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

Background: Medial sural artery perforator (MSAP) flaps are favored in head and neck reconstruction for skin paddle pliability, pedicle length, and low donor site morbidity. We sought to characterize MSA vascular branching patterns based on the Dusseldorp et al. classification system using pre-operative lower extremity computed tomography angiogram (CTA).

Methods: We conducted a retrospective review of 153 scans from 78 patients who underwent CTA prior to head and neck reconstruction at our institution. Primary data points included MSA branching pattern, branch dominance, and vessel depth.

Results: The type IIa branching type was most prevalent and the MSA lateral branch most frequently dominant, and they were significantly related to one another. There was no significant difference in depth between branching patterns.

Conclusions: Lower extremity CTA provides valuable insight to vascular anatomy for MSAP flap harvest. The type IIa and IIb types may be associated with lateral and medial MSA dominance, respectively.

Background: The primary aim of this study was to characterize the prevalence of external branch of the superior laryngeal nerve (EBSLN) injury with and without the use of intraoperative neuromonitoring (IONM) and identify factors associated with injury.

Methods: Patients referred to our clinic for thyroidectomy between June 2015 and June 2016 were prospectively randomized into two groups (single-blinded): in Group 1, IONM was used during upper pole dissection only for the management of the recurrent laryngeal nerve (RLN); in Group 2, IONM was used for both RLN and EBSLN management. After thyroidectomy completion in all patients, cricothyroid muscle (CTM) EMG was performed.

Results: EBSLN injury was significantly higher in Group 1 (15.4 vs. 2.1% of NAR, p < 0.001). EBSLN injury was detected in 23 (9.4%) of 245 Friedman type 1, in 7 (18.9%) of 37 Friedman type 2, and in 3 (3.2%) of 94 Friedman type 3 nerves.

Conclusion: EBSLN injury is often a transection injury associated with permanent EBSLN dysfunction. Use of IONM facilitates the prevention of EBSLN injury.

Background: The association of chloride intracellular channel 2 (CLIC2) with tumors has remained unclear. However, recently, CLIC2 was found to exhibit antitumor properties in some tumors. In this study, we aimed to evaluate the clinical relevance of CLIC2 expression in head and neck squamous cell carcinoma (HNSCC) to determine whether it exerts antitumor effects similar to those in brain tumors and to explore its potential as a novel therapeutic target in HNSCC.

Methods: We explored the significance of CLIC in HNSCC using cell biological analyses and investigated the gene expression profile of the CLIC2 forced-expressed HNSCC cell line. CLIC2 expression in human HNSCC was examined histopathologically.

Results: Forced expression of CLIC2 in HNSCC cells was accompanied by increased cell proliferation, resistance against natural killer cells, and expression of tumor-promoting genes in addition to increased tumorigenicity upon xenografting in a mouse model. CLIC2 expression was observed in several human cases of HNSCC.

Conclusion: CLIC2 may act potentially as a novel risk factor for HNSCC.

Background: Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms with smooth muscle and melanocytic differentiation, typically occurring in genitourinary or abdominopelvic sites. While multiple anatomic sites have been reported, craniofacial involvement is exceptionally rare.

Methods: We report the first documented case of a probable high-grade malignant PEComa of the sinonasal tract with anterior skull base and orbital extension. The patient was a 42-year-old woman with a germline RB1 mutation, prior radiotherapy for bilateral retinoblastoma as an infant, and a history of left-sided sinonasal leiomyosarcoma treated with surgical resection and anthracycline chemotherapy. She represented six years later with new contralateral epistaxis and a friable right-sided nasal mass. Upon endoscopy and imaging, a locally aggressive lesion was confirmed.

Results: Histopathology showed a highly proliferative tumor with immunohistochemistry positive for HMB45, melan-A, SMA, caldesmon, and TFE3, with absent desmin and MITF. The lesion was most in keeping with a malignant PEComa. The tumor was resected via a combined transcranial, transcaruncular, and endoscopic endonasal approach, achieving clear margins. This case shows unusually rapid progression, likely influenced by prior radiation and germline RB1 gene mutation. Our literature review identified 41 previously reported primary craniofacial PEComas, consisting of 51% sinonasal, 37% orbital, and 10% skull base. Nearly all cases were benign and treated with surgical resection.

Conclusions: This report highlights a rare, malignant craniofacial PEComa with extensive invasion into the orbit and skull base, expanding the known clinical and molecular spectrum of these tumors.

