Scharukh Jalisi, Katherine Tashman
Publication date 29-09-2023
Anusha P. Bharadia, Anthony D. DiPalma
Publication date 29-09-2023
Alexis Miller, Madelyn N. Stevens, Alice Tang, Elizabeth Cottrill, Shiayin F. Yang, Sarah L. Rohde
Publication date 29-09-2023
Abstract Objectives Evaluation of potential gender gaps among Head and Neck (H&N) surgeons can highlight areas for increased support of female H&N surgeons and improve gender diversity within the subspecialty. To evaluate gender trends in representation and career trajectory among recent H&N surgery fellowship graduates.
Methods This cross-sectional analysis included graduates from Head and Neck Surgery fellowships accredited by the American Head and Neck Society (AHNS) from 2008 to 2018. Additional demographic data was collected via publicly available websites including gender, years in practice, practice location, type of practice, h-index, and academic rank. The primary outcomes were the proportion of female Head and Neck fellowship graduates and gender trends in career trajectory and academic productivity (via h-index).
Results Between 2008 and 2018, 449 surgeons graduated from Head and Neck surgery fellowship with females comprising 99 of 449 graduates (22%). Female representation increased from 1 of 30 (3%) graduates in 2008 to 17 of 52 (33%) in 2018. A proportionally similar number of women graduating fellowship also practiced in an academic setting (23%). There were fewer female assistant, associate and full professors compared with their male counterparts. Women had lower h-indices compared with men even when controlling for years in practice (mean 11.4 vs. 8.2, p < 0.03).
Conclusion Despite the increase in women graduating from H&N surgery fellowships, gender disparities within academic rank and academic productivity as measured by h-index remain. While a proportional number of women completing fellowship are entering academic practice, additional investigation and support is needed to address the potential gender gaps identified within academic H&N surgery.
Douglas R. Farquhar, Maheer M. Masood, Nicholas R. Lenze, Jason Tasoulas, Siddharth Sheth, Catherine Lumley, Jeffrey Blumberg, Wendell G. Yarbrough, Jose Zevallos, Mark C. Weissler, Adam M. Zanation, Trevor G. Hackman, Andrew F. Olshan
Publication date 28-09-2023
Abstract Background In rural states, travel burden for complex cancer care required for head and neck squamous cell carcinoma (HNSCC) may affect patient survival, but its impact is unknown.
Methods Patients with HPV-negative HNSCC were retrospectively identified from a statewide, population-based study. Euclidian distance from the home address to the treatment center was calculated for radiation therapy, surgery, and chemotherapy. Multivariable Cox proportional hazards models were used to examine the risk of 5-year mortality with increasing travel quartiles.
Results There were 936 patients with HPV-negative HNSCC with a mean age of 60. Patients traveled a median distance of 10.2, 11.1, and 10.9 miles to receive radiation therapy, surgery, and chemotherapy, respectively. Patients in the fourth distance quartile were more likely to live in a rural location (p < 0.001) and receive treatment at an academic hospital (p < 0.001). Adjusted overall survival (OS) improved proportionally to distance traveled, with improved OS remaining significant for patients who traveled the furthest for care (third and fourth quartile by distance). Relative to patients in the first quartile, patients in the fourth had a reduced risk of mortality with radiation (HR 0.59, 95% CI 0.42–0.83; p = 0.002), surgery (HR 0.47, 95% CI 0.30–0.75; p = 0.001), and chemotherapy (HR 0.56, 95% CI 0.35–0.91; p = 0.020).
Conclusion For patients in this population-based cohort, those traveling greater distances for treatment of HPV-negative HNSCC had improved OS. This analysis suggests that the benefits of coordinated, multidisciplinary care may outweigh the barriers of travel burden for these patients.
Sareh Tajiki, Musa Joya, Vahideh Gharekhani, Dylan Richeson, Somayeh Gholami
Publication date 28-09-2023
Abstract This systematic review study aims to provide comprehensive data on different radiobiological models, parameters, and endpoints used for calculating the normal tissue complication probability (NTCP) based on clinical data from head and neck cancer patients treated with conformal radiotherapy. A systematic literature search was carried out according to the PRISMA guideline for the identification of relevant publications in six electronic databases of Embase, Pub Med, Scopus, and Google Scholar to July 2022 using specific keywords in the papers title and abstract. The initial search resulted in 1368 articles for all organs for the review article about the NTCP parameters. One hundred and seventy-eight articles were accepted for all organs with complete parameters for the mentioned models and finally, 20 head and neck cancer articles were accepted for review. Analysis of the studies shows that the Lyman-Kutcher-Burman (LKB) model properly links the NTCP curve parameters to the postradiotherapy endpoints. In the LKB model for esophagus, the minimum, and maximum corresponding parameters were reported as TD50 = 2.61 Gy with grade ≥3 radiation-induced esophagitis endpoints as the minimum TD50 and TD50 = 68 Gy as the maximum ones. nmin = 0.06, nmax = 1.04, mmin = 0.1, and mmax = 0.65, respectively. Unfortunately, there was not a wide range of published articles on other organs at risk like ear or cauda equina except Burman et al. (Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys Ther. 1991;21:123–135). Findings suggest that the validation of different radiobiological models and their corresponding parameters need to be investigated in vivo and in vitro for developing a more accurate NTCP model to be used for radiotherapy treatment planning optimization.
Pubmed PDF WebHawa M. Ali, George B. Sankar, Emily A. Stickney, Heather L. Johns, Rumeal D. Whaley, Michael Rivera, Christine M. Lohse, Kendall K. Tasche, Daniel L. Price, Kathryn M. Van Abel, Linda X. Yin, Eric J. Moore
Publication date 26-09-2023
Abstract Introduction Several diagnostic modalities with various sensitivity and specificities can be used to evaluate a parotid mass. The aims of this project were to compare the diagnostic actionability, accuracy, and ability to accurately predict extent of surgery for FNA and frozen section during the evaluation of a parotid mass.
MethodsA retrospective chart review of patients who underwent parotidectomy for a parotid mass from January 1, 2015 to January 30, 2022 was conducted. Actionability was defined as a pathology diagnosis or the histologic grade of a lesion, as this provided clear and useful information for the surgeon to act upon. Diagnostic accuracy was determined by comparing FNA and frozen section results to final pathology. Accuracy of extent of surgery was determined by comparing predicted extent of surgery from the FNA or frozen section result to the extent of surgery predicted by the final pathology.
ResultsA total of 626 patients were included in this study. FNA was obtained in 396 (63%) patients, while all neoplasms were evaluated by frozen section analysis. FNA diagnosis was actionable in 318 (80%), while frozen section diagnosis was actionable in 616 (98%) patients. Exactly 294 (92.5%) FNA diagnoses were accurate compared with 600 (98%) frozen section diagnoses. The FNA diagnosis predicted appropriate extent of surgery in 294 (74%) while the frozen section diagnosis predicted appropriate extent of surgery in 600 (96%). Among the 396 patients with FNA, frozen section was significantly more likely to accurately predict appropriate extent of surgery compared with FNA (p < 0.001).
Conclusion Frozen section is more likely to yield actionable and accurate results compared with FNA. Additionally, frozen section is better than FNA in predicting the appropriate extent of surgery.
Ping Zhou, Rui Zhou, Yi‐Feng Yu, Ming‐Yue Rao, San‐Gang Wu
Publication date 26-09-2023
Abstract Background To investigate the prevalence and predictive factors of xerostomia during induction chemotherapy (IC) in patients with nasopharyngeal carcinoma (NPC).
Methods We prospectively enrolled NPC patients who received IC between October 2020 and October 2021. The Visual Analogue Scale (VAS) and Xerostomia Inventory (XI) were used to evaluate the condition of xerostomia. The volume of the submandibular gland (SMG) was also calculated before and after IC.
Results Fifty-two patients were enrolled in this study. Of these patients, 32.7% (n = 17) experienced xerostomia before IC. There were 32 (61.5%) patients suffered from xerostomia after IC, including 21 (40.4%) patients with newly diagnosed xerostomia after IC and 11 (21.1%) patients complained their xerostomia aggravated in those with xerostomia before IC. The median XI scores increased from 11 (standard deviation SD, 2.930) to 18 (SD 3.995), 16 (SD 3.605), and 17 (SD 4.331) after the first, second, and third cycles of IC, respectively. The median score of VAS also increased from 0 to 4 during the following three cycles of IC. In those with IC-related xerostomia, the SMG volume after IC was significantly decreased compared with those without IC-related xerostomia (P = 0.001). The reduction of the SMG volume after IC was the independent risk factor for xerostomia (P = 0.002).
Conclusion Approximately two-thirds of NPC patients suffered from IC-related xerostomia and patients with a reduction of SMG volume after IC had a higher risk of xerostomia.
Katsuhiro Ishida, Haruyuki Hirayama, Keita Kishi, Takeshi Miyawaki
Publication date 26-09-2023
Abstract Background Circumferential pharyngoesophageal defects resulting from total pharyngolaryngectomy are commonly reconstructed using free jejunal (FJ) transfer or an anterolateral thigh (ALT) free flap.
Methods We reviewed the medical records of 92 patients with ALT free flaps and 140 who underwent FJ transfer between 2009 and 2022, and compared their surgical outcomes.
