When Are Surgical Drains Indicated in Head and Neck Surgery?

TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision-making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

BACKGROUND

Closed-suction drains have long been used in head and neck surgery to theoretically prevent hematoma, seroma, or chyle leak, particularly after thyroidectomy or lateral neck dissection. With the evolution of improved surgical techniques and enhanced recovery protocols, the necessity and optimal management of drains have evolved, and they lack clear consensus among surgeons. The benefits of drain placement must be balanced against risks such as infection, patient discomfort, and added expense. This summary reviews key literature informing current best practices regarding drain use, removal thresholds, and timing following thyroidectomy or lateral neck dissection.

BEST PRACTICE

Drain placement after thyroidectomy does not reduce complication rates and may increase infection risk and hospital length of stay, although their use may still be appropriate in high-risk cases. In lateral neck dissection, higher output drain removal thresholds have demonstrated earlier drain removal and shorter hospital stays without increasing wound complications or seroma formation. Traditional lower thresholds may still be appropriate in cases of extensive tumor resections or mucosal surgery, and individualized risk stratification and patient-specific decision making should guide decisions regarding drain placement and duration. There is some low-level support for drainless lateral neck dissection using fibrin sealant in place of standard drains. Although many of these findings are supported by prospective or randomized data, much of the literature remains retrospective and single-institution in nature. Future studies may help identify patient subgroups who benefit most from selective drain use and clarify the role of adjuncts like fibrin sealant in promoting safe drainless approaches.