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

Introduction: The anatomy of the tongue is three-dimensionally complex and is thought to play a central role in the local growth of oral tongue squamous cell carcinoma (OTSCC). Understanding patterns of tumor extension could improve a multimodal therapeutic approach. Thus, the main aim of this study was to provide a histological and microanatomical analysis of surgical specimens after compartmental surgery for OTSCC.

Materials and methods: The present prospective observational study included primary cT3 OTSCC (according to the eighth edition of the TNM classification) treated in an academic tertiary referral center with curative compartmental surgery, from July 2016 to July 2019. Analysis of histologic macrosections allowed assessment of standard pathologic parameters as well as a detailed analysis of the position of OTSCC cells from microanatomic and topographic standpoints.

Results: Of the 28 patients included, 71.4% were males, with a mean age of 64.9 years. Nine (32.1%) patients presented satellitosis, which was always located within the T-N tract. OTSCCs displaying satellitosis had a significantly higher median pathologic depth of invasion (DOI). A radiologic and pathological DOI > 15 mm significantly predicted the presence of satellites. There was a significant relationship between the presence of satellites and both positive lymph nodes and distant metastases.

Conclusion: Approximately one-third of cases of intermediate-to-advanced OTSCC are characterized by tumor satellites located in the T-N tract. DOI exceeding 15 mm and the presence of clinically appreciable nodal metastases best predict the presence of satellitosis. Satellite-bearing OTSCC behave more aggressively, with an increased risk of distant metastasis and reduced survival.

Background: This study evaluates the utility of PTeye autofluorescence (AF) technology in primary hyperparathyroidism (PHPT) surgery.

Methods: A retrospective review analyzed 232 patients undergoing first-time parathyroid surgery between September 2021 and 2023. Of these, 92 underwent surgery consecutively without PTeye assistance, then 140 underwent PTeye-guided surgery consecutively.

Results: The PTeye-guided surgery group showed significantly higher parathyroid gland identification rates (p < 0.001) and a 20.7 times greater likelihood of identifying all four glands compared to controls (3.3%). No cases of permanent hypoparathyroidism were reported, indicating the procedure's safety.

Conclusions: PTeye appears to be a safe and effective technology that can be used to improve parathyroid gland identification during first time surgery for PHPT. This is particularly beneficial for patient population with a high prevalence of multiglandular disease.

Background: Lymph node count (LNC) from neck dissection has been associated with undernutrition and survival in head and neck squamous cell carcinoma (HNSCC). As local components of the immune system, cervical lymph nodes may reflect anti-tumor immune status. This study investigates the relationship between decreased LNC, formation of tertiary lymphoid structures (TLS), and primary tumor infiltration by lymphocytes in undernourished patients.

Methods: A matched-cohort study was conducted in a tertiary medical center, where neck dissection quality was standardized for a total of 384 subjects that were evaluated. Six head and neck cancer patients that underwent primary surgery including neck dissection with low LNC and BMI (low BMI < 23, low LNC ≤ 5.6 per neck level) were matched by stage, p16 status, and subsite to 16 patients with normal BMI and high LNC. Multiplexed immunohistochemistry was used to evaluate the tumor-infiltrating lymphocytes and the number and quality of TLS within primary tumors. Whole primary cancers underwent automated analysis and counting of leukocytes after multiplexed immunohistochemistry staining of tumor slides. A head and neck pathologist blindly scored the number and maturity of TLS. Descriptive statistics were used to analyze outcomes.

Results: The patients with low BMI and low LNC had significantly fewer CD3 (p = 0.0136), CD8 (p = 0.0003), and CD20 (p = 0.0334) cells in their primary tumors compared to patients with normal BMI and LNC. The low BMI low LNC patients also had fewer mature TLS (0.83/tumor) in their primary cancers compared to patients with normal BMI and high LNC (5.4/tumor) and also had greater than fourfold lower mature TLS density (TLS per μm² mean) (6.34 × 10^-9 vs. 2.82 × 10^-8), with significantly worsened survival relative to patients with low BMI and normal LNC and patients with normal BMI.