Results Total flap loss occurred in two (2%) and five (4%) patients in the ALT free flap and FJ transfer groups, respectively. Fistula rates were 5% in both groups. Stricture rates were 21% and 5% in the ALT free flap and FJ transfer groups, respectively (p < 0.01). At the 5-year follow-up evaluation, intelligible speech was achieved by 83% and 28% of patients (p < 0.01) in the ALT free flap and FJ transfer groups, respectively.
Conclusions Each reconstructive method can be further optimized by proficient surgeons with expertise in the available methods and by considering patient-specific factors and available evidence.
"Vincenzo Abbate, Simona Barone, Gerardo Borriello, Stefania Troise, Paola Bonavolontà, Daniela Pacella, Luigi Angelo Vaira, Mario Turri‐Zanoni, Carlos Navarro Cuéllar, Luigi Califano, Giovanni Dell Aversana Orabona"
Publication date 26-09-2023
Abstract Background This study aimed to evaluate the diagnostic performance of serum inflammatory biomarkers in salivary gland tumors with dubious results following cytological analysis.
MethodsA retrospective analysis of 239 cases following surgery between January 2011 and June 2022 was performed. Receiver Operating Characteristic curves were drawn and areas under the curves were computed to evaluate the diagnostic performance of the inflammatory biomarkers (SII, SIRI, PLR, and NLR). Optimal cut-offs for each marker were determined by maximizing the Youden index.
Results Analysis showed that among the major biomarkers examined, SIRI performed an AUC of 0.77. The best SIRI cut-off was 0.94 with an accuracy of 79.9%. The accuracy, sensitivity, and specificity of cytological analysis were 77.8%, 59.6%, and 90.7% respectively. By combining SIRI with cytological analysis we demonstrated an increase in sensitivity to 82.8%.
Conclusions Inflammatory biomarkers could be evaluated to support the diagnosis and treatment of salivary gland tumors in difficult cases.
Sherwin Fazelpour, Maryam Vejdani‐Jahromi, Artem Kaliaev, Edwin Qiu, Deniz Goodman, V. Carlota Andreu‐Arasa, Noriyuki Fujima, Osamu Sakai
Publication date 22-09-2023
Abstract Background Human papillomavirus (HPV) status influences prognosis in oropharyngeal cancer (OPC). Identifying high-risk patients are critical to improving treatment. We aim to provide a noninvasive opportunity for managing OPC patients by training multiple machine learning pipelines to determine the best model for characterizing HPV status and survival.
Methods Multi-parametric algorithms were designed using a 492 OPC patient database. HPV status incorporated age, sex, smoking/drinking habits, cancer subsite, TNM, and AJCC 7th edition staging. Survival considered HPV model inputs plus HPV status. Patients were split 4:1 training: testing. Algorithm efficacy was assessed through accuracy and area under the receiver operator characteristic curve (AUC).
Results From 31 HPV status models, ensemble yielded 0.83 AUC and 78.7% accuracy. From 38 survival models, ensemble yielded 0.91 AUC and 87.7% accuracy.
Conclusion Results reinforce artificial intelligences potential to use tumor imaging and patient characterizations for HPV status and outcome prediction. Utilizing these algorithms can optimize clinical guidance and patient care noninvasively.
Sumerya Duru Birgi, Serap Akyurek, Erdem Birgi, Yakup Arslan, Esra Gumustepe, Batuhan Bakirarar, Saban Cakir Gokce
Publication date 22-09-2023
Abstract Purpose We aimed to describe the association between trigeminal nerve (TN) dose and toxicity and determine a threshold value that leads to TN toxicity in patients with parotid tumors treated with adjuvant conventional fractionated radiation therapy.
Methods and Materials Eighteen patients who underwent adjuvant radiotherapy (RT) between 2013 and 2018 were included in this retrospective study. TN and its branches were outlined subsequently on the planning CT scans. The doses received by TN were obtained based on the dose–volume histogram. The dose and toxicity relationship was investigated over the total prescribed dose. RT-related toxicity was graded according to Common Terminology Criteria for Adverse Events V4.0 (CTCAEv4.0).
Results The median follow-up was 29.5 months. After RT, 61% of patients had Grade I–II late TN toxicity divided into Grade I in 4 (22%) and Grade II in 7 (39%) patients.
TN injury symptoms were as follows: loss of sensation in the chin area in 3, difficulty in jaw movements in 3, and paresthesia in 5 patients. The total RT dose (p = 0.001), Dmax (p = 0.001), PTV-TN Dmax (p = 0.001), D1cc (p = 0.004), D0.5cc (p = 0.001), and D0.1cc (p = 0.01) had a significant effect on TN toxicity. Cut-off values leading to toxicity were determined as 66, 65.5, 65.25, 63.6, and 62.7 Gy for Dmax, PTV-TN Dmax, D0.1cc, D 0.5cc, and D1cc, respectively.
Conclusions Radiation-induced TN injury in head and neck cancer patients may further be investigated in clinically prospective trials by virtue of high toxicity rates with current RT doses in our retrospectively designed dosimetric study in parotid tumors.
Kevin T Robbins, Ohad Ronen, Nabil F. Saba, Primoz Strojan, Vincent Vander Poorten, Antti Mäkitie, Fernando López, Juan P. Rodrigo, Akihiro Homma, Ehab Hanna, Alfio Ferlito
Publication date 22-09-2023
Abstract The sinonasal structures and their adjacent organs host several functions including vision, olfaction, nasal respiration and filtration, secretory immunity, facial expression, articulation, and oral deglutition. We reviewed the current evidence supporting functional preservation in sinonasal cancer treatment. Primary surgery with or without adjuvant modalities continues to be the standard of care for sinonasal cancer. Unfortunately, functional compromise remains a dominant negative feature of this approach. More recently, through advances in therapeutic techniques and improved understanding of the relevant tumor biology, treatments aimed at preserving function and cosmesis are emerging. The evidence for such progress involving minimal access surgery, surgical reconstruction for rehabilitation, new techniques in radiation therapy, inclusion of systemic and locally enhanced chemotherapy, and therapeutic agents based on molecular targets are highlighted. This multi-prong approach bodes well for future patients with sinonasal cancer to undergo successful treatment that includes maximal preservation of associated functions.
Pubmed PDF WebRichard A. Raad, Katie Holland, Ethan M. Ritz, Bobby A. Tajudeen, Samer Al‐Khudari, Kerstin Stenson, Joshua Teitcher, Mary Jo Fidler, Michael Jelinek, Nikhil Joshi, Mihir K. Bhayani
Publication date 22-09-2023
Abstract Background We aim to describe outcomes of elderly patients undergoing salvage surgery for laryngeal cancer and to characterize the interplay of age with various other factors in this growing population.
Methods Using the National Cancer Database, we identified cases of salvage laryngectomy in patients who failed chemoradiation. An age cutoff of 70 years was used to separate subjects into two groups. Various factors were compared.
Results Of the 825 patients included, 166 (20.1%) were elderly. Elderly patients had worse overall survival (p = 0.001), higher 30-day and 90-day mortality (p = 0.006, p < 0.001), and a longer length of stay (LOS) (p = 0.015). LOS over 1 week was associated with worse survival (p = 0.032).
Conclusion Elderly patients had worse overall perioperative survival than their younger counterparts. LOS and 30-day readmissions were associated with higher risk of mortality in this group. We provide a contemporary set of relevant information for head and neck cancer providers to consider in this growing population
Tzong‐Hann Yang, Yen‐Fu Cheng, Chin‐Shyan Chen, Herng‐Ching Lin
Publication date 22-09-2023
Abstract Objective This study aimed to investigate prevalences of head and neck cancers in patients with and those without Sjögrens syndrome using a population-based dataset.
Methods We retrieved sampled patients from Taiwans Longitudinal Health Insurance Database. This study included 38 930 patients with Sjögrens syndrome and 155 720 propensity-score matched comparison patients without Sjögrens syndrome.
Results Chi-squared tests revealed that there was a statistically significant difference in the prevalences of head and neck cancers between patients with Sjögrens syndrome and comparison patients (1.77% vs. 1.22%, p < 0.001). The odds ratio for head and neck cancers for patients with Sjögrens syndrome relative to the comparison group was 1.452 (95% CI = 1.325–1.592).
Conclusions Our study demonstrated that patients with Sjögrens syndrome face increased odds of head and neck cancers, encompassing several sites including the oral cavity, oropharynx, nasopharynx, and thyroid.
Michael J. C. Schachtel, Mitesh Gandhi, James J. Bowman, Benedict J. Panizza
Publication date 22-09-2023
Abstract Background Improvements can be made in the management and staging of advanced pre-auricular cutaneous squamous cell carcinoma (cSCC). We aimed to analyze radiological patterns of spread and clinico-anatomical prognostic factors.
Methods Retrospective review of 54 patients with pre-auricular cSCC (cutaneous/nodal) who underwent temporal bone resection with curative intent.
Results Involvement of the cartilaginous external auditory canal (EAC) (79.6%) and retromandibular space (63.0%) was common. Styloid process/anterior carotid sheath (ACS) (11.1%) and bony EAC (7.4%) involvement were rare. ACS involvement resulted in high rates of involved surgical margins (100%) and poor outcomes on univariable analysis. Negative prognostic factors on multivariable analysis included salvage surgery and invasion of the bony EAC, mandible, pterygoid muscle(s), and dura.
