- M Matthijs Fockens
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernadette S de Bakker
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Krijn P van Lienden
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carlijn E L Hoekstra
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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6
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Chen Q, Chen Y, Su A, Ma Y, Yu B, Zou X, Peng D, Zhu J. Ultrasound-guided percutaneous injection of Pseudomonas aeruginosa-mannose sensitive hemagglutinin for treatment of chyle fistula following neck dissection: Two case reports. Medicine (Baltimore) 2020; 99:e18816. [PMID: 32000384 PMCID: PMC7004758 DOI: 10.1097/md.0000000000018816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Chyle fistula is a rare but troublesome complication of neck dissection. Topical application of Pseudomonas aeruginosa-mannose sensitive hemagglutinin (PA-MSHA) injection has been reported as a novel, viable, and effective approach in the treatment of chyle fistula following neck dissection. However, there have been no reports regarding the treatment of chyle fistula using ultrasound (US)-guided percutaneous injection of PA-MSHA. PATIENT CONCERNS We describe 2 patients with thyroid cancer who developed chyle fistula following neck dissection, which remained unresolved despite the use of conservative treatment. DIAGNOSES Both the patients were diagnosed with chyle fistula by laboratory testing, which showed that drainage fluid triglyceride concentration was >100 mg/dL. INTERVENTIONS When conservative treatment failed, a 2 mL undiluted PA-MSHA preparation was percutaneously injected at the effusion site of the left supraclavicular area under US guidance with aseptic technique. Concomitantly, the drainage tube was clamped for at least 30 minutes. OUTCOMES Chyle fistula in both patients were successfully resolved with this technique within 2 or 4 days, without notable side effects. LESSONS US-guided percutaneous injection of PA-MSHA is a simple and effective method to treat chyle fistula following neck dissection, which may serve as a useful addition to the medical treatment for cervical chyle fistula.
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Affiliation(s)
- Qiang Chen
- Department of Thyroid and Parathyroid Surgery Center
| | | | - Anping Su
- Department of Thyroid and Parathyroid Surgery Center
| | - Yu Ma
- Department of Thyroid and Parathyroid Surgery Center
| | - Boyang Yu
- Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu, China
| | - Xiuhe Zou
- Department of Thyroid and Parathyroid Surgery Center
| | - Dongmei Peng
- Department of Thyroid and Parathyroid Surgery Center
| | - Jingqiang Zhu
- Department of Thyroid and Parathyroid Surgery Center
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Tachibana T, Kariya S, Orita Y, Makino T, Haruna T, Matsuyama Y, Komatsubara Y, Naoi Y, Nakada M, Wani Y, Fushimi S, Hotta M, Haruna K, Nagatani T, Sato Y, Nishizaki K. The efficacy of OK-432 sclerotherapy on thyroglossal duct cyst and the influence on a subsequent surgical procedure. Acta Otolaryngol 2019; 139:788-792. [PMID: 31271329 DOI: 10.1080/00016489.2019.1633019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Although there are studies regarding the efficacy of OK-432 sclerotherapy on thyroglossal duct cyst (TDC), its effects on surgical procedure following this therapy have not been properly described. Objectives: The present study aimed to delineate the prognostic factors of OK-432 sclerotherapy in patients with TDC and investigate its influence on subsequent surgical procedure and the histological characteristics in patients with poor response to OK-432 sclerotherapy. Material and methods: We conducted a retrospective analysis of the medical records of 20 TDC patients treated with OK-432 sclerotherapy. Results: Of the 20 patients, OK-432 sclerotherapy was effective in 5 patients (25.0%). OK-432 showed a lower effective rate in multilocular cysts (9.1%) than in unilocular cysts (44.4%), although not significantly. Five cases were treated with surgery following OK-432 sclerotherapy. There was no significant difference in the operating time and the amount of bleeding between patients with and without OK-432 sclerotherapy. From the results of the histological examination of the cyst wall, two cases had stratified squamous epithelium and two cases showed the absence of lymphocyte infiltration. Conclusion and significance: OK-432 sclerotherapy is an acceptable initial treatment for TDC, especially in unilocular cysts, because of lack of influence on surgical procedure.
