Head and Neck 2022-11-27

"Bilateral axillo‐breast approach robotic total thyroidectomy in a 5‐year‐old patient with intractable Graves disease"

Ja Kyung Lee, Jee‐Hye Choi, Woochul Kim, Hyeong Won Yu, Su‐jin Kim, Young Jun Chai, June Young Choi, Jae Hyun Kim, Kyu Eun Lee

Publication date 27-11-2022


Abstract Robotic thyroid surgeries in children are gaining popularity due to cosmetic advantages, but most previous studies include patients of school-age or older. We hereby introduce our case of a 5-year-old patient with Graves disease to show key differences and similarities between pediatric and adult bilateral axillo-breast approach (BABA) robotic thyroidectomies. Despite the small body, no additional working space was needed and the flap creation was performed as similarly done in adults. The anatomy was not much different, except that the parathyroid tissues were easily identified due to low body fat, and the prominent thymus covered most of the level VI area. The patient did not experience postoperative complications such as hypoparathyroidism or vocal cord palsy. Postoperative wounds showed excellent results with minimal scars. BABA robotic thyroidectomy can be performed safely in pediatric patients and may be considered an alternative option for conventional open thyroidectomy in children.

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An objective analysis of composite free flap donor site morbidity in head and neck surgery: Prospective series

Joshua Russell, Glen Volker, Declan McGarvey, Catherine Sharpe, Omar Breik, Scott C. Borgna, Kelsey Pateman, Martin Batstone

Publication date 27-11-2022


Abstract BackgroundA poor evidence basis exists regarding the objective donor site morbidity associated with osseous free flap harvest. This study prospectively assessed the objective donor site morbidity associated with osseous free flap harvest for the fibula, scapula, and iliac crest (DCIA) donor sites.
MethodsA single-site, prospective cohort clinical research study was conducted. Sixty-four patients were recruited between 2017 and 2021. Patients were assessed using a donor site specific assessment tool pre-operatively, and again >12 months post-operatively.
Results There was a significant reduction post-operatively in assessment tool scores compared to the pre-operative period for the fibula, scapula and DCIA. Females were more likely to report a greater reduction in Harris Hip Score post-operatively compared to males.
Conclusions The fibula, scapula, and DCIA donor sites are associated with reduced objective function post-operatively compared to patients pre-operative baseline. The implications are least pronounced for the fibula.

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Survival outcomes for patients with T3N0M0 squamous cell carcinoma of the glottis treated with definitive radiation alone versus chemoradiation

Calvin B. Rock, Ryan J. Hutten, Chris R. Weil, Shane Lloyd, Kathleen C. Kerrigan, Richard B. Cannon, Ying J. Hitchcock

Publication date 26-11-2022


Abstract Background Given the poor lymphatics of the glottis, we evaluated omission of chemotherapy in patients treated definitely for T3N0M0 squamous cell carcinoma (SCC) of the glottis.
Methods We performed survival analysis of patients with T3N0M0 SCC of the glottis identified in the National Cancer Database treated with radiation alone versus chemoradiation.
ResultsA total of 3785 patients were identified. Patients age ≥70 and those with comorbidities were less likely to receive chemotherapy (odds ratio OR 0.30, 95% CI 0.25–0.37 and 0.48 0.31–0.76, respectively). Five-year OS was lower in patients treated with radiation versus chemoradiation (33.8% 30.3%–37.2% vs. 58.0% 55.8%–60.0%). In patients <70 with no comorbidities this difference persisted (51.0% 44.5%–57.0% versus 66.7% 64.0%–69.3%).
Conclusion Overall survival was higher in patients treated with chemoradiation compared to radiation alone, even when controlling for age and comorbidities. Radiotherapy with chemotherapy omission is not appropriate in patients with T3N0M0 SCC of the glottis.

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Enteral nutrition support and treatment toxicities in patients with head and neck cancer receiving definitive or adjuvant helical intensity‐modulated radiotherapy with concurrent chemotherapy

Claire L. Blake, Teresa E. Brown, Anita Pelecanos, Laura B. Moroney, Jennifer Helios, Brett G. M. Hughes, Benjamin Chua, Lizbeth M. Kenny

Publication date 25-11-2022


Abstract Background Enteral nutrition (EN) is often required in patients with head and neck cancer (HNSCC); however, initiation criteria is limited or inconsistent. This study aimed to describe the relationship of treatment toxicities and requirement for EN and investigate toxicity and baseline characteristics association with EN duration.
Methods Acute toxicities and baseline characteristics were collected from patients with HNSCC (n = 110) undergoing H-IMRT. Percentage EN contributing to estimated requirements and EN duration were measured.
Results The threshold for patients needing ≥50% of estimated requirements via EN increased from week 3 to 4 for grade ≥2 oral/pharyngeal mucositis, dysgeusia, thick saliva and nausea, and for grade 3 dysphagia. Patients with grade 2–3 dysphagia had a reduced risk of ceasing EN compared to those with grade 0–1 dysphagia.
Conclusions Using acute toxicities in clinical practice may be a useful tool to inform prompt initiation of EN prior to decline in nutritional status and anticipate EN duration.

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Salvage treatments for locally recurrent nasopharyngeal cancer: A systematic review and meta‐analysis

Dong Wang, Mange Liao, Jian Wu, Wenlong Luo, Siguo Qi, Bo Liu, Jiarong Li

Publication date 24-11-2022


Abstract The present study aimed to evaluate the effectiveness and safety of various salvage treatments to treat locally recurrent nasopharyngeal carcinoma (IrNPC). A comprehensive search was conducted to gather relevant research publications on salvage treatment for IrNPC. Specifically, 2-, 3-, and 5-year overall survival were the primary outcome. A total of 89 studies with 101 cohorts were collected. Endoscopic nasopharyngectomy was found to be associated with a significantly improved 5-year OS compared with CRT (p = 0.027) and IMRT (p = 0.016). Moreover, based on recurrence T classification, the 2-, 3-, and 5-year OS were similar across different treatments. Endoscopic nasopharyngectomy was associated with a significant reduction in treatment-related complications (grade ≥ 3) compared with IMRT (p < 0.001) and open nasopharyngectomy (p = 0.028). Endoscopic nasopharyngectomy may provide comparable treatment outcomes to re-irradiation, while offering a better safety profile for selective patients with resectable IrNPC.

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Predictive effect of pretreatment nutritional risk and GLIM‐defined malnutrition on the nutrition impact symptom clusters in patients with head and neck cancer undergoing radiotherapy

Yujie Wang, Lichuan Zhang, Tong Zhang, Sanli Jin, Zhou Huang, Dan Zhao, Baomin Zheng, Shaowen Xiao, Liqing Gong, Yan Sun, Qian Lu

Publication date 23-11-2022


Abstract Background Evidence supporting predictive effects of pretreatment nutritional risk and nutritional status on nutrition impact symptom (NIS) clusters during radiotherapy in patients with head and neck cancer (HNC) is insufficient.
Methods At baseline (T1), we collected severity and interference of NIS (Head and Neck Patient Symptom Checklist), nutritional risk, and nutritional status. During (T2) and at the end of radiotherapy (T3), we re-evaluated NIS. Symptom clusters were identified by exploratory factor analysis using mean scores of NIS severity at T2 and T3. Predictive effects were explored by generalized estimating equations.
Results Five hundred thirty-seven patients were recruited and 334 of them completed. Four clusters were identified; the oropharyngeal symptom cluster was the most severe and had the greatest interference with diet. Patients with pretreatment nutritional risk or malnutrition experienced more severe oropharyngeal symptom cluster.
Conclusions Pretreatment nutritional risk or malnutrition could predict the oropharyngeal symptom cluster in patients with HNC undergoing radiotherapy.

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Rate of atypical nodal metastases in surgically treated HPV‐associated\xa0oropharyngeal squamous cell carcinoma

Lauren E. Miller, Vivienne H. Au, Shanmugappiriya Sivarajah, Derrick T. Lin, Daniel G. Deschler, Mark A. Varvares, Daniel L. Faden, Allen L. Feng, Peter M. Sadow, Jeremy D. Richmon

Publication date 23-11-2022


Abstract Background Understanding of nodal metastasis in patients with HPV+ oropharyngeal squamous cell carcinoma (OPSCC) is warranted.
Methods Patients with HPV+ OPSCC who underwent neck dissection (ND) between 2016 and 2021 were reviewed. Pathology reports were reviewed for lymph node (LN) metastases. Noncontiguous metastases were defined as pathologic evidence of level II disease with another involved LN in a noncontiguous neck level. Skip metastases were defined as pathologic lymph node(s) in the neck without disease in level II.
Results One hundred and thirty-one patients underwent levels II–IV ND with a mean (SD) LN yield of 33.3 (±13.5). The rate of atypical metastases in both the therapeutic and elective ND cohort was 5%. The noncontiguous and skip metastases were in level IV (n = 2) and level III (n = 4), respectively.
Conclusions Skip and noncontiguous metastases were rare in patients with HPV+ OPSCC undergoing surgical treatment. Surgeons may consider a selective ND omitting Level IV in select patients with HPV+ OPSCC undergoing surgery.

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Neutrophil to lymphocyte ratio and peripheral blood biomarkers correlate with survival outcomes but not response among head and neck and salivary cancer treated with pembrolizumab and vorinostat

Cassie Pan, Qian “Vicky” Wu, Jenna Voutsinas, Jeffrey J. Houlton, Brittany Barber, Neal Futran, George E. Laramore, Jay J. Liao, Upendra Parvathaneni, Renato G. Martins, Jonathan R. Fromm, Cristina P. Rodriguez

Publication date 22-11-2022


Abstract Background Associations between peripheral blood biomarkers and oncologic outcomes were explored in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HN) and salivary gland cancer (SGC) treated with pembrolizumab and vorinostat on a phase II trial (NCT02538510).
Experimental Design Twenty-five HN and 25 SGCs were treated with pembrolizumab and vorinostat. Baseline peripheral blood was available in 21 HN and 20 SGCs and evaluated for associations with grade ≥3 adverse events (G ≥ 3AE) by CTCAEv4, objective response rate (ORR), overall survival (OS), and progression-free survival (PFS).
Results Higher pretreatment neutrophil-to-lymphocyte ratio (NLR) and neutrophils, as well as lower pretreatment lymphocytes and T helper cells correlated with worse OS and PFS. Higher NLR further predicted increased rates of G ≥ 3AEs. No correlations with ORR were observed.
Conclusions In a prospectively evaluated cohort of HN and SGCs treated with pembrolizumab and vorinostat, we observed novel associations between peripheral blood biomarkers and oncologic outcomes and toxicities.

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18F‐fludeoxyglucose positron emission computed tomography (18F‐FDG‐PET/CT) versus 68Ga‐DOTATATE‐PET/CT in patients with head and neck cancer: Comparisons and implications for treatment

Rusha Patel, Gary Marano, Joe Joseph, Jeffson Chung, Andrew Plata, Jeffrey A. Vos

Publication date 19-11-2022


Abstract Background Tumor-specific molecular imaging in head and neck squamous cell carcinoma (HNSCC) is not well established. Somatostatin receptors (SSTRs) are found in solid tumors, including HNSCC. 68Ga-DOTATATE, a commercially available radionuclide that binds SSTRs, may have utility in imaging HNSCC.
Methods Patients with HNSCC received pretreatment imaging with 18F-FDG-PET/CT and 68Ga-DOTATATE. Imaging was compared for concordance. When available, surgical resection specimens were compared to pretreatment imaging findings. Historic HNSCC tumor specimens were assessed for both SSTR and p16/human papilloma virus (HPV) expression.
Results Twenty patients were imaged. Fifteen had oropharyngeal cancer. Primary tumor site was concordant between imaging modalities for all patients. One of 45 lymph nodes was discordant. Retrospective specimen review showed a significant correlation with SSTR expression and HPV/p16 expression. No adverse events occurred.
Conclusions68Ga-DOTATATE imaging is safe and effective in HNSCC. SSTR expression may be increased in HPV-mediated tumors. Targeted therapies to SSTR should be explored.