Conclusion The bony EAC and ACS can form temporary barriers to tumor spread, with the latter representing a potential limit of resectability. Prognostic factors revealed can lead to the development of a more appropriate staging tool.
Akihiro Yamada, Hirotaka Shinomiya, Natsumi Uehara, Keisuke Iritani, Shun Tatehara, Tatsuya Furukawa, Masanori Teshima, Daisuke Miyawaki, Takeshi Fujita, Akinobu Kakigi, Naomi Kiyota, Ryohei Sasaki, Ken‐ichi Nibu
Publication date 22-09-2023
Abstract Background Squamous cell carcinoma of the external auditory canal (EACSCC) is a rare condition. However, a standard treatment has not yet been established. We retrospectively evaluated the efficacy, adverse events, and feasibility of TPF-CCRT (concomitant chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil) in patients with advanced EACSCC.
Methods Thirty-five consecutive patients with advanced EACSCC (T3, T4) initially treated with TPF-CCRT at Kobe University Hospital were included. T4 diseases with invasion of the brain, internal carotid artery, or internal jugular vein were classified as T4b, and those without these features were classified as T4a.
Results Five-year overall survival rates for T3 and T4 were 100% and 64.2%, respectively. A significant difference was observed between T4a and T4b (82.4% vs. 30%, p = 0.007). Five-year progression-free survival rates of T3, T4a, and T4b were 100%, 68%, and 20% (p = 0.022), respectively.
ConclusionsTPF-CCRT should be considered as a plausible treatment option for advanced EACSCC.
Gustavo Arruda Viani, Fabio Ynoe Moraes, Gustavo Nader Marta, Luiz Paulo Kowalski, Andre Guimaraes Gouveia
Publication date 22-09-2023
Abstract Background Compare outcomes after surgery (S) or radiotherapy (RT) for T1a-T1b glottic squamous cell carcinoma (T1GSCC) in a population-based cohort study.
Methods Patients diagnosed with T1GSCC from 1999 to 2020 were identified from a public database. Clinical, demographic, and social data were extracted. Treatment and patient groups and subgroups were compared with log-rank test, Cox proportional test, and propensity-score matched (PSM).
Results Eight hundred and eighty-eight patients with T1GSCC were included in the study, with a median follow-up of 61 months. The 5- and 10-year overall survival (OS) S versus RT were 76% versus 71% and 60% versus 52% (p = 0.02), respectively. In the subgroup analysis, S was associated with better OS for T1b, male, and public service patients (p < 0.05). In the PSM cohort of S versus RT with 110 patients each, there was no significant difference in the OS, CSS, and LC.
ConclusionsT1GSCC has favorable outcomes with S or RT.
Kevin J. Contrera, Jack Phan, Steven G. Waguespack, Mohammed Aldehaim, Xin Wang, Tze Yee Lim, Dianna B. Roberts, C. David Fuller, Michael T. Spiotto, Shaan M. Raza, Franco DeMonte, Ehab Y. Hanna, Shirley Y. Su
Publication date 22-09-2023
Abstract Background There are limited studies and no surveillance protocols on pituitary dysfunction for adults who underwent anterior skull base radiation.
Methods Cross-sectional study of 50 consecutive patients with sinonasal or nasopharyngeal cancer who underwent definitive radiotherapy. The mean radiation doses, prevalence of pituitary dysfunction, and associated factors were calculated.
Results Pituitary hormone levels were abnormal in 23 (46%) patients, including 6 (12%) with symptomatic abnormalities requiring treatment. The most common hormonal abnormality was hyperprolactinemia (30%), central hypothyroidism (8%) and central hypogonadism (6%). Patients with abnormal pituitary hormone values received higher mean radiation doses to the pituitary gland (1143 c Gy, P = 0.04), pituitary stalk (1129 c Gy, P = 0.02), optic chiasm (1094 c Gy, P = 0.01), and hypothalamus (900 c Gy, P = 0.01).
Conclusions Nearly half of the patients had abnormal pituitary function, including over a tenth requiring treatment. There may be a dose-dependent association between hormonal dysfunction and radiation.
Taijiro Ozawa, Isao Oze, Takashi Matsuzuka, Eiichi Sasaki, Junkichi Yokoyama, Yoshie Sano, Masayuki Tomifuji, Koji Araki, Yasunao Kogashiwa, Ichiro Tateya, Shinya Agena, Tomohiro Sakashita, Hidenori Tsuzuki, Hoshino Terada, Hidenori Suzuki, Daisuke Nishikawa, Shintarou Beppu, Takuma Matoba, Nobuaki Mukoyama, Keisuke Oguri, Yasuhisa Hasegawa
Publication date 22-09-2023
Abstract Background We aimed to define the indications for sentinel lymph node biopsy (SLNB), the third option for cervical treatment in oral cancer with negative cervical lymph nodes.
Methods The greatest depth of invasion (DOI) and long diameter (LD) of the primary site were used as exposures. SLN metastasis was considered the outcome.
Results In three trials conducted between 2009 and 2016, 158 patients were eligible and reassigned to this study group. The scatterplot based on the respective values of DOI and LD would eventually be divided into three sections. In cases of sections T1, T2, and T3, the proportions of SLN metastasis positivity were 21.3%, 35.3%, and 51.2%, respectively. In certain cases of T1 with 2 mm < DOI ≤ 5 mm and 8 mm < LD ≤ 20 mm, the proportion of SLN metastasis positivity was 40.9%.
ConclusionsSLNB-navigated or assisted neck dissection can be added as an effective procedure for N0 neck control.
Jian‐Feng LiuFu, Xiao‐Ming Lv, Zong‐Yan Yang, Yi‐Fan Kang, Shang Xie, Xiao‐Feng Shan, Zhi‐Gang Cai
Publication date 22-09-2023
Abstract Background The purpose of this study was to investigate the effect of anterior superior iliac spine (ASIS) preservation on donor site morbidity and function after harvesting a vascularized iliac bone flap (VIBF).
Methods Patients who underwent jaws reconstruction with VIBF were divided into a maintaining the anterior superior iliac spine (MASIS) group and a not maintaining the anterior superior iliac spine (NMASIS) group. Pain, tenderness, sensory deficit, gait disturbance, and function of the donor site were evaluated before and after the operation.
Results Thirty-three patients were included in this study, of which 18 were in the MASIS group. The incidence of sensory deficit in the MASIS group was significantly lower than that in the NMASIS group (50.0% vs. 86.7%, p = 0.010). Pain, tenderness, gait disturbance, and function did not differ statistically between the two groups.
Conclusion Except for sensory deficit, ASIS preservation has minimal impact on donor site morbidity and function.
Bo Lin, Jianlin Lin, Feng Wang, Yufan Wang, Shiyue Shen, Xia Hong, HuiJun Yang, Shunji Wang, Hongyu Yang
Publication date 22-09-2023
Abstract Background Postoperative complications after free flap reconstruction for oral cancer can increase cost and prolong hospitalization. This study explored risk factors for complications, focusing on sarcopenia.
Methods The study explored the associations between computed tomography-defined sarcopenia and the occurrence of postoperative complications, adjusted for age, gender, smoking, alcohol, ASA scoring, clinical stage of tumor, tumor site, type of free flap used, presence of tracheotomy, and blood test parameters.
Results Of 253 patients, 17.39% (44/253) of oral cancer patients had comorbid sarcopenia. Univariate analysis showed an overall postoperative complication rate of 65.90% in the sarcopenia group and 51.67% in the non-sarcopenia group. Multivariate modeling showed sarcopenia and smoking were major risk factors for total and respiratory complications, increasing the risks by over two-fold. No factors significantly impacted surgery-specific complications.
Conclusions This study identified sarcopenia as a risk factor for postoperative complications in oral cancer patients undergoing flap reconstruction.
Jooin Bang, Hyun‐Il Shin, Geun‐Jeon Kim, Sang‐Yeon Kim, Dong‐Il Sun
Publication date 22-09-2023
Abstract Background Functional outcomes of neoadjuvant chemotherapy in human papillomavirus (HPV)-positive tonsillar cancer remained unclear.
Methods We retrospectively reviewed the medical records of HPV-positive patients with tonsillar cancer. Of 112 patients, 38 were assigned to a neoadjuvant chemotherapy group and 74 were assigned to an upfront surgery group.
Results Pathological analyses showed that the risks of close or positive resection margins and lymphovascular invasion were lower in patients who received neoadjuvant chemotherapy. The 5-year disease-free survival was significantly higher in the neoadjuvant chemotherapy group than in the upfront surgery group, but the 5-year overall survival was not. The time to commencement of oral feeding and the mean hospital stay were significantly shorter in the neoadjuvant chemotherapy group. The neoadjuvant chemotherapy group was more likely than the upfront surgery group to resume a regular diet.
Conclusions Compared with upfront surgery, neoadjuvant chemotherapy improved the functional outcomes and 5-year disease-free survival.