Conclusion: Low LNC predicts worsened survival only in low BMI HNSCC patients with non-HPV related tumors and in these patients is associated with markers of immunosuppression such as fewer tumor-infiltrating CD8+ T-cells, CD20+ cells, and fewer TLS in primary cancers compared to matched normal BMI patients with high LNC.

Background: This study aimed to assess the occurrence of post-traumatic stress symptoms (PTSS) in head and neck cancer (HNC) patients. The goal also was to explore potential associations between PTSS, demographic factors, psychological variables, and specific genetic variants.

Methods: This study included a total of 155 HNC patients, divided into pre-pandemic (n = 76) and COVID-19 pandemic (n = 79) groups. PTSS assessments were conducted using a standardized questionnaire. The assessment of adverse childhood experiences (ACEs) involved specific questionnaire items. Genetic variants were identified via RT-PCR. Statistical analysis employed linear multivariate regression, while mediation analysis examined gene-environment interactions.

Results: In the pre-pandemic, higher PTSS scores were found to be associated with younger age (p = 0.02) and a history of cumulative ACEs (p = 0.001). Mediation analysis revealed that ACEs had a direct impact on PTSS scores, with the FKBP5 CC genotype (rs1360780, C>T) mediating this association by 29%. In the pandemic, elevated PTSS scores were correlated with a history of depression (p = 0.001), the negative impact of the pandemic (p = 0.007), and undergoing palliative treatment (p = 0.02).

Conclusions: Our findings provide insights into the psychosocial and genetic factors contributing to PTSS in HNC patients, considering the additional stressors introduced by the COVID-19 pandemic.

Background: The prognostic significance of close margins in oral squamous cell carcinoma (OSCC) is controversial. We wished to investigate the impact of close margins on the risk of local recurrence (LR) in OSCC according to the oral subsite.

Methods: A retrospective cohort study of 342 OSCC patients undergoing primary surgical treatment was conducted. Surgical margins were based on the main specimen and defined as positive (SCC at margins), close (< 5 mm), or clear (≥ 5 mm).

Results: Among tongue SCC cases, both positive (hazard ratio 13.48, 95% CI 2.03, 32.91) and close margins (hazard ratio 3.87, 95% CI 1.31, 11.34) were significantly associated with LR. Tongue margins < 4 mm were associated with higher LR. Among non-tongue SCC cases, only positive margins (hazard ratio 4.10, 95% CI 1.19, 14.21) were associated with LR. Close margins were not significant (hazard ratio 1.59, 95% CI 0.46, 5.42).

Conclusions: Close margins appear to have a differential impact on LR in OSCC according to the oral subsite.

Background: The reverse flow technique describes flap revascularization via anastomoses at the distal pedicle. The technique has been described for various indications but rarely as a means of flap salvage. To our knowledge, there are no previously reported cases where the reverse flow concept was utilized as a means of salvage of an osteocutaneous fibula free flap with severe atherosclerosis of the proximal peroneal artery.

Methods: We describe the use of reverse flow to salvage the case of a 71-year-old male with significant atherosclerosis of the proximal peroneal artery preventing adequate microvascular anastomosis and inflow, despite multiple attempts.

Results: We were able to establish arterial perfusion of the flap using a reverse flow technique, with perfusion through the distal peroneal artery via the contralateral facial artery.

Conclusion: This case describes the first reported use of the reverse flow technique for salvage of an osteocutaneous fibula free flap when severe atherosclerosis prevented antegrade arterial inflow. The technique appears to be a viable option for free flap salvage in similar instances.

Background: This study evaluated the efficacy of fluconazole prophylaxis in reducing radiation-induced oral mucositis (RIOM) and Candida carriage in head and neck cancer (HNC) patients undergoing concurrent chemoradiotherapy (CCRT).