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Affiliation(s)
- Tomoyasu Tachibana
- Departments of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Shin Kariya
- Departments of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Yorihisa Orita
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto City, Japan
| | - Takuma Makino
- Departments of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Takenori Haruna
- Departments of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Yuko Matsuyama
- Departments of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Yasutoshi Komatsubara
- Departments of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Yuto Naoi
- Departments of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | | | - Yoji Wani
- Departments of Pathology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Soichiro Fushimi
- Departments of Pathology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Machiko Hotta
- Departments of Pathology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Katsuya Haruna
- Departments of Inspection technology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Tami Nagatani
- Departments of Inspection technology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Yasuharu Sato
- Departments of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Kazunori Nishizaki
- Departments of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
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Slough CM, Kamani D, Randolph GW. In-Office Ultrasonographic Evaluation of Neck Masses/Thyroid Nodules. Otolaryngol Clin North Am 2019; 52:559-575. [PMID: 30954268 DOI: 10.1016/j.otc.2019.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Office-based ultrasonography is increasingly becoming an integral part of an otolaryngology-head and neck surgery practice. A thorough knowledge of the ultrasonic appearance of normal and abnormal pathology are key for performing/interpreting office-based head and neck ultrasonography. A focused but systematic approach allows for efficient and effective office-based head and neck ultrasonography. Office-based ultrasonography also allows for imaging procedures expanding the otolaryngologist's armamentarium. Ultrasound-guided fine needle aspiration (USgFNA) is an integral part of clinician-performed ultrasonography because it allows cytologic diagnosis of suspicious lesions. Understanding the successful techniques and pitfalls in this procedure are critical for the otolaryngologist performing USgFNA.
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Affiliation(s)
- Cristian M Slough
- Willamette Valley Ear, Nose, & Throat, Willamette Valley Medical Center, 2700 SE Stratus Ave, McMinnville, OR 97128, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, 243, Charles Street, Boston, MA 02114, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, 243, Charles Street, Boston, MA 02114, USA; Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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9
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Percutaneous treatment of ranulas: ultrasound-guided drainage with salivary gland chemical ablation. Pediatr Radiol 2019; 49:801-807. [PMID: 30815715 PMCID: PMC6614164 DOI: 10.1007/s00247-019-04356-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/20/2019] [Accepted: 02/14/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ranulas are salivary pseudocysts in the floor of the mouth adjacent to damaged salivary glands. Current surgical management is drainage of the ranula with removal of the offending gland. An analogous percutaneous procedure could potentially offer similar treatment efficacy in a more minimally invasive way. OBJECTIVE To evaluate the outcomes of a cohort of patients with ranulas treated with percutaneous ranula aspiration and chemical ablation of the source salivary gland to see whether this technique could be proposed as a minimally invasive treatment alternative. MATERIALS AND METHODS This retrospective single-center study evaluated 24 patients treated percutaneously for ranulas between January 2004 and December 2014. All patients were treated with percutaneous ranula aspiration and chemical ablation of the offending salivary gland. Treatment success and any complications were recorded. RESULTS Complete ranula eradication was successfully accomplished in 87.5% of the patients with no complications. CONCLUSION Initial results suggest that our technique of percutaneous aspiration of ranulas and chemical ablation of the source salivary gland is safe and effective.