Shaheen Hasmat, Gillian Heller, Lachlan Cook, Ruta Gupta, Jonathan R. Clark, Eng H. Ooi, Tsu‐Hui (Hubert) Low
Publication date 22-09-2023
Abstract Background Perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) does not contribute to the current American Joint Committee on Cancer 8th edition (AJCC8) staging manual. This study seeks to validate the effect of multifocal PNI in a large cohort of patients.
Methods Patients undergoing primary surgical treatment of OSCC with curative intent between 1995 and 2022 was retrieved from two Australian head and neck databases. PNI was categorized as a single focus or multiple foci. Study end points included disease-specific survival (DSS) and overall survival (OS).
Results Complete data for survival analysis was available in 993 patients. Multifocal PNI was associated with a 61% increased risk of death due to OSCC (HR 1.61, 95% CI 1.11–2.33, p = 0.014) and a 32% increased risk of death from any cause (HR 1.32, 95% CI 1.01–1.73, p = 0.045).
Conclusions Multifocal PNI is a significant predictor of survival in OSCC.
Wenlu Li, Wenli Yu, Haifei Cao, Aolin Zhang
Publication date 22-09-2023
Abstract Background To clarify the impact of the number of positive lymph nodes (LNs) on the prognosis of parotid mucoepidermoid carcinoma (MEC).
Methods Patients who underwent neck dissection for parotid MEC were retrospectively enrolled. The primary outcome variable was overall survival (OS). Associations between OS and LN factors, including the AJCC N stage, intraparotid LN metastasis, number of positive LNs, LN size, and extranodal extension (ENE), were evaluated using Cox proportional hazard regression analyses.
ResultsA total of 720 patients were included with a mean age of 56 ± 16 years. There was no additional survival compromise until two positive LNs were presented. After adjusting for the number of positive LNs, intraparotid LN metastasis, ENE, and LN size were not related to prognosis. Our proposed N stage based on the number of metastatic LNs (0/1 vs. 2–4 vs. 5+) showed a superior C-index to the AJCC N stage in OS prediction.
Conclusion Quantitative LN burden was an important determinant of prognosis, and the proposed N stage provided better OS stratification than the AJCC N stage.
Masaru Konishi, Naoya Kakimoto
Publication date 22-09-2023
Abstract Background We investigated the predictability of late cervical lymph node metastasis using radiomics analysis of ultrasonographic images of tongue cancer.
Methods We selected 120 patients with tongue cancer who underwent intraoral ultrasonography, 30 of which had late cervical lymph node metastasis. Radiomics analysis was used to extract and quantify the image features. Bootstrap forest (BF), support vector machine (SVM), and neural tanh boost (NTB) were used as the machine learning models, and receiver operating characteristic curve analysis was conducted to determine diagnostic performance.
Results The sensitivity, specificity, accuracy, and AUC in the validation group were, respectively, 0.600, 0.967, 0.875, and 0.923 for the BF model; 0.700, 0.967, 0.900, and 0.950 for the SVM model; and 0.900, 0.967, 0.950, and 0.967 for NTB model.
Conclusions Radiomics analysis and machine learning models using ultrasonographic images of pretreated tongue cancer could predict late cervical lymph node metastasis with high accuracy.
Christian Bräuer, Katrin Ullmann, Günter Lauer, Adrian Franke, Niall M. H. McLeod, Henry Leonhardt
Publication date 22-09-2023
Abstract Background Reconstruction of continuity defects following osteonecrosis in multimorbid patients is challenging. In all cases of the predescribed palliative treatment method for alloplastic mandible reconstruction, plate fractures were detected in follow-up. We hypothesized that a modification could avoid these fractures, leading to stable long-term results.
Methods This retrospective study compares the original method with a modification using single, laser-sintered CAD–CAM plates instead of manually bent miniplates. The predescribed shuttering technique was used to reconstruct the mandible in its original shape with bone cement.
Results Uneventful wound healing was observed in 86% of the cases after modification of the method. No implant or plate fracture occurred.
Conclusions The presented method should be considered as a treatment option for mandible reconstruction in elderly, multimorbid patients in palliative situations. The results of this study suggest that the modification of the method leads to significantly improved long-term stability. Donor site morbidity is avoided with this method of palliative surgery.
Vivianne Landry, Apostolos Christopoulos, Louis Guertin, Eric Bissada, Paul Tabet, Ilyes Berania, Émilie Royal‐Lajeunesse, Marie‐Jo Olivier, Tareck Ayad
Publication date 22-09-2023
Abstract Objective We aimed to determine patterns of alaryngeal voice acquisition and predictive factors of vocal rehabilitation (VR) failure following total laryngectomy (TL) at a large Canadian tertiary care center.
Methods All consecutive patients having undergone a TL between January 1st, 2011 and December 31st, 2019, at the Centre Hospitalier de l Université de Montréal were included.
Results One hundred and ninety-seven laryngectomized patients were identified. Successful VR was achieved in 86 (59.0%) patients, while 59 (41.0%) failed to use a method of alaryngeal voice as their principal means of communication at 1 year postoperatively. The use of tracheoesophageal puncture (TEP) was associated with higher VR success rates (70.6%) when compared with the artificial larynx (48.6%), and esophageal voice (18.8%). The only independent predictor of VR failure on multivariate analysis at all time points was a low socioeconomic status.
Conclusion Failure to adopt an alaryngeal voice following TL is highly prevalent, despite comprehensive and free speech language pathologist services being offered at our center. A low resort to TEP at our institution and a poor acceptability and accessibility of alternative VR methods may contribute to this trend. The challenges of VR may be further exacerbated by the barriers linked to a lower socioeconomic status, which in turn may contribute to reduced candidacy for TEP.
Pratima Agarwal, Jacob Bloom, Yinfeng Zhou, Runqi Zhao, Simu Huang, Masanao Yajima, Anand K. Devaiah
Publication date 22-09-2023
Abstract Background This retrospective study utilizes The Surveillance, Epidemiology, and End Results database to investigate socioeconomic factors leading to treatment disparities in hypopharyngeal malignancy.
Methods Treatment was compared to National Cancer Care Network guidelines. Novel analyses, including logistic modeling, allowed survival analysis and identification of socioeconomic variables not previously considered in staging and management guidelines.
Results Black and older patients, and residence in low-income areas predict lower likelihood of standard therapy (p < 0.05). Early-stage disease and standard therapy correlate with improved survival (p < 0.001). Medicaid, advanced age, advanced disease, and treatment outside of consensus guidelines correlated with lower survival (p < 0.0001).
Conclusions There are clear socioeconomic factors impacting treatment and survival in hypopharyngeal malignancies. Standard therapy affords superior survival rate. Black, low socioeconomic status, and older patients are less likely to receive standard therapy. Education and language isolation do not predict treatment or survival. Understanding these discrepancies is paramount to palliating disparities in healthcare.
Shivee Gilja, Arvind Kumar, Vikram Vasan, Scott A. Roof, Eric M. Genden, Diana N. Kirke
Publication date 22-09-2023
Abstract Background The impact of evaluating versus not evaluating surgical margins for early-stage laryngeal squamous cell carcinoma (LSCC) has not been evaluated.
Methods Overall survival was compared between patients who underwent endoscopic surgery for cT1-2, N0, M0 LSCC and had surgical margins evaluated versus not evaluated versus unevaluable in the National Cancer Database (2010–2019) using multivariable-adjusted Cox proportional hazards analyses.
Results7597 patients met study eligibility criteria. 4123 (54.3%) patients underwent margin evaluation, 1631 (21.5%) did not undergo margin evaluation, and 1843 (24.3%) had unevaluable margins. Patients undergoing margin evaluation had better overall survival than patients who did not undergo margin evaluation (HR: 0.88, 95% CI: 0.78–1.00, p = 0.044) and patients with unevaluable margins (HR: 0.88, 95% CI: 0.78–0.98, p = 0.021). Patients undergoing margin evaluation received significantly less adjuvant radiation.
Conclusions Surgical margin evaluation is an important prognostic factor for patients receiving endoscopic surgery for early-stage LSCC and should be conducted whenever possible.
Jun Yun, Vivian Su, Danielle Kapustin, Samuel J. Rubin, Margaret Brandwein‐Weber, Mohemmed N. Khan, Raymond Chai, Scott Doyle, Michael Karasick, Mark L. Urken
Publication date 22-09-2023
Abstract Background We have demonstrated the effectiveness of 3D resection specimen scanning for communicating margin results. We now address the corresponding surgical defect by debuting 3D defect models, which allow for accurate annotations of harvested supplemental margins.
Methods Surgical defects were rendered into 3D models, which were annotated to document the precise location of harvested supplemental margins. 3D defect scans were also compared with routine 2D photography and were analyzed for quality, clarity, and the time required to complete the scan.
Results Forty defects were scanned from procedures including segmental mandibulectomy, maxillectomy, and laryngopharyngectomy. Average duration of defect scan was 6 min, 45 s. In six of ten 2D photographs, the surgeon was unable to precisely annotate the extent of at least one supplemental margin.
Conclusion3D defect scanning offers advantages in that this technique enables documentation of the precise location and breadth of supplemental margins harvested to address margins at-risk.
