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

Background: Preirradiated patients undergoing microvascular head and neck reconstruction for tumor recurrence or osteoradionecrosis (ORN) face surgical site infection (SSI) rates exceeding 30%. The impact of perioperative extended-spectrum antibiotic coverage remains unclear. This study hypothesizes that calculated prophylaxis with piperacillin/tazobactam reduces early-onset SSI in this high-risk population.

Methods: From a microvascular reconstructed cohort, 161 with prior irradiation were retrospectively identified (tumor, N = 101; ORN, N = 60). SSI risk reduction was compared between patients receiving piperacillin/tazobactam (N = 39) and standard prophylaxis (N = 122).

Results: With underlying SSI incidence of 36%, piperacillin/tazobactam showed a fourfold SSI risk reduction (HR 0.24; p = 0.002) across the entire cohort and a fivefold reduction in patients with bone resection (HR 0.17; p = 0.01). Subgroup analyses confirmed this effect with a sevenfold reduction in tumor patients (HR 0.14; p = 0.008) and a threefold reduction in ORN patients (HR 0.29; p = 0.04). Extended coverage did not significantly prolong antibiotic treatment times.

Conclusion: In summary, calculated use of piperacillin/tazobactam in previously irradiated patients requiring microvascular reconstruction appears effective in reducing early-onset SSI.

Objective: Human papillomavirus-related (HPV+) sinonasal squamous cell carcinoma (SNSCC) is associated with improved overall survival (OS) compared to similarly staged HPV-negative SNSCC. However, data on treatment-specific outcomes remain limited.

Methods: We analyzed the National Cancer Database (NCDB) for all SNSCC cases diagnosed between 2010 and 2017 with available HPV testing data. Prognostically significant variables were identified via multivariable Cox regression. Propensity score-matched cohorts were then created, matching HPV-positive and HPV-negative patients exactly by treatment modality and other significant prognostic factors. The association between HPV status and 5-year OS was assessed across treatment strategies.

Results: A total of 1697 HPV-tested SNSCC cases were identified; 551 (32.5%) were HPV+. Multivariable Cox regression showed that HPV status, age, comorbidity score, tumor size, lymphovascular invasion, stage, and surgical margin status were significantly associated with outcomes. Within the propensity score-matched cohort, HPV positivity was significantly associated with improved OS among patients treated with chemoradiation (HR = 0.55; 95% CI = 0.35-0.87, p = 0.01). No survival benefit was observed in patients treated with surgery alone (HR = 0.85; 95% CI = 0.35-2.04, p = 0.71), surgery with radiation (HR = 1.38; 95% CI = 0.64-3.02, p = 0.41), radiation alone (HR = 0.40; 95% CI = 0.11-1.41, p = 0.16), or in the combined group of these three treatment strategies (HR = 0.97; 95% CI = 0.57-1.62, p = 0.90).

Conclusion: These findings suggest that HPV+ SNSCC may be particularly sensitive to chemoradiation. Routine HPV testing may be warranted to investigate if tailored treatment approaches focusing on chemoradiation may benefit patients with HPV+ SNSCC.

Background: Perineural invasion (PNI) in head and neck squamous cell carcinoma (SCC) results in worse overall survival. Diagnosis requires resection and microscopic evaluation.

Methods: A 63-year-old male with persistent cT4aN0 p16-positive SCC of the left base of tongue following chemoradiotherapy underwent salvage total glossectomy. Fluorescence-guided imaging of the wound bed was performed with PDE-GEN3 near-infrared (NIR) imaging following infusion of an optically EGFR-targeted antibody, Panitumumab-IRDye800 (pan800).

Results: The proximal resected hypoglossal nerve was imaged intraoperatively and demonstrated a strong green fluorescence signal, raising concern for subclinical PNI. Biopsy of the nerve revealed SCC on frozen section analysis. This was re-resected with subsequent proximal margin negative for carcinoma. Postoperatively, ex vivo imaging of the nerve using PDE-GEN3 NIR imaging again demonstrated the presence of pan800 within the initial positive nerve margin, confirming subclinical PNI.

Conclusions: This case shows the feasibility of intraoperative fluorescence as a method to help identify subclinical PNI.

Trial registration: ClinicalTrials.gov identifier: NCT05945875.

Background: Squamous cell carcinoma (SCC) of the oral vestibule is associated with significant surgical challenges, often requiring extensive resections with functional and cosmetic sequelae. Interventional radiotherapy (IRT, brachytherapy) may provide a function-preserving alternative.

Methods: We retrospectively analyzed clinical data from 12 patients with primary oral vestibule SCC treated between February 2022 and March 2025. Eleven underwent high-dose-rate IRT (HDR-IRT) with curative intent after multidisciplinary tumor board evaluation. Clinical outcomes, toxicity, and functional preservation were assessed.

Results: Of the 11 patients treated with HDR-IRT, ten achieved a complete response. At a mean follow-up of 20 months, nine were alive and disease-free. Two-year disease-specific survival and overall survival were 86% and 78%, respectively. Acute toxicity was limited to grade II mucositis, and long-term sequelae were minimal, with only mild skin dyschromia. No patient developed trismus or Stensen's duct dysfunction.

