Laryngoscope最新文献

Objectives: Transoral robotic surgery (TORS) and transoral laser microsurgery (TOLM) plus neck dissection are viable alternatives to radiotherapy as a treatment modality in select cases of oropharyngeal squamous cell carcinoma. Many centers advocate for elective ligation of the feeding arteries at index neck dissection prior to TORS/TOLM to mitigate the risk of catastrophic perioperative hemorrhage. Although there are multiple cadaveric studies in the literature to identify the lingual artery at multiple points throughout its course, there are no studies on the intraoperative identification of the lingual artery for elective ligation prior to TORS/TOLM.

Methods: A retrospective review of all patients undergoing neck dissection with vessel ligation prior to TORS. Lingual artery was identified at its origin, and relation to hypoglossal nerve was recorded. Patient demographics, intraoperative findings including the relation between lingual artery and hypoglossal nerve measured in millimeters, and postoperative complications were extracted from medical records.

Results: Of the 33 cases eligible for this study, the lingual artery was identified directly deep to the hypoglossal nerve in 21 cases (63.6%). Of the remaining cases, seven were within 5 mm inferior to the hypoglossal nerve (21.2%), and only two cases (6.1%) were identified superior to the hypoglossal nerve.

Conclusion: The hypoglossal nerve is a useful landmark for the intraoperative identification of the lingual nerve in elective neck dissection prior to TORS. The lingual artery can be identified either immediately deep to or within 5 mm inferior to the hypoglossal nerve in majority of cases.

Level of evidence: 4 Laryngoscope, 2025.

Objective: The goal of this study was to better understand the epidemiology, clinical characteristics, and treatment outcomes of head and neck sarcomas using real-world data from Japan.

Methods: Using the Japanese Head and Neck Cancer Registry, we identified 438 patients who were pathologically diagnosed with head and neck sarcoma between 2011 and 2020. We compared epidemiological, clinical, and prognostic data for the different histological types of sarcoma.

Results: The top five most common histopathological types were rhabdomyosarcoma, osteosarcoma, chondrosarcoma, leiomyosarcoma, and liposarcoma. The most common primary sites were the nasal cavity and paranasal sinuses. The overall cohort had clinical, pathologic, and occult lymph node positivity rate (OLR) of 18%, 15%, and 2%, respectively. Clinical lymph node positivity was highest in rhabdomyosarcoma (46%), followed by angiosarcoma (26%), with leiomyosarcoma, chondrosarcoma, and liposarcoma accounting for less than 10%. The 3-year overall survival rate was 74.8% among the 147 patients with available prognostic information. The histological type with the lowest 3-year overall survival was undifferentiated pleomorphic sarcoma (54%), followed by leiomyosarcoma (65%), and angiosarcoma (69%). In six of seven histological types, the 3-year locoregional-free survival rate was less than 70%.

Conclusion: Sarcomas of the head and neck most commonly occur in the nasal cavity and paranasal sinuses. The prevalent histological type depended on the primary site. Rhabdomyosarcoma and angiosarcoma are histological types with a high risk of cervical metastasis. In the head and neck region, there are numerous histological types many of which lack local control.

Level of evidence: Level 3 Laryngoscope, 2025.

Objective: To determine whether and when early division of the paramedian forehead flap may be safely performed.

Data sources: PubMed (NLM), Scopus (Elsevier), and Embase (Elsevier).

Methods: A systematic search of PubMed, Scopus, and Embase was conducted according to PRISMA guidelines. Data extraction included time to pedicle division, patient and defect characteristics, and postoperative complications. Additionally, a retrospective analysis of patients at our institution was performed to augment the cohort.

Results: A total of 103 patients (85 from 6 studies identified via systematic review and 18 via retrospective review) underwent early flap division defined as 16 days and earlier. The average time to division was 9.89 days (3-16). There were no cases of flap loss, and complications were rare. Several studies excluded full thickness defects. Five studies included patients requiring cartilage grafting, although some limited this to less than 50% of the defect area. All patients in our retrospective cohort had partial thickness defects and none required cartilage grafting. Despite smoking being a major risk factor for vascular disease, 13.7% of patients were current smokers. Several studies utilized imaging tools such as indocyanine green angiography to assess flap perfusion. Notably, in these instances, no cases were delayed due to lack of adequate neovascularization.

Conclusion: Early paramedian forehead flap division may be an option in select patients with partial thickness nasal defects. Adjunct imaging may be a cost-effective method of evaluating appropriate timing of division.

