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Objectives/hypothesis: The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients., Methods: The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes., Results: One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved., Conclusions: The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal., Level of Evidence: 4 Laryngoscope, 131:2471-2477, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Elective neck dissection (END) for salvage laryngectomy remains controversial due to variability in reported occult nodal metastasis rates and postoperative complications. We performed a meta-analysis to examine the role of END for treatment of the clinically N0 (cN0) neck in the salvage setting., Methods: A PubMed search, without limit on years searched, was conducted for English language articles. Additional sources were found by reviewing bibliographies of pertinent articles. Studies had to include END data for salvage laryngectomy for locally recurrent squamous cell carcinoma of the larynx with clinically negative regional metastasis. For patients who underwent END, pathological node status had to be reported. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations were followed. Data were pooled using a random-effects model., Results: Nineteen studies were included in the analysis. Within the END group, 31% were supraglottic, 61% were glottic, 6% were transglottic, and 1% were subglottic. The pooled rate of occult nodal metastasis was 14% (95% CI = 0.11-0.17) for all subsites. In subsite-specific analyses, occult nodal metastasis rates were 24% for supraglottic, 9% for glottic, and 17% for transglottic recurrences. Occult nodal metastasis was higher in recurrent T3/4 tumors (21%) compared to recurrent T1/2 tumors (9%) (relative risk (RR) = 2.17, 95% CI = 1.23-3.63, p = 0.003). The RR of postoperative complications with END compared to observation was 1.72 (95% CI = 0.96-3.10, p = 0.07)., Conclusions: The highest rates of occult nodal metastasis are associated with supraglottic recurrence and recurrent T3/T4 tumors. These data should be considered when deciding whether to perform END for salvage laryngectomy., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: The literature is scarce regarding transoral robotic surgery (TORS) with simultaneous neck dissection. This study evaluates the safety and efficacy of concurrent neck dissection in oropharyngeal squamous cell carcinoma (SCC) treated with TORS., Methods: Analysis of 113 patients with oropharyngeal SCC treated with TORS and concurrent neck dissection., Results: Six intraoperative communications between the pharynx and neck region were recognized. After pharyngeal mucosal flap advancement, 1 defect was closed primarily and another one was reinforced with acellular dermal matrix. In 1 case, submandibular gland was transposed posteriorly over the sutured defect as a support. One omohyoid and 2 digastric muscular pedicle rotation flaps were used in the remaining 3 patients for the reconstruction of pharyngeal communications. None of the patients developed postoperative pharyngocutaneous fistula., Conclusion: The advantage of TORS oropharyngectomy, when compared with open approaches, is the avoidance of pharyngocutaneous fistula even in the presence of concurrent neck dissection © 2015 Wiley Periodicals, Inc. Head Neck 38: E519-E523, 2016., (© 2015 Wiley Periodicals, Inc.)

Multiple diagnostic and treatment paradigms exist for the management of carcinoma of unknown primary (CUP) metastatic to cervical lymph nodes. Transoral robotic surgery (TORS) has emerged as a modality for diagnosis and treatment of CUP, optimizing identification and resection of the primary tumor, although also preventing chemotherapy in a subset of patients. This article presents the authors' treatment paradigm and reviews the literature supporting the use of TORS in the management of CUP., (© 2015 Wiley Periodicals, Inc.)