Cristiane Pereira Vargas Cousseau, Bruna Pereira Sorroche, Renan Jesus Teixeira, Ana Carolina Carvalho, Matias Eliseo Melendez, Renato Castro Capuzzo, Ana Carolina Laus, Luciane Sussuchi Silva, Nei Soares Menezes, André Lopes Carvalho, Lidia Maria Rebolho Batista Arantes
Publication date 22-09-2023
Abstract Background Metastatic lymph node involvement influences therapy decisions and serves as a prognostic indicator in oral squamous cell carcinoma (OSCC). However, many early-stage patients with clinically negative lymph nodes exhibit no metastasis upon surgical staging. This study aimed to identify differentially expressed miRNAs capable of distinguishing pathologically positive (pN+) from negative (pN0) nodes in OSCC patients without clinical evidence of lymph node metastases (cN0).
Methods Expression levels of 798 miRNAs were assessed in tumor samples from 10 pN+ and 10 pN0 patients using the Nanostring n Counter platform. Validation was performed in an independent cohort of 15 pN+ and 24 pN0 patients through RT-qPCR.
Results Eight miRNAs exhibited differential expression between pN0 and pN+ patients. Notably, hsa-miR-99a-5p demonstrated high sensitivity and specificity in predicting patients at higher risk of positive lymph nodes.
Conclusions These findings highlight hsa-miR-99a-5p as a potential biomarker for detecting lymph node metastasis in primary OSCC tumors.
Chen‐xi Li, Qi He, Zheng‐ye Wang, Chang Fang, Zhong‐cheng Gong, Hua‐rong Zhao, Bin Ling
Publication date 22-09-2023
Abstract Importance Venous thromboembolism (VTE) is closely relevant to head and neck cancer (HNC) prognosis, but little data exist on the risk prediction of VTE in patients with HNC.
Objective To study the risk factors regarding VTE in HNC patients and construct a nomogram model for its prediction.
Design, Setting, and ParticipantsA cross-sectional retrospective study was implemented to comparatively analyze 220 HNC patients from January 2018 to December 2021. The Lasso algorithm was used to optimize the selection of variables. A nomogram model for predicting HNC-associated VTE was established using multivariate logistic regression analysis. Internal validation of the model was performed by bootstrap resampling (1000 times). Calibration plot and decision curve analysis (DCA) were applied to evaluate the calibration capability of the prediction model.
Main Outcome and Measure The demographics, medical history, blood biochemical indicators, and modalities of treatment were included for analysis.
Results The incidence of HNC-associated VTE was 2.8% (55/1967) in authors affiliation. Five variables of risk factors, including surgery, radiochemotherapy, D-dimer, aspartate transaminase, and globulin, were screened and selected as predictors by Lasso algorithm. A prediction model that incorporated these independent predictors was developed and presented as the nomogram. The model showed good discrimination with a C-index of 0.972 (95% CI: 0.934–0.997), and had an area under the receiver operating characteristic curve value of 0.981 (p < 0.001, 95% CI: 0.964–0.998). The calibration curve displayed good agreement of the predicted probability with the actual observed probability for HNC-associated VTE. The DCA plot showed that the application of this nomogram was associated with net benefit gains in clinical practice.
Conclusions and Relevance The high-performance nomogram model developed in this study may help early diagnose the risk of VTE in HNC patients and to guide individualized decision-making on thromboprophylaxis.
Guo‐Ying Liu, Zhuo Li, Xiu‐Xing Chen, Wei‐Xiong Xia, He‐Rui Yao, Yan‐Qun Xiang
Publication date 22-09-2023
Abstract Objective Our objective was to establish a prognostic model for patients with de novo metastatic nasopharyngeal carcinoma (NPC) who received chemotherapy followed by locoregional radiotherapy (LRRT) to identify candidates for metastasis-directed therapy (MDT).
Methods De novo metastatic NPC patients who received chemotherapy followed by LRRT were enrolled. Propensity score matching (PSM) method was used to compare overall survival (OS) for patients receiving LRRT alone and MDT plus LRRT. We developed a predictive model to predict survival and estimate the outcome of stratified therapy and identify suitable candidates for MDT.
ResultsA total of 107 patients received MDT plus LRRT and 178 received LRRT alone were enrolled. PSM analysis identified 107 patients in each cohort and showed that MDT plus LRRT was associated with a significant survival benefit (HR: 0.640; 95% CI, 0.29–0.956; p = 0.027). Based on five independent prognostic factors, including metastases number, serum lactate dehydrogenase, liver metastasis, C-reactive protein, and tumor response, a prognostic model was established. All patients were stratified according to the prognostic score obtained by the prognostic model. In the low-risk group, MDT plus LRRT group revealed a significant improvement for OS compared with LRRT alone group (5-year OS, 69.9% vs. 57.8%, p = 0.020). However, no significant difference was observed between MDT plus LRRT group and LRRT alone in the high-risk group (p = 0.75).
ConclusionMDT plus LRRT was associated with improved OS in patients with de novo metastatic NPC, especially low-risk patients identified with a newly developed prognostic model.
Monica Pentenero, Patrizio Castagnola, Faride Victoria Castillo, Elena Isaevska, Samuele Sutera, Sergio Gandolfo
Publication date 22-09-2023
Abstract Background This prospective observational study investigated the determinants of malignant transformation (MT) in localized oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL).
Methods Demographic, clinical, histological, and DNA ploidy status data were collected at enrolment. Survival analysis was performed (MT being the event of interest).
Results One-hundred and thirty-three patients with OL and 20 patients with PVL entered the study over 6 years (mean follow-up 7.8 years). The presence of OED, DNA ploidy, clinical presentation, and lesion site were associated with MT in patients with OL in a univariate analysis. In a multivariate model, OED was the strongest predictor of MT in patients with OL. Adding DNA ploidy increased the models predictive power. None of the assessed predictors was associated with MT in patients with PVL.
ConclusionsDNA ploidy might identify a subset OL with low risk or minimal risk of MT, but it does not seem to be a reliable predictor in patients with PVL.
Badr Id Said, Adam Mutsaers, Hanbo Chen, Zain A. Husain, Tithi Biswas, Roi Dagan, Darby Erler, Matthew Foote, Alexander V. Louie, Kristin Redmond, Umberto Ricardi, Arjun Sahgal, Ian Poon
Publication date 22-09-2023
Abstract Background We report the results of an international multi-institutional cohort of oligometastatic (OMD) head and neck cancer (HNC) patients treated with SBRT.
Methods Patients with OMD HNC (≤5 metastases) treated with SBRT between 2008 and 2016 at six institutions were included. Treated metastasis control (TMC), progression-free survival (PFS), and overall survival (OS) were analyzed by multivariable analysis (MVA).
Results Forty-two patients with 84 HNC oligometastases were analyzed. The TMC rate at 1 and 2 years were 80% and 66%, with a median time to recurrence of 10.1 months. The median PFS and OS were 4.7 and 23.3 months. MVA identified a PTV point maximum (BED)10 > 100 Gy as a predictor of improved TMC (HR = 0.31, p = 0.034), and a cumulative PTV > 48 cc as having worse PFS (HR = 2.99, p < 0.001).
Conclusion Favorable TMC and OS was observed in OMD HNCs treated with SBRT.
Kristijonas Milinis, Chinar Parikh, Stephen Williams, Katharine Davies, Jason C. Fleming
Publication date 22-09-2023
Abstract Background The aim of this study is to investigate the impact of preoperative gastrostomy in patients undergoing pharyngolaryngectomy (PL) on gastrostomy tube dependence at 6 months postoperatively.
MethodsA retrospective review of patients undergoing PL for laryngeal squamous cell carcinoma between 2005 and 2019 was performed. Parameters were collected and analyzed within the multivariate models.
Results Ninety-three patients (82% male, mean age 63.4 SD 9.4) were included. Preoperative tube placement and pharyngocutaneous fistula (PCF) were associated with an increased likelihood of gastrostomy tube dependence at 6 months (odds ratio 6.43, CI 1.1–38.3, p = 0.041) after adjusting for multiple confounding factors. There was no difference in the incidence of delayed oral feeding, PCF, or hospital stay between the groups.
Conclusions Preoperative tube and PCF are associated with an increased likelihood of tube dependence at 6 months. Patients for preoperative tube insertion should be carefully selected and early oral feeding reintroduction should be encouraged.
Jun Yun, Danielle Kapustin, Aisosa Omorogbe, Samuel J. Rubin, Daniel G. Nicastri, Reade A. De Leacy, Azita Khorsandi, Mark L. Urken
Publication date 22-09-2023
Abstract Background Vagus nerve paragangliomas are rare tumors, comprising 0.03% of head and neck neoplasms. These tumors are usually located cephalad to the hyoid bone, and there is only one previously reported case that arose from the lower third of the neck.
Methods We describe the second reported case of a lower neck vagus nerve paraganglioma that was managed with a limited sternotomy for access and surgical removal.
ResultsA 66-year-old male presented with a long-standing lesion of the cervicothoracic junction. CT, MRI, and Ga-68 DOTATATE PET/CT showed an avidly enhancing 5.2 × 4.2 × 11.5 cm mass extending from C6 to approximately T4 level. FNA confirmed the diagnosis. The patient underwent catheter angiography and embolization via direct puncture technique followed by excision of the mass via a combined transcervical and limited sternotomy approach.
Conclusion We describe an unusual case of vagal paraganglioma at the cervicothoracic junction with retrosternal extension requiring a sternotomy for surgical excision.
