Current Opinion in Otolaryngology & Head and Neck Surgery最新文献

Purpose of review: To summarise current understanding of and highlight recent literature on the management of paediatric head and neck teratomas.

Recent findings: Advances in foetal ultrasonography and MRI have enhanced early detection and anatomical characterisation, allowing for birth planning. The tracheoesophageal displacement index (TEDI) offers a predictive tool for airway risk. The EXIT (ex utero intrapartum treatment) procedure remains critical for airway control in high-risk cases, with foetal endoscopic tracheal intubation (FETI) emerging as a minimally invasive alternative. While histologically immature teratomas were previously thought to carry higher malignant potential, recent studies challenge this assumption. Complete surgical resection remains the cornerstone of treatment, with increasing use of intraoperative nerve monitoring. The role of adjuvant chemotherapy remains unclear, with limited evidence of efficacy in immature tumours.

Summary: Contemporary management of paediatric head and neck teratomas prioritises early identification, airway safety, and complete resection. Innovations in foetal imaging and perinatal planning have reduced morbidity, while long-term outcomes remain favourable. Ongoing research into minimally invasive foetal interventions and tumour biology is essential to further optimise care.

Purpose of review: This paper is aimed at synthetizing the conceptual basis of compartmental surgery (CS) for tumours of the anterior (floor of mouth and oral tongue) as well as posterior (base of tongue, superior and inferior gingival-buccal sulcus extending into the masticator space and infratemporal fossa) oral cavity, its indications, and outcomes.

Recent findings: In spite of numerous bioendoscopic, radiological, and surgical advancements in management of oral cancer, its oncologic surgical control continues to be hampered by a considerable risk of local recurrence rate. Use of a conventional approach based on an empirical 5 mm safe margin surrounding the lesion in its three-dimensional extension, even when associated to accurate frozen sections techniques, seems inadequate to improve the oncologic outcomes of these patients in the near future. In contrast, application of the CS concepts herein detailed seems to open new opportunities for increasing surgical radicality, while maintaining adequate functional outcomes when proper reconstructive techniques are applied.

Summary: Even though further multicentric prospective studies are needed to confirm the replicability of the oncological results described by pioneers of the CS approach, as well as to quantify the functional outcomes obtained by its large-scale application, this surgical philosophy confirms its vitality, relentless diffusion, and progressive evolution in the head and neck cancer arena.

Purpose of review: To examine how the clinical management of adults with laryngotracheal stenosis (LTS) by speech and language therapists (SLTs) has evolved over the past decade. The review highlights changes in assessment, counselling, and rehabilitation practices in response to advances in surgical interventions and explores implications for multidisciplinary care.

Recent findings: Recent literature and clinical experience demonstrate that SLTs play a critical role in managing voice and swallowing outcomes for patients with LTS. While established care pathways exist for reconstructive surgery, the increasing use of minimally invasive endoscopic procedures and complex cases require more nuanced, individualized approaches. Prospective studies have defined the impact of LTS and its treatments on voice and swallowing, and a core outcome set (COS-LTS) has been developed to standardize outcome reporting in future research. Psychosocial support and patient-centred decision-making have become integral components of care.

Summary: Adults with LTS experience multifaceted challenges affecting breathing, voice, and swallowing. SLTs are essential members of the multidisciplinary team, providing pre and postoperative assessment, counselling, and rehabilitation. Advances in treatment options and recognition of psychosocial impacts necessitate flexible, holistic care strategies. Future research should focus on validating outcome measures, implementing the COS-LTS, and incorporating patient priorities to optimize functional and quality-of-life outcomes.

Purpose of review: This review addresses the timely and relevant challenge of reconstructing extensive infratemporal fossa defects following composite bucco-alveolar cancer resection. The complexity of these three-dimensional defects, involving mucosa, soft tissue, and skin, alongside the frequent need for adjuvant radiation and the proximity to dissected cervical vessels, necessitates a deliberate and robust reconstructive strategy.

Recent findings: Recent literature underscores a shift towards a structured, component-based reconstructive approach. This review details the utility and specific limitations of regional pedicled and microvascular free flap options to restore critical elements: bulk, reliable lining, and durable external cover. Key technical considerations prominently discussed include managing vessel-depleted necks, utilizing vein grafts, mitigating risks associated with postchemotherapy thrombosis, and planning for salvage surgery.

Summary: The reviewed evidence supports a tailored, flap-specific approach based on defect components and patient-specific risk factors. For optimal outcomes in this complex anatomical region, surgical planning must prioritize the introduction of well vascularized tissue to ensure healing, protect vital structures, and withstand adjuvant therapies, thereby reducing complications and facilitating rehabilitation.

Purpose of review: This review highlights current management strategies for recurrent nasopharyngeal carcinoma (NPC) and their balance between efficacy and toxicity.

