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

Introduction: Head and neck rhabdomyosarcoma (HNRMS) is an aggressive malignant soft tissue tumor that easily develops lymph node metastasis (LNM) and distant metastasis. No literature investigates the pattern of LNM in HNRMS.

Methods: Ninety-five consecutive patients with HNRMS newly diagnosed at one institution between November 2011 and July 2023 were retrospectively reviewed. All the patients underwent head and neck contrast-enhanced MRI and/or CT, PET-CT if necessary. The associations between LNMs and clinical characteristics and histopathological parameters were discovered.

Results: 44.2% of patients had evidence of LNM at diagnosis, and the most common LNM occurred in the ipsilateral retropharyngeal space. The primary tumor metastasizes to the retropharyngeal space, and then next to level II is the most common LN drainage basin. In multivariate analysis, only distant metastasis determines the prognosis, other than LN status.

Conclusions: LNM has a high incidence in HNRMS and rarely causes contralateral metastasis for localized lesions or skip metastasis.

Background: Preserving laryngeal function after partial laryngectomy for laryngeal cancer is an important consideration. Therefore, we examined the use of thyroid flaps for this purpose.

Methods: We analyzed 21 patients who underwent thyroid flap reconstruction after partial laryngectomy for laryngeal cancer in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from January 2010 to January 2020. All patients were male and aged 51-64 years. Seventeen patients underwent modified tracheocricohyoidoepiglottopexy, and the remaining four patients underwent modified cricohyoidopexy. The thyroid flap was pedicled from the superior thyroid blood vessels. In the modified tracheocricohyoidoepiglottopexy, the flap was turned to cover the area between the tracheal ring and epiglottis to reconstruct the anterior wall of the cricoid cartilage, whereas in the modified cricohyoidopexy, it was turned over between the cricoid cartilage and tongue root to reduce anastomotic tension. A total of seven patients underwent radiotherapy and chemotherapy after surgery.

Results: Thyroid flap reconstruction was successfully performed in all patients. The postoperative hospitalization time was 9-21 days, the postoperative nasal feeding time was 18-47 days, and the tracheotomy tube was removed 30-160 days after surgery. No laryngeal stenosis, flap necrosis, bleeding complication, or dysfunction of the thyroid and parathyroid glands was observed after surgery. Two patients experienced wound infections about 1 week after discharge and were admitted again for antibiotic treatment. After dressing and compressing the neck wound, the patients were discharged. Three patients experienced local tumor recurrence after surgery, two of whom did not receive radiotherapy and chemotherapy after modified tracheocricohyoidoepiglottopexy. No patients had distant metastasis after surgery.

Conclusions: Thyroid flaps have significant application value in the reconstruction of the laryngeal cavity after partial laryngectomy for laryngeal cancer. It has high safety and feasibility, convenient surgical procedure, and satisfactory postoperative outcomes.

Major head and neck surgery poses a threat to perioperative airway patency. Adverse airway events are associated with significant morbidity, potentially leading to hypoxic brain injury and even death. Following a review of the literature, recommendations regarding airway management in head and neck surgery were developed with multicenter, multidisciplinary agreement among all Irish head and neck units. Immediate extubation is appropriate in many cases where there is a low risk of adverse airway events. Where a prolonged definitive airway is required, elective tracheostomy provides increased airway security postoperatively while delayed extubation may be appropriate in select cases to reduce postoperative morbidity. Local institutional protocols should be developed to care for a tracheostomy once inserted. We provide guidance on decision making surrounding airway management at time of head and neck surgery. All decisions should be agreed between the operating, anesthetic, and critical care teams.

Background: Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon.

Methods: Multi-institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103).

Results: Majority were gunshot wounds (GSW; 85%, n = 88) and motor vehicle accidents (11%, n = 11). Majority underwent osseous reconstruction (82%, n = 84). FF failures (9%, n = 9/103) occurred in GSW patients (100%, n = 9/9) and when multiple subsites were injured (89%, n = 8/9). Preoperative antibiotics correlated with lower rates of a neck washouts (4% vs. 19%) (p = 0.01) and 30-day readmissions (4% vs. 17%) (p = 0.02).

Conclusions: All FF failures occurred in the setting of a GSW and the majority involved multiple subsites. Preoperative antibiotics correlated with lower rates of postoperative washout procedures and 30-day readmission.

Circular pharyngolaryngectomy for oncologic resection requires a tubular reconstruction. Different options can be proposed to the patient: digestive free flap, fasciocutaneous flap, or musculocutaneous flap. The jejunum free flap is a tubular flap commonly used in esophageal and pharyngeal reconstruction with good functional outcomes and an acceptable rate of complications. Reconstruction with a jejunum free flap is an ideal choice. Patients at Gustave Roussy Institute (Villejuif, France) were offered a jejunum flap free flap for all circular pharyngolaryngectomies. The surgical technique is explained with a step-by-step video. The jejunum flap free flap has many advantages in circular pharyngolaryngectomy. This video article explains surgical steps for other teams.

Background: SWI/SNF complex-deficient sinonasal carcinomas are rare, genetically distinct, and aggressive entities.

Methods: SMARCB1 and SMARCA4 immunohistochemistry was retrospectively performed on a cohort of undifferentiated, poorly differentiated, and poorly defined sinonasal carcinomas. Survival outcomes were compared between SMARCB1/SMARCA4 (SWI/SNF complex)-deficient and -retained groups.

Results: Eight SWI/SNF complex-deficient (six SMARCB1-deficient, two SMARCA4-deficient) cases were identified among 47 patients over 12 years. Triple-modality treatment was more frequently utilized in SWI/SNF complex-deficient carcinomas than in SWI/SNF complex-retained carcinomas (71.4% vs. 11.8%, p = 0.001). After a median follow-up of 21.3 (IQR 9.9-56.0) months, SWI/SNF complex-deficient sinonasal carcinomas showed comparable recurrence rates (57.1% vs. 52.9%, p = 0.839), time-to-recurrence (7.3 [IQR 6.6-8.3] vs. 9.1 [IQR 3.9-17.4] months, p = 0.531), and overall survival (17.7 [IQR 11.8-67.0] vs. 21.6 [IQR 8.9-56.0] months, p = 0.835) compared to SWI/SNF complex-retained sinonasal carcinomas.

Conclusion: Triple-modality treatment may improve survival in SWI/SNF complex-deficient sinonasal carcinomas.

Background: Radiotherapy is used to treat oral cancer, yet it negatively affects patients' health-related quality of life (HRQOL). The aim was to evaluate the impact of an oral healthcare intervention on HRQOL of patients with oral cancer who receive radiotherapy with or without chemotherapy.

Methods: An oral healthcare intervention was provided to 41 patients with oral cancer before radiotherapy (fluoride varnish application, scaling, permanent restorations, adjustment of sharp teeth, and extraction of teeth with questionable prognosis, oral hygiene instructions), during, and 3 months after radiotherapy (baking soda mouthwash, artificial saliva spray). EORTC QLQ-H&N35 was used to compare the HRQOL of the intervention and control groups, with the latter having received routine oral healthcare.

Results: The intervention group showed lesser values for HRQOL domains and items indicating fewer side effects during the last week of radiotherapy and 3 months after, compared to the control group. Most of the changes in HRQOL were significantly less in the intervention group compared to the control group (p < 0.01).

Conclusion: The oral healthcare intervention effectively reduced the effect of radiotherapy and positively impacted on HRQOL of patients with oral cancer.