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Erratum

Publication date 16-11-2022


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Reply to Letter to the Editor regarding “Salvage surgery in recurrent sinonasal cancers: Proposal for a prognostic model based on clinicopathologic and treatment‐related parameters”

Davide Mattavelli, Michele Tomasoni, Marco Ferrari, Alberto Schreiber, Vittorio Rampinelli, Paolo Bossi, Cesare Piazza, Piero Nicolai

Publication date 16-11-2022


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Letter to the Editor regarding “Salvage surgery in recurrent sinonasal cancers: Proposal for a prognostic model based on clinicopathologic and treatment‐related parameters”

Giulio Cantù

Publication date 16-11-2022


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Innovative Fudan rT staging in endoscopic surgery for recurrent nasopharyngeal carcinoma

Wanpeng Li, Qiang Liu, Haoyuan Xu, Huan Wang, Huangkang Zhang, Quan Liu, Jingjing Wang, Li Hu, Houyong Li, Xicai Sun, Hongmeng Yu, Dehui Wang

Publication date 15-11-2022


Abstract Background American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) rT staging have great clinical impracticality. The aim of the present study was to establish a new rT staging to guide endoscopic surgery for the treatment of recurrent nasopharyngeal carcinoma (rNPC).
Methods This surgical rT staging (named Fudan rT staging) was constructed using two significant risk factors: the distance from the tumor margin to the internal carotid artery, and dural invasion. Log-rank and receiver operating characteristic (ROC) curve analyses were used to evaluate its effectiveness.
Results Fudan rT staging can effectively separate the overall survival (OS) and progression-free survival (PFS) of patients with rNPC according to the different rT stages (p < 0.05). In addition, ROC analysis showed that the Fudan rT staging exhibited enhanced prognostic value for OS and PFS compared with the AJCC/UICC rT staging.
Conclusions The innovative Fudan rT staging has a better predictive value for the survival of patients with rNPC than AJCC/UICC rT staging.

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A radical shift in the communication paradigm in head and neck frozen section analysis: Intraoperative three‐dimensional specimen scanning

Margaret Brandwein‐Weber, Mark L. Urken, Michael C. Topf, James S. Lewis, Stephen Y. Kang, Joseph M. Curry, Raymond Chai, Mohammed Khan, Ippolito Modica, Dan Chung, Eben L. Rosenthal

Publication date 15-11-2022


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Empirical comparison of routinely collected electronic health record data for head and neck cancer‐specific survival in machine‐learnt prognostic models

Damian P. Kotevski, Robert I. Smee, Claire M. Vajdic, Matthew Field

Publication date 11-11-2022


Abstract Background Knowledge of the prognostic factors and performance of machine learning predictive models for 2-year cancer-specific survival (CSS) is limited in the head and neck cancer (HNC) population.
Methods Data from our facilities oncology information system (OIS) collected for routine practice (OIS dataset, n = 430 patients) and research purposes (research dataset, n = 529 patients) were extracted on adults diagnosed between 2000 and 2017 with squamous cell carcinoma of the head and neck.
Results Machine learning demonstrated excellent performance (area under the curve, AUC) in the whole cohort (AUC = 0.97, research dataset), larynx cohort (AUC = 0.98, both datasets), and oropharynx cohort (AUC = 0.99, both datasets). Tumor site and T classification were identified as predictors of 2-year CSS in both datasets. Hypothyroidism and fitness for operation were further identified in the research dataset.
Conclusions Datasets extracted from an OIS for routine clinical practice and research purposes demonstrated high utility for informing 2-year head and neck CSS.

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Neutrophil‐to‐lymphocyte and hypopharyngeal cancer prognosis: System review and meta‐analysis

Xianyang Hu, Tengfei Tian, Xueyan Zhang, Qin Sun, Yanyang Chen, Wenxiu Jiang

Publication date 11-11-2022


Abstract Several studies have reported the value of neutrophil-to-lymphocyte ratio (NLR) for the prognosis of hypopharyngeal cancer. However, contradictory findings have also been published. We aimed to clarify the effect of NLR on the prognosis of hypopharyngeal cancer through meta-analysis. Systematic search of Pub Med and other database with study selection and data extraction. The combined hazard ratio (HR) and 95% confidence intervals (CI) were calculated using STATA, applying either a fixed-effects or random-effects model. Meta-regression, subgroup analysis, and sensitivity analysis were used to analyze sources of heterogeneity. Publication bias were also assessed. This meta-analysis included 2232 patients with hypopharyngeal cancer from seven studies. The combined HR (OS, HR = 1.80, 95CI%, 1.14–2.82; PFS, HR = 1.88, 95CI%, 1.26–2.79) suggested that high NLR was associated with poor overall survival (OS) and progression-free survival (PFS). Pretreatment NLR can be used as an effective serological indicator to assess the prognosis of patients with hypopharyngeal cancer.

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Radiomics‐based machine learning for the diagnosis of lymph node metastases in patients with head and neck cancer: Systematic review

Caterina Giannitto, Giuseppe Mercante, Angela Ammirabile, Luca Cerri, Teresa De Giorgi, Ludovica Lofino, Giulia Vatteroni, Elena Casiraghi, Silvia Marra, Andrea Alessandro Esposito, Armando De Virgilio, Andrea Costantino, Fabio Ferreli, Victor Savevski, Giuseppe Spriano, Luca Balzarini

Publication date 08-11-2022


Abstract Machine learning (ML) is increasingly used to detect lymph node (LN) metastases in head and neck (H&N) carcinoma. We systematically reviewed the literature on radiomic-based ML for the detection of pathological LNs in H&N cancer. A systematic review was conducted in Pub Med, EMBASE, and the Cochrane Library. Baseline study characteristics and methodological quality items (modeling, performance evaluation, clinical utility, and transparency items) were extracted and evaluated. The qualitative synthesis is presented using descriptive statistics. Seven studies were included in this study. Overall, the methodological quality items were generally favorable for modeling (57% of studies). The studies were mostly unsuccessful in terms of transparency (85.7%), evaluation of clinical utility (71.3%), and assessment of generalizability employing independent or external validation (72.5%). ML may be able to predict LN metastases in H&N cancer. Further studies are warranted to improve the generalizability assessment, clinical utility evaluation, and transparency items.

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Antipsychotic drug trifluoperazine as a potential therapeutic agent against nasopharyngeal carcinoma

Chien‐Fu Yeh, Wen‐Ya Lee, Ting‐Han Yu, Yen‐Bin Hsu, Ming‐Chin Lan, Ming‐Ying Lan

Publication date 08-11-2022


Abstract Background Trifluoperazine (TFP) is a typical antipsychotic primarily used to treat schizophrenia. In this study, we aimed to evaluate whether TFP can be used as a therapeutic agent against nasopharyngeal carcinoma (NPC) and identify its underlying molecular mechanisms.
Methods We used NPC-TW01, TW03, TW04, and BM to assess the anticancer effects of TFP by using cytotoxicity, wound healing, colony formation, and cell invasion assays. An in vivo animal study was conducted. RNA sequencing combined with Ingenuity Pathways Analysis was performed to identify the mechanism by which TFP influences NPC cells.
Results Our data revealed that TFP decreased NPC cell viability in a dose-dependent manner. The invasion and migration of NPC tumor cells were inhibited by TFP. An in vivo study also demonstrated the anticancer effects of TFP. RNA sequencing revealed several anticancer molecular mechanisms following TFP administration.
Conclusions The antipsychotic drug TFP could be a potential therapeutic regimen for NPC treatment.

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A novel stapler‐assisted technique for closure of persistent tracheoesophageal puncture fistula

Michelle Buncke, Peter Andersen, Christopher Connelly, Daniel Clayburgh

Publication date 07-11-2022


Abstract Tracheoesophageal puncture (TEP) is a reliable method to restore voice and is an important part of voice rehabilitation following laryngectomy. However, complications following this procedure, including peri-prosthetic leakage and resulting aspiration pneumonia, may necessitate surgical closure. In this study, we present an effective and reliable method for TEP closure using a stapler-assisted technique. Case series study for patients who underwent stapler-assisted TEP closure reviewed from 2017 to 2021. All five patients had successful closure of their TEP tract without further leakage. No postoperative bleeding, wound infection, or esophageal stenosis occurred. One patient had postoperative stomal stenosis. The stapler-assisted technique for TEP closure is easy, quick, and effective. The reliability and quick return to oral intake post-operatively make it a preferable option over previous techniques.

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Impact of AJCC 8 pT staging in cutaneous head and neck squamous cell carcinoma in a nonselected real‐world patient sample

Fábio Muradás Girardi, Vivian P. Wagner, Manoela Domingues Martins, Aliende Lengler Abentroth, Luiz Alberto Hauth

Publication date 07-11-2022


Abstract Objective Our aim was to evaluate characteristics associated with worse survival and the effectiveness of AJCC 8 in a real-world cohort of HNCSCC from South Brazil.
MethodsA 10-year retrospective cohort study (2011–2020) at a tertiary care center comprising 647 HNCSCC excised from 435 patients.
Results At multivariable analysis, ear/nose/zygomatic or periorbital site, compromised or exiguous margins, and advanced pT stage were independent factors associated to DFS, while age, pN, and loco-regional recurrence were independent factors associated to DSS. Cox-regression multivariable models showed that the pT stage was statistically significant for the DFS, but not DSS. A significant distinction was only observed between T1 and T2.
Conclusion It was only in the lower categories of AJCC 8 (T1 and T2) that we were able to demonstrate the ability to stratify tumors with a significant risk of poor disease-related outcomes.

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Endoscopic‐assisted total maxillectomy with precise surgical margins

Masato Nagaoka, Kazuhiro Omura, Kazuhiro Nomura, Teppei Takeda, Nobuyoshi Otori, Hiromi Kojima

Publication date 06-11-2022


Abstract In traditional open maxillectomy, identifying the posterior margin is difficult because of its deep location and bleeding from the pterygoid venous plexus. Here, we present our endoscope-assisted total en bloc maxillectomy technique and discuss its merits and demerits compared to previously reported methods. We developed an endoscope-assisted total en bloc maxillectomy procedure. We reviewed a series of total maxillectomies performed with and without endoscopic assistance to verify the advantages of endoscopic assistance over conventional total maxillectomy. We analyzed (1) the precision using the distance of the remaining pterygoid process, (2) the operation time, and (3) blood loss. The length of the remnant pterygoid process was significantly shorter in the endoscopic assistance group. The operation time and blood loss were not significantly different between the two groups. Endoscopic assistance makes total maxillectomy more precise without requiring additional time and is a reasonable option for total maxillectomies.

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Advantages of the scapular system in mandibular reconstruction

Gabrielle L. Wolter, Brian P. Swendseid, Shruthi Sethuraman, Ryan Ivancic, Theodoros N. Teknos, Catherine T. Haring, Stephen Y. Kang, Matthew O. Old, Nolan B. Seim

Publication date 06-11-2022


Abstract Background Fibula free flaps (FFF) are often considered the first choice for mandibular reconstruction, but scapular system free flaps (SFF) have increased in popularity due to versatility, donor site advantages, and patient factors.
Methods Retrospective chart review of patients undergoing mandibulectomy with FFF or SFF reconstruction from 2016 to 2021.
Results Hundred and seventy-six patients (FFF n = 145, SFF n = 31) underwent the aforementioned procedures. Mean FFF operative time was 9.47 h versus 9.88 for SFF (p = 0.40). Two-flap reconstructions required 12.65 h versus 10.09 for SFF with soft tissue (p = 0.002). Donor site complications were identified in 65.6% of FFF with skin grafting.
Conclusions These findings suggest that SFF requires similar operative time and results in reduced donor site morbidity as compared to FFF. Supine, concurrent harvesting of SFF allows for single-flap harvest with significantly shorter operative time. SFF could be considered a primary option for mandible reconstruction for complex defects and in select patients.

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Endoscopic transoral approach to the lateral poststyloid space

Lifeng Li, Hongbo Xu, Nyall R. London, Ricardo L. Carrau, Yonggang Jin, Xiaohong Chen

Publication date 05-11-2022


Abstract The lateral poststyloid space (LPSS) located at the posterolateral aspect of the styloid process. This study aims to explore the anatomical relationships in LPSS via a transoral corridor, providing reference for addressing lesions extending to this region. An endoscopic transoral approach for exposure of the LPSS was performed on 6 cadaveric specimens (12 sides). Related landmarks were explored, and transoral extirpation of tumors extended into LPSS was employed in 12 patients. The deep lobe of the parotid gland, extratemporal facial nerve, and the accompanying artery in the LPSS were sufficiently exposed via the transoral corridor in all 12 cadaveric sides. The transoral corridor provided adequate exposure for tumors extending to the LPSS, and en bloc resection was achieved in these 12 patients. No facial nerve or vascular injury occurred, and no recurrence observed in this cohort with an average follow-up of 26 months. An endoscopic transoral approach provides a direct access to the LPSS. Appreciation of the anatomical relationships within the LPSS is valuable for employing a transoral extirpation of tumors extending to this specific region.

