Laryngoscope最新文献

Objectives: Laryngeal chondrosarcoma (LC) is a rare tumor accounting for less than 1% of all laryngeal cancers. While surgery is the primary treatment, national trends in management and outcomes remain poorly defined. This study aimed to analyze incidence, survival, and treatment strategies for LC using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: Patients with LC diagnosed between 2000 and 2021 were identified from SEER. Demographic, treatment, and survival data were analyzed. Kaplan-Meier analysis and multivariate Cox regression were used to analyze survival outcomes.

Results: In total, 351 patients with LC were identified, representing 0.3% of all laryngeal malignancies. Among patients with treatment data, 53.3% underwent local excision or partial laryngectomy, 27.5% underwent total laryngectomy (TL), and 19.2% received no surgery. Ten-year disease-specific survival was 84.8%. Patients undergoing partial resection demonstrated significantly improved survival compared with TL (p < 0.05), although this finding is likely confounded by tumor size and stage. On multivariate analysis, advanced stage (HR 2.59, 95% CI 1.68-3.97), older age (HR 1.66, 95% CI 1.36-1.99), and TL (HR 2.95, 95% CI 1.88-4.62) were associated with worse survival.

Conclusion: LC remains rare but carries favorable long-term survival. National trends demonstrate a shift toward organ-preserving surgery, with partial resections increasingly favored over TL. Prognosis is most strongly influenced by age and stage, while radiation therapy appears to play a little role. These findings support organ preservation in appropriately selected patients and highlight the need for prospective studies integrating oncologic and functional outcomes.

Level of evidence: 4:

Objective: This scoping review aims to identify factors influencing adherence to dental guidelines following radiation therapy (RT) and to describe dental outcomes associated with poor adherence.

Data sources: The authors conducted a comprehensive search of PubMed, Embase, Web of Science, and Google Scholar databases, reported using the PRISMA-ScR guidelines.

Review methods: Studies were included if they reported on rates of dental adherence among post-RT head and neck cancer (HNC) patients. Data were extracted on rates of guideline adherence, dental health outcomes, barriers to care, and interventions.

Results: Twelve studies with a pooled sample size of 2925 patients met inclusion criteria. Adherence to post-RT dental guidelines ranged from 19% to 93%. Commonly reported barriers to adherence included lack of patient education, financial hardship, limited dental provider availability, access to health insurance, and poor care coordination. Facilitators of adherence included integrated survivorship clinics, pre-RT dental counseling, and structured follow-up programs. Interventions with multidisciplinary collaboration and streamlined referral processes showed promise in improving adherence rates.

Conclusion: Adherence to dental guidelines post-RT is influenced by a combination of individual, provider, and systemic factors. While several interventions show potential, further research is needed to develop effective implementation strategies. Strengthening multidisciplinary communication, improving patient education, and implementing structured follow-up may enhance long-term oral health outcomes for HNC survivors.

Objective: Conventional grading scales and static image assessments may not capture dynamic facial movement in facial paralysis. We developed a video-based, dynamic, artificial intelligence (AI) application, DynaFace, to objectively quantify facial metrics and determine which measures correspond with patient-reported appearance, function, and psychosocial outcomes, providing insight into how objective dynamics relate to subjective patient experience.

Methods: DynaFace automatically extracted dynamic facial metrics (facial asymmetry index [FAI], bilateral palpebral fissure, and oral commissure excursion [OCE]) at rest and during smile, laughter, and pucker. Multivariable linear regression, controlling for paralysis duration and baseline trait emotional intelligence, assessed associations between objective metrics and patient-reported outcomes from FACE-Q subsets.