Sophia Peifer, Ryan Carey, Eric Nisenbaum, Jason Leibowitz, Elizabeth Nicolli
Publication date 22-09-2023
Abstract Background The radial forearm free flap (RFFF) is considered a workhorse for head and neck cancer reconstructive surgery due to its generally consistent anatomy, pliability, long pedicle, and accessible harvest location.
MethodsA 63-year-old male with trisomy 21 and recurrent midface basal cell carcinoma presented for surgical management. The patient underwent tumor resection including left infrastructure maxillectomy with ipsilateral rhinectomy. Preoperative Allens test was normal; however, the planned osteocutaneous radial forearm free flap reconstruction was aborted intraoperatively due to aberrant vascular anatomy in the form of a diminutive radial artery branch. Reconstruction was instead performed with an anterolateral thigh free flap.
Results The patient recovered well in the hospital and was subsequently discharged to his care facility.
Conclusions Radial artery anomalies may be present among trisomy 21 patients making reconstruction with a RFFF not feasible, and thus preoperative Doppler ultrasound to assess arterial anatomy is essential in this population.
Teja Kantamani, Shivakumar Thiagarajan
Publication date 22-09-2023
Allen S. Ho, Michael Luu, Bonnie L. Balzer, Zachary S. Zumsteg
Publication date 22-09-2023
Publication date 22-09-2023
Yue Yuan, Fei Ye, Jian‐Hui Wu, Xiao‐Yan Fu, Zhong‐Xi Huang, Tao Zhang
Publication date 22-09-2023
Abstract The low positive predictive value (PPV) of early screening of nasopharyngeal carcinoma (NPC) is the problems that need to be solved urgently. The combination of cell-free DNA (cfDNA) methylation testing and Epstein–Barr virus (EBV) serological testing is the key to solve this problem. This paper reviews recent advances in early screening for NPC and cfDNA methylation, with future perspectives. Pubmed was searched for the literature related to early screening of NPC and cfDNA methylation in the past 5 years. The results of these studies were summarized. Despite these efforts, the PPV is still low (10%). Previous studies have shown that cfDNA methylation analysis has good specificity and accuracy across a variety of tumors. The combination of cfDNA methylation and EBV detection helps to improve the PPV for early screening of NPC. The combination of cfDNA methylation and EBV serological testing is key to addressing the low PPV of NPC early screening.
Pubmed PDF WebKevin G. Wu, Christian T. Chong, Hunter Hanlon, Tyler L. Langenfeld, R. Michael Johnson, Timothy N. Crawford, Mark K. Wax, Sameep P. Kadakia
Publication date 22-09-2023
Abstract The implantable arterial doppler (IAD) is frequently used to postoperatively monitor free flaps with high accuracy, but there are no guidelines for its use. Bedside exam is used adjunctively to determine necessary intervention. This systematic review seeks to discover why the doppler is used adjunctively despite its established record of accuracy. Criteria for inclusion and exclusion were established. In total, 280 articles were found on Pub Med and Web of Science, then screened accordingly. Data from 22 articles were analyzed using a bivariate hierarchical random effects model. Twenty-two studies yielded 2996 total patients undergoing 3127 free flap procedures. The meta-analysis found a high sensitivity of 0.809 (95% CI = 0.709, 0.880) and specificity of 0.966 (95% CI = 0.947, 0.979). False-positive rate was found to be 0.034 (95% CI = 0.021, 0.053). Positive and negative predictive values were 0.711 (95% CI = 0.581, 0.817) and 0.979 (95% CI = 0.966, 0.988). Positive and negative likelihood ratios were 24.7 (95% CI = 14.5, 39.5) and 0.20 (95% CI = 0.12, 0.30). The established efficacy of the IAD is supported by this study. Clinical exams may remain as the final adjunct due to the risks of inaccurate IAD signals. Further studies are warranted to optimize its use for future practice guidelines.
Pubmed PDF WebAinhoa García‐Lliberós, Daniel I. Martin‐Jimenez, Ronsard J. Mondesir, Edoardo Agosti, A. Yohan Alexander, Luciano C. P. C. Leonel, Garret Choby, Maria Peris‐Celda, Carlos D. Pinheiro‐Neto
Publication date 22-09-2023
Abstract Background For aggressive maxillary sinus and pterygopalatine fossa (PPF) tumors, an en-bloc pterygomaxillectomy may be indicated.
Methods Five head specimens were used to study the feasibility of an en-bloc pterygomaxillectomy. Eighty-five non-pathological CT scans were used to compare the superior edge of the inferior turbinate (IT) and the middle turbinate tail (MT) as landmarks for the pterygoid osteotomy.
Results Through a combined sublabial–subperiosteal incision and transoral route, a mid-sagittal osteotomy through the hard palate and an axial osteotomy below the infraorbital foramen were performed. For the endoscopic pterygoid osteotomy, an infra-vidian transpterygoid approach was performed, subsequently removing the pterygomaxillectomy en-bloc. As landmarks, the osteotomies at the level of the MT tail and IT resected the pterygoid plates completely, but the IT osteotomy was further away from the vidian canal (7.5 vs. 6 mm).
Conclusions The endoscopic-assisted en-bloc pterygomaxillectomy is feasible. The IT landmark is safe and ensures complete resection of the pterygoid plates.
Roberto Saetti, Guglielmo Ronzani, Stefano Meneghesso, Marina Silvestrini
Publication date 22-09-2023
Abstract Tracheal stenosis is an uncommon pathological condition in which the lumen of the trachea is reduced. Within its management an adequate preoperative workup is crucial to determine the most appropriate procedure for each patient. In this scenario tracheal resection and anastomosis is a viable approach, as a procedure in which part of the trachea is removed and then restored with a tension-free anastomosis. It is usually indicated for extensive and high-grade lesions or when previous endoscopic procedures had failed. The patient here presented had already undergone a balloon dilatation twice and a tracheal resection and referred to our clinic with a residual tracheal stenosis graded Myer-Cotton 3 involving three tracheal rings. We here illustrate step-by-step the surgical procedure and highlight a peculiar way to perform the anastomosis, especially in a revision surgery.
Pubmed PDF Web"Nicolette Jabbour, Timothy Rodriggs, Meredith ODea, Taha Mur, Kailey Vitale, Daniel L. Faden"
Publication date 22-09-2023
Abstract Tracheoesophageal (TE) puncture with voice prosthesis placement is a common method for vocal rehabilitation in patients who have undergone total laryngectomy. Tracheoesophageal voice prosthesis (TEP) placement after laryngectomy, known as secondary TE puncture, is traditionally done in the operating room, using rigid esophagoscopy. Traditional secondary TEP placement carries a number of downsides including risks associated with general anesthesia, high cost, and technical challenges associated with anatomical variables. As a result, in-office secondary TE puncture has become an increasingly utilized procedure with many advantages but currently lacks standardization. Here, we describe a kit-based, awake, in-office secondary TE puncture with primary TEP placement technique. This technique calls for an endoscopic snare in the event there is difficulty passing the guidewire in the cranial trajectory. No surgical technique videos demonstrating in-office secondary TE puncture currently exist. Here, we present a video tutorial of our technique, breaking down the procedure into 10 steps from analgesia to voicing.
Pubmed PDF WebLuca Calabrese, Marta Tagliabue, Alberto Grammatica, Rita De Berardinis, Federica Corso, Luca Gazzini, Monir Abousiam, Enrico Fazio, Davide Mattavelli, Walter Fontanella, Lorenzo Giannini, Lorenzo Bresciani, Roberto Bruschini, Sara Gandini, Cesare Piazza, Mohssen Ansarin
Publication date 20-09-2023
Abstract BackgroundA multicentric study was conducted on technical reproducibility of compartmental tongue surgery (CTS) in advanced tongue cancers (OTSCC) and comparison to standard wide margin surgery (SWMS).
Methods We studied 551 patients with OTSCC treated by CTS and 50 by SWMS. Oncological outcomes were analyzed. A propensity score was performed to compare survival endpoints for the two cohorts.
Results In the CTS group, survival and prognosis were significantly associated with positive lymph-nodes, extranodal extension, depth of invasion and involvement of the soft tissue connecting the tongue primary tumor to neck lymph nodes (T-N tract), independently from the center performing the surgery. SWMS versus CTS showed a HR Cause-Specific Survival (CSS) of 3.24 (95% CI: 1.71–6.11; p < 0.001); HR Loco-Regional Recurrence Free Survival (LRRFS) of 2.54 (95% CI: 1.47–4.40; p < 0.001); HR Overall Survival (OS) of 0.11 (95% CI: 0.01–0.77; p = 0.03).
Conclusion Performing the CTS could provide better CSS and LRRFS than SWMS regardless of the center performing the surgery, in advanced OTSSC.