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Detection of increased intracranial pressure in trans‐oral robotic thyroidectomy using optic nerve sheath diameter measurement

Hyunyoung Lim, Eugene Kim, Soo Yeon Kim, Ji‐Yoon Kim, Yundo Jung, Tagkeun Lee, Nayeon Kim, Kyung Tae

Publication date 05-11-2022


Abstract Background During transoral robot-assisted thyroidectomy, there is a risk of increasing intracranial pressure because the site of CO2 insufflation is narrow and close to the brain.
Methods We analyzed the pre- to post-CO2 neck insufflation change in the optic nerve sheath diameter during transoral robot-assisted thyroidectomy. Changes in vital-signs, airway pressure, and arterial carbon dioxide pressure were analyzed along with postoperative complications.
Results Among the 30 participants, the post-CO2 inflation mean optic nerve sheath diameter (5.64 ± 0.54 mm) was higher than the pre-induction diameter (4.81 ± 0.37 mm) with a mean difference of 0.83 (95% CI, 0.69–0.97; p < 0.001), but returned to baseline after CO2 deflation in most cases. One participant had sustained increased optic nerve sheath diameter (6.35 mm) associated with severe new-onset postoperative headache.
Conclusion Transient elevation in the intracranial pressure during low-pressure CO2 neck insufflation in the transoral robot-assisted thyroidectomy did not appear to adversely affect patients.

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Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors

Gustavo Fink‐Josephi, Luis Mauricio Hurtado‐López, Aldo Francisco Hernández‐Valencia, Jesús Antonio Higuera‐Calleja, Guadalupe Guerrero‐Avendaño

Publication date 02-11-2022


Abstract Objective Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach.
Materials and Methods Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre.
Results We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc.
Symptoms Presence of tumors in the neck in all cases and two cases of dysphagia.
Conclusion This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.

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Occult metastasis to the superficial level VI lymph nodes in papillary thyroid carcinoma

Ha Na Lee, Chang Myeon Song, Yong Bae Ji, Jae Kyung Myung, Young‐Jun Lee, Kyung Tae

Publication date 02-11-2022


Abstract Background This study aimed to evaluate the incidence and risk factors of occult metastasis to superficial level VI, defined as the space anterior to the strap muscles, including the lymph nodes between the sternocleidomastoid and sternohyoid muscles and suprasternal space lymph nodes.
Methods We studied 129 patients with papillary thyroid carcinoma who underwent thyroidectomy and neck dissection, including superficial level VI dissection.
Results Of the 129 patients, 62 (48%) had lymph nodes in the harvested specimens of superficial level VI, and the mean number of lymph nodes retrieved was 1.9 ± 1.2. Occult metastasis to superficial level VI occurred in four patients (3.1%). No significant risk factors of superficial level VI occult metastasis were noted in multivariate analysis.
Conclusions Occult metastasis to superficial level VI was rare in patients with papillary thyroid carcinoma. Therefore, prophylactic dissection of superficial level VI may not be necessary for primary papillary thyroid carcinoma.

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Monitoring postoperative ambulation and sleep after head and neck surgery: Feasibility and utility study using wearable devices

Vivek C. Pandrangi, Matthew Jorizzo, Suparna Shah, Jennifer Bruening, Mark K. Wax, Daniel Clayburgh, Peter Andersen, Ryan J. Li

Publication date 02-11-2022


Abstract Background To evaluate use of wearable activity devices to monitor trends in ambulation and sleep after head and neck surgery.
Methods Patients utilized Fitbit devices after surgery. Daily activity and sleep scores, step counts, and total sleep time (TST) were obtained.
Results There were 30 patients within the final cohort. Trends in step counts after specific procedures were identified, and higher subjective activity level correlated with step counts (r = 0.25, 95% CI = 0.07–0.41). Among patients with complete step data (n = 24), POD1 steps ≥200 were associated with reduced length of stay (4.5 ± 1.7 days vs. 7.2 ± 4.0 days, 95% CI = 0.33–5.0). Mean TST was 5.4 ± 2.5 h, TST correlated with subjective sleep scores (r = 0.25, 95% CI = 0.03–0.044), and clinical events associated with sleep–wake transitions on Fitbit devices were identified.
Conclusions Wearable activity devices appear feasible for monitoring trends in postoperative ambulation and sleep. Use of these devices may facilitate postoperative recovery.

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Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with human papillomavirus‐related squamous cell cancer: Long‐term results

Somiah Siddiq, Sarah Stephen, Daniel Lin, Hannah Fox, Max Robinson, Vinidh Paleri

Publication date 02-11-2022


Abstract Introduction To report the long-term oncological and functional outcomes of en bloc TORS lateral oropharyngectomy to address the close/involved margin following diagnostic tonsillectomy in HPV-related SCC of unknown primary.
Material and methodsA single tertiary center observational cohort over a 4-year period. Primary outcome measures were disease-specific survival (DSS), overall survival (OS), and PSS NOD (Performance Status Scale-Normalcy of Diet) scores.
ResultsTORS specimens did not evidence residual carcinoma in 93% of patients. Of 14 patients, 50% received surgery alone (median follow-up 57 months; range 46–96), the remainder surgery and adjuvant therapy (median follow-up of 58 months; range 51–69) with 100% DSS, OS and no deterioration of PSS NOD scores.
Conclusions Long-term oncological outcomes confirm TORS lateral oropharyngectomy alone is an oncologically safe treatment. Due consideration of this approach is warranted to mitigate against the morbidity of adjuvant radiotherapy treatment in this group of patients.

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Radiomics based on magnetic resonance imaging for preoperative prediction of lymph node metastasis in head and neck cancer: Machine learning study

Yuepeng Wang, Taihui Yu, Zehong Yang, Yuwei Zhou, Ziqin Kang, Yan Wang, Zhiquan Huang

Publication date 02-11-2022


Abstract Background In this study, we use machine learning techniques to develop an efficient preoperative magnetic resonance imaging (MRI) radiomics approach for evaluation of cervical lymph node (CLN) status.
Methods After collecting all patients MRI images, we used CLN radiomic features, the apparent diffusion coefficients (ADC) from diffusion-weighted imaging (DWI), and lymph node short diameter of the CLN to build MRI model to predict the status of the CLN.
Results One hundred and twenty cases met inclusion criteria. The MRI model including the radiomic features, ADC, and lymph node size of the CLN achieved better performance for CLN status prediction with the area under the receiver operating characteristic (ROC) curve (AUC) of 0.83.
Conclusions The multiomic signature of MRI radiomics, ADC, and lymph node size of CLNs has high predictive value for the status of CLNs. This model has provided scientific value to the surgeon regarding cervical lymph nodes before surgery.

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Controlling Nutritional Status (CONUT) score is a prognostic marker for laryngeal cancer patients with curative resection

Qin Lin, Shuchun Lin, Wei Chen, Xiaoqiang Chen, Xuehan Yi, Shoujun Lu, Huihui Li, Chen Li, Desheng Wang

Publication date 02-11-2022


Abstract Background To investigate the prognostic value of pre-treatment Controlling Nutritional Status (CONUT) score in laryngeal cancer.
Methods Preoperative CONUT score was retrospectively calculated in 154 laryngeal cancer patients who underwent curative resection in our hospital from 2013 to 2016. The associations of CONUT with clinicopathological factors and survival were evaluated. The efficacy of CONUT score to predict prognosis was evaluated.
Results The CONUT score was associated with body mass index (p = 0.033), neutrophil (p = 0.011), tumor size (p = 0.017), pTNM stage (p = 0.001), adjuvant radiotherapy (p < 0.001), negative pathologic factors (p < 0.001), and larynx preservation (p < 0.001). Patients with a higher CONUT score had worse overall survival (hazard ratio: 1.94, 95% confidence interval CI: 1.13–3.72, p = 0.039) and disease-free survival (hazard ratio: 2.16, 95% CI: 1.19–3.90, p = 0.011). The area under the curve of CONUT score (0.728) was higher than Preoperative Nutritional Index (0.72), platelet-to-lymphocyte ratio (0.675), and neutrophil-to-lymphocyte ratio (0.687).
Conclusion The CONUT score can be useful for predicting survival in laryngeal cancer patients after curative resection.

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Superiority of metastatic lymph node ratio over number of node metastases and TNM/AJCC N classification in predicting cancer‐specific survival in medullary thyroid cancer

Andreas Machens, Kerstin Lorenz, Frank Weber, Henning Dralle

Publication date 02-11-2022


Abstract Background In medullary thyroid cancer (MTC), it is unclear which nodal classification system, metastatic lymph node ratio (MLNR), number of node metastases, or TNM/AJCC N classification, predicts cancer-specific survival best.
Methods Kaplan–Maier analysis of cancer-specific survival after operation at a tertiary center.
Results Included were 505 MTC patients. The spread of the survival curves was greatest after stratification by MLNR (in 0.20 increments), followed by number of node metastases (in 10-node and 20-node increments) and TNM/AJCC classification (N0, N1a, N1b). After collapsing overlapping survival curves, all adjacent curves (MLNRs ≤0.20 vs. 0.21–0.60 vs. >0.60; 0 vs. 1–20 vs. >20 node metastases; and TNM/AJCC N classification N0/N1a vs. N1b) significantly differed between each other.
Conclusions In MTC, MLNR, reflecting intensity of lymphatic spread, predicts cancer-specific survival better than number of node metastases or TNM/AJCC N classification. The applicability of these findings to patients with limited neck dissection requires more research.

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Development of the remote 100 ml water swallow test versus clinical assessment in patients with head and neck cancer: Do they agree?

Laura‐Jayne Watson, Sarah H. Woodman, Deborah Ganderton, Katherine A. Hutcheson, Shirley Pringle, Joanne M. Patterson

Publication date 02-11-2022


Abstract Background The 100 ml water swallow test (WST) is a validated swallow assessment used in head and neck cancer (HNC). We aimed to determine the level of agreement when completing the 100 ml WST via clinician-graded video-testing or patient self-testing compared to standard face-to-face assessment (FTF).
Methods Convenience sampling from four UK centers.
Inclusion criteria: patients with HNC treated with any modality prior to, or within 5 years of treatment. Participants were recruited to complete the 100 ml WST by video-testing or self-testing and compared with FTF.
Results Sixty-three patients were recruited; 1 was unable to perform the task; 30 in video-testing; and 32 in self-testing. There was no difference in swallow capacity (p = 0.424) and volume (p = 0.363) for the video-testing or the self-testing swallow capacity (p = 0.777) and volume (p = 0.445).
Conclusions This study demonstrates that video-testing and self-testing are reliable methods of completing the 100 ml WST for this sample of patients with HNC.

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Tracheostomy dependence following “organ preservation” (chemo)radiation protocol for laryngeal and hypopharyngeal cancers

Clare Jing Jing Batchelor, Stephanie Patricia Flukes

Publication date 02-11-2022


Abstract Background Patients receiving primary (chemo)radiotherapy for laryngeal or hypopharyngeal cancer risk developing severe laryngeal dysfunction and becoming tracheostomy dependent, detracting from the benefits of organ preservation. We aim to describe the airway outcomes for this cohort and identify risk factors for developing tracheostomy dependence.
Methods Patients with laryngeal or hypopharyngeal cancer who were recommended for and underwent primary (chemo)radiotherapy over a 6-year period were identified from a tertiary hospital Head and Neck cancer database. Patient, tumor, and treatment details were collected and analyzed.
Results Of 166 patients, 18.7% (N = 31) required tracheostomy insertion. Advanced tumor classification was the only significant predictor (p < 0.00001). Successful decannulation was observed in 12.9% (N = 4). Decannulation was observably less successful with advanced tumors, bilateral vocal cord immobility, tracheostomies inserted under emergency conditions.
Conclusion We quantified tracheostomy insertion rates and dependence in patients undergoing “organ-preserving” (chemo)radiotherapy, to assist in the pre-treatment counseling of patients opting for this approach.

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Elevated preradiotherapy serum lactate dehydrogenase predicts distant metastasis for lymphoepithelial carcinoma of major salivary gland following postoperative radiotherapy

Wenbin Yan, Yang Liu, Chunying Shen, Junlin Yi, Xiaomin Ou, Chaosu Hu

Publication date 02-11-2022


Abstract Background To evaluate the predicting factors associated with distant metastasis (DM) for lymphoepithelial carcinoma of salivary gland (LECSG) following postoperative radiotherapy (PORT).
Methods We retrospectively collected 160 eligible patients from two cancer institutions. The DM rate was evaluated using competing risk method.
Results The median follow-up time was 65.6 months. Elevated preradiotherapy serum LDH (ratio >0.5) (p = 0.006) and N classification (N2-3) (p = 0.001) were independently associated with DM for the LECSG. After the risk stratification, the high-risk subgroup was defined as the patients presented higher risk score (score >0), whereas 5-year cumulative incidence of DM in the high- and low-risk group was 30.9% and 6.0%, respectively (p < 0.001). Moreover, a significantly worse overall survival (OS) was observed in the high-risk patients compared with the low-risk subgroup (5-year OS: 83.9% vs. 97.8%, p = 0.006).
Conclusion Elevated preradiotherapy serum LDH could serve as a predictive factor for DM in the LECSG following PORT.

