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

Background: Our study evaluated long-term morbidities in patients and compared subjective morbidities to those measurable objectively.

Methods: Patients completed a questionnaire regarding long-term morbidity, filled out the Pain Sensitivity Questionnaire by Ruscheweyh et al. and were examined physically.

Results: Eighty-two patients were included in the study, 31 patients returned to the clinic for further evaluation and testing. The most common morbidities were weakened dorsiflexion of the great toe (34 patients), reduced ambulatory status (33), and muscle weakness (31). A significant correlation (p < 0.01) was found between higher pain intensity and high pain sensitivity scores. However, donor-site morbidities were not significantly associated with pre-existing comorbidities like smoking, diabetes, or age over 70. Subjective morbidities were reported 2.3 times more frequently than objectively measured ones.

Conclusions: Our findings suggest a notable discrepancy between subjective and objective morbidities, highlighting the importance of considering patients' subjective experiences when assessing postoperative outcomes and rehabilitation progress.

Background: There is lower female representation within academic medicine. We aimed to investigate female authorship (FA) and female-held chair or program director (PD) positions within head and neck oncology (HNO).

Methods: Articles authored by females about microvascular and reconstructive surgery (MRS) and transoral robotic surgery (TORS) were identified. A sub-analysis was performed by investigating the gender of HNO fellows, PDs, and chairpersons. These were collected, and FA reported.

Results: There were 1227 publications, 656 on MRS and 567 on TORS. Females authored 299 (24%) publications, 139 (23%) about MRS and 160 (30%) about TORS. There was no significant increase in FA or fellowship trends over time (p > 0.05). In our sub-analysis, we identified four HNO chairwomen (3%), and eight (6%) female HNO PDs. HNO chairwomen authored an average of 97 publications, PDs authored 37.

Conclusion: FA in MRS and TORS remained stable between 2001 and 2022. Although few HNO females hold program chair or PD positions they perform quality research and serve as senior authors on a large proportion of publications.

Introduction: Salivary gland malignancies are heterogeneous tumors with highly variable outcomes. Elective neck management options include observation, neck dissection (ND), and neck irradiation (NI). We sought to compare outcomes of cN0 salivary gland cancer by elective neck management.

Methods: An IRB-approved registry was queried for cN0 salivary gland cancers and categorized based on neck management into observation, ND, NI, and ND + NI groups. cN0 included no evidence of clinical or radiographic metastatic lymphadenopathy.

Results: A total of 445 patients were included with 203 in observation, 83 ND, 71 NI, and 88 ND + NI. Median follow-up was 60.8 months (range 0.4-258). There were 47% clinical T1 tumors, 29% T2, and 12% of each T3 and T4. Exactly 90% were cN0 and 10% with borderline lymph node(s). The major salivary gland was the most common site (74%) and the most common histologies included 28% mucoepidermoid and 20% adenoid cystic. Risk factors associated with regional recurrence include age, borderline lymph node features, pathologic T and N stage, poorly differentiated, positive margin, lymphovascular space invasion, and extranodal extension (all p < 0.05). There was no significant difference in local (9.9%-16.7%, p = 0.6) or regional (3.9%-9.4%, p = 0.76) recurrence between all four groups. Five-year distant recurrence was significantly different at 7% for observation, 16% in ND, 25% in NI, and 37% in ND + NI (p < 0.001). Ten-year OS estimates were 78% for observation, 66% for ND, 69% for NI, and 52% in ND + NI (p < 0.001).

Conclusion: For patients with cN0 salivary gland cancer, ND and NI yield similar regional control in appropriately selected patients. In high-risk patients with several adverse risk features ND + NI results in favorable regional control but distant metastasis is a driving factor affecting overall survival.

Background: This study analyzed the clinical features of patients with recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC), who developed progressive disease (PD) after immune checkpoint inhibitor (ICI) therapy.