Methods: A prospective, double-blinded, randomized controlled trial was conducted with 78 HNC patients receiving either fluconazole (100 mg daily) or placebo during CCRT. The primary outcome was the incidence of grade 2 or higher RIOM. Secondary outcomes included positive Candida cultures and colony-forming units (CFUs). Mixed-effects ordinal logistic regression and logistic regression were used for analysis.

Results: Fluconazole significantly reduced the incidence of grade 2 or higher RIOM at week 7 (p = 0.039), positive Candida carriage at week 4 (p = 0.024) and week 7 (p = 0.029), and median CFUs at week 7 (p = 0.050).

Conclusions: Fluconazole significantly reduces RIOM severity and Candida colonization in HNC patients undergoing CCRT, suggesting its efficacy as a prophylactic treatment.

Objective: We hypothesized that a method to segment human airways from clinical cases and import them into a case presentation environment in Virtual Reality (VR) could be developed to model and visualize complex airway stenosis for efficient surgical planning.

Methods: One normal and two pathological airways modeled from CT scans at a slice thickness of 0.625 mm were processed. A multidisciplinary team composed of airway surgeons, VR engineers, educators, and radiologists collaborated to create a clinically relevant VR rendering and explanatory Narrations of the three clinical cases. Segmentation and postprocessing were completed in the Mimics Innovation Suite v24 from Materialize. Structures were segmented from the level of bifurcation of common carotid arteries to the level of bifurcation of the main bronchi, including cartilaginous and bony airway structures, vessels, and soft tissues. They were then postprocessed into 3D image volumes and imported into syGlass (IstoVisio Inc.), a VR software.

Results: Direct visualization and free manipulation of these 3D airway models within the VR environment provided improved geometrical and anatomical details compared to traditional two-dimensional (2D) CT. Then, specialized presentation and active learning tools developed for scientific communication using the VR environment permitted the creation of VR Narrations to explain pathological cases.

Conclusion: The method to segment human airways from clinical cases used in this paper, combined with intuitive VR tools to overlay segmentation and image data in an active learning environment, shows potential in the use of 3D airway modeling and VR in clinical practice for the description and surgical planning of complex airways. Further work is needed to validate the use of these models in clinical practice and patient education.

Level of evidence: Level 4.

Background: Reconstruction of skin defects after oncological surgery for a cutaneous squamous cell carcinoma is often mandatory to facilitate adjuvant treatment and/or to prevent chronic wound problems. Some of the most challenging regions to reconstruct after resection of a skin tumor are the frontal and parietal parts of the skull.

Methods: This article describes three patients with large skin defects after oncological surgery that were reconstructed with the use of a (hemi) visor flap.

Results: The (hemi) visor flap is easy to harvest, resulting in a concise procedure and short hospitalization with maximum wound control.

Conclusion: The (hemi) visor flap is a safe and reliable option for the closure of large skin defects on the skull. Especially in the older and frail patient group.

Background: The scapula free flap is becoming increasingly more utilized in head and neck reconstruction due to its natural geometry and soft tissue versatility. This study reviews the incidence rate, risk factors, and treatments of complications of scapula donor site morbidity.

Methods: A review was performed for articles published between October 1990 and November 2022 in Medline (OVID), PubMed, Web of Science, and CENTRAL. After screening, 24 articles meeting the criteria were included.

Results: Overall, 660 head and neck surgeries with the scapula donor bone across 24 studies were included. Twenty studies of 612 scapula free flaps reported a pooled postoperative complication rate of 10.7%, with no major complications. Seven studies of 199 scapula reconstructions showed a mean Disability of Arm, Shoulder and Hand (DASH) score of 14.39/100.

Conclusion: With its low rate of morbidity, the scapula flap presents itself as a good alternative for patients at risk for poor healing.