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Significance of nuclear EGFR and ABCG2 expression in malignant transformation of oral potentially malignant disorders

Marko Tarle, Danko Müller, Marina Raguž, Ivica Lukšić

Publication date 02-11-2022


Abstract Background The purpose of this study was to investigate the expression of nuclear EGFR (nEGFR) and the stem cell marker ABCG2 in oral leukoplakia (OL) and oral erythroplakia (OE) and to assess their significance as prognostic biomarkers for malignant transformation.
Methods In this study we included 50 patients with oral potentially malignant disorders (OPMD), 31 with OL and 19 with OE, in whom we examined the expression of nEGFR and ABCG2 by immunohistochemical methods.
Results Twenty-one (42%) of 50 patients with OL and OE developed oral squamous cell carcinoma (OSCC). The malignant transformation was increased 12,84-fold (95% CI, 2.15–76.44, p = 0.005) in OPMD expressing both ABCG2 and nEGFR. Expression of nEGFR is a strong indicator of malignant transformation, unlike ABCG2 expression, respectively.
Conclusions Determining the co-expression of the biomarkers nEGFR and ABCG2 in OPMD may serve us to determine the risk of malignant transformation in OSCC.

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Low postoperative lymphocyte count increases risk of progression in human papillomavirus associated oropharyngeal cancer

Linda X. Yin, David M. Routman, Courtney N. Day, William S. Harmsen, Travis Haller, Kathleen Bartemes, Daniel L. Price, Eric J. Moore, Robert L. Foote, Michelle Neben‐Wittich, Ashish V. Chintakuntlawar, Daniel J. Ma, Katharine A. Price, Kathryn M. Van Abel

Publication date 02-11-2022


Abstract Background We aim to explore the prognostic role of absolute lymphocyte count (ALC) before, during, and after treatment on oncologic outcomes in human papillomavirus associated oropharyngeal cancer (HPV(+)OPSCC).
Methods Retrospective cohort at a tertiary center, 2006–2018. Multivariable Cox regressions were used to determine the effect of ALC on risk of progression. Univariate linear regression was performed to determine clinical factors associated with lower ALC.
Results All 197 patients underwent primary surgery. Mean (SD) ALC nadirs (×109 cells/L) were: baseline (N = 149): 1.69 (0.56); postoperative (N = 126): 1.58 (0.59); post-RT (N = 141): 0.68 (0.35) and long-term (N = 105): 0.88 (0.37). Lower baseline ALC nadir was associated with worse overall survival (HR 3.85, 95%CI: 1.03–14.29, p = 0.04). Lower postoperative ALC nadir was associated with higher risk of progression (HR 2.63, 95%CI: 1.04–6.67, p = 0.04).
Conclusions Lower baseline ALC is associated with worse survival, whereas lower postoperative ALC is associated with increased risk of progression in surgically treated HPV(+)OPSCC.
Level of Evidence3

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Preclinical feasibility of robot‐assisted sentinel lymph node biopsy using multi‐modality magnetic and fluorescence guidance in the head and neck

Giri Krishnan, Aidan Cousins, Nguyen Pham, Valentina Milanova, Melanie Nelson, Shridhar Krishnan, Nynke S. Berg, Anil Shetty, Eben L. Rosenthal, Peter‐John Wormald, Benjamin Thierry, Andrew Foreman, Suren Krishnan

Publication date 02-11-2022


Abstract Background Sentinel lymph node biopsy (SLNB) is a staging procedure dependent on accurate mapping of draining lymphatics via tracers. Robot-assisted SLNB enables access to multiple neck levels with a single incision and intraoperative fluorescence guidance to the SLN.
Methods Lymphatic mapping in swine was done using a magnetic tracer and fluorescent dye, injected into the tongue. MRI preoperatively mapped lymphatic spread of the magnetic tracer. Dissection was performed using a da Vinci Xi robot guided by fluorescence-imaging of the dye.
Results Robot-assisted SLNB was successfully performed in all animals (n = 5). A novel MRI protocol differentiated SLNs (n = 6) from lower echelon nodes (n = 11) based on flow progression. Fluorescence imaging provided valuable intraoperative guidance and correlated with magnetic-positive nodes.
Conclusions This study demonstrates preclinical feasibility of a robot-assisted approach to SLNB using magnetic and fluorescent tracers in the head and neck, enabling both preoperative mapping and intraoperative guidance.

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Multi‐institutional review of sinonasal and skull base chondrosarcoma: 20‐year experience

Jacob G. Eide, Rijul S. Kshirsagar, Jacob C. Harris, Alyssa Civantos, Robert M. Brody, John Y. K. Lee, Michelle Alonso‐Basanta, Jillian W. Lazor, Ali Nabavizadeh, Beverly Y. Wang, Edward C. Kuan, James N. Palmer, Nithin D. Adappa

Publication date 02-11-2022


Abstract Background Chondrosarcomas of the sinonasal cavity and skull base are uncommon malignancies. We sought to provide long-term outcomes at two tertiary care centers.
Methods Patients with chondrosarcoma treated between 2000 and 2021 were included. The primary outcomes were overall survival (OS) and disease-specific survival (DSS).
Results Thirty-eight patients met inclusion criteria. Fourteen patients had sinonasal (36.8%), 7 petroclival (18.4%), and 17 other primary skull base lesions (44.7%). Twenty-eight patients (73.7%) underwent radiation with an average dose of 67.3 ± 15.1 Gy. Eighteen patients (47.4%) required revision surgery for recurrence. 1, 5, and 10-year OS were 97.3%, 93.1%, and 74.7%. DSS at 5- and 10-year survival was 95.7%. Adjuvant radiation was associated with improved OS (HR: 0.12; 95% CI: 0.02–0.75, p = 0.023).
Conclusion We present our experience over the last 20 years treating chondrosarcomas. Favorable survival outcomes can be achieved but recurrence requiring repeat resection is common.

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Endoscopic pituitary surgery: National database review

Zaid Al‐Qurayshi, Douglas M. Bennion, Jeremy D. W. Greenlee, Scott M. Graham

Publication date 02-11-2022


Abstract Background Pituitary tumors surgery is increasingly performed via endoscopic transsphenoidal approach (TSP). This study describes outcomes of TSP surgery in the United States.
MethodsA retrospective cross-sectional analysis of adult patients with pituitary adenoma was performed using the Nationwide Readmissions Database, 2010–2015.
ResultsA total of 5891 patients were identified. The average age was 51.29 ± 0.29 years. The risk of postoperative epistaxis, diabetes insipidus, cerebrospinal fluid (CSF) leak, and other general postoperative complications was 0.71%, 10.20%, 8.35%, and 2.37%, respectively.
Independent risk factors of CSF leak included: age <65-year, male, body mass index ≥25, and multiple comorbidities (p < 0.001 each). The prevalence of CSF leak was not associated with hospital TSP volume and teaching status.
Conclusion This study provides a national epidemiological perspective on TSP in the United States. The risk of postoperative CSF leak appears to be associated with intrinsic patient factors rather than resource and expertise availability.

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Epidemiology and treatment outcomes of cutaneous squamous cell carcinoma extending to the temporal bone

Michael J. C. Schachtel, Mitesh Gandhi, James J. Bowman, Sandro V. Porceddu, Benedict J. Panizza

Publication date 02-11-2022


Abstract Background Accurate epidemiological and outcomes data regarding cutaneous squamous cell carcinoma (cSCC) extending to the temporal bone is lacking.
Methods Retrospective analysis of 167 Australian patients with primary and peri-temporal bone cSCC.
ResultscSCC extending from secondary subsites (93.4%) was 14 times more frequent than primary temporal bone SCC (6.6%). For patients who underwent curative surgery ± post-operative radiotherapy (n = 146, 87.4%), 5-year disease-free survival, locoregional recurrence-free survival, disease-specific survival, and overall survival was 53.0%, 59.4%, 67.9%, and 44.7%, respectively. External ear and pre-auricular tumors, salvage surgery, tumor size (≥40 mm medial-lateral), nodal disease, and involved margins were negative predictors of survival in multivariable analysis.
Conclusion In regions of high sun exposure, cSCCs extending to the temporal bone are more common than primary cancers. Outcomes are improved with clear margins, justifying the need for radical resection. Further research regarding pre-auricular cancers is required given poorer associated survival outcomes.

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Characterizing critical predictors of an academic career following head and neck fellowship in otolaryngology

Neeraj V. Suresh, Mary Jue Xu, Jacob Harris, Eesha Balar, Louis‐Xavier Barrette, Kevin T. Chorath, Alvaro G. Moreira, Karthik Rajasekaran

Publication date 02-11-2022


Abstract Background Historically, graduating head and neck (HN) fellows outpace available academic HN positions, resulting in a highly competitive job market. We identified factors that associate with full-time academic HN positions post-HN fellowship.
Methods Graduates of American Head and Neck Society (AHNS)-accredited fellowships from 2005 to 2017 (n = 356) were extracted from the AHNS website.
Results From 2015 to 2017, the supply–demand mismatch for academic HN jobs improved. Of the 57.3% (n = 204) of graduating HN fellows who entered academia, 64% (n = 130) trained at just 10 fellowship institutions, 47% (n = 94) attended OHNS residency at an NIH top 40 funded institution, and 54% (n = 111) attended OHNS residency at an AHNS-accredited institution offering HN fellowship. After multivariate regression, number of manuscripts (OR = 1.14; p = 0.01) was significantly associated with initial academic job post-fellowship.
Conclusion The recent improvement in supply–demand mismatch for academic jobs is promising for future HN fellows interested in academia.

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Magnetic resonance imaging‐based radiomics model for predicting radiation‐induced temporal lobe injury in nasopharyngeal carcinoma after intensity‐modulated radiotherapy

Dan Bao, Yanfeng Zhao, Zhou Liu, Haijun Xu, Ya Zhang, Meng Yuan, Lin Li, Meng Lin, Xinming Zhao, Dehong Luo

Publication date 02-11-2022


Abstract Background To develop a model based on magnetic resonance imaging (MRI) radiomics and clinical features for predicting radiation-induced temporal lobe injury (RTLI) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).
Methods Two hundred and sixteen patients with NPC were retrospectively included. Radiomics features were extracted and selected. The logistic regression analysis was performed for prediction models construction. The area under the receiver operating characteristic curve (AUC) was calculated for performance evaluation.
Results Three radiomics features were selected to construct the radiomics signature (AUC of 0.94 and 0.92). The clinical-radiomics model, integrating radiomics signature with T classification, achieved higher predictive performance in the training and validation cohorts (AUC of 0.95 and 0.93), as well as improved accuracy of the classification of RTLI outcomes (net reclassification improvement: 0.711; 95% CI: 0.57–0.86; p < 0.001).
Conclusions The clinical-radiomics model and radiomics signature both showed great performance in predicting RTLI in patients with NPC.

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The effect of adjuvant radiotherapy on clinical outcomes in early major salivary gland cancer

Wei‐Ju Hong, Shih‐Lun Chang, Chia‐Jen Tsai, Hung‐Chang Wu, Yi‐Chen Chen, Ching‐Chieh Yang, Chung‐Han Ho

Publication date 02-11-2022


Abstract Background This study investigated the effects of adjuvant radiotherapy on outcomes in early-stage major salivary gland cancers.
MethodsA total of 655 patients were identified, including 355 (54.2%) received adjuvant radiotherapy and 300 (45.8%) had surgery alone. The effect of adjuvant radiotherapy on 5-year locoregional recurrence and disease-specific survival (DSS) was calculated using the Kaplan–Meier method, Wilcoxon rank sum test, and Cox proportional hazards model.
Results There were no significant differences in locoregional recurrence and DSS between patients receiving adjuvant radiotherapy and those not in both univariate and multivariable analysis. Although patients with positive margin status had a higher locoregional recurrence and those with moderate/poor differentiation had a worse DSS, stratified analysis still indicated there were no protective effects from the use of adjuvant radiotherapy.
Conclusions The use of adjuvant radiation therapy was not associated with improved locoregional recurrence and DSS, even for those with high-risk histopathological factors.

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The impact of operability status on outcomes in patients with T4 larynx cancer undergoing larynx preservation

Ashley J. Schlafstein, Subir Goyal, Arya Amini, Sana D. Karam, Nabil F. Saba, Azeem S. Kaka, Ashley H. Aiken, Jonathan J. Beitler, William A. Stokes

Publication date 02-11-2022


Abstract Background Large analyses of T4 larynx cancer (LC) have raised concerns that larynx preservation (LP) contributes to reduced survival compared with laryngectomy (LGX). The role of operability has not been previously considered as a confounder.
Methods We queried the National Cancer Database for T4M0 LC diagnosed 2004–2015. Patients were categorized as undergoing LGX, chemoradiotherapy but operable (LP-operable), and chemoradiotherapy inoperable (LP-inoperable). Overall survival (OS) was estimated by Kaplan–Meier. Cox multivariate analysis (MVA) identified variables associated with OS.
Results We identified 1405 LGX, 164 LP-operable and 1969 LP-inoperable patients. Compared with LGX, MVA demonstrated worse OS among LP-inoperable (HR 1.28 95%CI 1.17–1.40, p < 0.01) but not LP-operable patients (HR 1.12 95%CI 0.91–1.39, p = 0.28).
ConclusionsLP-operable patients did not have significantly worse OS than those undergoing LGX.