Methods: We retrospectively analyzed 256 patients with R/M HNSCC treated with ICIs at 11 medical centers. Associations between the treatment outcomes-best response, overall survival, and progression-free survival-and various clinical factors were analyzed.

Results: The objective response rate was 19.5% and PD was observed in 50.4% of the patients. A high neutrophil-to-lymphocyte ratio (NLR > 4; HR, 2.20 [1.28-3.78]) and large tumor size (sum of the target lesions > 40 mm; HR, 1.74 [1.03-2.94]) were significant risk factors for PD. High NLR (HR, 2.00 [1.42-2.82]), poor performance status (ECOG PS 2-3; HR, 3.51 [2.04-6.05]), and large tumor size (HR. 1.63 [1.19-2.24]) were independently associated with poor overall survival.

Conclusions: Patients with high NLR and large tumor size are at higher risk of PD during ICI therapy.

Background: Local recurrence of nasopharyngeal carcinoma (NPC) occurs in 10%-20% of patients, with salvage potential in early recurrences. Yet, clear surveillance protocols are lacking. We compare survival outcomes and suitability for salvage in symptomatic and incidentally detected locally recurrent NPC.

Methods: Locally recurrent NPC patients, initially diagnosed at the National Cancer Center Singapore between October 2003 and November 2009, were identified. Demographics, symptoms, detection modalities, and survival outcomes were analyzed.

Results: Eighty-two patients were studied. Median follow up and time to local recurrence was 5.51 and 2.19 years; 45.1% were symptomatic; 65.9% were diagnosed incidentally; 62.2% were offered salvage treatment. Symptomatic patients (vs. asymptomatic) had lower 5-year overall-survival (39.1% vs. 74.5%, p = 0.011). Nonincidental diagnoses (vs. incidental) had lower 5-year overall-survival (33.6% vs. 71.1%, p = 0.02). Incidentally-detected recurrences (vs. nonincidental) were more likely offered salvage treatment (75.9% vs. 35.7%, p < 0.001).

Conclusion: Routine clinical examination, nasoendoscopy, and imaging allow early detection of asymptomatic recurrences, with improved outcomes.

Background: Virtual surgical planning (VSP) with simple cutting templates could help surgeons preoperatively plan scapula reconstructions in the vertical and horizontal orientations.

Methods: Virtually, eight defects were created in ten healthy mandibles and reconstructed with the subject-specific scapula vertically and horizontally. In the clinical series, 15 single-piece scapula mandible reconstructions planned with in-house VSP and guided with simple templates were compared with 15 freehand reconstructions.

Results: Virtually, the vertical placement outperformed the horizontal placement in dice score (DSC) and Hausdorff-95 for all but one defect. Clinically, the VSP cohort had shorter operative time (386.6 ± 111.6 min vs. 268.9 ± 50.6 min, p = 0.002), fewer tracheostomies (73% vs. 15%, p = 0.002), lower length of hospital stay (16.6 ± 13.5 days vs. 12.2 ± 8.1 days, p = 0.319), and higher complete/partial union to a non-significant degree (78% vs. 100%, p = 0.471).

Conclusion: A single-piece scapula free flap is a versatile option for mandibular reconstruction. VSP has time and cost savings potential and quality of life impact that should be further investigated.

Objective: The aim of this study was to compare the incidence of positive surgical margins (PSMs) between different races and sexes in a national cohort.

Materials and methods: In this study, we analyzed the association between race and sex disparities and the incidence of PSMs based on data from the 2004-2016 National Cancer Database (NCDB). The NCDB includes deidentified data collected from over 1500 hospitals as part of the Commission on Cancer approvals program and represents over 70% of new cancer cases in the United States. This analysis provides minimally adjusted and further adjusted multivariate analyses of the incidence of positive surgical margins in OCSCC stratified by sex and race, disease characteristics, other demographics, comorbidities, and social determinants of health (SDOH).