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10
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Foo MI, Braswell LE, Lubeley LJ, Murakami JW. Minimally invasive treatment of pediatric head and neck dermoids: percutaneous drainage and radiofrequency coblation. Pediatr Radiol 2019; 49:1222-1228. [PMID: 31165183 PMCID: PMC6660509 DOI: 10.1007/s00247-019-04438-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/08/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermoids are common benign head and neck cysts in children containing a variety of different skin elements. Current standard treatment is surgical removal that sometimes requires extensive dissection to ensure complete resection and often leaves unwanted facial scarring. A minimally invasive treatment alternative should offer a similar rate of success with a decrease in operative complexity, recovery time and postoperative scarring. OBJECTIVE To assess the outcomes of our minimally invasive percutaneous treatment of head and neck dermoids, we reviewed our 9-year interventional radiology (IR) department experience. MATERIALS AND METHODS The medical records, imaging and procedural details were reviewed from a cohort of pediatric patients with dermoids treated in our IR department from January 2009 through February 2018. Patients in the study underwent ultrasound (US)-guided cyst puncture, 3% Sotradecol (sodium tetradecyl sulfate [STS]) emulsification of the thick cyst contents allowing complete drainage, and radiofrequency coblation of the cyst wall. RESULTS In this retrospective study, we report on 22 dermoids in 21 patients. The average patient age was 3 years. Twenty-one of the 22 dermoids were successfully treated for an overall success rate of 95%. Four intraosseous dermoids were successfully treated using computed tomography (CT) guidance instead of, or in addition to, US. Average follow-up time was 22 months. CONCLUSION The combination of percutaneous cyst drainage using STS as an emulsifying agent followed by radiofrequency coblation is a safe, effective, minimally invasive treatment for pediatric patients with head and neck dermoids.
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Affiliation(s)
- Madeline I Foo
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Leah E Braswell
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Lacey J Lubeley
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - James W Murakami
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA.
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11
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Slonimsky G, Baker A, Crist H, Goldenberg D. A midline mediastinal parathyroid cyst. EAR, NOSE & THROAT JOURNAL 2018; 97:58-60. [PMID: 29554397 DOI: 10.1177/014556131809700318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Guy Slonimsky
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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12
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Jama GM, Baruah P, Pugh A, Liew L. Non-functional parathyroid cyst masquerading as a thyroid cyst: Report of two cases and review of the literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2018. [DOI: 10.1080/23772484.2018.1476063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Guled M. Jama
- Department of ENT Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Paramita Baruah
- Department of ENT Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Abigail Pugh
- The Royal Wolverhampton NHS Trust, Histopathology, New Cross Hospital, Wolverhampton, UK
| | - Leonard Liew
- Department of ENT Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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13
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Slonimsky G, Baker A, Crist H, Goldenberg D. A Midline Mediastinal Parathyroid Cyst. EAR, NOSE & THROAT JOURNAL 2018. [DOI: 10.1177/014556131809700305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Guy Slonimsky
- Department of Surgery, Division of
Otolaryngology–Head and Neck Surgery
| | - Aaron Baker
- Department of Surgery, Division of
Otolaryngology–Head and Neck Surgery
| | - Henry Crist
- Department of Pathology, The Pennsylvania State
University, College of Medicine, Hershey
| | - David Goldenberg
- Department of Surgery, Division of
Otolaryngology–Head and Neck Surgery
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14
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Wong W, Loya MF, Martynov A, Shah SS, Berman D. Successful sclerotherapy of a recurrent, benign parotid cyst. Radiol Case Rep 2017; 13:146-149. [PMID: 29552253 PMCID: PMC5850872 DOI: 10.1016/j.radcr.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/26/2017] [Accepted: 09/05/2017] [Indexed: 02/02/2023] Open
Abstract
Benign parotid lesions can grow to be a cosmetic deformation with psychological sequelae for a patient. Although surgical resection is the treatment of choice, cyst aspiration has also been attempted. This, however, has been shown to recur, requiring repeat intervention. An alternative therapeutic method not as widely recognized, but which has been reported to be both effective and less invasive than surgery for treating parotid cyst lesions, is sclerotherapy. Here we describe a report of a patient with a benign, localized, cystic neck mass refractory to 2 trials of fine needle aspiration. After the patient refused surgical resection, a trial of sterile ethanol sclerotherapy was performed. Our patient tolerated the procedure well with a significant reduction in the size of the lesion.