Recent findings: Optimal management of recurrent NPC requires individualized, multidisciplinary decisions that consider not only oncologic control but also functional outcomes and toxicity. Advances in imaging and Epstein--Barr virus DNA monitoring are improving early detection and risk stratification, helping tailor salvage approach to patient and disease factors. Recent evidences also shows that severe toxicity is not only modality-dependent but is shaped by patient and disease-related factors.

Summary: Endoscopic nasopharyngectomy achieves the best outcomes in resectable cases, with higher survival and lower morbidity than re-irradiation (re-RT). Extended resections are feasible only in selected cases. Re-RT, particularly with hyperfractionated intensity-modulated RT or proton therapy, remains essential for unresectable tumors but demands careful patient selection and vigilant management of late adverse effects. Systemic therapy has uncertain benefit, while immunotherapy is mostly effective in metastatic disease. Nodal recurrence is mainly managed with neck dissection, with prognosis shaped by extranodal spread and recurrence type.

Purpose of review: Intraorbital tumors present unique surgical challenges due to their proximity to critical neurovascular structures. This review examines current surgical approaches, emerging techniques, and outcomes in the management of these complex lesions.

Recent findings: Minimally invasive endoscopic approaches have expanded treatment options, particularly for medially and inferiorly located tumors. Classification systems such as CHEER and ORBIT now guide surgical planning based on anatomic location. Integration of image guidance, three-dimensional modeling, radiomics, and early reports of robotic assistance are promising adjuncts improving preoperative assessment and surgical precision.

Summary: Surgical management of intraorbital tumors has evolved significantly, with both traditional and endoscopic approaches achieving high rates of tumor control and functional preservation. A multidisciplinary approach, individualized surgical planning, and careful patient selection are essential for optimal outcomes.

Purpose of review: Systematic follow-up protocols, often including regular imaging, are an essential component of posttreatment care for head and neck cancer, aimed at the early detection of disease relapse and mitigating treatment-related morbidity. However, there is no consensus on the optimal length of follow-up and the value of imaging in surveillance.

Recent findings: Most head and neck cancer recurrences occur within 1-2 years after treatment. After 2 years, the recurrence rate decreases significantly, and after 3 years, recurrences are infrequent. Most of the recent studies suggest that prolonged scheduled follow-up programs are not necessary, as asymptomatic salvageable late recurrences are rare. Imaging surveillance for the early detection of otherwise undetected recurrences is supported by many studies, although its impact on survival remains unclear.

Summary: Recent literature emphasizes intensive follow-up programs during 1-2 years, as well as patient education for self-observation of alarming symptoms. Prolonged surveillance programs after 2-3 years may not be effective in detecting asymptomatic recurrences. While personalized surveillance based on risk factors is suggested, a lack of strict evidence hampers stratification. Imaging may be of value in detecting early asymptomatic recurrences at least up to 2 years, but disagreement exists regarding its utility in improving survival.

Purpose of review: Adnexal carcinomas (AC) are rare skin lesions predominantly affecting elderly individuals. These tumors are often located in the head and neck region and are influenced by factors such as sun exposure, prior radiation therapy, and immunosuppression. Understanding the pathogenesis and management of AC is crucial for improving patient outcomes.

Recent findings: AC may arise de novo or from preexisting benign lesions. They may act as cutaneous markers for hereditary syndromes, highlighting the need for their early identification. Accurate diagnosis is critical, requiring adequate biopsy for proper characterization, as superficial excisions may lead to mistakes. Surgical treatment remains the primary approach, with wide (at least 1 cm) surgical margins also recommended for lesions with lower malignancy potential. Mohs surgery is particularly useful for tumors located in cosmetically sensitive areas, offering precise resection and clear margins.

Summary: AC are classified into good, intermediate or poor prognosis categories based on the risk of local recurrence and distant metastasis. This classification assists in determining the need for adjuvant treatments and follow-up strategies. The proper understanding of risk factors, pathogenesis, and treatment options is essential to improve outcomes and ensure optimal management of AC.

Purpose of review: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been recognized as a diagnostic entity since 2017. It has been shown to exhibit indolent behaviour, and lobectomy alone is advocated as the treatment of choice. In this review, the diagnostic challenges including interobserver variation, the role of artificial intelligence, and the latest data on the risk of recurrence or metastasis, is evaluated.

Recent findings: Diagnosis of NIFTP is reliant on examination of the entire tumour-parenchymal interface. Strict criteria are required in order to establish a diagnosis. Inter-observer variation exists even among experienced thyroid pathologists. Recent studies continue to support the nonaggressive nature of NIFTP lesions.

Summary: NIFTP is considered a low risk follicular-cell derived thyroid neoplasm. Adherence to diagnostic criteria is crucial in accurately applying the diagnosis. Further long-term follow up is required in order to establish guidelines on the long term management of these patients.