{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T01:55:49Z","timestamp":1769824549147,"version":"3.49.0"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T00:00:00Z","timestamp":1615248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Assess the impact of surgical technique used to address level IV on the rate of postoperative chyle leak.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Academic tertiary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An analysis of 436 consecutive neck dissections (NDs) in 368 patients was performed by 3 head and neck surgeons between 2014 and 2017. Variation in technique reflects individual approaches to the management of level IV and included suture ligation (SL), monopolar electrocautery (MC), and harmonic scalpel transection (HS). Data points included patient demographics, surgical technique, intraoperative findings, postoperative chyle leaks, and leak management. Correlation between variables was analyzed through \u03c7<jats:sup>2<\/jats:sup> test and Student <jats:italic>t<\/jats:italic> test with statistical \u03b1 set at. 05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 12 patients (3.2%) developed chyle leaks postoperatively. Nine of 12 and 3 of 12 presented with left\u2010 and right\u2010sided leaks, respectively. Five of 12 leaks occurred following bilateral ND, 5 of 12 following left ND, and 2 of 12 following right ND. Univariate analysis showed a statistically significant difference (<jats:italic>P<\/jats:italic> =. 001) favoring SL (1.0%) and MC (1.2%) techniques over the HS technique (8.6%). A statistically significant increase existed in the rate of leak with endocrine vs nonendocrine pathology (<jats:italic>P<\/jats:italic> =. 003). Average duration of leak was 13.3 \u00b1 13.5\u00a0days. Management included diet modification (n = 11, 91.6%), pressure\u2010dressing placement (n = 7, 58.3%), and octreotide (n = 5, 41.7%). No cases required reoperation, and no mortality or severe malnutrition was observed in this series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SL and MC techniques demonstrated superiority over the HS technique in preventative management of chyle leak in level IV, with a significantly higher rate of chyle leak observed in endocrine\u2010related pathology.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599821993815","type":"journal-article","created":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T11:41:30Z","timestamp":1615290090000},"page":"667-672","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Predictors for Postoperative Chyle Leak Following Neck Dissection, a Technique\u2010Based Comparison"],"prefix":"10.1002","volume":"165","author":[{"given":"Quinn","family":"Dunlap","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery 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