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15
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Ha EJ, Baek SM, Baek JH, Shin SY, Han M, Kim CH. Efficacy and Safety of Ethanol Ablation for Branchial Cleft Cysts. AJNR Am J Neuroradiol 2017; 38:2351-2356. [PMID: 28970243 DOI: 10.3174/ajnr.a5373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/10/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Branchial cleft cyst is a common congenital lesion of the neck. This study evaluated the efficacy and safety of ethanol ablation as an alternative treatment to surgery for branchial cleft cyst. MATERIALS AND METHODS Between September 2006 and October 2016, ethanol ablation was performed in 22 patients who refused an operation for a second branchial cleft cyst. After the exclusion of 2 patients who were lost to follow-up, the data of 20 patients were retrospectively evaluated. All index masses were confirmed as benign before treatment. Sonography-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%) into the lesion. The injected volume of ethanol was 50%-80% of the volume of fluid aspirated. Therapeutic outcome, including the volume reduction ratio, therapeutic success rate (volume reduction ratio of >50% and/or no palpable mass), and complications, was evaluated. RESULTS The mean index volume of the cysts was 26.4 ± 15.7 mL (range, 3.8-49.9 mL). After ablation, the mean volume of the cysts decreased to 1.2 ± 1.1 mL (range, 0.0-3.5 mL). The mean volume reduction ratio at last follow-up was 93.9% ± 7.9% (range, 75.5%-100.0%; P < .001). Therapeutic success was achieved in all nodules (20/20, 100%), and the symptomatic (P < .001) and cosmetic (P < .001) scores had improved significantly by the last follow-up. In 1 patient, intracystic hemorrhage developed during the aspiration; however, no major complications occurred in any patient. CONCLUSIONS Ethanol ablation is an effective and safe treatment for patients with branchial cleft cysts who refuse, or are ineligible for, an operation.
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Affiliation(s)
- E J Ha
- From the Departments of Radiology (E.J.H., M.H.)
| | - S M Baek
- Department of Radiology (S.M.B., S.Y.S.), Sharing and Happiness Hospital, Busan, Korea
| | - J H Baek
- Department of Radiology and Research (J.H.B.), Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - S Y Shin
- Department of Radiology (S.M.B., S.Y.S.), Sharing and Happiness Hospital, Busan, Korea
| | - M Han
- From the Departments of Radiology (E.J.H., M.H.)
| | - C-H Kim
- Otolaryngology (C.-H.K.), Ajou University School of Medicine, Suwon, Korea
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16
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Ryu KH, Lee JH, Lee JY, Chung SR, Chung MS, Kim HW, Choi YJ, Baek JH. Ethanol Ablation of Ranulas: Short-Term Follow-Up Results and Clinicoradiologic Factors for Successful Outcome. AJNR Am J Neuroradiol 2017; 38:1794-1798. [PMID: 28663262 DOI: 10.3174/ajnr.a5292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 05/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Surgical excision of an affected sublingual gland for treatment of a ranula can carry a potential of a nerve damage or postoperative complications. However, there have been little studies about effective minimally invasive therapeutic method, yet. Our aim was to evaluate the efficacy and safety of ethanol ablation of ranulas and the clinicoradiologic factors that can predict outcome. MATERIALS AND METHODS This retrospective study evaluated 23 patients with ranulas treated by percutaneous ethanol ablation. Treatment outcome was assessed in 20 patients followed for at least 6 months. The duration of symptoms before ethanol ablation, pretreatment volume, and parapharyngeal extension on sonography and/or CT were correlated with the outcome. The Mann-Whitney U test and Fisher exact test were used for comparison of the factors according to the outcome. RESULTS The study evaluated 14 males and 9 females with a median age of 26 years (range, 3-41 years). Among 20 patients who were followed for at least 6 months (median, 20 months; range, 6-73 months), 9 patients (45%) demonstrated complete disappearance of the ranulas and 11 (55%) showed an incomplete response. When the patients were divided according to the duration of symptoms before ethanol ablation, the complete response rate was significantly higher in patients with ≤12 months of symptoms (73%, 8/11) than that in others (11%, 1/9) (P = .010). Pretreatment volume and parapharyngeal extension were not significantly different between the 2 groups. CONCLUSIONS Ethanol ablation is a safe and noninvasive treatment technique for ranulas with a significantly better outcome in patients with ≤12 months of symptoms. Therefore, it could be considered an alternative nonsurgical approach for ranulas with recent onset of symptoms.