Objectives: (1) To determine the incidence of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated base-of-tongue (BOT) oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery; and (2) to compare survival and recurrence in patients who did and did not undergo contralateral neck treatment.

Background: Contralateral neck management in patients with early-stage HPV+ OPSCC of the BOT treated surgically remains controversial. Despite lacking data, most patients receive surgery and/or radiation to the contralateral neck based on historical incidence of occult lymph node metastasis in OPSCC.

Methods: A retrospective chart review of patients with AJCC 7th edition pT1-2, pN0-1 HPV+ BOT OPSCC undergoing transoral robotic BOT resection and ipsilateral neck dissection with adjuvant treatment was conducted. The incidence of occult contralateral nodal metastasis was assessed. Overall and disease-free survival were compared between patients who did and did not undergo contralateral neck treatment.

Results: Of 106 patients meeting inclusion criteria, 46 (43.3%) did not undergo treatment of the contralateral neck with radiation or lymphadenectomy, whereas 29 (27.4%) received radiation alone to the contralateral neck, and 31 (29.2%) underwent elective contralateral neck dissection without identification of occult metastasis in any case. Overall survival (HR: 0.95, 95% CI: 0.23-4.00) and disease-free survival (HR: 1.43, CI: 0.55-3.71) did not significantly differ between patients who did and did not receive treatment to the contralateral neck.

Conclusion: Risk of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated BOT OPSCC treated with primary surgery was low, prompting consideration of forgoing contralateral neck treatment in these patients.

Background: Neck dissection, a cornerstone of head and neck squamous cell carcinoma (HNSCC) treatment, is associated with significant postoperative neck disability. This study prospectively evaluates the trajectory of patient-reported and objective functional outcomes to quantify disability and identify key predictors.

Methods: A prospective cohort of 178 patients undergoing neck dissection for HNSCC was assessed preoperatively and at 3, 6, and 12 months postoperatively. The primary outcome was the change in the Neck Disability Index (NDI). Secondary outcomes included neck pain (Visual Analog Scale, VAS), patient-specific function (Patient-Specific Functional Scale, PSFS), cervical range of motion (CROM), manual muscle testing (MMT), and spinal accessory nerve (SAN) function.

Results: At 12 months, functional outcomes failed to return to preoperative baselines. A significant proportion of patients had severe neck disability (NDI > 25, 22.7%) or poor objective neck mobility (CROM < 70% normative, 26.7%). Radical neck dissection (RND vs. MRND/SND: OR = 2.10, 95% CI: 1.02-4.32), dissection involving levels IV/V (OR = 2.45, 95% CI: 1.11-5.39), and administration of chemotherapy (OR = 2.18, 95% CI: 1.02-4.66) were independent predictors of severe disability. The upper trapezius was the most affected muscle, with SAN function remaining impaired in 42% of patients at 12 months. Strong correlations were observed between subjective disability and objective measures like CROM (r = -0.72, p < 0.001) and trapezius strength (r = -0.65, p < 0.001).

Conclusion: Neck dissection results in persistent disability strongly linked to surgical extent and chemotherapy. The concordance between patient-reported and objective measures underscores the need for integrated assessment and the development of tailored, multidisciplinary rehabilitation to mitigate long-term morbidity.

Background: The majority of lesions originally diagnosed as cancer of unknown primary (CUP) are eventually identified as HPV-associated oropharyngeal squamous cell carcinoma. Accurate primary tumor localization can facilitate targeted treatment or reduce adjuvant therapy.

Methods: This retrospective study examined patients who underwent transoral robotic surgery (TORS) for CUP from 2019 to 2022 at a tertiary care center. We analyzed the primary tumor identification rate, recurrence rate, and need for adjuvant therapy.

Results: A total of 48 patients with HPV-associated CUP underwent TORS, achieving an 87.5% identification rate (42/48). A total of 39.5% (19/48) avoided direct radiation to the primary site, and 20.8% (10/48) received no radiation. No patients had local recurrence, though three experienced regional or distant recurrence.

Conclusions: A primary surgical approach to HPV-associated CUP of the head and neck should be considered in every patient with CUP. When combined with a robust frozen section pathology protocol helping to guide intraoperative decision-making and margin revision, and a multidisciplinary approach to adjuvant therapy, precise tumor localization can help appropriately direct adjuvant therapy.

