Head and Neck-Journal for the Sciences and Specialties of the Head and Neck最新文献

Background: The scapula free flap is an unpopular option for osseous reconstruction of the head and neck in part due to the inability to perform simultaneous ablative surgery and harvesting of the free flap. In addition, it was originally described as having minimal bone stock making dental rehabilitation with dental implants very difficult.

Methods: Retrospective review from 2015 to 2025 of patients that underwent segmental resections involving the maxillofacial complex and received scapula free tissue transfer with dental implants. Contributing surgeons are affiliated with the following institutions: Northwell Health (Northwell Cancer Institute), University of Pittsburgh, Oregon Health & Science University, Washington University in St. Louis, and the Medical University of South Carolina.

Results: Eighty-seven dental implants were placed in 29 patients mainly using the angular branch of the thoracodorsal artery. Fifteen patients (51.7%) had their implants placed during the initial ablative and scapular reconstruction. The median number of dental implants placed in each scapula was two, and overall implant osseointegration was 88.8% after following patients on average for 41 months.

Conclusion: Our multi-institution review has demonstrated that the scapula free flap has adequate bone quantity to support immediate and delayed dental implants to provide long term success for dental rehabilitation. We recognize that the sample size in this series is relatively small; however, this series represents one of the largest in the current literature.

Background: Intraoperative free flap failure necessitates prompt intraoperative decision-making on alternative reconstructive strategies. In this study, we investigate the etiology and management of intraoperative flap loss.

Methods: Retrospective review between 2010 and 2024 at 6 institutions.

Results: There were 7423 free flaps performed with 46 instances of intraoperative flap failure (0.62%). The most common recipient subsite was oral cavity (27/46, 57%). Anterolateral thigh (ALT) was the most common flap type to fail (18/46, 39%), followed by the fibula (15/46, 32%). The most common reasons for total failure were clotting without observable vessel abnormality (12/35, 34.3%), poor quality perforator (11/35, 31.4%), and vessel spasm or intimal abnormality leading to clotting (8/35, 22.9%). The most common acute management was converting to an additional free flap intraoperatively (28/46, 60.9%).

Conclusions: Flap failure intraoperatively is rare. The majority of cases were acutely managed with an additional flap to provide defect coverage.

Background: To evaluate the health-related quality of life (HRQoL) in patients with differentiated thyroid cancer (DTC) and to identify clinical and demographic factors associated with HRQoL outcomes.

Methods: This cross-sectional study included 202 patients diagnosed with differentiated thyroid cancer who completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questionnaire. Sociodemographic and clinical data such as age, sex, educational status, employment, tumor size, ATA risk classification, TNM stage, and radioactive iodine (RAI) therapy were recorded. Statistical analyses included descriptive statistics, non-parametric tests, Spearman correlation, and multivariable linear regression to determine predictors of global HRQoL score.

Results: The median global HRQoL was 58.3 (IQR: 50.0-75.0). Functional scores were highest in role, emotional, cognitive, and social domains (median 66.7). Fatigue was the most prominent symptom (median: 44.4), followed by pain, dyspnea, and insomnia (each 33.3). Female sex, lower educational level, and higher RAI dose were associated with lower global HRQoL scores. Emotional functioning was significantly lower in patients aged ≥ 55 years. Multivariable regression analysis identified sex, education level, RAI dose, and TNM stage as significant predictors of HRQoL.

Conclusion: Despite generally favorable prognoses in DTC, multiple demographic and treatment-related variables significantly influence patient-reported HRQoL. RAI therapy and disease stage may impact HRQoL less than previously assumed. These findings highlight the importance of individualized supportive care strategies in survivorship plans.

Background: This study aimed to compare donor-site morbidity among three common major lower extremity free flaps: fibula (FFF), anterolateral thigh (ALT), and the medial sural perforator (MSAP) using an established patient-reported outcome measure (PROM), the Lower Extremity Functional Scale (LEFS).

Methods: Patients who underwent head and neck reconstruction with either FFF, MSAP, or ALT were included. The primary outcome was functional recovery, assessed using the modified LEFS, a PROM measuring functional status, administered at multiple post-operative timepoints.

Results: Seventy-five patients were included in the analysis: 33 FFF, 22 MSAP and 20 ALT. Patients undergoing lower extremity free flap surgery overall recovered well. The LEFS scores at different time points demonstrated quicker recovery for the MSAP group, while ALT and FFF recovered later. After 360 days, the MSAP group also demonstrated improved functional outcomes compared to the ALT and FFF.