Mac Kenzie Reece, Hannah Walker, Isabella Benintendi, Stacey Ward, Ashley Thatcher, R. Michael Johnson, Sameep P. Kadakia
Publication date 20-09-2023
Abstract The clinical use of Integra™ has expanded to include scalp reconstruction since its FDA approval in 1996. Integra™, or dermal regeneration template, can be utilized in patients who are elderly with multiple medical comorbidities. Well-established Integra™ techniques utilize skin grafting 1–2 weeks following evidence of template vascularity. Most studies show the time to graft placement as <30 days, with almost all <52 days. No single article proposes a time frame for applying STSG after neodermis regeneration. Therefore, we aimed to describe our protocol to define a time frame for delaying scalp reconstruction with STSG following dermal regeneration. Over the last several years, the senior author has utilized a delayed reconstruction with skin grafting method where-in Integra™ is applied to either debrided bone or exposed pericranium in selected patients, and allowed to mature for ~6 weeks before performing skin grafting. The results have been predictable, reproducible, and have yielded high levels of patient and provider satisfaction due to the improved contour cosmesis. In this pictorial essay, the authors novel protocol is detailed.
Pubmed PDF WebFrancesca Paolini, Flaminia Campo, Oreste Iocca, Valentina Manciocco, Armando De Virgilio, Valentina De Pascale, Silvia Moretto, Gianluca Dalfino, Antonello Vidiri, Giovanni Blandino, Fulvia Pimpinelli, Aldo Venuti, Raul Pellini
Publication date 16-09-2023
Abstract The possibility of detecting circulating tumor HPV DNA (ctHPVDNA) in plasma in patients with oropharyngeal cancer has been demonstrated in several reports. However, these data are from small cohorts and available tests for detection of ctHPVDNA are not fully validated. The aim is to evaluate sensitivity, specificity, and accuracy of ctHPVDNA by ddPCR to define its efficacy in the clinical setting for the diagnosis of HPV + OPSCC.
A comprehensive search of three different databases: MEDLINE, Embase, and Cochrane Library databases. A total of 998 patients were evaluated from the 13 studies. OPSSC p16+ were 729, while controls p16− were 269. The meta-analytic study estimated the diagnostic performance of ctHPVDNA as follows: pooled sensitivity and specificity of 0.90 (95% CI: 0.82–0.94) and 0.94 (95% CI: 0.85–0.98), respectively; positive and negative likelihood ratios of 12.6 (95% CI: 4.9–32.1) and 0.05 (95% CI: 0.02–0.13), respectively. ddPCR for ctHPVDNA has good accuracy, sensitivity, and specificity for diagnosis of HPV + OPSCC. ctHPVDNA kinetic represents a great reliable opportunity to improve diagnostic and therapeutic management of cancer patients and could open new perspectives for understanding tumor biology.
Shivee Gilja, Joshua Barlow, Arvind Kumar, Michael H. Berger, Mohemmed N. Khan, Diana N. Kirke, Scott A. Roof
Publication date 12-09-2023
Abstract Background The prognostic impact of depth of invasion (DOI) in American Joint Committee on Cancer 8th edition TNM staging for oral cavity squamous cell carcinoma (OCSCCa) across oral cavity subsites is unknown.
Methods Overall survival of patients with pT1-4a OCSCCa in the National Cancer Database (2010–2017), stratified by tumor size and DOI across eight oral cavity subsites, was evaluated using multivariable-adjusted Cox proportional hazards modeling.
Results When stratified by tumor size ≤2 cm and >2 cm, DOI >5 mm and DOI >10 mm were only associated with worse overall survival, respectively, for tumors of the oral tongue (Tumor size ≤2 cm, DOI >5 mm v DOI ≤5 mm: HR: 1.31, 95% CI: 1.12–1.53, p < 0.001; Tumor size >2 cm, DOI >10 mm v DOI ≤10 mm: HR: 1.15, 95% CI: 1.01–1.30, p = 0.03). DOI >5 mm and DOI >10 mm was not prognostic for any other tumor location.
Conclusions These findings suggest that the current staging schema for DOI in OCSCCa may not be prognostic across all oral cavity subsites.
Ya‐Yun Yu, Yu‐Tsai Lin, Hui‐Ching Chuang, Chih‐Yen Chien, Tai‐Lin Huang, Fu‐Min Fang, Yao‐Te Tsai, Hui Lu, Ming‐Hsien Tsai
Publication date 12-09-2023
Abstract Background We aimed to evaluate the prognostic significance of preoperative neutrophil-to-albumin ratio (NAR) in oral squamous cell carcinoma (OSCC).
MethodsA total of 622 patients with surgically treated OSCC were enrolled. NAR was defined as the absolute neutrophil count divided by the serum albumin level in peripheral blood before the radical surgery. Cox proportional hazards model were used to discover survival outcome-associated factors.
Results The optimal cut-off of NAR to predict overall survival (OS) was determined to be 0.1. In Cox model, high NAR was identified as an independent negative prognosticator of OS, cancer-specific survival, and recurrence-free survival (adjusted hazard ratio: 1.503, 1.958, and 1.727, respectively; all p < 0.05). The NAR-based nomogram accurately predicted OS (concordance index: 0.750).
Conclusion Our study suggests that preoperative NAR is a convenient and effective prognostic marker for OSCC and NAR-based nomogram can be a promising prognostic tool in clinical setting.
Zhangwei Hu, Xueqin Guo, Lin Chen, Wenbin Lei
Publication date 11-09-2023
Abstract Background Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF.
Methods We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non-TNPT groups. The 2 years overall survival (OS) was compared through the log-rank test.
Results There were 18 patients in the TNPT group and 29 in the non-TNPT group. There was no significant between-group difference in the healing rate (chi-square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non-TNPT group. The 2-year OS rate was significantly higher in the TNPT group (p = 0.0473, log-rank test).
ConclusionTNPT promoted wound healing after surgery for PCF and improved the 2-year OS rate. This tool is worthy of clinical application and promotion.
Mranalini Verma, Divya Kukreja, Sanjay Singhal
Publication date 11-09-2023
Meytal Guller, Dylan J. Cooper, Hosam Alkhatib, Aditya Suru, Angelo Blancaflor, Christopher A. Maroun, Tristan Tham, Hailey Allen, Eden Mazzara, Jerin Thomas, Neha Amin, Evan Wu, David W. Eisele, Carole Fakhry, Drew Pardoll, Tanguy Y. Seiwert, Gangcai Zhu, Rajarsi Mandal
Publication date 08-09-2023
Abstract Objectives To explore the impact of pre-existing comorbidities on immunotherapy response, overall and progression-free survival, and immune-related adverse events (irAEs) of patients with advanced head and neck cancer (HNC) treated with immunotherapy.
Patients and methods Ninety-three patients treated with immunotherapy were identified and stratified into comorbidity absent or present (CCI < 1 and CCI ≥ 1, respectively) cohorts, and clinical outcomes were compared between these two groups.
Results Patients with no comorbidities had longer overall survival (aHR = 2.74, 95% CI 1.18, 6.40, p = 0.02) and progression-free survival (aHR = 2.07, 95% CI 1.03, 4.16, p = 0.04) and a higher tumor response rate (32% in CCI < 1 vs. 14% in CC ≥ 1, p = 0.05). Risk for irAEs was higher in the comorbidity absent group (p = 0.05).
Conclusion Comorbidity should be considered as a significant prognostic factor in clinical decision-making for patients with advanced HNC undergoing immunotherapy.
Bharat A. Panuganti, Christine Carico, Harishanker Jeyarajan, Mitchell Flagg, Pablo Tamayo
Publication date 08-09-2023
Abstract Background There is a paucity of data concerning molecular heterogeneity among glottic squamous cell carcinoma, and the clinical implications thereof.
Methods Data corresponding to glottic squamous cell carcinoma were derived from The Cancer Genome Atlas. The Onco-GPS computational methodology was levied to derive four patterns of transcriptional activity and three functional subtypes of glottic cancer.
Results Thirty glottic cancer samples stratified to three distinct oncogenic states (S0–S2) based on a Onco-GPS model containing four transcriptional components (F0-F3). Membership in S2 and association with transcriptional component F0 conveyed an invasive phenotype, with transcriptional activity strongly reflecting EMT programming (including TGF-B and NF-KB signaling). S2 membership also correlated with inferior disease-specific survival (HR 9.027, 95% CI 1.021–79.767), and higher incidences of extracapsular spread and perineural invasion.
Conclusions We present a functional taxonomy of glottic cancer, with subtypes demonstrating differential upregulation of canonical oncogenic networks and survival implications.