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Development and validation of prognostic nomograms in patients with ascending type of nasopharyngeal carcinoma: Retrospective study based on SEER database

Kai‐Hua Chen, Yu‐Ting Jiang, Rong Zhao, Yong‐Chu Sun, Xiao‐Dong Zhu

Publication date 02-11-2022


Abstract Background Nomograms specifically used to predict the prognosis of ascending type nasopharyngeal carcinoma (NPC) have not been constructed.
Methods Data of ascending type (T3-4N0-1M0) NPC from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 were extracted.
Results Altogether 862 patients with ascending type NPC were enrolled, including 603 in training cohort and 259 in validation cohort. Age, marital status, pathology, grade, tumor size, T classification, and chemotherapy were the independent prognostic factors for overall survival (OS). Age, marital status, pathology, grade, and chemotherapy were the independent prognostic factors for cancer-specific survival (CSS). In training cohort, the concordance index of the OS and CSS nomograms were 0.694 (95% confidence interval CI, 0.677–0.711) and 0.678 (95%CI, 0.659–0.697), respectively, while those in validation cohort were 0.740 (95%CI, 0.715–0.765) and 0.708 (95%CI, 0.679–0.737), separately.
Conclusion The as-constructed nomograms for ascending type NPC could provide accurate prognostic predictions of OS and CSS.

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Analysis of the accuracy of computer‐assisted DCIA flap mandibular reconstruction applying a novel approach based on geometric morphometrics

David Steybe, Philipp Poxleitner, Marc C. Metzger, Rainer Schmelzeisen, Maximilian F. Russe, Marc Anton Fuessinger, Leonard S. Brandenburg, Pit J. Voss, Stefan Schlager

Publication date 02-11-2022


Abstract Background This study evaluated the accuracy of computer-assisted surgery (CAS)–driven DCIA (deep circumflex iliac artery) flap mandibular reconstruction by traditional morphometric methods and geometric morphometric methods (GMM).
Methods Reconstruction accuracy was evaluated by measuring distances and angles between bilateral anatomical landmarks. Additionally, the average length of displacements vectors between landmarks was computed to evaluate factors assumed to influence reconstruction accuracy. Principal component analysis (PCA) was applied to unveil main modes of dislocation.
Results High reconstruction accuracy could be demonstrated for a sample consisting of 26 patients. The effect of the number of segments and length of defect on reconstruction accuracy were close to the commonly used significance threshold (p = 0.062/0.060). PCA demonstrated displacement to result mainly from sagittal and transversal shifts.
ConclusionsCAS is a viable approach to achieve high accuracy in mandibular reconstruction and GMM can facilitate the evaluation of factors influencing reconstruction accuracy and unveil main modes of dislocation in this context.

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Neuropathic pain prevalence and risk factors in head and neck cancer survivors

Raniv D. Rojo, Jenny L. Ren, Demis N. Lipe, Hoda Badr, Sanjay Shete, Ehab Y. Hanna, Cielito C. Reyes‐Gibby

Publication date 02-11-2022


Abstract Background Neuropathic pain (NP) is a debilitating symptom among head and neck cancer (HNC) survivors although few large studies report its prevalence and associated risk factors.
MethodsA cross-sectional survey assessing demographic, behavioral, and clinical risk factors for NP. NP was assessed using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS).
Results Forty-five percent (227/505) reported having pain including 13.7% (69/505) who were positive for S-LANSS. Reported pain sites were in the regions of the head and oral cavity (46.2%) and neck and throat (41.5%). Despite a higher self-reported use of analgesic medication (NP+ = 41.2%; NP− = 27.4%; p = 0.020) and alternative pain therapies (NP+ = 19.1%; NP− = 8.4%; p = 0.009), severe pain was more prevalent among those with NP (N+ = 23.2%; NP− = 13.3%; p = 0.004). Adjusted for opioid medications, ethnicity/race, age, surgery, depression, and comorbidities were risk factors for NP.
ConclusionNP remains prevalent in HNC survivors highlighting the importance of routine pain surveillance.

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Issue Information

Publication date 02-11-2022


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Epstein–Barr virus‐associated leiomyosarcoma of the larynx in an adult patient with human immunodeficiency virus infection: Case report and review of the literature

Jian‐Di Jin, Zhe Chen, Zai‐Zai Cao, Shui‐Hong Zhou, Xiu‐Ming Zhang, Hong‐Tian Yao

Publication date 02-11-2022


Abstract We investigated the clinical features, treatment, and prognosis of laryngeal leiomyosarcoma (LLMS) and Epstein–Barr virus-associated (EBV-associated) LMS. We report a case of EBV-associated LLMS in an adult patient with HIV infection. We also conducted a review of the English-language literature on LLMS and EBV-associated leiomyosarcoma. To the best of our knowledge, 62 cases of LLMS and EBV-associated leiomyosarcoma have been reported to date. Of patients with LLS, 18.9% had distant metastases and 17.0% had local recurrence. The overall 5-year survival rate was 64.0%. Distant metastases affected the survival of patients with LLMS (p = 0.04). EBV-positive patients had a low survival rate (p = 0.01). Among patients with EBV-associated LMS, 8.2% had distant metastases and recurrence and the overall 5-year survival rate was 50.0%. EBV-associated LLMS is rare. The EBV infection might be a poor prognostic factor of LLMS.

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Return to work in patients with head and neck cancer: Systematic review and meta‐analysis

Justin Yu, Justin Smith, Ravi Marwah, Oskar Edkins

Publication date 02-11-2022


Abstract Background The aim of this review was to determine the prevalence of return to work (RTW) amongst head and neck cancer (HNC) survivors and to determine its impact on quality of life (QoL).
MethodsA literature search was conducted in Pub Med, Scopus, Embase and CINAHL in March 2021. Articles were included if they reported the number of patients with HNC receiving definitive treatment who were working at the time of diagnosis and returned to work.
Results There were 21 articles deemed eligible for inclusion. Meta-analysis suggested that 67% of patients with HNC who were employed at diagnosis RTW (95% CI 62%–73%, I2 = 97.53%). Patients who RTW were demonstrated to have lower levels of anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale.
Conclusions Return to work is an important clinical outcome which must be considered in the survivorship care of patients with HNC.

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Correlation between radiologic and pathologic extranodal extension in HPV‐associated oropharyngeal cancer: Systematic review

Tristan Morey, John‐Charles Hodge, Cindy Stern, Suren Krishnan, Andrew Foreman

Publication date 02-11-2022


Abstract Pretreatment determination of extranodal extension (ENE) has significant clinical implications in human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Unfortunately there is no gold-standard imaging modality for radiological assessment of ENE in HPV+ OPSCC, leading to subjective assessments and complex decision making concerning ENE. A systematic review of diagnostic test accuracy was therefore undertaken, with five databases systemically searched to evaluate the diagnostic performance of an imaging modality for detection of ENE in HPV+ OPSCC. A meta-analysis was conducted on four CT studies using a random-effects model. While a narrative synthesis was provided for the studies using PET/CT and “CT and MRI.” Out of 1772 hits, six studies were included in the review. Meta-analysis on four CT studies showed CT had an overall sensitivity of 77% and specificity of 60%. PET/CT had a sensitivity of 37.5% and specificity of 97%. “CT and MRI” had a sensitivity of 62% and specificity of 78%. Further diagnostic studies involving CT, PET/CT and MRI are ultimately required.

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Systemic conditions associated with increased risk to develop oral squamous cell carcinoma: Systematic review and meta‐analysis

Erison Santana Dos Santos, Maria Eduarda Pérez‐de‐Oliveira, Ana Gabriela Costa Normando, Luiz Alcino Monteiro Gueiros, Silvia Regina Rogatto, Pablo Agustin Vargas, Márcio Ajudarte Lopes, Eliete Neves Silva Guerra, Adriana Franco Paes Leme, Alan Roger Santos‐Silva

Publication date 02-11-2022


Abstract This study aimed to map systemic alterations predisposing to oral squamous cell carcinoma (OSCC) onset. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Five databases were used to access (1) reports of OSCC co-occurring in patients with systemic conditions, (2) prevalence of OSCC among these patients, and (3) clinicopathological profiles. Data from more than 1 million patients worldwide showed that Fanconis anemia, xeroderma pigmentosum, dyskeratosis congenital, chronic fatigue syndrome, and patients post bone marrow transplantation (BMT) present increased risk for OSCC development. The overall prevalence of OSCC in syndromic patients and post-BMT were 0.65% (95% CI = 0.13–3.11, p < 0.01) and 5.83% (95% CI = 0.00–30.90, p < 0.01), respectively. The certainty of the evidence was moderate. This study demonstrated that some systemic conditions predispose to OSCC. These results present an impact on the screening of OSCC in systemically compromised patients.

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The T‐shaped FST pharyngoplasty step‐by‐step closure technique

Gerardo Petruzzi, Danilo Di Giorgio, Federico Leone, Barbara Pichi, Flaminia Campo, Armando De Virgilio, Valentino Valentini, Raul Pellini

Publication date 02-11-2022


Abstract Pharyngocutaneous fistula is one of the most common and serious complications associated with total laryngectomy. Numerous studies tried to evaluate causative and predisposing factors associated with this complication, but data are considerably variable and there is still no international consensus. Incidence rate varies considerably between studies, with reported rates from 3% to 65%. This 4K video presents our T-shaped four-step technique (FST) for closing the pharyngeal mucosa after total laryngectomy in a step-by-step manner. All sutures were performed by braided absorbable 3/0 26 mm 1/2c (Vicryl plus 3.0; Ethicon, Somerville, NJ, USA). Recordings were performed using a Karl Storz 4K 3D VITOM® exoscope (Karl Storz SE & Co. KG, Tuttlingen, Germany). We have been described this technique through a high-definition video, showing each step, and tips from the authors. Our T-shaped pharyngoplasty closure technique can be divided into four steps: 1. “Key Stitches”; 2. “Area Refinement Stitches”; 3. “Modified Connell Suture”; 4. “Modified Purse String Suture.” Our T-shaped FST closure technique proved to be an effective and reproducible method, which we feel could be the preferred choice for primary pharyngoplasty closure.

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Three‐dimensional exoscope‐assisted single‐stage tracheal resection

Francesca Pirola, Giuseppe Mercante, Elena Russo, Caterina Giannitto, Luca Malvezzi, Fabio Ferreli, Giuseppe Spriano, Umberto Cariboni, Armando De Virgilio

Publication date 02-11-2022


Abstract The three-dimensional (3D) 4K exoscope is a surgical tool recently introduced in numerous fields of otolaryngology, such as microvascular surgery, otology, and laryngology. However, other surgical fields may also benefit from this technology. In this case, a single-stage tracheal resection was planned with the aid of the 3D 4K exoscope, in a 75-year-old female with post-tracheostomy tracheal stenosis. High-quality magnification of the surgical field was obtained, with facilitated skeletonization of the laryngotracheal axis. The exoscope provided greater involvement in surgery and allowed more interactions among all operating room personnel and learners, as they could access the same field of view of the first surgeon, as well as perceiving depth of the surgical field with 3D technology. The exoscope represents a valid application in open surgery performed for laryngotracheal stenosis, with advantages of enhancing training and education, allowing precise surgical dissection, and reducing risks of iatrogenic damage to surrounding structures.

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Distant metastases in human papillomavirus‐related oropharyngeal squamous cell carcinoma: Systematic review and meta‐analysis

Jason R. Crossley, Lacey L. Nelson, Jiling Chou, Jessica H. Maxwell

Publication date 28-10-2022


Abstract The prevalence of distant metastases (DM) in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) remains unknown. A PRISMA systematic review of DM rates in patients with HPV-related OPSCC was performed. Pub Med-MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched. The primary outcome was prevalence of DM. Data on demographics, tumor classification, and clinical outcomes were also collected. Meta-analysis of pooled DM rate was determined. Ten articles met inclusion criteria, representing 1860 patients with mean follow-up of 3.6 years. Overall DM rate was 7.0% (95% CI: 5.9–8.2). T3 or T4 classification disease was associated with a 4.88-fold (95% CI: 1.92–12.40) risk of DM compared to T1 or T2 classification disease. This study is the first to systematically review the prevalence of DM among patients with HPV-related OPSCC, where pooled DM rate was found to be 7%.