Results: Greater asymmetry (higher FAI) during smile and laugh was associated with poorer perceived facial (β = smile: -2.82/laugh: -3.01, p < 0.05), eye (β = -3.99/-3.12, p < 0.05), and smile appearance (β = -4.40/-4.80, p < 0.01), as well as lower overall facial function (β = -3.05/-3.60, p < 0.05) and self-esteem (β = -2.93/-3.12, p < 0.05). In contrast, greater ratio of OCE change (affected to unaffected hemiface) during smile predicted better perceived facial appearance (β = 0.88, p < 0.01), smile appearance (β = 0.69, p < 0.05), and higher self-esteem (β = 0.62, p < 0.05). Greater ratio of OCE change during both smile and laugh predicted improved social function (β = 0.48/0.44, p < 0.05). Palpebral fissure asymmetry was associated with only eye appearance.

Conclusions: Dynamic AI-derived facial metrics from DynaFace align with patient perceptions, showing that greater symmetry in movement enhance satisfaction and function. These findings highlight the clinical potential of DynaFace to bridge objective and patient-reported measures in facial paralysis assessment.

Level of evidence: 4:

This study presents a case of undiagnosed HIV presenting with Kaposi sarcoma (KS) of the head and neck with acute upper airway obstruction (UAO) and provides an updated scoping literature review to examine the patient characteristics, lesion characteristics, interventions, and outcomes of KS cases with UAO from the pharynx, larynx, and/or trachea.

Objective: Prior studies have demonstrated the feasibility of fluorescently labeled tilmanocept for sentinel lymph node biopsy (SLNB) in the oral cavity. We evaluated the added value of fluorescently labeled tilmanocept in sentinel lymph node biopsy (SLNB) of the oral cavity compared to gamma probe.

Methods: Healthy male New Zealand white rabbits received oral cavity injections of radioactive (Technetium 99m) and fluorescently (IRDye800) conjugated tilmanocept followed by either fluorescence guided (n = 14) or gamma probe guided (n = 14) SLNB performed 1 h, 48 h, or 5 days postinjection. Duration of the SLNB performed by two individuals was measured and compared using the two methods.

Results: Fluorescence guidance resulted in a 1.8-fold reduction in time of SLN removal (median 104 vs. 191 s, p = 0.05). For the fluorescence guided SLNB, 7.1% (1 of 14) had nonsentinel node tissue removed prior to the correct identification of the SLN, whereas gamma probe/radioactivity guided SLNB had 28.6% (4 of 14). When comparing operation time between attending and resident surgeon, time to identification of first SLN was not significantly different for fluorescence guided surgery (82 vs. 107 s, respectively) or with gamma probe (158 vs. 204 s); however, median times using the gamma probe were nearly double for both operators. We additionally show the durability of fluorescence signal up to 5 days and clear visualization of proposed tracer with commercially available intraoperative imagers.

Conclusion: The use of fluorescent labeled tilmanocept decreases operative time needed for SLNB as well as reduces the amount of nonsentinel tissue removed.

Level of evidence: N/A.

Objectives: While standard treatments for mandibular osteoradionecrosis (MORN) exist for mild/superficial and severe/full thickness disease, there is no consensus on treatment for advanced, partial thickness disease. In this niche, the anterolateral thigh fascia lata (ALTFL) "rescue" flap has managed MORN successfully. This study aimed to compare ALTFL with fibula free flap (FFF) reconstruction to determine differences in outcomes, complications, and postoperative logistics.

Methods: A retrospective chart review of patients undergoing ALTFL or FFF for MORN between 2008 and 2024 was carried out.

Results: Fifty-one patients with Grade III (n = 26) or IV (n = 25) MORN underwent FFF (n = 22) or ALTFL (n = 29). ALTFL patients were older but did not differ in preoperative MORN treatment or risk factors compared to FFF. Median operative time for ALTFL was significantly less than FFF in both Grade III (298 min vs. 516 min) and IV (298 min vs. 599 min), without differences in subsites of mandible involved. Hospitalization for ALTFL was significantly shorter than FFF for both Grade III (2 days vs. 7 days) and IV (4.5 days vs. 7 days) without differences in peri-operative complications, flap failure or MORN resolution. Tracheotomy was performed more often for patients undergoing FFF for Grade III MORN. Patients who underwent ALTFL were more likely to return to a diet beyond soft within the follow-up period.

