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

Introduction: Transoral robotic surgery (TORS) is increasingly used for oropharyngeal squamous cell carcinoma (OPSCC), yet national patterns of TORS availability for Medicare beneficiaries are not well defined. We characterized hospital type, geographic distribution, and market concentration of TORS.

Methods: We conducted a retrospective cross-sectional study of inpatient Medicare claims from 2017 to 2023, identifying OPSCC with ICD-10-CM codes and TORS with ICD-10-PCS codes including a robotic-assistance qualifier. Claims were linked to inpatient prospective payment system files for hospital teaching status, disproportionate share hospital (DSH) percentage, urbanicity, and geographic labor market area (GLMA). We mapped county-level procedure counts, calculated GLMA-level Herfindahl-Hirschman Index (HHI), and used negative binomial regression to evaluate associations of hospital factors with TORS volume and inpatient length of stay (LOS).

Results: We identified 2499 unique TORS procedures at 161 hospitals; 86.2% occurred at teaching hospitals, and annual volume rose 31% from 2017 to 2023. TORS use was geographically diffuse but locally concentrated: among 102 GLMAs with any TORS, 64.7% had HHI = 10 000 and 28.4% had HHI 5000-9999. Six GLMAs with > 100 procedures accounted for 33.6% of all cases and were predominantly teaching centers. Higher teaching intensity was associated with greater TORS use (incidence rate ratio [IRR]: 1.99, 95% CI: 1.63-2.45). LOS was longer in urban and rural hospitals versus metropolitan centers and shorter in high-volume GLMAs (IRR: 0.82, 95% CI: 0.76-0.87).

Conclusion: Among Medicare beneficiaries with OPSCC, TORS is concentrated in teaching hospitals and a few high-volume markets, with shorter LOS in high-volume regions, highlighting trade-offs between centralization and access.

Objective: Aggressive care at the end of life (EoL) is a marker of poor-quality care for patients with advanced head and neck cancer (HNC). We aimed to investigate aggressive inpatient care and palliative care (PC) at the EoL for hospitalized patients with distant metastases.

Study design: Retrospective cohort study.

Setting: Patients with metastatic head and neck cancer and terminal hospitalization were identified in the National Inpatient Sample database between 2016 and 2020.

Methods: We examined the level of aggressive inpatient care (intensive care unit (ICU) level of care, chemotherapy, radiotherapy, and surgery) and PC at the EOL. Multivariate logistic regression was performed to determine their associations with selected patient and hospital characteristics.

Results: A total of 43 310 patients met the inclusion criteria. Thirty-five percent of patients received one or more forms of aggressive EOL interventions, and 61.76% received PC. Among the 15 095 receiving aggressive intervention, 76.9% received ICU level of care, 12.18% received chemotherapy, 19.2% surgery, and 8.04% radiotherapy during their terminal hospitalization. In multivariable analyses, younger age, lower PC use, larger hospitals, urban teaching hospitals, and higher risk of mortality were associated with a greater likelihood of aggressive care. PC was associated with lower hospital costs (-$20,115; [-$28,284, -$11,946]) and aggressive care was associated with higher terminal hospitalization costs ($100,309; [$91,373, $109,245]).

Conclusion: Receiving PC at the EoL was associated with less aggressive interventions and costly hospitalization. Further research should examine these associations using prospective designs and evaluate whether increased PC referral and early uptake might help diminish poor quality of care and costly hospitalizations.

Background: An oronasal fistula is an abnormal communication between the oral and nasal cavities, which can arise as a result of radiation therapy for head and neck cancer, resulting in significant speech and swallowing challenges.

Methods: We present a case in which a transesophageal prosthesis (TEP) was used as an alternative to existing treatment options for oronasal fistulas, which include surgical repair or a palatal obturator prosthesis.

Results: A 59-year-old female with a history of poorly differentiated squamous cell carcinoma of the nasopharynx with metastatic neck disease, treated with radiation therapy over 20 years ago, presented with an oronasal fistula resulting in significant weight loss and hypernasal speech. Due to the discomfort caused by a palatal obturator, a TEP device was offered as an alternative treatment option for the patient's oronasal fistula. Post-procedure videofluoroscopic swallow study and speech analysis demonstrated markedly improved nasal regurgitation and speech intelligibility.

Conclusion: This case demonstrates the use of a TEP device as an effective, non-surgical treatment option for oronasal fistula.

Background: Obstructive sleep apnea (OSA) may contribute to fatigue in head and neck cancer patients undergoing chemotherapy and radiotherapy, particularly as both have the potential to impact the mechanics and dynamics of the airway. We conducted a scoping review and exploratory meta-analysis to evaluate the risk of OSA following chemoradiation.

Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched for studies assessing incident OSA after radiotherapy or chemotherapy. Eligible studies isolated the effect of one treatment and reported OSA rates in each group.

Results: Of 559 papers identified, 110 were duplicates and 30 underwent full-text review; 13 met criteria for exploratory meta-analysis. A modest, nonsignificant trend toward increased risk of mild OSA was observed with radiotherapy (z = 1.42, p = 0.15). Chemotherapy was not associated with mild (z = -0.83, p = 0.41) or moderate (z = 0.00, p = 1.00) OSA.

Conclusions: Studies are limited in size and number, and do not support increased risk of OSA with radiotherapy.

Background: The updated American Joint Committee on Cancer (AJCC) staging system has excluded minimal extrathyroidal extension (mETE) from the T3 category. However, mETE remains classified as an intermediate-risk feature for recurrence in thyroid cancer. The prognostic significance of mETE and its association with recurrence risk remain subjects of ongoing debate.

Methods: This study analyzed a retrospective cohort of 1870 papillary thyroid carcinoma (PTC) patients who underwent total thyroidectomy (TT) with central lymph node dissection (CLND) between 2015 and 2020. Cox proportional hazards regression models and subgroup analyses were employed to evaluate the association of mETE with structural recurrence.

Results: After a median follow-up of 27.9 months, 124 patients (6.6%) experienced structural recurrence. The recurrence rate was significantly higher in patients with mETE than in those without (11.0% vs. 5.6%, p < 0.001). Subgroup analyses revealed that mETE was an independent risk factor, particularly in patients with bilateral tumors (HR: 2.99, 95% CI: 1.8-4.95) and those without Hashimoto's thyroiditis (HT) (HR: 2.33, 95% CI: 1.53-3.63). A significant interaction between tumor bilaterality and mETE was observed (p = 0.003).

Conclusions: In patients with PTC, mETE is a significant prognostic factor of structural recurrence and is associated with decreased disease-free survival (DFS). Critically, we demonstrate for the first time that mETE elevates recurrence risk to near the ATA intermediate-high threshold (17.6%) in bilateral PTC, regardless of tumor size. This synergy of mETE and bilaterality supports upgrading risk stratification and intensifying surveillance for this subset.

Background: Tensor fascia lata (TFL) slings are widely used in facial nerve reconstruction (FNR) to restore symmetry and tone, but postoperative trismus is a significant morbidity. This study assessed the feasibility of early rehabilitation using Restorabite, a novel force-controlled trismus device.

Methods: Twenty-seven patients undergoing FNR with TFL slings commenced 10 weeks of Restorabite therapy a mean 1.3 ± 1.2 weeks postoperatively. Outcomes included maximal incisal opening (MIO) and trismus-related quality of life (Gothenburg Trismus Questionnaire, GTQ).

Results: Mean MIO improved by 13.0 mm (95% CI 11.0-15.0; p < 0.001), with 16 patients improving in trismus severity and 8 no longer meeting trismus criteria (> 35 mm). GTQ scores improved by 17.6 (95% CI 15.4-19.7; p = 0.02), particularly in eating and pain. Benefits were sustained at 6 and 12 months. Radiotherapy was associated with poorer outcomes.

Conclusions: Early use of Restorabite is safe and effective for trismus rehabilitation following FNR with TFL slings.

Background: Synthesize transoral styloidectomy approaches, highlight advantages, disadvantages, surgical outcomes, and describe an improved endoscopic transoral technique.

Methods: A systematic review of peer-reviewed articles was conducted on November 11, 2025 in PubMed, Embase, the Cochrane Library, and Medline.

Results: Of the 204 articles screened, 45 met inclusion criteria. Four transoral approaches and four visual enhancement techniques were described. Surgical success rate was 94% with no intraoperative complications and a postoperative complication rate of 6.3%. The length of resected styloid averaged 2.91 ± 1.33 cm (range: 1-6 cm). Mean operative time was 47 ± 22 min. Median follow-up time was 6 months (IQR: 3-12 months).

Conclusion: Transoral styloidectomy is safe and effective for the treatment of Eagle's syndrome. An enhanced endoscopic approach with indocyanine green (ICG) fluoroscopy and neuromonitoring improves intraoperative visualization and helps identify critical vascular structures, potentially reducing the risk of inadvertent injury.

