The aim of this study is to assess outcomes in managing post-operative chyle leaks, following neck dissection using a volume-based risk stratification algorithm.

A retrospective series (2010–2024) at a tertiary head and neck centre included all patients with chyle leaks after neck dissection for malignancy. Chyle leaks were stratified as low, medium or high volume and managed either medically or with planned intervention, video-assisted thoracoscopic surgery, thoracic duct ligation or thoracic duct embolisation.

Thirty-five patients were identified. Sixty-five point seven per cent (n = 23) with low-volume leaks resolved with conservative management, 31.4 per cent (n = 11) with moderate-/high-volume leaks underwent video-assisted thoracic duct ligation, with 10/11 resolving within one day post-operatively, 5.7 per cent (n = 2) underwent thoracic duct embolisation. All cases with ongoing chyle leaks resolved without neck re-exploration surgery.

Volume-based risk stratification, paired with early video-assisted thoracoscopic surgery ligation or embolisation, provides a highly effective, low-morbidity strategy for managing post-operative chyle leaks.

This study aimed to assess the efficacy of core needle biopsy in the diagnostic workup of thyroid.

All patients referred to the thyroid multidisciplinary team who underwent core needle biopsy as part of their diagnostic workup were identified for analysis. Data was collected from initial fine needle aspiration cytology to final multidisciplinary team outcome for patients assessed between December 2022 and April 2024.

Data on 50 patients with thyroid nodules who underwent core needle biopsy was collected. A definitive diagnosis of malignancy was reached in 6.0 per cent (n = 3) of cases through core needle biopsy. Most patients (n = 39, 79.6 per cent) were offered diagnostic hemithyroidectomy after having had core needle biopsy. There was an average of 40 days between multidisciplinary team decision to offer core needle biopsy and decision to offer diagnostic surgery.

The value of offering core needle biopsy in all initially graded Thy3a fine needle aspiration biopsies is limited. Its potential benefit in progressing patient management requires further evaluation and its ongoing use should be determined on a case-by-case basis following multidisciplinary team discussion.

To investigate the stapes superstructure removed during surgical procedure under a light microscope, see whether the stapes superstructure was directly or indirectly affected by otosclerosis, and evaluate the results using the audiometric data.

Histologic section of the stapes superstructures of 30 patients operated for otosclerosis were retrospectively analysed.

There were no obvious active/inactive otosclerotic foci in the investigated stapes superstructures. Nevertheless, stapes superstructures had certain histopathologic findings that were not normally expected. Patients with otosclerotic alterations (Group 1) and without otosclerotic alterations (Group 2) were compared by pre-operative and post-operative air conduction, bone conduction, and air–bone gap.

The stapes superstructure contained degenerative findings similar to osteoarthritis of long bones and histopathologic changes that might be considered significant in terms of otosclerosis. Nevertheless, these changes did not significantly affect pre-operative and post-operative pure tone audiometry data. This is the first study known to us that investigated the stapes superstructure from the otosclerosis perspective, and the cases were assessed in combination with audiometric data.

This study investigates the seasonal and regional distribution of paediatric laryngomalacia admissions in the United States, hypothesizing higher admission rates in winter and colder regions due to reduced sunlight exposure affecting vitamin D levels.

We analyzed data from the 2016 Kids’ Inpatient Database (KID), focusing on children under three years old. Laryngomalacia cases were identified using International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) code Q31.5. Seasonal and regional differences in admission rates were assessed using Pearson’s chi-squared test, with a significance level of p less than 0.05.

Of 4,512,196 estimated national admissions, 11,638 were due to laryngomalacia. Admissions increased by 10.0 per cent in winter and decreased by 10.9 per cent in summer (p < 0.005). Regionally, admissions were higher in the Midwest/Central (18.6 per cent) and Northeast (9.3 per cent) and lower in the South (7.4 per cent) and West (11.1 per cent) (p < 0.005).

Laryngomalacia admissions are significantly influenced by seasonal and regional factors, likely related to environmental conditions affecting vitamin D synthesis.

