Recovery After Transoral Excision of Vallecular Growth
For an adult patient undergoing transoral excision of a vallecular growth, expect a rapid recovery with most patients discharged within 1-2 days postoperatively, achieving complete swallowing function within 7 days, and experiencing no recurrence with complete excision. 1, 2
Immediate Postoperative Period
Hospital Stay:
- Average length of hospital stay is approximately 2 days or less for uncomplicated cases 3
- Some patients may require up to 9.5 days on average depending on complexity and any concomitant procedures 3
- The European Society for Clinical Nutrition and Metabolism emphasizes assessing swallowing function before resuming oral intake, as the vallecula plays a critical role in bolus control 1
Early Recovery (First Week):
- 71% of patients recover adequate swallowing function and are free from tube feeding within 7 days of transoral surgery for supraglottic lesions 4
- Postoperative healing is typically uneventful with no major complications when cold instruments and proper technique are used 2, 5
- Pain is a notable early symptom, particularly in the TORS arm compared to radiation therapy approaches 4
Functional Outcomes
Swallowing Function:
- For vallecular lesions specifically, complete excision via transoral approach provides excellent functional outcomes with minimal morbidity 1
- Only 9% of patients become gastrostomy tube dependent long-term after transoral supraglottic surgery 4
- The extent of base of tongue resection significantly impacts swallowing: resection ≥50% of the base of tongue is strongly associated with poor swallowing outcomes (OR 3.19,95% CI 1.21-8.43) 6
Voice Quality:
- Voice outcomes are excellent for supraglottic lesions that do not involve the vocal cords 4
- Voice quality remains optimal when transoral surgery is used as a single modality without need for adjuvant radiation 4
Long-Term Outcomes
Recurrence:
- Complete surgical excision of benign vallecular cysts is curative with excellent outcomes, and recurrence after complete excision is exceptionally rare 1
- In adult series, recurrence rates of 22.2% were reported, but these occurred after incomplete excision or marsupialization rather than complete excision 7
- No recurrences were observed in pediatric series with complete excision at follow-up ranging from 4-755 days 3
Critical Factors Affecting Recovery
Predictors of Poorer Outcomes:
- Older age (OR 1.06 per year, 95% CI 1.00-1.12) 6
- Need for adjuvant radiation therapy, which substantially impairs swallowing recovery 4
- Extent of resection, particularly if ≥50% of base of tongue is removed 6
Optimal Recovery Scenario:
- Single-modality transoral excision without need for adjuvant therapy provides the best functional results 4
- Complete excision with negative margins avoids the need for postoperative radiation and its associated morbidity 4
Common Pitfalls to Avoid
- Incomplete excision leads to recurrence: Marsupialization rather than complete excision increases recurrence risk 7
- Underestimating swallowing assessment needs: The vallecula's critical role in bolus control requires careful preoperative and postoperative swallowing evaluation 1
- Inadequate patient selection: Patients with anatomical limitations may require alternative approaches to balance surgical exposure with safety 8