Background: Individuals with oral cavity cancer (OCC) have negatively impacted functional status and quality of life. Little is known regarding patients' perspectives of their speech impairments. This study compared self-reported speech function between patients surgically treated for OCC and healthy controls using the Speech Handicap Index (SHI) and identified factors associated with worse scores.

Methods: This is a multiinstitutional cross-sectional study of OCC patients and healthy controls recruited between July 2024 and March 2025. Participants completed the SHI and self-reported speech quality. Demographics, tumor, and treatment details were abstracted from the electronic health record for OCC. Group differences were assessed with t-tests, χ², and Fisher's exact tests.

Results: Among 69 OCC and 90 controls, OCC patients had significantly higher mean SHI scores (50.2 vs. 34.7, p < 0.01) and were less likely to rate their speech as "good" or "excellent" (47.8% vs. 85.6%, p < 0.01). Both speech and psychosocial domain scores were significantly worse among OCC. Free flap reconstruction was associated with worse scores (29.6 vs. 15.5, p = 0.02) and worse self-rated speech quality.

Conclusions: Patients with surgically treated oral cavity cancer have significantly impaired self-perceived speech and psychosocial functioning compared with healthy individuals. Greater deficits were observed in patients who required free flap reconstruction. Despite the functional deficit, nearly half of OCC patients reported satisfaction with their speech quality. These findings highlight the importance of using validated measures for speech function and support the need for early, multidisciplinary rehabilitation including speech therapy in this population, particularly for those undergoing free flap reconstruction.

Background: HPV-negative HNSCC is driven by cell cycle dysregulation, including CDK4/6 activation. Abemaciclib targets this pathway and may offer therapeutic benefits. This study aimed to identify biomarkers predicting abemaciclib efficacy.

Methods: In the NGS-based TRIUMPH trial, patients with platinum-refractory HNSCC harboring CDK4/6 pathway alteration received abemaciclib, classified as "long stable disease (SD)" (progression-free survival [PFS] > 6 months) and "short SD" (PFS < 6 months). In this post hoc analysis, the genetic profiles were compared. In vitro studies were conducted to assess abemaciclib's antitumor effects in HNSCC cell lines.

Results: Among 23 patients, abemaciclib showed limited efficacy (overall response rate, 0%; disease control rate, 43.5%). CDKN2A deletion was significantly associated with long SD (p = 0.0078), unlike CCND1 amplification and CDKN2A mutation. In vitro, CDKN2A-deleted cell lines showed greater sensitivity to abemaciclib.

Conclusions: Although abemaciclib resulted in limited tumor regression, CDKN2A deletion may be a predictive biomarker for prolonged disease stabilization. Further investigations on genomically selected populations and combination strategies are required.

Background: Although the AJCC eighth edition staging system incorporates HPV status, it remains insufficient to guide personalized treatment in HPV-positive oropharyngeal cancer (OPC). This study aimed to identify the optimal age threshold and evaluate its association with overall survival (OS) to improve risk stratification and inform individualized treatment strategies.

Methods: Data were extracted from the SEER database (2018-2021), the University Health Network (UHN), University of Toronto, and the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (NCC). Only HPV-positive OPC cases with complete survival records were included. The optimal age threshold was identified using restricted cubic spline modeling in combination with a recursive partitioning approach. Prognostic factors beyond HPV status and AJCC eighth edition stage were evaluated using multivariable Cox proportional hazards models. Recursive partitioning analysis (RPA) was used to construct a risk stratification model. The primary endpoint was OS.

Results: Of the 10 283 eligible patients (87.9% male; median age, 62 years), 2.7% had distant metastases at diagnosis. Restricted cubic spline analysis revealed that 62 years of age represents an important critical threshold. Multivariable Cox analysis revealed that patients younger than 62 years exhibited significantly improved OS (HR, 0.61; 95% CI, 0.54-0.70; p < 0.001). RPA stratified patients into five risk groups with distinct 2-year OS: extremely low (96.8%), low (93.7%), intermediate (86.1%), high (74.6%), and extremely high risk (47.5%). Among patients classified in the extremely low-risk group (T0-2N0-1M0 and younger than 62 years), no significant difference in OS was observed between those treated with radiotherapy alone and those treated with chemoradiotherapy. External validation in the UHN (N = 843) and NCC (N = 167) cohorts suggested that extremely low-risk patients might be spared concurrent chemotherapy.

Conclusions: This study developed a risk stratification model for patients with p16-positive OPC based on the AJCC eighth edition staging and age. Patients in the extremely low-risk group may derive limited benefit from concurrent chemotherapy, suggesting that its omission could be considered in selected patients and may help guide the design of future de-escalation trials.