Conclusions: Exclusive HDR-IRT appears to be a safe, effective, and organ-preserving therapeutic option for selected oral vestibule SCCs; however, further studies in larger cohorts are needed to validate our findings.

Background: HPV-mediated oropharyngeal cancers have shown improved oncologic outcomes compared to traditional head and neck squamous cell carcinoma (HNSCC). P16, a surrogate marker for HPV, is also overexpressed in non-oropharyngeal squamous cell carcinoma (non-OPSCC), but its clinical impact remains unclear. This study evaluates the effect of p16 status in non-OPSCC.

Methods: A retrospective chart review of non-OPSCC patients from January 2017 to November 2023 was conducted. Demographics, clinical data, and p16 expression were analyzed. Survival and recurrence rates were compared using Cox regression and Kaplan-Meier with log-rank testing.

Results: A total of 197 patients with non-OPSCC were included, most commonly in the oral cavity (55.3%). P16+ tumors were found in 21.8% of cases. Median follow-up length was similar between groups (p = 0.724). Tumor recurrence rates were similar (p = 0.377), and p16+ status did not significantly impact survival.

Conclusions: P16 overexpression in non-OPSCC does not confer a significant survival advantage or reduced recurrence.

Background: This study aimed to develop a connector that adapts standard endoscopic instruments into functional nerve stimulator probes.

Methods: The connector underwent engineering validation in a laboratory and preclinical testing using a porcine model. A handheld standard stimulator probe served as the control. The experimental group consisted of a long monopolar probe and two connector-adapted probes. Recurrent laryngeal nerve (RLN) and vagus nerves were stimulated to compare the efficacy and safety of the adapted probes with the standard probe.

Results: The connector, when coupled to endoscopic instruments, did not show a statistically significant difference in electromyographic (EMG) amplitude at 1 mA stimulation compared with the standard probe. Safety analysis showed no significant hemodynamic effects.

Conclusion: This proof-of-concept study demonstrates that the developed connector, when paired with endoscopic instruments, enables reliable nerve identification and preservation during endoscopic thyroid surgery, with favorable efficacy and safety profiles.

Background: Head and neck cancer (HNC) is rising globally and linked to poor clinical outcomes. Health Literacy (HL) could potentially have a role throughout the HNC pathway.

Methods: Following PRISMA, this review assessed HL impact in HNC. Five databases and gray literature were searched for observational studies. Descriptive analysis and proportional meta-analyses were performed.

Results: Of the 70 studies, 11 met the inclusion criteria (2153 HNC patients), mostly from the USA (n = 7). The Brief Health Literacy Screen was the most used tool (n = 6). The post-treatment phase and quality of life (QoL) were the main outcomes studied. Inadequate HL (11.9%-47%) was more common among men, laryngeal cancer, and advanced HNC, reducing post-treatment adherence and delaying postoperative radiotherapy. Adequate HL was associated with higher education, better QoL, better health-promoting lifestyle, and shorter time to diagnosis.

Conclusions: HL influences diagnostic timelines, overall QoL, and post-treatment phase. However, its role in prevention, screening, and survival remains understudied.

Background: Subglottic stenosis (SGS) is a narrowing of the airway below the glottis and may be congenital or acquired. While prolonged intubation is the most common cause of acquired SGS, other etiologies remain incompletely understood.

Methods: A 37-year-old woman presented with a four-year history of mild progressive stridor, dysphonia, and chronic cough. Her medical history was notable for Graves' disease, treated initially with long-term carbimazole followed by radioactive iodine (RAI). She had never been intubated and had no autoimmune or rheumatologic disease. Awake fiberoptic endoscopy raised suspicion of SGS, which was confirmed by preoperative magnetic resonance imaging.

Results: Suspension microlaryngoscopy with biopsy and dilation revealed a Myer-Cotton grade II SGS with an irregular aspect and exposed cartilage. Histopathology demonstrated chronic inflammation, fibrosis, and reactive epithelial changes consistent with radiation-induced injury. After a second endoscopic dilation, only a minor anterior synechia remained, without evidence of recurrent stenosis.

Conclusions: This case report highlights a temporal association between RAI therapy and the subsequent development of SGS, supported by histopathological findings suggestive of radiation-induced tissue injury. In the absence of other established risk factors, RAI treatment may represent a rare but clinically relevant cause of acquired SGS, a complication not previously reported in the literature.

Background: Human papillomavirus-positive (HPV+) head and neck squamous cell carcinoma (HNSCC) generally has a better prognosis, but some cases are aggressive with poor outcomes. This study established KUSCC-192, a de novo HPV+ tonsillar cancer cell line, and evaluated its tumorigenicity.

Method: The HPV status in KUSCC-192 was assessed using RT-qPCR, RT-PCR, and FISH. Aggressive characteristics were compared with other HPV+ cell lines and HPV- cell lines.

Result: KUSCC-192 exhibited a mixed type with a predominantly diffused FISH pattern and a few dotted signals and lower E2 gene expression. These findings, combined with its aggressive features, suggest that the mixed type may contribute to the poor prognosis observed in 2%-30% of HPV+ HNSCC cases.

Conclusion: KUSCC-192 is a valuable model to study aggressive HPV+ cancer behaviors. Further research is needed to explore the clinical significance of mixed-type HPV integration in HNSCC.