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Efficacy of optical coherence tomography in the diagnosing of oral cancerous lesion: systematic review and meta‐analysis

Do Hyun Kim, Sung Won Kim, Se Hwan Hwang

Publication date 28-10-2022


Abstract Non-invasive diagnostic tools that facilitate visualization of potentially malignant oral lesions and cancers have been introduced. Oral lesions detected by optical coherence tomography (OCT) were compared to reference results based on histological findings. The diagnostic odds ratio (DOR), along with summary receiver operating characteristic curve (SROC), area under SROC, sensitivity, specificity, and negative predictive values, were the outcomes. The DOR of OCT was 86.9190 (95% confidence interval CI: 38.7435, 194.9985), and the area under SROC was 0.951. OCT showed good sensitivity (0.9138; 95% CI: 0.8758, 0.9409) and specificity (0.9110; 95% CI: 0.8568, 0.9460), and a high negative predictive value (0.9225; 95% CI: 0.8863, 0.9478). Diagnostic sensitivity was higher when using artificial intelligence and automated algorithms compared to diagnoses made by clinicians. OCT is non-invasive, provides rapid results without radiation exposure, and can aid in the diagnosis and follow-up of oral cancer and oral precancerous lesions.

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Diagnostic efficacy of positron emission computerized tomography scans in suspicious laryngeal findings postorgan preservation treatment

Anton Warshavsky, Ariel Holan, Nidal Muhanna, Yael Oestraicher, Yuval Nachalon, Liyona Kampel, Narin Nard‐Carmel, Hen Chaushu, Udi Shapira, Omer Ungar, Orit Gutfeld, Inna Ospovat, Yasmin Natan Oz, Einat Even‐Sapir, Gilad Horowitz

Publication date 27-10-2022


Abstract Background Larynx preservation protocols (LPP) for glottic primary squamous cell carcinoma has gained popularity worldwide. Direct laryngoscopy (DL) with biopsy is mandated when recurrence is suspected. The efficacy of 18Fluoro-deoxy-glucose positron emission computerized tomography (PET-CT) as alternative first-line diagnostic investigation in suspected recurrence was evaluated.
MethodsA retrospective study of patients with suspicious fiber-optic findings at more than 12 weeks after LPP. Sensitivity, specificity, and the negative predictive value (NPV) of DL and PET-CT were compared.
Results Seventy-two patients presenting 105 cases of suspicious events were included in this study. Fifty-two events were initially investigated by DL and 53 events by PET-CT. The sensitivity of DL and PET-CT was 56.25% and 100%, respectively. The NPV was 84% for DL and 100% for PET-CT (p = 0.015).
Conclusion Negative PET scans after LPP are highly accurate in ruling out recurrent/persistent disease and may spare the patient from negative biopsies.

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Postoperative analysis of osseous midface reconstructions: The value of imaging and a novel scoring system for complexity and operative success

Brian Swendseid, Ramez H. W. Philips, Ryan M. Carey, Steven B. Cannady, Larissa Sweeny, Mark K. Wax, Adam J. Luginbuhl, Joseph M. Curry

Publication date 27-10-2022


Abstract Background Few standardized methods exist for evaluating the postoperative outcomes of osteocutaneous free flaps. We propose an anatomic-based scoring system for midface free flap reconstruction.
Methods One hundred and twelve patients across four institutions underwent osteocutaneous reconstruction of the midface. Postoperative scans were scored based on the number of independent osseous subunits reconstructed (Subunit Score), the number of different bony appositions with bony contact (Contact Score), and the number of osseous segments in anatomic position (Position Score). These were added together to create a Total Score.
Results Osteocutaneous radial forearm flaps had the lowest Subunit Score (p = 0.001). Fibula flaps had the highest Contact Score (p = 0.0008) and Position Score (p = 0.001). Virtual surgical planning was associated with an increased Subunit Score (p = 0.02) and Total Score (p = 0.04).
Conclusions We propose a novel scoring system for osseous midface reconstruction based on postoperative imaging scans. This can help guide management decisions and create a common language to compare outcomes.

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Src family kinase targeting in head and neck tumor cells using SU6656, PP2 and dasatinib

Anh Thu Vu, Lara Akingunsade, Konstantin Hoffer, Cordula Petersen, Christian Stephan Betz, Kai Rothkamm, Thorsten Rieckmann, Lara Bussmann, Malte Kriegs

Publication date 25-10-2022


Abstract Background We have recently shown a frequent upregulation of Src-family kinases (SFK) in head and neck squamous cell carcinoma (HNSCC). Here we tested, if SFK targeting is effective especially in HNSCC cells with upregulated SFK signaling.
Methods The impact of SFK inhibitors SU6656, PP2 and dasatinib on three HNSCC cell lines with different SFK activity levels was analyzed using proliferation and colony formation assays, Western blot and functional kinomics.
Results Proliferation was blocked by all inhibitors in a micro-molar range. With respect to cell kill, dasatinib was most effective, while SU6656 showed moderate and PP2 minor effects. Cellular signaling was affected differently, with PP2 having no effect on SFK signaling while dasatinib probably has non-SFK specific effects. Only SU6656 showed clear SFK specific effects on signaling.
Conclusion The results demonstrate potential benefit of SFK inhibition in HNSCC but they also highlight challenges due to non-specificities of the different drugs.

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Small extravesicular microRNA in head and neck squamous cell carcinoma and its potential as a liquid biopsy for early detection

Chenna R. Galiveti, Damaris Kuhnell, Jacek Biesiada, Xiang Zhang, Karl T. Kelsey, Vinita Takiar, Alice L. Tang, Trisha M. Wise‐Draper, Mario Medvedovic, Susan Kasper, Scott M. Langevin

Publication date 22-10-2022


Abstract Background The objective was to assess secretion of small extracellular vesicular microRNA (exo-miRNA) in head and neck squamous cell carcinoma (HNSCC) according to human papillomavirus (HPV) status, and determine the translational potential as a liquid biopsy for early detection.
Methods This study employed a combination of cell culture and case–control study design using archival pretreatment serum. Small extracellular vesicles (sEV) were isolated from conditioned culture media and human serum samples via differential ultracentrifugation. miRNA-sequencing was performed on each sEV isolate.
Results There were clear exo-miRNA profiles that distinguished HNSCC cell lines from nonpathologic oral epithelial control cells. While there was some overlap among profiles across all samples, there were apparent differences in exo-miRNA profiles according to HPV-status. Importantly, differential exo-miRNA profiles were also apparent in serum from early-stage HNSCC cases relative to cancer-free controls.
Conclusions Our findings indicate that exo-miRNA are highly dysregulated in HNSCC and support the potential of exo-miRNA as biomarkers for HNSCC.

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Knockdown of circGOLPH3 inhibits cell progression and glycolysis by targeting miR‐145‐5p/lysine demethylase 2A (KDM2A) axis in oral squamous cell carcinoma

Tao Cheng, Feifei Huang, Yin Zhang, Zhen Zhou

Publication date 21-10-2022


Abstract Background Oral squamous cell carcinoma (OSCC) is one of the most common head and neck malignancies. The aim of this study is to explore the role of circRNA Golgi phosphoprotein 3 (GOLPH3) (circGOLPH3) in OSCC.
Methods Quantitative real-time polymerase chain reaction (qRT-PCR) and western blot were performed to detect changes in the levels of circGOLPH3, microRNA-145-5p (miR-145-5p), and lysine demethylase 2A (KDM2A). The functions of circGOLPH3 were assessed using in vitro and in vivo assays. Dual-luciferase reporter assay detected the interaction of miR-145-5p with circGOLPH3 or KDM2A.
ResultscircGOLPH3 expression was upregulated in OSCC. circGOLPH3 downregulation inhibited cell growth, metastasis, and glycolysis in vitro, and in vivo experiments revealed that circGOLPH3 inhibited tumor growth. In addition, circGOLPH3 bound to miR-145-5p and competitively inhibited KDM2A expression, thereby regulating OSCC cell behaviors as well as glycolysis.
ConclusioncircGOLPH3 exerted pro-oncogenic effects through the miR-145-5p/KDM2A axis to regulate OSCC cell behaviors.

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Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Stefan Janik, Blazen Marijic, Muhammad Faisal, Stefan Grasl, Chieh‐Han J. Tzou, Andres Rodriquez‐Lorenzo, Rudolf Seemann, Matthias Leonhard, Boban M. Erovic

Publication date 19-10-2022


Abstract It was the purpose of this study to evaluate the role of the serratus anterior free flap (SAFF) with its long thoracic nerve (LTN) as composite flap for dynamic facial reanimation. A total of 10 studies, published between 2004 and 2021, met inclusion criteria. Clinical data of 48 patients were used for the systematic review and analysis. One to three slips were used, mainly as one-stage procedures (n = 39; 81.3%), to create different force vectors. Single or double innervated muscle transfers were utilized in 32 (66.7%) and 16 (33.3%) cases with additionally harvested skin paddles in 4 (8.3%) patients. The LTN was mostly anastomosed to the ipsilateral masseteric nerve (45.8%; n = 22) or to remaining facial nerve branches (37.5%; n = 18), while cross-facial-nerve-grafting was rarely used (16.7%; n = 8). The SAFF as composite flap with different force vectors proved to be a good candidate for immediate dynamic facial reanimation after any midface defects.

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Comparison of propeller flaps versus skin grafts for coverage of osteocutaneous fibula free flap donor site defects

Arshad Kaleem, Neel Patel, Enrique Schubert, Dani Stanbouly, Rabie Shanti, Ramzey Tursun

Publication date 18-10-2022


Abstract Background Authors compare use of propeller flaps versus skin grafts in defect coverage after fibula flap harvest.
Materials and Methods Retrospective review of patients who received either PFPF or STSG. Primary predictor variable was technique, and secondary predictor variables were comorbidities. Primary outcome variable was flap/graft healing, and secondary outcome variables were cosmesis, adverse events, effect on activities of daily living (ADLs), pain, additional procedures, and cost. Statistical analysis performed via independent sample t tests, ANOVA, and χ2 tests. Logistic regression analysis was performed.
Results Study sample was 50 patients. PFPFs showed higher rates of success, while STSG showed increased complications and adverse events. Pain and ADLs significantly affected in STSG group. Cosmesis was better in the PFPF group, and overall cost was significantly higher in STSG group.
ConclusionPFPFs show greater success rates, fewer complications, improved cosmesis, less pain, reduced cost compared to STSG for wound coverage after fibula flap harvest.

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Spontaneous regression of an human papillomavirus‐positive oropharyngeal squamous cell carcinoma

Stefanie Seo, Lisa Rooper, Tanguy Y. Seiwert, Carole Fakhry

Publication date 18-10-2022


Abstract Background Spontaneous regression (SR) of cancer is an exceedingly rare phenomenon. While SR is well-documented for some cancers, very few reports exist in oropharyngeal squamous cell carcinomas (OPSCCs) and none in human papillomavirus (HPV)-positive OPSCCs.
MethodsA 67-year old man presented with a left-sided neck mass. Neck CT, PET, and biopsies showed a SCC in a left-sided lymph node without a primary lesion. Immunohistochemistry confirmed HPV16. Six weeks after biopsy, the patient underwent left selective tonsillectomy and neck dissection.
Results Surgery revealed a left tonsillar SCC and no lymph nodes with tumor. Histology revealed homogenous fibrosis and intermixed immune cells indicative of tumor regression analogous to reports of immune-related pathologic responses. AE1/AE3 immunostain was also negative for tumor. All lymph nodes remained negative at 1 year follow-up.
Conclusion We described a spontaneously regressed lymph node in a tonsillar HPV-positive SCC. The unique immune environment of HPV-positive OPSCCs, and unknown environmental or host factors, may have played a role in our patients SR which requires future studies to elucidate.

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Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design

Khanh Linh Tran, Jae Young Kwon, Xi Yao Gui, Edward Wang, David Yang, James Scott Durham, Eitan Prisman

Publication date 18-10-2022


Abstract Background The studys objective is to assess the feasibility and utility of VSP for maxillary reconstruction with the scapular free flap.
Methods An open-source VSP platform was used to create the reconstruction models and simple guides. Clinical, operative, and postoperative data were collected.
Results Ten patients in the VSP cohort and 18 in the non-VSP control cohort were included in the study. There was a significant reduction in operative time (256.0 ± 69.4 vs. 448.1 ± 108.2 min, p < 0.01), tracheotomy rate (20% vs. 72%, p < 0.01), increased two-team utilization rate (80% vs. 0%, p < 0.01) and better reconstructive accuracy (7.5 ± 3.4 vs. 11.7 ± 7.6 mm, p = 0.048) for the VSP cohort.
Conclusions Maxillary reconstruction planned with an in-house open-source VSP platform and accompanied simple guides can facilitate a two-team approach, reduce operative time, and improve structural accuracy. This open-source technology has great potential to be readily applied in other institutions to improve efficiency and outcomes.