Results: The incidence of PSMs was found to be elevated in black males of any age, black males under the age of 45, and in Indigenous American and native Alaskan males under the age of 45, independent of clinicopathologic factors. Specifically, black patients had a significantly higher incidence of PSMs when controlling for age, subsite, stage, grade, LVI, and CDCS. Our results remained unchanged after adjusting for the SDOH variables of insurance coverage, level of education, income, metropolitan versus urban versus rural location, distance from treatment center, and facility type.

Conclusion: The findings of this study suggest that black males of any age, black males under 45, and Indigenous American and native Alaskan males under 45 have a higher incidence of PSMs, independent of clinicopathologic factors and SDOH. Our findings may help inform clinicians and hospitals of lapses in our healthcare system that perpetuate these inequities and further the goal of tackling disparities in surgical care.

Objectives: Local flaps are widely described for scalp reconstruction, but there is minimal literature surrounding the snail flap. The objective of this study was to describe the surgical technique and outcomes of scalp reconstruction with the snail flap.

Methods: This case series retrospectively evaluated all consecutive patients undergoing scalp snail flap reconstruction from January 1, 2019 to February 1, 2024. The primary outcome measure was incidence and extent of complications. Demographic and intra-operative variables were assessed.

Results: A total of 44 patients were included with a median age (range) of 74 years (27-88) with scalp defects ranging in size from 3 x 3 cm to 8 x 8 cm (median defect size 5 cm). The mean (SD) flap base-to-defect ratio was 1.82 (0.31). Forty (91%) of the cases were performed outpatient or with overnight observation only. Complications included 9 (20%) wound infections, 12 (27%) patients with necrosis (all minimal), and 2 (5%) patients with hematoma, which were all managed outpatient. The flap survival rate was 100%.

Conclusions: The snail flap is easy to perform with high reliability and allows for hair preservation. The morbidity and need for hospitalization are minimal, making it an ideal reconstructive option for elderly or frail patients with moderate-sized scalp defects.

Background: Radiofrequency ablation guided by ultrasound (RFA-USG) is an alternative treatment for primary hyperparathyroidism (PHPT) patients. Despite showing accurate precision and minimal invasion, its efficacy remains questionable.

Methods: We searched PubMed, Embase, Scopus, Cochrane Library, Portal Regional da Biblioteca Virtual em Saúde (BVS), Web of Science databases for randomized controlled trials (RCTs) and observational studies evaluating RFA-USG in PHPT patients. Statistical analysis was performed with R software, version 4.4.3.

Results: Eight studies were included with 208 patients with PHPT undergoing RFA-USG treatment. After 3 months of treatment, parathyroid volume was 0.31 mL (0.16-0.61), Parathyroid hormone (PTH) level was 60.71 pg/mL (53.87-68.42), and calcium level was 5.43 mEq/L (2.63-11.23). The occurrence of hoarseness among the patients was 4.4% (1.64-11.02).

Conclusion: RFA-USG is safe for PHPT patients, with associated parathyroid volume reduction and decrease in PTH. However, further study is needed to compare RFA-USG to the gold standard of surgery for PHPT.

Background: Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are common chronic inflammatory diseases associated with malignant transformation. Risk factors associated with malignant transformation of OLP and OLL are not well defined.

Methods: A retrospective chart review assessed risk factors for progression of OLP and OLL to oral epithelial dysplasia (OED) or oral squamous cell carcinoma (OSCC) at a tertiary care centre in Toronto, Canada.

Results: Five-hundred-fifty-five patients identified with biopsy proven OLP or OLL met the inclusion criteria. In total, 3.2% (n = 18) progressed to OED (1.8%, n = 10) or OSCC (1.4%, n = 8). Risk factors associated with transformation included the plaque-like subtype (OR = 40.33, p < 0.001) and lesions located on the tongue (OR = 6.81, p = 0.008).

Conclusions: Clinical examination to identify lesion subtype and location provides useful indicators for risk of progression in patients with OLL and OLP.