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

Background: Head and neck reconstruction after resection of cutaneous malignancies spans the entire reconstructive ladder. Local flaps, such as the bilobed flap, offer excellent versatility, negligible morbidity, and minimal hospitalization. However, there is sparse data regarding the bilobed flap for large defects of the head and neck.

Methods: A retrospective case series identified patients undergoing head and neck reconstruction with a large bilobed flap for defect sizes ≥ 5 x 5 cm. Data collected included demographics, risk factors for impaired healing, operative variables, and complications.

Results: Nineteen patients were included; 15 (79%) were male, and median age was 80 years (47-88). Twelve patients had pertinent comorbidities and risk factors, including diabetes mellitus, current smoker, prior radiation to the operative area, and immunosuppressive state. Ten (53%) patients experienced complications, including infection, necrosis, or hematoma. Eleven (58%) patients received adjuvant radiation. Eleven (58%) patients were discharged within 1 day.

Conclusion: The large bilobed flap is an effective reconstructive technique for large head and neck cutaneous defects in properly selected patients. This flap can be a useful alternative to free tissue transfer in elderly patients.

Objective: To characterize the perioperative complications after ablative and reconstructive surgery in patients with head and neck cancer (HNC) based on race.

Methods: We conducted a retrospective study of the 2015-2020 National Surgical Quality Improvement Program Database. We compared the perioperative outcomes between White, Asian, Black, Native Hawaiian or Pacific Islander, and American Indian or Alaskan Native patients with bivariate analysis. Multivariate logistic regression assessed the independent association of race with perioperative complications.

Results: Black patients experienced longer surgeries (aβ, 43; 95% CI, 33, 53), longer hospital stays (aβ, 1.6 [95% CI, 1.1-2.1]), and were less likely to be discharged home (aOR, 0.64; [95% CI, 0.54, 0.76]). Black patients also had higher major complications risk (aOR, 1.38; [95% CI, 1.13-1.67]) with the most common being reintubation/ventilation (Black, 4.4% vs. White 2.7%; p = 0.003) and sepsis/septic shock (Black, 3.4% vs. White 1.8%; p = < 0.001). Black patients had higher reoperation rates (aOR, 1.33; [95% CI, 1.12-1.56]) with incision and drainage of abscess and hematoma, exploration of postoperative hemorrhage, thrombosis or infection, or surgical debridement being the top reasons for reoperation. Concordantly, they were at higher risk of postoperative transfusion (Black, 18%; White, 7.2%; p = < 0.001) and wound dehiscence (Black, 4.1%; White, 2.1%; p = < 0.001).

Conclusion: There is evidence of racial disparities in HNC surgery perioperatively. Black patients face an increased risk of major complications, reoperation, extended hospital stay, and non-home discharge. Developing a comprehensive surgical database with more social determinants of health variables and using a socioecological framework of health can help us identify contributors to these disparities and design high-leverage solutions.

Background: To spare important anatomical structures from damage during treatment of cystic odontogenic lesions, decompression has become a conservative alternative to enucleation. Marsupialization, in combination with the use of a custom-made decompression prosthesis, is an effective method of inducing reduction and bony infill of cystic lesions of the jaw.

Methods: In this case series and review of the literature, we describe three patients with odontogenic cysts of the mandible who were treated with custom-made decompression obturator prostheses (DOP) at the Memorial Sloan Kettering Cancer Center Dental Service.

Results: At the conclusion of treatment, all patients demonstrated complete resolution of their respective bony defects.

Conclusion: DOP provide effective means of keeping the cyst opening patent following marsupialization, which allows for adequate, if not complete, resolution of defects, often without need for subsequent enucleation.

Introduction: This study aims to improve the diagnostic yield of cervical fine-needle aspiration (FNA) through training on a novel liver model. Ultrasonography-guided fine-needle aspiration (US-FNA) is crucial for diagnosing head and neck lumps but requires meticulous execution. Limited resources often hinder systematic teaching, making practical models essential for training.

Methods: Fifteen otorhinolaryngology residents trained using a liver model with inserted Sensorium spheres to simulate cervical masses. The training involved viewing an instructional video, performing US-FNA on the model, and completing pre- and posttraining self-assessments. Performance was evaluated using visual analog scales (VAS), an adapted version of objective structured assessment of ultrasound skills (adapted OSAUS), and timing of procedures. Clinical impact was assessed by comparing diagnostic rates of US-FNA before and after training.

Results: Participants reported increased comfort and proficiency in US-FNA techniques posttraining. Adapted OSAUS scores improved significantly for image recognition and both in-plane and out-of-plane techniques. The diagnostic yield of US-FNA in clinical practice increased from 71% to 85%. No significant influence of gender, preferred ultrasound orientation, age, or experience on the learning curve was found. However, male participants showed a more substantial benefit from the training.

Conclusion: The liver model effectively enhances US-FNA skills, reflected in improved clinical diagnostic rates. Training on such models should be incorporated into medical education to reduce inconclusive punctures and enhance patient satisfaction. This study demonstrates the feasibility and effectiveness of a cost-efficient, reproducible model for US-FNA training, emphasizing the importance of practical training in medical education.

Objective: To identify current airway management practice patterns during free tissue transfer (FTT) reconstruction of head and neck defects.

Methods: A 27-question survey distributed to American Head and Neck Society (AHNS) members. Correlation between surgeon and patient variables with likelihood to perform tracheotomy and tracheotomy technique were evaluated.