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Microelectrodes and radiofrequency for transoral horizontal supraglottic laryngectomy in T3 tumors

Jorge Basterra, Natsuki Oishi, José Ramón Alba, Enrique Zapater

Publication date 17-10-2022


Abstract The aim of this manuscript is to show the surgical technique for horizontal supraglottic laryngectomy in T3 carcinomas by a transoral approach using microelectrodes and radiofrequency. From 2009 to 2020, 11 selected cases of T3 laryngeal supraglottic carcinomas invading the pre-epiglottic space, with preserved vocal cords mobility underwent surgery. The technique is described step by step. Average time duration of the larynx surgery was 95 min. Nine percent of the patients presented a profuse hemorrhage 7 days postoperative; in 73% of patients the nasogastric feeding tube was withdrew 10 days after surgery. We emphasize a remarkable short surgical time and high hemostatic effectiveness. The ME tips allow to perform cuts at angles and contribute with a sense of touch. The low cost of the equipment and its easy handling and maintenance is a remarkable advantage over other technologies for transoral surgery.

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Adoption of adjuvant chemotherapy in high‐risk salivary gland malignancies

Alex J. Gordon, Michael S. Chow, Aneek Patel, Kenneth S. Hu, Zujun Li, Adam S. Jacobson, Alec E. Vaezi, Moses M. Tam, Babak Givi

Publication date 17-10-2022


Abstract Background The present study characterizes national trends in the utilization of adjuvant chemotherapy to treat salivary gland malignancies.
Methods The National Cancer Database was queried for salivary gland malignancies treated by surgery with radiation in 2004–2019. Proportions of patients receiving adjuvant chemotherapy over the study period were analyzed by linear regression. The impact of chemotherapy on overall survival was assessed using Kaplan–Meier and Cox proportional hazards analyses.
Results Among 15 965 patients meeting inclusion criteria, 2355 (14.8%) received adjuvant chemotherapy. Chemotherapy utilization significantly increased from 4.9% to 16.5% over the study period (p < 0.001). No survival benefit was observed with adjuvant chemotherapy on propensity score-matched Kaplan–Meier analysis (HR: 0.98; 95% CI: 0.86–1.11; p = 0.72) or multivariable Cox regression (HR: 0.92; 95% CI: 0.78–1.09; p = 0.34).
Conclusions Adjuvant chemotherapy has been increasingly utilized to treat salivary gland malignancies in recent years. Our findings highlight the importance of obtaining high-quality prospective data regarding the benefit of chemotherapy.

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The role of adjuvant therapy in pT4N0 laryngectomized patients: A multicentric observational study

Francesco Mattioli, Edoardo Serafini, Alfredo Lo Manto, Francesca Mularoni, Andi Abeshi, Marco Lionello, Marco Ferrari, Alberto Paderno, Davide Lancini, Davide Mattavelli, Gennaro Confuorto, Filippo Marchi, Alessandro Ioppi, Claudio Sampieri, Giuseppe Mercante, Armando De Virgilio, Gerardo Petruzzi, Erika Crosetti, Raul Pellini, Spriano Giuseppe, Peretti Giorgio, Cesare Piazza, Gabriele Molteni, Andy Bertolin, Giovanni Succo, Piero Nicolai, Matteo Alicandri‐Ciufelli, Daniele Marchioni, Livio Presutti, Matteo Fermi

Publication date 17-10-2022


Abstract Background To retrospectively evaluate oncological outcomes in two groups of patients with pT4aN0 glottic SCC treated with total laryngectomy (TL) and neck dissection (ND) who underwent postoperative radiotherapy or exclusive clinical and radiological follow-up.
Methods It includes patients with pT4N0 glottic SCC who underwent TL and unilateral or bilateral ND with or without PORT.
Divided in two comparison groups: the first group underwent adjuvant RT (TL-PORT); the second group referred to clinical and radiological follow-up (TL).
ResultsPORT was associated with a better OS while no differences were found in terms of DSS. A better local control is achieved when PORT is administered while no differences in terms of regional and distant control rates were found. Bilateral ND positively impacts on the regional control while the PNI negatively impact the regional control.
ConclusionsA tailored PORT protocol might be considered for pT4N0 glottic SCC treated with TL and ND, both considering the NDs extent and presence of PNI.

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POINT: Pilot randomized, controlled, preoperative intervention for nutrition trial in head and neck cancer

Kevin J. Sykes, Heather Gibbs, Nathan Farrokhian, Anna Arthur, John Flynn, Yelizaveta Shnayder, Kiran Kakarala, Rohit Nallani, Joshua B. Smith, Joseph Penn, Scott Fassas, Emily Cummings, Zack Arambula, Omar Karadaghy, Andrés M. Bur

Publication date 17-10-2022


Abstract Background Several prospective studies report improved outcomes with pretreatment nutrition interventions prior to radiation therapy for head and neck cancer (HNC), but none have assessed similar interventions before surgery for HNC.
MethodsPOINT, a pilot randomized controlled trial, was conducted to evaluate a multimodal nutrition intervention. Patients undergoing primary surgery with free flap reconstruction for HNC were randomly assigned to the control arm or a preoperative multimodal nutrition intervention.
ResultsPOINT included 49 patients. Nutrition risk scores did not change significantly for either the intervention or control group. Control patients had a significant decrease in body weight in the preoperative period (p < 0.001). Conversely, weight among intervention patients did not significantly decrease (p = 0.680). The intervention mitigated weight loss in patients with dysphagia (p = 0.001).
Conclusions Preoperative nutrition optimization shows potential to reduce weight loss normally experienced by patients with head and neck cancer prior to surgical extirpation, especially among those with subjective dysphagia.

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Development and validation of a nomogram for the prediction of lymph node metastasis within 2‐year postoperatively in cT1‐T2N0 oral squamous cell carcinoma

Aoming Cheng, Zhen Wang, Xiaohong Yuan, Huan Liu, Wei Cao, Wei Wei, Shimin Chang, Zhengxue Han, Chuanbin Guo, Zhien Feng

Publication date 13-10-2022


Abstract Background The current neck management for early oral squamous cell carcinoma (OSCC) has always been a controversial issue. A comprehensive model is necessary for predicting an individuals metastasis risk and appropriate patient counseling.
MethodsA nomogram for predicting 2-year LNM in patients with cT1-2N0 OSCC was developed and validated using clinicopathological data from 642 patients from 2000 to 2018 in four hospitals, China.
Results Three variables (pathology grade, depth of invasion, tumor-infiltrating lymphocytes) were included in nomogram. C-indices were 0.826 (95% CI: 0.786–0.866) and 0.726 (95% CI: 0.653–0.780) in the internal and external validation. Kaplan–Meier method found the 2-year LNM rate of high-risk group (35.8%) was much higher than that of the low-risk group (14.5%). The nomogram model has an advantage over the 8th AJCC TNM stage in predicting the individual 2-year LNM probability for early OSCC.
Conclusion Patients with low-risk nomogram score may receive neck observation; those with high-risk score should receive END.

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External validation of the H‐index (host index) in patients with head and neck squamous cell carcinomas

Aina Sansa, Cristina Valero, Anna Holgado, Rosselin Vásquez, Miquel Quer, Snehal G. Patel, Xavier León

Publication date 12-10-2022


Abstract Background The aim of the current study is to perform an external validation of the prognostic capacity of the H-index in patients with head and neck squamous cell carcinoma (HNSCC).
Methods Retrospective study of 835 patients with HNSCC located in the oral cavity, oropharynx, hypopharynx, or larynx.
Results When applying the cutoffs proposed in the original description of the H-index (1.5 and 3.5), we observed an orderly and significant decrease in the disease-specific survival and overall survival as H-index increased. Additionally, we were able to observe a decrease in survival as the H-index increased regardless of the location, the extension of the tumor or the type of treatment performed.
Conclusion We have validated the prognostic capacity of the H-index in patients with HNSCC regardless of the location of the primary tumor, the extent of the disease, or the type of treatment performed.

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Adenoid cystic carcinoma of the head and neck: Patterns of recurrence and implications for intensity‐modulated radiotherapy

Robert W. Gao, David M. Routman, William S. Harmsen, Sasha Ebrahimi, Robert L. Foote, Daniel J. Ma, Michelle Neben‐Wittich, Lisa A. McGee, Samir H. Patel, Eric J. Moore, Garret W. Choby, Kendall K. Tasche, Katharine A. Price, Mauricio E. Gamez, Scott C. Lester

Publication date 12-10-2022


Abstract Background We seek to inform radiotherapy (RT) delivery for adenoid cystic carcinoma of the head and neck (ACC) by evaluating RT techniques and recurrence patterns.
Methods We identified patients with ACC treated with curative-intent RT from 2005 to 2021. Imaging was reviewed to determine local recurrence (LR).
Results Ninety-one patients were included. The 5-year LR risk was 12.2% (6.6–22.7). One patient each experienced a marginal and out-of-field recurrence. Patients receiving >60 Gy postoperatively had a 5-year LR risk of 0% compared to 10.7% (4.2–27.2) with ≤60 Gy. Those receiving 70 and <70 Gy definitively had a 5-year LR risk of 15.2% (2.5–91.6) and 33.3% (6.7–100.0), respectively. No patients had regional nodal failure.
Conclusions Modern, conformal RT for ACC results in low rates of LR. Doses >60 and 70 Gy may improve control in the postoperative and definitive settings, respectively. Elective nodal treatment can be omitted in well-selected patients.

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Role of immune‐inflamed phenotype in the prognosis of hypopharyngeal carcinoma following primary surgery

Renhui Chen, Qian Cai, Peiliang Lin, Faya Liang, Ping Han, Long Zhang, Pan Song, Tingzhen Zhang, Xiaoming Huang

Publication date 12-10-2022


Abstract Background The immune profile in primary resected hypopharyngeal squamous cell carcinoma (HPSCC) and its prognostic value remain to be defined.
Methods We enrolled 100 patients with HPSCC underwent primary surgical resection at our department. HPSCC samples were examined using immunohistochemistry for the expressions of CD8, Foxp3, CD163, CD66B, programmed death ligand-1 (PD-L1), and interferon (IFN)-γ. The immune pattern of the tumor microenvironment (TME) was discriminated into inflamed and non-inflamed tumors based on the presence or absence of parenchymal CD8+ T cells.
Results We found that 74% of HPSCC cases in our cohort were characterized by an immune-inflamed TME. Immune-inflamed patterns demonstrated an inferior survival with a significantly increased density of CD163+ tumor-associated macrophages and Foxp3+ regulatory T cells. Additionally, the inflamed tumor showed increased expression of PD-L1, without IFN-γ upregulation.
Conclusions The immune-inflamed pattern is the predominant preexisting immune phenotype in HPSCC and demonstrates immunosuppressive immune cell recruitment.

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Presentation and outcomes of patients with clinically T1‐2, N0 oropharynx squamous cell carcinoma: The interplay of primary treatment modality and human papillomavirus status

Zaid Al‐Qurayshi, Vivian L. Zhu, Rodrigo Bayon, Marisa R. Buchakjian

Publication date 07-10-2022


Abstract Background To examine the pattern of utilization and outcomes of definitive radiotherapy (RT) versus primary robotic-assisted surgery in patients with early-stage oropharyngeal squamous cell carcinoma (OPSCC).
MethodsA retrospective cohort analysis of patients with clinically T1-2, N0 OPSCC was performed using the National Cancer Database, 2010–2016.
ResultsA total of 1451 patients were included. Prevalence of human papillomavirus (HPV)-positive tumors was 58.30%. Primary surgery was performed in 30.25% of the sample. Tongue base and clinically T1 tumors were each associated with a higher likelihood of undergoing surgery (p < 0.05). Histopathology of patients who underwent surgery demonstrated a prevalence of 15.95% with lymphovascular invasion, 16.67% with extranodal extension, 19.36% were T updated, and 30.00% were N upstaged. Improved survival was observed in the surgery + adjuvant RT group compared to RT alone for HPV-positive tumors (HR: 0.27; 95%CI: 0.12, 0.62; p = 0.002).
Conclusion This study provides epidemiological perspective regarding management pattern and outcomes of patients with early-stage OPSCC.

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Cost comparison between open thyroid lobectomy and radiofrequency ablation for management of thyroid nodules

Jonas R. Miller, Ved Tanavde, Chris Razavi, Anirudh Saraswathula, Jonathon O. Russell, Ralph P. Tufano

Publication date 06-10-2022


Abstract Background There is an increasing array of treatment options for addressing clinically significant thyroid nodules, including radiofrequency ablation (RFA). While effective, the cost compared to alternative approaches has not been well elucidated.
Methods This study involved a retrospective chart review, focusing on variable direct cost (VDC) of each procedure, from April 2016 to January 2020. We analyzed costs for 53 open lobectomies and 16 RFA procedures.
Results Cost effectiveness depended on the simulated cost of the RFA probe. In comparison to open lobectomy, the VDC to perform RFA was $597 (19%) cheaper when the simulated probe cost was $1500 and $403 (13%) more expensive for a probe cost of $2500. Statistical significance was achieved for both these differences.
Conclusions If cost per RFA probe can be less than $2100—the break-even dollar amount between open lobectomy and RFA—there would be considerable cost savings for treating thyroid nodules.