Level of evidence: NA Laryngoscope, 2025.

Objectives: Hearing loss (HL) has significant implications on social functioning. Here, we study the relationship between HL, race, and these combined categories as risk factors for discrimination in the large national All of Us cohort.

Methods: The National Institutes of Health All of Us dataset was analyzed after including individuals who completed the Everyday Discrimination Survey between November 2021 and January 2022. HL and potential medical confounders were defined per ICD-10 codes or demographics. Multivariable linear regressions analyzing the relationship between HL and discrimination were adjusted for potential confounders, including age, gender, race, ethnicity, other demographic factors, and relevant medical conditions, such as depression and dementia. Additional regressions were conducted to evaluate how combined HL and race categories associated with discrimination risk.

Results: Totally 8,722 individuals ≥18 years old had complete data. The mean age was 65 years (SD = 13.0 years), and 41% were women. Individuals with HL, compared with those without, were more likely to report discrimination in six out of nine questions on the Everyday Discrimination Survey (p < 0.05, with effect sizes ranging from -0.05 to -0.16 on a 6-point scale from 0 = "Almost everyday" to 5 = "Never"). Notably, for four out of those six questions, combined Black race and HL was associated with a risk of discrimination independent from the risk conveyed by race and/or HL individually.

Conclusions: This study offers evidence of HL as a risk factor for self-reported discrimination. Further, this study provides support for an intersectional understanding between discrimination, race, and HL.

Level of evidence: III, Laryngoscope, 2024 Laryngoscope, 2025.

Objectives: Bimodal cochlear implant (CI) users vary in speech recognition outcomes. This variability may be influenced partly by the CI and contralateral hearing aid (HA) programming procedures, which can result in mismatches in latency and frequency. We assessed the performance of bimodal listeners when latency mismatches were corrected and analyzed how frequency mismatches influenced outcomes.

Methods: Twelve adults with at least 1 year of bimodal use were evaluated in latency mismatched versus matched conditions. Masked sentence recognition was assessed in a 10-talker masker for three spatial configurations: target from the front and the masker either co-located, 90° toward the CI-ear, or 90° toward the HA-ear. Frequency mismatch for the most apical electrode (E1) was determined from postoperative imaging and the filter frequency assignment of their familiar CI map.

Results: Participants had significantly better performance when latency mismatches were small or matched between the devices, with an approximately 10% improvement in the configuration with the masker toward the HA-ear. Significantly, poorer performance was observed with larger magnitudes of frequency mismatch, with a 2% drop in performance for every one semitone deviation increase in mismatch. The interaction between latency and frequency mismatch was nonsignificant, suggesting that the benefit of latency matching was approximately additive across the range of frequency mismatches.

Conclusions: Detrimental effects of interaural mismatches in latency and frequency were observed, even after long-term device use. These preliminary results suggest that bimodal CI users might benefit from individualized fitting procedures that match latency across devices and minimize frequency mismatch for the CI.

Level of evidence: 3 Laryngoscope, 2025.

Objectives: To analyze the prognostic value of markers available at the onset of idiopathic facial palsy. To define the evolution of the episode by tracing changes in facial function over time.

Methods: This is an observational prospective study on patients with facial palsy consulting in the first 24 hs. The evolution was recorded with photographs and monthly visits. Multivariate analysis was conducted between clinical and analytical parameters determined in the first visit and prognostic outcomes: progression, resolution, and "facial palsy evolution index," which integrates severity of the palsy and duration.

Results: Sixty-five patients were included. The mean initial HB grade was III, but 31% of the cases progressed in the following days. Complete recovery was observed in 89.5% of the cases (mean duration of the episode of 48 days), and exposure keratitis in 21.5%, with a mean of 42 days after the onset. Multivariate analysis showed that retroauricular pain and white blood cell count were significantly related to progression (odds ratio [OR] 19.08; 1.49, p < 0.05), incomplete resolution (OR 1/0.04; 1/0.59, p < 0.05), and higher evolution index (12.8; 2.9, p < 0.05). Age was also significantly associated with evolution index (0.27, p < 0.05), and platelet-to-lymphocyte ratio with progression (OR 1.02, p < 0.05). The rest of the parameters did not show an association with prognosis.

Conclusions: Retroauricular pain and white blood cell count are early indicators of prognosis in idiopathic facial palsy. Initial examinations may not reflect the maximum grade of weakness reached by the patient. Ocular complications can occur several weeks after the onset, even with mild grades of paralysis.