The aim of this study was to evaluate the rate of dysplasia and carcinoma-ex-papillomatosis in patients with recurrent respiratory papillomatosis and assess for any risk factors.

A 15-year retrospective observational cohort study was performed from a single centre. Data on patient demographics, treatment history and pathology results were extracted from clinical records.

Of the 123 patients identified, nine had juvenile-onset recurrent respiratory papillomatosis and 114 had adult-onset recurrent respiratory papillomatosis. Thirteen (11 per cent) of patients with adult-onset recurrent respiratory papillomatosis had dysplasia, and one patient progressed to carcinoma-ex-papillomatosis. Patients with evidence of dysplasia had an average older age of disease onset compared to those without dysplasia (49 years vs 39 years, p = 0.03).

An older age of recurrent respiratory papillomatosis onset was the only risk factor for dysplasia. Gender, tobacco use, subglottic or tracheal involvement, number of surgeries and cidofovir were not prognostic factors in this series.

Head and neck cancer has a 5 per cent incidence of synchronous primary cancer. Synchronous primary cancers are commonly detected with imaging and flexible nasoendoscopy. Routine panendoscopy is still being used to screen for synchronous primary cancers. The aim was to establish the method of detection of synchronous primary cancer.

A retrospective cohort study of newly diagnosed head and neck cancer patients with a synchronous primary cancer, presented at the West of Scotland Head and Neck Multidisciplinary Team from December 2020 to August 2022. This study is Level 3 evidence.

A total of 2325 patients were presented to the Multi-Disciplinary Team with head and neck cancer and 54 (2.3 per cent) had SPC; 63.8 per cent (30) of patients had a panendoscopy. All patients with comprehensive out-patient assessment had their synchronous primary cancer detected on examination or imaging, without the need for panendoscopy.

Panendoscopy did not detect any new synchronous primary cancer in patients assessed with flexible nasoendoscopy and imaging. With modern high-resolution imaging and fibreoptics, panendoscopy does not play a role in the detection of synchronous primary cancers.

Image enhancement systems are important diagnostic tools in the detection of laryngeal pathologies. This study aimed to compare three different image enhancement systems: professional image enhancement technology, Image1 S and narrow-band imaging.

Using the three systems, 100 patients with laryngeal lesions were investigated using a flexible and a 30° rigid endoscope. The lesions were diagnosed by three experts and classified using the Ni classification. The findings were compared.

Lesions classified as ‘benign’ were histopathologically confirmed in 50 per cent of patients, malignant lesions were confirmed in 41 per cent and recurrent respiratory papillomatosis were confirmed in 9 per cent. There was no significant difference between the experts’ assessments of each image enhancement system.

The three systems give comparable results in the detection of laryngeal lesions. With two additional systems, more users can perform image-enhanced endoscopy, resulting in a broadly available tool that can help to improve oncological assessment.

The 2014 British Thyroid Association guidelines acknowledged the value of risk-stratifying thyroid nodules by utilising an ultrasound reporting system (‘U’ classification). This study assessed whether using pre-existing parameters in combination can better stratify patients’ malignancy and completion thyroidectomy risks.

A multicentre, retrospective, observational review identified 936 NHS Greater Glasgow and Clyde patients from pathology records who underwent hemithyroidectomy between 1 January 2014 and 31 December 2019.

A total of 308 patients had thyroid malignancy, 180 (58.4 per cent) progressed to completion thyroidectomy. A nodule classified as ‘U3’ (indeterminate) was associated with a 35.4 per cent chance of malignancy and a 21.6 per cent risk of requiring completion surgery. Amalgamation of ‘U’ score with Thy score enhanced risk prediction. The malignancy rate in U3, Thy-3f nodules was 38 per cent, and 21 per cent required completion surgery. The malignancy and completion thyroidectomy rates were comparatively lower for U3, Thy-3a nodules (22 per cent and 14.3 per cent, respectively).

Combining ultrasound ‘U’ score and Thy score improves pre-operative thyroid nodule risk stratification, leading to better informed patients regarding the risks of malignancy and completion surgery. A move towards an integrated assessment approach should be considered.