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Fourteen years old as the best age cutoff to differentiate prepubertal from pubertal papillary thyroid carcinoma

Yuqin He, Han Li, Kai Wang, Jian Wang, Yiming Zhu, Song Ni, Shaoyan Liu

Publication date 06-10-2022


Abstract Background It is unclear whether differences in clinical presentation and/or prognosis exist between prepubertal papillary thyroid cancer (PTC) and pubertal PTC. At present, there is a lack of definition for the appropriate cutoff age to define prepubertal PTC.
Methods This study retrospectively reviewed 227 pediatric PTC patients (aged ≤18 years) who underwent initial surgery from March 2000 to December 2018. The median duration of follow-up was 85 months (range, 8–258).
Results The age range was basically linearly related to multiple risk factors, such as T3–T4 disease, distant metastasis. Age (p = 0.032) was an independent risk factor for recurrence and persistent disease. Patients aged <14 years had obviously higher rates of extensive disease. The 10-year disease-free survival (DFS) rate of patients aged <14 years was 59.5% and that of patients aged ≥14 years was 82.6% (p = 0.004).
Conclusions Fourteen years of age may be an appropriate cutoff to differentiate prepubertal PTC from pubertal PTC.

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Disparities in head and neck cancer incidence and trends by race/ethnicity and sex

Angela L. Mazul, Smrithi Chidambaram, Jose P. Zevallos, Sean T. Massa

Publication date 06-10-2022


Abstract Background The epidemiology of head and neck cancer (HNC) sites differ substantially. This study compares HNC incidence trends by site and demographic subgroups.
Methods We used the U.
S. Cancer Statistics Public Use Database to calculate HNC incidence rates per 100 000. We assessed trends with annual percent change (APC) longitudinally from 2001 to 2017.
Results The oropharyngeal cancer incidence APC decreased from 4.38% (95% CI: 3.6, 5.1) to 2.93% (2.5, 3.3) in 2008 among White males. Oral cavity cancer incidence rose in Other race males (APC 2.5% 1.6, 3.36) and White females (APC: 0.96% 0.7, 1.2). Although decreasing (APC: −1.15% −1.48, −0.83), laryngeal cancer incidence remained disproportionately high among Black males.
Conclusions Notable incidence trends occurred in non-White groups at non-oropharyngeal sites. With parity of smoking rates by race, differing sexual behaviors, and shifting demographics by race and sex, future studies of HNC trends should consider stratifying analyses to understand health disparities.

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Feasibility of clinical evaluation of individuals with increased risk for HPV‐associated oropharynx cancer

"Nicholas Scott‐Wittenborn, Gypsyamber DSouza, Nafi Aygun, Sakshi R. Tewari, Javad Azadi, Peter Vosler, Zhen Gooi, Vikas Mehta, Wojciech Mydlarz, Melonie Nance, Stefan Mlot, Mihir R. Patel, Marietta Tan, Brett A. Miles, Tanya Troy, Carole Fakhry"

Publication date 06-10-2022


Abstract Background Human papillomavirus-associated oropharynx squamous cell carcinoma (HPV-OPSCC) has no known pre-malignant lesion. While vaccination offers future primary prevention, there is current interest in secondary prevention. The feasibility of clinical evaluation of individuals at increased risk for HPV-OPSCC is unclear.
Methods Individuals with risk factors for HPV-OPSCC were enrolled in a prospective study (MOUTH). Participants positive for biomarkers associated with HPV-OPSCC were eligible for a clinical evaluation which comprised a head and neck examination and imaging with ultrasound and/or magnetic resonance imaging (MRI). This study was designed to evaluate feasibility of clinical evaluation in a screening study.
Results Three hundred and eighty-four participants were eligible for clinical evaluation. Of the 384, 204 (53%) completed a head and neck examination or imaging. Of these, 66 (32%) completed MRI (n = 51) and/or ultrasound (n = 64) studies.
Conclusions Clinical evaluations, including head and neck examination and imaging, are feasible in the context of a screening study for HPV-OPSCC.

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Role of sentinel lymph node biopsy for oral squamous cell carcinoma: Current evidence and future challenges

Sophie S. Jang, Morgan E. Davis, David R. Vera, Stephen Y. Lai, Theresa W. Guo

Publication date 04-10-2022


Abstract Sentinel lymph node biopsy (SLNB) has been used across oncological specialties for prognostication, staging, and identification of occult nodal metastasis. Recent studies demonstrated the potential clinical utility of SLNB in oral cavity squamous cell carcinoma (OCSCC). Elective neck dissection is the current standard of care in early management of OCSCC with depth of invasion greater than 2–4 mm; however, majority of patients ultimately do not have nodal disease on final pathology. SLNB is an alternative procedure widely adopted in early cancer management in many oncological subspecialities. Several considerations such as depth of invasion, nodal mapping, histopathology methods, operator variability, postoperative complications, and advancement in preoperative and intraoperative imaging technology can guide the appropriate application to SLNB in OCSCC. The aim of this review is to discuss the current evidence for SLNB in the treatment of early stage OCSCC, imaging technologies that support SLNB procedures, and studies that are currently underway.

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One hundred most‐cited articles in head and neck surgery and analysis of female authorship

Monica S. Trent, Lauren Michelle, Kelsey Roman, Joshua K. Kim, Yarah M. Haidar, Tjoson Tjoa, Mehdi Abouzari

Publication date 04-10-2022


Abstract Background While female head and neck surgeons have made significant contributions to the field, womens achievements in scientific communication have traditionally been underreported.
MethodsA search of high-impact journals in the field of head and neck surgery was performed in the Elseviers Scopus database to identify the top 100 most-cited articles.
Results The top 100 most-cited articles (during the span of 1953 and 2016) had the highest total number of citations between 2005 and 2009. Women accounted for 36% of first authors and 25% of corresponding authors. Change in the relative number of first female authors in these top 100 articles did not increase significantly between 1950 and 2019.
Conclusion The proportion of female first authors in head and neck surgery has not significantly increased over the past several decades, despite greater numbers of female trainees. Our findings support the need for additional research on female representation in head and neck surgery.

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American Head and Neck Society position statement on the use of PD‐1 inhibitors for treatment of advanced cutaneous squamous cell carcinoma

"Cecelia E. Schmalbach, Thomas J. Ow, Karen Y. Choi, Miriam OLeary, Alice Lin, Brian B. Hughley, Kevin S. Emerick, Brian Moore, Nancy Y. Lee, Dan P. Zandberg, Steven J. Wang"

Publication date 30-09-2022


Abstract BackgroundA position statement put forth by the American Head and Neck Society (AHNS) was constructed to provide evidence-based treatment recommendations for PD-1 inhibitor use in advanced cutaneous squamous cell carcinoma (cSCC). Secondarily, we sought to identify knowledge gaps warranting further investigation.
MethodsA literature search utilizing key terms: cutaneous squamous cell carcinoma, cutaneous cancer, checkpoint inhibitors, systemic therapy, Program Cell Death, PD-1 (Pub Med, Cochrane, and Google Scholar) was carried out to generate evidence-based statements. The statements were distributed among the AHNS membership. Delphi methodology was applied to identify statements achieving 70% or greater consensus among the leadership team.
Results Twenty-six position statements achieved consensus.
Knowledge gaps for future research included: impact of immunosuppression on cSCC staging and associated treatment; role of PD-1 inhibitors in immunosuppressed patients.
Conclusion This comprehensive position statement put forth by the AHNS represents majority consensus by practicing head and neck surgeons throughout the country.

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Partial laryngectomy for naïve pT3N0 laryngeal cancer: Systematic review on oncological outcomes

Flaminia Campo, Francesco Mazzola, Giulia Bianchi, Valentina Manciocco, Massimo Ralli, Antonio Greco, Isabella Sperduti, Marco de Vincentiis, Raul Pellini

Publication date 30-09-2022


Abstract The first aim was to define the oncologic outcomes of open partial laryngectomy (OPL) in naïve pT3 laryngeal cancer. The second aim was to analyze the outcomes after OPL versus total laryngectomy (TL). A literature search was conducted in three databases (MEDLINE, EMBASE, and Cochrane Library) until January 2022. In 805 patients treated with OPL, 5-year OS, DSS, DFS and LFS were 80.5% (95% CI 70.6–87.6), 83.4% (95% CI 75.7–89), 77.4% (95% CI 66.3–85.7) and 77.9% (95% CI 68.7–85), respectively.
Three articles compared TL versus OLP: 5-year OS, DSS and DFS risk difference were 0.100 (95% CI −0.092 to 0.291), 0.067 (95% CI −0.085 to 0.220) and 0.018 (95% CI −0.164 to 0.201) respectively. OPL for selected pT3 laryngeal cancer is able to guarantee a high percentage of oncological success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery.

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The computer‐aided design margin: Ex vivo 3D specimen mapping to improve communication between surgeons and pathologists

Kayvon F. Sharif, James S. Lewis, Kim A. Ely, Mitra Mehrad, Sumit Pruthi, James L. Netterville, Sarah L. Rohde, Alexander Langerman, Kyle Mannion, Robert J. Sinard, Eben L. Rosenthal, Michael C. Topf

Publication date 26-09-2022


Abstract Background Numerous challenges exist in determining surgical margin status. Communication between surgeons and pathologists is crucial for specimen orientation and accurate margin assessment.
MethodsA prospective study to determine feasibility of incorporating three-dimensional (3D) scanning into surgical pathology workflow was performed. A structured-light 3D scanner captured the photorealistic surface topography of fresh surgical specimens. Computer-aided design (CAD) software was used to document sites of margin sampling and sectioning. Surveys were distributed among faculty and staff stakeholders to assess feasibility.
ResultsA series of 40 cases were 3D-scanned. Median image acquisition time was 8 min. The majority of respondents agreed that the experimental 3D system helped achieve clearer communication. 3D specimen maps assisted in the communication of a focally positive or close margin in 4 of 17 cases.
Conclusions Routine 3D scanning and specimen mapping is feasible and represents an innovative approach to intraoperative and final pathology documentation, margin analysis, and surgeon–pathologist communication.

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Utilizing 3D head and neck specimen scanning for intraoperative margin discussions: Proof of concept of our novel approach

Michael P. Saturno, Margaret Brandwein‐Weber, Lily Greenberg, Alex Silberzweig, Daniel Buchbinder, Eric M. Dowling, Mohemmed N. Khan, Raymond Chai, Mark L. Urken

Publication date 06-09-2022


Abstract Background The current standard of documenting and communicating frozen section margin results is inefficient. We present a novel method of generating 3D digital models of gross tumor specimens to more clearly visualize histopathological margin results.
Methods Fifty-five head and neck specimens were scanned and virtually “inked” using 3D software. These 3D specimen maps were displayed in the operating room to provide the surgeon with a real-time specimen-to-defect relationship by which further resections could be guided.
Results Margin results were reported within an average of 34 min using the proposed workflow. The scanner rendered accurate models of specimens that exceeded 3.0 × 3.0 × 3.0 cm. Critical specimen features to consider were size, color, textural complexity, and the presence of discernible anatomic landmarks.
Conclusions Optical 3D scanning technology can improve the quality of head and neck margin documentation and the efficiency with which results are communicated between the pathologist and surgeon.

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Magnetic resonance imaging‐based radiogenomics analysis for predicting prognosis and gene expression profile in advanced nasopharyngeal carcinoma

Publication date 22-12-2021


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ERRATUM

Publication date 15-11-2020


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18Fluorodeoxyglucose‐positron emission tomography/Ct computer‐assisted biopsies for suspected persistent or recurrent malignant skull base disease

Patrick Dubach, Thiago Oliveira–Santos, Stefan Weber, Nicolas Gerber, Andreas Dietz, Marco Caversaccio

Publication date 03-09-2018


ABSTRACTBackground Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT is increasingly used for the evaluation of regional or distant metastasis in head and neck oncology. However, positive PET findings lack specificity, which is especially challenging for localized disease at the skull base.
Methods An optically tracked navigation system for multimodal image-guided biopsies was tested to evaluate PET-positive skull base lesions between 2009 and 2013.
ResultsFDG-PET/CT navigated biopsies of patients with suspected persistence or recurrence of carcinoma (sinonasal, n = 3; nasopharyngeal, n = 1; adenocarcinoma, n = 2; and carcinoma of unknown primary origin, n = 1) have been safely performed. Histology confirmed local persistent or recurrent malignant disease (n = 5), radio-osteonecrosis (n = 1), and super-infection (n = 1).
Conclusion In the follow-up of patients with tumors, FDG-PET/CT-navigated biopsies are a valid tool to evaluate PET-positive skull base lesions. This is an especially useful technique if functional anomalous areas in FDG-PET/CT do not cause structural alterations in MRI/CT, and if endoscopic visualization is impossible because of posttreatment alterations. © 2014 Wiley Periodicals, Inc. Head Neck, 2014

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