Purpose: We evaluate the appropriateness of current radiology size criteria (short axial diameter, SAD ≥ 10 mm) for malignant nodes in the parotid region (PLN), and appreciate the clinical implications of the Node-Reporting-and-Data-System (Node-RADS) in nasopharyngeal carcinoma (NPC).

Methods and material: NPC patients who received curative IMRT were included. Pre-treatment MRI was reviewed by two radiologists to record the presence/absence, size, and configuration of PLN, and calculated Node-RADS score. Malignant PLN was defined as either fine-needle aspiration (FNA) positive or the occurrence of subsequent out-field in situ PLN failure following parotid-sparing IMRT.

Results: Pre-treatment PLN was identified in 74 (11.8%) of 627 consecutive patients. SAD PLNs were 5-6 mm (n = 53, 72%), 6-8 mm (n = 15, 20%), 8-10 mm (n = 4, 5%), and ≥ 10 mm (2, 3%), respectively. FNAs were positive in 6 patients (2 each in SAD 6-8 mm, 8-10 mm, and ≥ 10 mm). Out-field in situ PLN failure occurred in 6 patients: 1 with SAD 5-6 mm, 3 with SAD 6-8 mm, and 2 with SAD 8-10 mm. The risk of PLN being malignant was 1.9% (1/53), 33.3% (5/15), 100% (4/4), and 100% (2/2) in SAD 5-6 mm, 6-8 mm, 8-10 mm, and ≥ 10 mm subsets, respectively. Malignant PLN with Node-RADS score ≥ 4 were 10% (1/10), 45.5% (5/11), and 100% (4/4) in SAD 5-6 mm, 6-8 mm, 8-10 mm subsets, respectively.

Conclusion: Current radiologic size criteria of ≥ 10 mm for positive PLN should be reduced to ≥ 8 mm. Node-RADS score of 4-5, which includes adverse morphological nodal features, could improve the specificity of identifying malignant PLNs in the 6-8 mm subset.

Objective: Obstructive sleep apnea (OSA) is a disorder with significant health implications. Variations in upper airway anatomy and pharyngeal tone are factors that predispose patients to OSA. Oropharyngeal cancer (OPC) may increase the risk of OSA due to treatment-induced changes in the upper airway. This scoping review aims to assess the prevalence of OSA in OPC patients post-treatment.

Data sources: A search was conducted across multiple databases, including PubMed, Embase, and Cochrane Library, to identify studies reporting the prevalence of OSA in OPC patients post-treatment (including surgery, radiation, and/or chemoradiation).

Review methods: Studies were screened for eligibility by two reviewers. Inclusion criteria required studies to use standardized diagnostic criteria for OSA and provide prevalence data specifically for post-treatment OPC patients.

Results: The search identified 788 studies: 30 underwent full-text review, and 13 studies with 373 head and neck cancer (HNC) patients met inclusion criteria. The majority of studies did not disaggregate data for OPC from other subsites; one study provided sufficient data on OSA prevalence in OPC patients post-treatment. Five studies reported AHI changes pre- and post-treatment with a mean change of 5.4 events/h with only 2 studies reporting significant changes in OSA rates. Sleep-related symptoms were captured in 11 studies with 2 comparing pre- and post-treatment.

Conclusion: Despite the growing recognition of OSA as a potential comorbidity in cancer survivors, the literature does not adequately address the prevalence of OSA in OPC patients post-treatment. This highlights the need for future studies targeting OSA prevalence in this population using standardized diagnostic methods and reporting criteria.

Background: Substernal goiters can cause aerodigestive symptoms but are often asymptomatic. This study evaluated the relationship between symptoms, demographics, pathology, and anatomical severity in substernal goiter patients using standardized tools.

Methods: A retrospective review of 201 patients surgically treated for substernal goiters over 11 years at a quaternary-care center was conducted. CT scan images were analyzed to measure tracheal deviation (TD), compression (TC), and depth. Symptoms included dysphagia, dyspnea, dysphonia, and coughing. Associations with demographics, anatomy, and pathology were analyzed.

Results: Dysphagia was the most common symptom (48.8%); 27% were asymptomatic. TC and larger specimen weights were significantly associated with dyspnea (p < 0.001, 0.013). TD, depth, age, and BMI showed no significant correlation with symptoms. Cough and vocal cord dysfunction were linked to aggressive pathology (p = 0.003, 0.017).

Conclusion: CT imaging is essential in evaluating substernal goiters, as symptoms alone are insufficient. Symptom profiles may also aid in predicting pathological severity.