Results: Our survey yielded 151 respondents. The majority (69.5%) reported performing tracheotomy for "most"/"every" FTT case. There was higher likelihood (p < 0.05) toward tracheotomy for patients with poor preoperative pulmonary status, larger defect size, and reconstruction of glossectomy and oropharyngeal defects. Tracheotomy was less likely (p < 0.05) during reconstruction of maxillary or palatal defects. Surgeons in practice for > 10 years were less likely to perform tracheotomy following reconstruction of hemiglossectomy defects (OR 0.36, p = 0.018, 95% CI 0.18-0.72).

Conclusion: This study identified practice patterns of airway management in patients undergoing head and neck FTT reconstruction. There is no current consensus regarding perioperative airway management in these patients.

Background: Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) aims to detect and prevent iatrogenic damage during thyroid surgery. Mechanisms of injury include traction, heat damage, and nerve transection. Continuous IONM (C-IONM) techniques detect impending damage due to traction and heat related when they are still reversible.

Methods: We present a 73-year-old woman who underwent a total thyroidectomy due to a goiter. The IONM included intermittent IONM (I-IONM) in combination with C-IONM using the laryngeal adductor reflex (LAR). The intraoperative neurophysiological signals recorded were correlated with the surgical maneuver and the postoperative evaluation.

Results: During surgery, a significant decrease in left LAR amplitude was observed, coinciding with the use of the harmonic. After some corrective maneuvers, the intraoperative signals recovered, and the postoperative examination showed adequate VF function.

Conclusions: C-IONM of the RLN using the LAR can be a valuable tool for detecting and preventing thermal spread injury during thyroid surgery.

Objectives: The choice of surgical access for resection and reconstruction of buccal squamous cell carcinoma (BSCC) with the lip-splitting incision is controversial. Thus, this study aimed to evaluate the clinical and functional outcomes of midline lip split with lazy-S incision (MLSI) against the lateral lip-splitting incision (LLSI).

Methods: A retrospective review was conducted on 41 patients with primary BSCC who underwent resection and reconstruction using MLSI approach (n = 19) and LLSI approach (n = 22) between 2022 and 2024. Functional outcomes, including skin sensitivity testing, oral competency, lip movement, cold perception, and other relevant measures, were evaluated with appropriate scales. Functional satisfaction and Patient and Observer Scar Assessment Scale (POSAS) were analyzed.

Results: None of the patients in either group demonstrated differences in sensation to light touch from baseline at 6 months postoperatively. Patients with MLSI approach reported higher lip function satisfaction (p = 0.037), and no patients in either group reported drooling. Besides, groove formation was significantly more common in the LLSI compared to the MLSI groups (50% vs. 15.8%, respectively; p = 0.046). A statistically significant difference was also observed in the self-assessment of mouth-opening movement among MLSI patients (p = 0.041). No significant differences were found in the mean POSAS scores, except that irregularity and surface area parameters were better in the MLSI group.

Conclusions: Objective sensation deficits are reversible and do not impact long-term daily activities. The MLSI approach provides better postoperative outcomes and low disfigurement perception.

Background: In this study, we aimed to analyze the efficacy and failure patterns of contouring target volume based on the residual tumor and decreasing the dose to the area of tumor regression after neoadjuvant therapy in locoregionally advanced head and neck squamous cell carcinoma (HNSCC).

Methods: We retrospectively analyzed the patients with locoregionally advanced HNSCC treated by our group from May 2011 to June 2023. All patients received neoadjuvant therapy followed by intensity-modulated radiation therapy. Gross tumor volumes for the primary tumor and metastatic lymph nodes were delineated according to postneoadjuvant extension. The tumor shrinkage after neoadjuvant therapy was included in the high-risk clinical target volume (CTV1) and prescribed a dose of 60 Gy. Kaplan-Meier analysis was employed to calculate local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), overall survival (OS), and distant metastasis-free survival (DMFS). Failure patterns were analyzed by mapping the location and extent of locoregional recurrence onto pretreatment planning CT.

Results: This study included a total of 114 patients, with a median follow-up of 34 months. The 5-year LRFS, RRFS, OS, and DMFS rates were 70.2%, 70.7%, 74.8%, and 73.8%, respectively. Among the 14 patients with recurrences, there were 5 local failures, 6 regional recurrences, and 3 both local and regional recurrences. All local recurrences occurred within the 95% isodose line, classified as in-field failures. Only one regional recurrence was marginal failure. No out-of-field failure was observed.

Conclusion: Reduction of target volume after neoadjuvant therapy and distribution of 60 Gy of dose to the tumor regression area may be feasible.

Background: Hashimoto's thyroiditis' (HT) impact on the aggressive lymph node (ALN) status of papillary thyroid carcinoma (PTC) remains understudied.

Methods: Univariate and multivariate analyses assessed PTC aggressiveness markers, comparing PTC + HT to PTC alone from a single center retrospectively. ALN categorization included > 5 positive, ≥ 1 > 3 cm, and/or ≥ 4 with extranodal extension lymph nodes.

Results: Of 533 patients with PTC, 19.1% concurrently had HT. Compared to PTC alone, PTC + HT patients were predominantly female (p < 0.001), younger (p = 0.034), non-smokers (p = 0.035), and had more pN0 stage tumors (p < 0.001). PTC + HT was associated with lower odds of pN1 stage (OR_adj, 0.50) and lymphatic invasion (OR_adj, 0.53). No significant differences were observed in ALN status, pT stage, lymphatic and perineural invasion, gross ETE, margin, and focality.

Conclusion: ALN status does not differ between PTC with or without HT.