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Affiliation(s)
- K H Ryu
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Radiology (K.H.R.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - J H Lee
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - J Y Lee
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Radiology (J.Y.L.), Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - S R Chung
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - M S Chung
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Radiology (M.S.C.), Chung-Ang University College of Medicine, Chung-Ang University Medical Center, Seoul, Republic of Korea
| | - H W Kim
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Y J Choi
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - J H Baek
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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17
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Non-functioning parathyroid cysts refractory to conservative treatment. Cir Esp 2017; 96:52-54. [PMID: 28400142 DOI: 10.1016/j.ciresp.2017.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 11/22/2022]
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18
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Park HS, Baek JH, Choi YJ, Lee JH. Innovative Techniques for Image-Guided Ablation of Benign Thyroid Nodules: Combined Ethanol and Radiofrequency Ablation. Korean J Radiol 2017; 18:461-469. [PMID: 28458598 PMCID: PMC5390615 DOI: 10.3348/kjr.2017.18.3.461] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 10/16/2016] [Indexed: 12/31/2022] Open
Abstract
In the treatment of benign thyroid nodules, ethanol ablation (EA), and radiofrequency ablation (RFA) have been suggested for cystic and solid thyroid nodules, respectively. Although combining these ablation techniques may be effective, no guidelines for or reviews of the combination have been published. Currently, there are three ways of combining EA and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after EA. Additional EA can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve). In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Lee JY, Lee HY, Kim HJ, Jeong HS, Kim YK, Cha J, Kim ST. Plunging Ranulas Revisited: A CT Study with Emphasis on a Defect of the Mylohyoid Muscle as the Primary Route of Lesion Propagation. Korean J Radiol 2016; 17:264-70. [PMID: 26957912 PMCID: PMC4781766 DOI: 10.3348/kjr.2016.17.2.264] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/31/2015] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this study was to clarify the pathogenesis of plunging ranulas in regard of the pathway of lesion propagation using CT scans. Materials and Methods We retrospectively reviewed CT scans of 41 patients with plunging ranula. We divided plunging ranulas into two types: type 1 was defined as those directly passing through a defect of the mylohyoid muscle with the presence (type 1A) or absence (type 1B) of the tail sign and type 2 as those through the traditional posterior route along the free edge of the mylohyoid muscle. Images were also analyzed for the extent of the lesion in respect to the spaces involved. As for type 1 lesions, we recorded the location of the defect of the mylohyoid muscle and the position of the sublingual gland in relation to the defect. Results CT scans demonstrated type 1 lesion in 36 (88%), including type 1A in 14 and type 1B in 22, and type 2 lesion in 5 (12%). Irrespective of the type, the submandibular space was seen to be involved in all cases either alone or in combination with one or more adjacent spaces. Of the 36 patients with type 1 lesions, the anterior one-third was the most common location of the defect of the mylohyoid muscle, seen in 22 patients. The sublingual gland partially herniated in 30 patients. Conclusion Our results suggest that the majority of plunging ranulas take an anterior shortcut through a defect of the mylohyoid muscle.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hee Young Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Han Sin Jeong
- Departments of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Yi-Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jihoon Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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