Yu Wang, Mingyi Wang, Lili Hou, Fuping Xiang, Xiaomei Zhao, Meizhen Qian
Publication date 07-09-2023
Abstract We systematically review the incidence and risk factors of surgical site infection (SSI) in patients with head and neck cancer. Pub Med, Embase, Cochrane Library, and Web of Science databases were searched to obtain studies on the risk factors for SSI in patients with HNC. The retrieval time was from the establishment of the database to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Meta-analysis was performed by using Stata 15.1 software. A total of 32 articles including 128 919 patients with head and neck cancer and 2949 cases of SSI were included in this meta-analysis. The incidence rate of SSI in head and neck cancer ranges from 19% to 29%, and the overall infection rate was 24%. Meta-analysis indicated that BMI < 20 kg/m2 (OR, 2.64; 95% CI, 1.74–4.00; I2, 0%), diabetes (OR, 3.00; 95% CI, 2.12–4.16; I2, 60.6%), ASA score (OR, 1.51; 95% CI, 1.29–1.77; I2, 0%), radiotherapy (OR, 2.27; 95% CI, 1.87–2.77; I2, 44.8%), chemotherapy (OR, 2.36; 95% CI, 1.64–3.40; I2, 0%), clindamycin antibiotic (OR, 2.99; 95% CI, 1.82–2.93; I2, 36.5%), deficit repair (OR, 3.76; 95% CI, 1.22–11.59; I2, 91.4%), neck dissection (OR, 2.13; 95% CI, 1.63–2.79; I2, 16.4%), blood transfusion (OR, 2.29; 95% CI, 1.52–3.45; I2, 66.2%), mandibular (OR, 3.17; 95% CI, 1.85–5.42; I2, 73%), tracheostomy (OR, 2.51; 95% CI, 1.74–3.62; I2, 86.4%), operation time (OR, 1.42; 95% CI, 1.16–1.74; I2, 86.4%), ALB (OR, 2.48; 95% CI, 1.95–3.15; I2, 5.3%) were risk factors of surgical site infection in patients with head and neck cancer (p < 0.05). The results of the sensitivity analysis showed good agreement in all risk factors and the results had stability. The present meta-analysis suggests that BMI < 20 kg/m2, diabetes, ASA score, radiotherapy, chemotherapy, clindamycin antibiotic, deficit repair, neck dissection, blood transfusion, mandibular, tracheostomy, operation time, and ALB were significant risk factors for SSI.
Pubmed PDF WebMasaru Konishi, Toshinori Ando, Mutsumi Miyauchi, Naoya Kakimoto
Publication date 07-09-2023
Abstract Background Mass lesions occurring under the oral mucosal epithelium are often small and difficult to diagnose; however, intraoral ultrasonography can delineate these lesions. We aimed to investigate the features of submucosal mass lesions in the oral cavity using intraoral ultrasonography.
Methods Fifty patients with hemangioma, irritation fibroma, mucous cyst, lipoma, and pleomorphic adenoma were included. Age, site, largest diameter, thickness, marginal morphology type, border type, internal echo posterior echo, and internal or peripheral Doppler images of the lesions were recorded.
Results The hemangiomas were internally hypoechoic and exhibited a cord-like structure; irritation fibromas, mainly internally isoechoic; mucous cysts, hypoechoic; and the lipomas appeared as homogeneous, isoechoic, or hyperechoic images with unclear borders. Pleomorphic adenomas were surrounded by a single hypoechoic zone, suggesting a thick capsular structure, were predominantly isoechoic internally, and appeared as cyst-like hypoechoic images.
Conclusions The features of the lesions were identified and delineated using intraoral ultrasonography.
Muthuswamy Dhiwakar, Jeevithan Shanmugam, Zubair A. Khan, Shivprakash Mehta, Konagalla Karthik
Publication date 06-09-2023
Abstract Background To assess outcomes of pectoralis major myocutaneous flap (PMF) wherein the skin paddle (SP) was positioned with its distal portion extending beyond the lower border of pectoralis major by ≥2 cm (PMF-d).
Methods Consecutive head and neck reconstructions with PMF-d (n = 110). SP dimensions l2 (distal extent below the lower border of pectoralis major), l1 (proximal extent above lower border of pectoralis major), and b (breadth) were recorded. Endpoints were SP necrosis, recipient dehiscence, early fistula, and persistent fistula.
Results Median values of l2, l1, and b were 3.0, 6.0, and 6.0 cm, respectively. When l2 = 2.0–3.0 cm, SP necrosis occurred in only one (1%) subject (with obesity). When l2 was ≥3.5 cm, necrosis occurred in four (16%) subjects, three of whom also had l1/l2 < 2.0 (proximal SP < 67% of entire SP). Statistically, increased l2 was the only risk factor for necrosis (p = 0.001). Overall, incidence of recipient dehiscence, early fistula, and persistent fistula were 32 (29%), 20 (20%), and 3 (3%), respectively. Persistent fistula occurred only in the setting of SP necrosis and/or re-irradiation.
Conclusion Careful patient selection, adequate proximal SP, and l2 = 2.0–3.0 cm is associated with a negligible risk of necrosis. The enhanced reach and laxity and additional skin surface area and soft tissue volume conferred with PMF-d facilitate recipient wound healing.
Ziming Fu, Xiaolong Xu, Yangyang Bao, Zhe Chen, Jiangtao Zhong, Shuihong Zhou
Publication date 06-09-2023
Abstract Background The definition of “collision tumor” is the coexistence of two histologically and morphologically distinct tumors within the same anatomical area without histological admixture. Collision tumors featuring primary squamous cell and adenoid cystic carcinomas of the hypopharynx, combined with synchronous esophageal carcinoma, are very rare.
Methods We describe a patient with a collision tumor of the hypopharynx and synchronous esophageal carcinoma who underwent partial laryngectomy, with preservation of laryngeal function, and radical esophageal resection featuring esophageal reconstruction using a gastric tube. Surgery was successful.
Results Postoperative radiotherapy was recommended after surgery; the patient exhibited no recurrence or distant metastasis to the 17-month follow-up.
Conclusion To the best of our knowledge, this is the first report of collision of primary squamous cell carcinoma and adenoid cystic carcinoma in the hypopharynx and synchronous esophageal carcinoma. We performed appropriate surgery and prescribed postoperative radiotherapy. This preserved laryngeal function.
Peter P. Issa, Brandon M. Magazine, Alexandra LaForteza, Mohamed Shama, Emad Kandil
Publication date 05-09-2023
Abstract Background Radiofrequency ablation (RFA) is a minimally-invasive ablative technique with an impressive safety profile used to manage thyroid nodules. Current reports with RFA describe the treatment of a single nodule in a single-setting. We describe the first series of bilateral nodule RFA in a single-setting.
MethodsRFA was performed on patients with bilateral thyroid nodules in a single-setting. A cohort of randomly selected patients undergoing RFA for bilateral thyroid nodules in a separate setting was reported as a control cohort.
ResultsA total of 12 patients were included in our series, included 6 patients in the single-setting ablation cohort. For patients with bilateral nodules treated by RFA in a separate setting, the mean volume reduction rate (VRR) at 6 months of 63.79% ± 18.86%. There were no reports of complications in the separate setting cohort. For patients with bilateral nodules treated by RFA in a single-setting, the mean VRR at 6 months was 64.% ± 18.97%. There were no reports of complications in the single-setting cohort.
Conclusions Our work describes a novel use of RFA, providing preliminary insight into its use for appropriately selected patients with bilateral thyroid nodules. Future studies with larger sample sizes are warranted to corroborate and expand on our findings.
Tiffany Wang, Scott Roof, William H. Westra
Publication date 30-08-2023
Abstract Background The pulse granuloma (PG) is believed to represent a distinctive foreign body reaction to ingested particles of legumes. Its presentation in the neck is entirely unexpected.
MethodsA woman presented with a mass of the lower neck that recurred following incision and drainage. The recurrent mass was found to be associated with an open sinus tract at the apex of the left pyriform sinus. The opening of the sinus tract was closed and the cyst was removed.
Results Histologic examination of the neck mass showed vegetable material with an associated granulomatous reaction known as PG.
Conclusions The documentation of a PG arising in the neck would seemingly discredit the legume theory, but it only further supports it. Its association with a fourth branchial cleft cyst provides evidence for the existence of the complete fourth branchial cleft fistula with seeding of ingested material through sinus tract opening.
Christopher McDonald, Samuel Kent, Andrew Schache, Simon Rogers, Richard Shaw
Publication date 29-08-2023
Abstract Background Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer.
MethodsPRISMA guidelines were followed. Thirteen studies met inclusion criteria.
Results Results favoring sentinel lymph node biopsy were found in complications, scar length and appearance, length of hospital stay, time to drain removal, and objective shoulder measures at timepoints up to 12 months. Where differences in health-related quality of life were found, methodological issues make their clinical significance questionable.
Conclusions Sentinel lymph node biopsy was associated with fewer complications and statistically better outcomes in a number of physical measures. There is as yet no strong evidence to suggest it is associated with better health-related quality of life outcomes. While a number of health-related quality of life outcome measures show promise, their interpretation is hampered by methodological concerns. Further rigorous research is required to address this.
Li Su, Qiao‐Jing Lin, Shu‐Qing Ma, Xiu‐Rong Song, Jin‐Ru Ye, Meng‐Shan Ni, Jin‐Sheng Hong
Publication date 29-08-2023
Abstract Background To explore the value of early oral nutritional supplements (ONS) in patients with nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT).
Methods Patients with newly diagnosed II-IVA stage NPC were analyzed and divided into Early and Routine ONS groups according to whether they received early ONS at the beginning of CCRT. Changes in nutritional indicators, incidence of treatment-related toxicity, radiation interruption, and completion of CCRT were compared.
Results In total, 161 patients with NPC were analyzed, including 72 in the Early ONS group and 89 in the Routine ONS group. Multivariate analysis showed that early ONS was an independent protective factor for concurrent chemotherapy ≥2 cycles, and a protective factor against ≥grade 3 radiation-induced oral mucositis (RIOM) and weight loss >5%. In stage III-IVA patients, early ONS was beneficial in decreasing the risk of severe malnutrition.
Conclusions Early ONS can improve nutritional outcomes, reduce RIOM, and enhance treatment adherence.
Publication date 15-11-2020
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