Level of evidence: 3 Laryngoscope, 2025.

Objectives: To investigate the consistency of associations between modified frailty index-5 (mFI-5) and postoperative adverse outcomes in head and neck cancer (HNC) reconstruction.

Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2017 to 2022 was utilized to identify HNC patients undergoing locoregional or microvascular free tissue transfers. Kaplan-Meier estimates and multivariable Cox regression analyses were utilized to compare risk of infections, bleeding, readmissions, reoperations, major adverse cardiovascular events (MACE), and mortality within the first postoperative month for each mFI-5 score with mFI-5 = 0 as reference. Further analyses investigated associations between individual mFI-5 components and the outcomes of interest.

Results: We included 5,573 patients (median age: 64; 31.5% female), 63% (n = 3,519) of whom underwent microvascular free tissue transfers. Unadjusted univariate analyses associated higher mFI-5 scores with longer hospital stays. In locoregional tissue transfers, adjusted hazard ratios (aHRs) for reoperation were 1.37 (p = 0.03) for mFI-5 = 1 and 2.19 (p = 0.03) for mFI-5 ≥ 3. In microvascular free tissue transfers, aHRs for MACE were 1.93 (p = 0.04) for mFI-5 = 2 and 6.53 (p < 0.001) for mFI-5 ≥ 3, while aHRs for mortality was 3.88 (p = 0.04) for mFI-5 ≥ 3. No associations were observed between increasing mFI-5 scores and increased relative risk of infection, bleeding, or readmission. Individual component analysis associated congestive heart failure with aHRs of 3.92 (1.84-8.35; p < 0.001) for MACE and 5.30 (2.03-13.88; p < 0.001) for mortality. Additionally, COPD was associated with an aHR of 1.39 (1.16-1.67; p < 0.001) for infections.

Conclusion: The associations of higher mFI-5 scores with postoperative adverse outcomes following oncoplastic head and neck reconstruction were inconsistent and possibly driven by individual effects of its components.

Level of evidence: Level III (three) Laryngoscope, 2025.

Objective: Post-tonsillectomy hemorrhage (PTH) rates have increased in children over the last decade. This study aimed to determine whether PTH incidence in adults had also increased over the last 15 years.

Study design: Retrospective study.

Setting: TriNetX database.

Methods: A search was conducted using TriNetX for patients 18 years and older within the US Collaborative Network who had undergone tonsillectomy (CPT codes 42821 or 42826) and yielded 72,232 subjects. PTH diagnoses were identified using ICD-10 codes J95.830 or K91.840, and those who returned to the operating room (RTOR) to control PTH were identified using CPT 42962. PTH events that occurred and analgesics given following 14 days of tonsillectomy were tabulated annually from 2008 to 2022. Mann-Kendall test for monotonic trend examined significant trends in PTH and analgesic use.

Results: Mean age at tonsillectomy was 32.8 years (SD = 13.8). 4.1% were diagnosed with PTH in 2008, compared with 6.2% by 2022 (p = 0.0030). In 2008, 0.7% required RTOR to control PTH, compared with 2.4% in 2022 (p < 0.0001). Use of codeine decreased from 6.9% in 2008 to 2.5% in 2022 (p = 0.0022). Use of ibuprofen, acetaminophen, ketorolac, and oxycodone increased from 1.6% to 23.4% (p = 0.0005), 36.1% to 78.6% (p < 0.0001), 1.5% to 11.9% (p < 0.0001), and 20.6% to 63.6% (p < 0.0001), respectively. No change was detected in use of hydrocodone.

Conclusion: Post-tonsillectomy analgesia in adults has changed significantly over the last 15 years. Our study highlights a concurrent increase in PTH which bears more investigation.

Level of evidence: 3 Laryngoscope, 2025.

We present an interesting case of a 74-year-old female who presented with spinal accessory neuropathy following an ipsilateral right-sided carotid endarterectomy 6 months after the initial injury. Subsequent surgical exploration revealed a surgical clip that had been placed directly across the spinal accessory nerve. Clip removal and neurolysis was subsequently performed, leaving the nerve intact. After surgical intervention, she immediately demonstrated increased bilateral shoulder shrug motion and continues to improve her function with physical therapy. This case demonstrates a fascinating case of cranial nerve recovery after delayed intervention in the context of existing literature. Laryngoscope, 2025.