Conclusion: Patients undergoing lower extremity free flap surgery recover well. The MSAP had the least donor-site morbidity. Donor-site morbidity should be considered when counseling patients.

Objective: To evaluate oncological outcomes and their predictors following salvage oropharyngectomy.

Methods: This single-center retrospective study included patients who underwent a salvage oropharyngectomy in an irradiated neck for recurrent or metachronous oropharyngeal squamous cell carcinoma (OPSCC) between 2014 and 2023.

Results: Ninety-four patients were included. Five-year overall survival (OS), disease-specific survival (DSS), and local recurrence-free survival (LRFS) were 31.7%, 58.5%, and 55.2%, respectively. In multivariable analysis, pN+ status (HR 2.32; p = 0.031), pT status ≥ 3 (HR 2.03; p = 0.020), and age (HR 1.05; p = 0.014) were associated with OS. DSS was associated with pT status ≥ 3 (HR 5.24; p < 0.001), metachronous (vs. recurrent) OPSCC (HR 0.32; p = 0.006), and cN+ status (HR 2.31; p = 0.053). LRFS was associated with metachronous OPSCC (HR 0.30; p = 0.002) and pT status ≥ 3 (HR 3.60; p = 0.001).

Conclusions: This last-resort procedure is associated with poor survival outcomes. In this series, patients with p16-positive OPSCC did not fare better than their p16-negative counterparts.

Objective: To compare the safety and surgical efficacy of endoscopic thyroidectomy by gasless unilateral axillary (ETGUA) with conventional open thyroidectomy in patients with papillary thyroid carcinoma (PTC).

Methods: This prospective, single-center, and randomized controlled trial included 196 patients with PTC who met the inclusion and exclusion criteria. Patients were randomly assigned in a 1:1 ratio to the ETGUA group (n = 98) or the open thyroidectomy group (n = 98). Complications within 30 days, parathyroid function [intact parathyroid hormone (iPTH) and serum calcium], and short-term oncological outcomes were observed. Secondary outcomes included operative time, intraoperative blood loss, postoperative recovery, pain score, cosmetic satisfaction, and hospitalization cost.

Results: The ETGUA group had a significantly longer operative time than the open thyroidectomy group, less intraoperative blood loss, more postoperative drainage at postoperative day 1, as well as a shorter postoperative hospital stay (all p < 0.05). At 1 year postoperatively, surgical efficacy and oncological indicators such as the number of lymph nodes dissected, number of positive lymph nodes, stimulated thyroglobulin (sTg) level, and the proportion of patients receiving adjuvant radioactive iodine therapy were comparable between groups (p > 0.05). The ETGUA group reported lower visual analog scale (VAS) pain scores and higher cosmetic satisfaction, though the total hospitalization cost was slightly higher (all p < 0.05). The learning curve analysis indicated that operative time and intraoperative blood loss stabilized after approximately 30-40 cases.

Conclusion: ETGUA demonstrates comparable safety and oncological efficacy to conventional open thyroidectomy in PTC patients.

Background: Head and neck squamous cell carcinoma of unknown primary (hnSCCUP) remains a clinical conundrum. Diagnostic transoral robotic surgery (TORS) now routinely identifies occult primary tumors previously undetected by conventional methods. Here we analyze the histopathology of these tumors, demonstrating novel patterns of submucosal spread in predominantly microscopic tumors.

Patients/methods: Eighty patients with HPV-mediated hnSCCUP who underwent diagnostic TORS from 2013 to 2022, analyzing tumor histopathology and oncologic outcomes.

Results: Primary tumors were identified in 66 (83%) patients averaging 6 × 3 mm in diameter. These microscopic primaries produced cervical metastases over 6 times larger, with many exhibiting ribbon-like submucosal spread through lymphoepithelial crypts that evaded conventional detection. Almost all (98%) were T1 tumors; 71% measured < 1 cm. At 38-month follow-up, 96% of patients remained alive without locoregional recurrence.

Conclusions: Diagnostic TORS reveals that most HPV+ hnSCCUP are actually T1-microscopic oropharyngeal carcinomas, which might constitute a distinct clinical entity requiring new tailored treatment approaches.