Conclusions: The ALTFL rescue flap offers reduced morbidity and improved resource allocation compared to FFF for the treatment of advanced, partial thickness MORN with similar outcomes.

Level of evidence: 4:

Objectives: To evaluate the prognostic importance of impaired vocal cord mobility (VCM) in T2N0 glottic cancer.

Methods: All patients with T2N0 glottic cancer treated with partial laryngeal IMRT in 2009-2021 in our institution were retrospectively reviewed. For comparison, cohorts with T1N0 and T3N0 disease were also included. Locoregional failure (LRF), disease-free survival (DFS), and overall survival (OS) were compared among T1N0, T2N0 with normal VCM (T2-Normal-VCM), T2N0 with impaired VCM (T2-Impaired-VCM), and T3N0 groups. Multivariable analysis (MVA) assessed the prognostic value of VCM within the T2N0 group.

Results: A total of 642 cases were included: 288 T1N0, 224 T2N0 (147 T2-Normal-VCM, 77 T2-Impaired-VCM), and 130 T3N0. Median follow-up was 5.0 years (IQR 3.4-6.2). Five-year LRF for T1N0, T2-Normal-VCM, T2-Impaired-VCM, and T3N0 were 4% (95% CI 2-6), 9% (5-15), 27% (17-38), and 35% (27-44), respectively. Corresponding DFS was 83% (78-88), 80% (73-87), 55% (45-68), and 50% (41-60), while OS was 85% (80-90), 86% (80-92), 71% (61-83), and 59% (50-69), respectively. In T2N0, MVA confirmed that impaired VCM was associated with higher LRF (aHR 3.72 [95% CI 1.79-7.71], p < 0.001), lower DFS (aHR 2.74 [1.68-4.45], p < 0.001), and lower OS (aHR 2.07 [1.17-3.67], p = 0.013).

Conclusions: In this contemporary cohort, LRF rates increased stepwise from T1N0 to T2-Normal-VCM, T2-Impaired-VCM, and T3N0 glottic cancer. Within T2N0 disease, impaired VCM is an adverse prognostic factor, supporting subdivision into T2a (normal VCM) and T2b (impaired VCM) in future TNM revisions. Prospective studies are warranted to assess whether treatment intensification can improve outcomes for T2-Impaired-VCM disease.

Level of evidence: 3:

Objectives: Percutaneous dilatational tracheostomy (PDT) is increasingly preferred in intensive care due to its procedural efficiency. Standard approaches typically rely on real-time bronchoscopic or ultrasound guidance, which may be unavailable in resource-limited settings. We evaluated the feasibility, safety, and learning curve of landmark-guided PDT performed without adjunctive visualization.

Methods: We retrospectively analyzed 71 consecutive adult patients who underwent landmark-guided PDT without bronchoscopic or ultrasound guidance between August 2024 and June 2025. All procedures were performed by a head and neck surgeon newly trained in PDT. Outcomes included procedure duration, complication rates, and patient-specific predictors of procedural difficulty. The learning curve was assessed using correlation and linear regression, and independent predictors of prolonged procedure time were identified through multivariable linear modeling.

Results: The median procedure time was 7.0 (3.0-54.0) min, and a significant learning curve was observed (r = -0.41; p < 0.001). Complications occurred in 14.1% of patients, with major events being limited to one bleeding episode and two pneumothoraces. In multivariable analyses, prior cerebrovascular accident and increased cricoid-manubrium distance independently predicted prolonged procedure times.

Conclusion: Landmark-guided PDT without real-time visualization was feasible and safe following a brief learning phase. With appropriate patient selection and operator training, this technique may represent a practical alternative in settings where visualization adjuncts are unavailable.

Level of evidence: 4: