Evaluating safety of observation after resection of low- and intermediate-grade major salivary cancers with isolated perineural invasion with or without facial nerve sacrifice.

Incidence of facial nerve sacrifice in parotidectomy for primary and metastatic malignancies

Cutaneous squamous cell carcinomas (cSCC) metastasizing to the parotid gland can cause facial nerve (FN) dysfunction secondary to direct invasion, perineural spread, or surgical ablation. This study aims to characterize the prevalence of preoperative FN involvement in metastatic cSCC to the parotid and identify risk factors resulting in FN sacrifice. Patients with parotid metastases from cSCC, treated surgically with parotidectomy with curative intent were identified through a retrospective cohort analysis of a prospectively maintained Sydney Head and Neck database from 1992 to 2021. Of 408 patients identified, 39 (10%) were found to have preoperative FN weakness, of which 41% underwent concurrent temporal bone resection compared to 9.1% for the overall cohort. All patients with preoperative FN weakness underwent FN sacrifice. FN sacrifice occurred in n = 145 (36%), of which 88 (61%) required sacrifice of a trunk or division. The 5-year disease free survival and disease specific survival was worse for patients requiring sacrifice of the FN trunk compared to no sacrifice, however there was no difference in survival for patients requiring sacrifice of the FN division or branch. We found those with > 23.5 mm parotid deposits had an odds ratio of 9.9 for FN sacrifice (95% CI 3.0-32.8, p < 0.001). Preoperative FN weakness was present in 10% of patients and 36% had some part of the FN sacrificed. There was no significant difference in outcomes for patients with and without preoperative FN weakness. Patients who undergo sacrifice of the FN trunk have worse survival compared to those not requiring FN sacrifice, however similar outcomes were observed in those requiring lessor degrees of FN sacrifice. The likelihood FN sacrifice rises with increasing parotid deposit size.

Recurrent pleomorphic adenoma of the parotid gland: Long-term outcome of patients treated with radiation therapy

This American Head and Neck Society (AHNS) consensus statement focuses on the detection and management of recurrent thyroid cancer. This document describes the radiologic approach to defining structural recurrent disease and the operative and nonoperative rationale in addressing identified structural disease to create equipoise in the personalized treatment strategy for the patient. The recommendations of this AHNS multidisciplinary consensus panel of the American Head and Neck Society are intended to help guide all multidisciplinary clinicians who diagnose or manage adult patients with thyroid cancer. The consensus panel is comprised of members of the American Head and Neck Society and its Endocrine Surgical Committee, and there is representation from medical endocrinology and both national and international surgical representation drawn from general/endocrine surgery and otolaryngology/head and neck surgery. Authors provided expertise for their respective sections, and consensus recommendations were made regarding the evaluation and treatment of recurrent thyroid cancer. Evidence-based literature support is drawn from thyroid cancer studies, recurrent thyroid cancer studies, and American Thyroid Association (ATA) guidelines. The manuscript was then distributed to members of the American Head and Neck Society Endocrine Committee and governing counsel for further feedback. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1862-1869, 2016.

Facial nerve (FN) palsy and perineural invasion (PNI) are adverse features in carcinomas of the parotid gland. FN sacrifice at the time of surgery is associated with significant morbidity. The role of adjuvant radiotherapy in patients with high-risk features, including FN involvement, remains unclear. Analyze the disease-free survival (DFS) and overall survival (OS) and the impact of tumor characteristics, including FN involvement, for patients treated with surgical resection for carcinoma of the parotid gland. This is a retrospective chart review. University of Utah and Intermountain Healthcare, Utah. A total of 129 patients who were treated with primary surgery for nonmetastatic primary malignancies of the parotid gland from 1988 to 2006. Parotidectomy with or without adjuvant therapy. Kaplan-Meier analysis was used to obtain 5-year estimates of DFS and OS. Recurrence risk factors, particularly the impact of FN involvement, were analyzed. Five-year DFS and OS rates were 79% and 78%, respectively. Thirty-two (28%) patients developed recurrent disease. Disease recurrence occurred in 64% of patients with both FN palsy and PNI, in 43% with FN palsy without PNI, in 27% with only PNI, and in 16% without either feature. FN involvement, particularly FN palsy, is a predictor of increased risk of recurrence and death. Radiotherapy cannot substitute for FN sacrifice in high-risk patients.

ObjectiveWe analyzed the incidence of facial nerve sacrifice during parotidectomy formetastatic cutaneous squamous cell carcinoma (CSCC).Study DesignWe retrospectively reviewed the charts of patients with cutaneous squamouscell carcinoma.SettingWe used our CSCC institutional database, which includes patients treated atthe University of California–Davis from 2001 to 2018.MethodsWe evaluated patients who presented with biopsy-proven head and neck CSCC whounderwent parotidectomy as a part of surgical treatment. We assessed thefrequency of facial nerve sacrifice required in patients with normalpreoperative facial nerve function with metastatic disease to the parotid.We evaluated the association between sacrifice and high-risk tumor variablesusing multivariate analysis.ResultsWe identified 53 patients with parotid metastasis and normal preoperativefacial nerve function. Thirteen percent of patients required sacrifice ofthe main trunk of the facial nerve and 27% required sacrifice of a branch ofthe facial nerve. All patients who underwent facial nerve sacrifice hadextracapsular spread (ECS). Perineural invasion (PNI) in the primary tumor(odds ratio [OR], 9.11; P = .041) and location ofmetastasis within the parotid body (OR, 6.6; P = .044) wereindependently associated with facial nerve sacrifice.ConclusionPatients with regionally metastatic CSCC to the parotid gland frequentlyrequire sacrifice of all or a component of the facial nerve despite normalpreoperative function. The likelihood of nerve sacrifice is highest fortumors with PNI and metastatic disease within the body of the parotid.

Background: Neoplasms of the parotid gland are difficult management issues because of the wide variation in their biological behavior and the potential for sacrifice of the facial nerve during resection. Because of the significant associated morbidity, prediction of facial nerve sacrifice is critically important for planning surgical procedures and preoperative counseling of patients. We hypothesize that along with the knowledge of the tumor type we would be able to accurately predict the likelihood of facial nerve sacrifice using cross-sectional imaging. Methods: All patients included in this study were previously untreated patients with parotid neoplasms operated on between January 1997 and July 2002. Only those patients with an available preoperative imaging were included and this resulted in 44 patients for review. Nine patients with preoperative deficits in facial nerve function were excluded from this study since these patients would require facial nerve sacrifice regardless of the radiological prediction. The prediction of facial nerve sacrifice was determined using a prediction of tumor location and an algorithm. The predicted results were compared to the operative record. Results: For all lesions, cross-sectional imaging predicted the need for sacrifice of the facial nerve with a sensitivity of 0.83 (95% CI, 0.36–0.99), specificity of 0.90 (95% CI, 0.72–0.97), PPV of 0.63 (95% CI, 0.26–0.90), and NPV of 0.96 (95% CI, 0.79–0.99). For malignant lesions only, prediction of sacrifice of the facial nerve had a sensitivity of 0.83 (95% CI, 0.36–0.99), specificity of 0.80 (95% CI, 0.51–0.95), PPV of 0.63 (95% CI, 0.26–0.90), and NPV of 0.92 (95% CI, 0.62–0.99). Conclusion: Cross-sectional imaging and application of our algorithm is a sensitive method for identifying patients with parotid neoplasms who require facial nerve sacrifice. CT and MRI have a high negative predictive value for facial nerve sacrifice.

Background: Oncological surgery of the parotid gland or of the temporal bone may require the contemporary sacrifice of the facial nerve (FN). In such cases, the immediate repair of the sacrificed FN is recommended. The aim of this study is to evaluate the impact of facial rehabilitation (FR) and, secondarily, of post-operative radiotherapy (PORT) on the FN outcome after FN sacrifice and reconstruction via cable graft. Methods: This is a multicentric retrospective study including patients affected by malignant tumors whose surgical excision required FN sacrifice and contextual FN reconstruction with a cable graft. Other FN reconstruction techniques were excluded. FN function was assessed using both House-Brackmann and Sunnybrook grading systems. Results: A total of 28 patients were included. Most of the patients underwent a total parotidectomy. The greater auricular nerve was the main donor for cable graft. FR and PORT were performed in 22 and 15 patients, respectively. In particular, 20 patients underwent neuro-muscular retraining (NMR). Patients who underwent FR had better FN outcomes compared to those who did not (p = 0.02 at 12 months and p = 0.0002 at 24 months). In contrast, there was no statistically significant difference between patients who underwent PORT and those who did not (p > 0.05). Pre-operative FN palsy is a risk factor of worse FN function outcomes after cable graft. Conclusions: Our study, even though it was limited to only 28 cases, may demonstrate that cable graft failure is not due to PORT, as widely believed among clinicians, but to the absence of a rehabilitation program. Moreover, we suggest that the key to obtaining the best possible FN function results after FN sacrifice is the association of a technically correct FN reconstruction with a proper and targeted FR.

Objectives To conduct a systematic review of facial nerve hemangiomas (FNH), focusing on patient characteristics, management options, and treatment outcomes. Design A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, utilizing PubMed, EMBASE, Scopus, and Cochrane databases from inception to December 31, 2022. Setting Literature sourced from various databases providing information on FNH cases. Participants A total of 176 patients with FNH were included in the study, identified from 40 articles meeting inclusion criteria. Main Outcome Measures Patient demographics, lesion characteristics, preoperative symptoms, surgical approaches, and postoperative outcomes, including House-Brackmann (HB) grades. Results Among the 1,682 initially identified articles, 40 were included in the final review. From these, a total of 176 patients (mean age = 42.7 ± 12.8, 51.1% male) were included for analysis. Bivariate analysis showed that patients with longer preoperative symptom duration and facial nerve sacrifice had significantly greater postoperative HB Grades ( p < 0.001). Additionally, a strong positive correlation was observed between pre- and postoperative HB Grades (Spearman's rho = 0.649). Multivariable linear regression analysis showed that both facial nerve sacrifice (β = 0.86, 95% confidence interval [CI]: 0.38-1.34; p < 0.001) and greater preoperative HB Grades (β = 0.36, 95% CI: 0.20-0.53; p < 0.001) were associated with significantly greater postoperative HB Grades, but preoperative symptom duration did not persist as a significant predictor of postoperative HB Grades. Conclusion FNHs are rare lesions of the skull base affecting the temporal bone. Our findings highlight the role of preoperative facial nerve function and intraoperative preservation of the facial nerve in predicting postoperative outcomes. Timely resection of lesions that prioritizes facial nerve preservation is critical to achieving optimal patient outcomes.

The primary purposes of this interdisciplinary consensus statement were to review the relevant indications for central neck dissection (CND) in patients with papillary thyroid cancer (PTC) and to outline the appropriate extent and relevant techniques required to accomplish a safe and effective CND. A writing group convened by the American Head and Neck Society (AHNS) Endocrine Committee was tasked with identifying the important clinical elements to consider when managing the central neck compartment in patients with PTC based on available evidence in the literature, and the group's collective experience. The position statement paper was then submitted to the full Endocrine Committee, Education Committee, and AHNS Council. This consensus statement was developed to inform the clinical decision-making process when managing the central neck compartment in patients with PTC from the AHNS. This document is intended to provide clarity through definitions as well as a basic guideline from which to manage the central neck. It is our hope that this improves the quality and reduces variation in management of the central neck, facilitates communication, and furthers research for patients with thyroid cancer. This represents, in our opinion, contemporary optimal surgical care for this patient population and is endorsed by the American Head and Neck Society. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1269-1279, 2017.

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

For decades, the American Head and Neck Society (AHNS) has been providing funding for meritorious research to investigators for studies on head and neck cancer. Recently, the AHNS Foundation sought to evaluate the impact of its funds for investigators and research. To examine the mechanisms and outcomes of research funding by the AHNS. An online survey was sent to all AHNS grant-funded principal investigators who had received funds from 1998 to 2018. Over this time, approximately $1.5 million in grant funding was awarded for research. Grants were separated into 2 groups: pilot and resident grants (PRs), approximately $10 000 each type of grant for 1 year, and career development grants (CDAs), approximately $20 000 to $80 000 over 1 to 2 years. Of 82 awardees, 49 individuals (60%) responded to the survey (36 men [73%]), including 28 recipients (57%) of PR grants and 21 recipients (43%) of CDA grants. Twenty-six studies (53%) were reported as translational, 20 studies (41%) were basic science, 2 studies (4%) were clinical, and 1 study (2%) was outcomes research. At the time of the award, 19 recipients (39%) were faculty/attending physicians, 11 recipients (22%) were fellows, and 19 recipients (39%) were residents/students. Twenty of 21 CDA grants (95%) were given to fellows or faculty. Thirty-seven grants (75%) resulted in publications, with a total of 84 publications reported. Nineteen CDA grants (90%) and 18 PR grants (64%) resulted in publication. Thirty-one (63%) investigators were awarded another grant after their AHNS grant: 19 CDA (90%), 8 pilot (44%), and 4 (40%) resident awardees reported having a future grant. Fourteen respondents (29%) reported a future K, R, or other major foundation grant. Of all awardees, 46 recipients (93%) were still conducting research and 40 recipients (82%) reported serving as academic faculty. Respondents also noted associations between grants and mentorship, investigator development, institutional support, and academic promotion. The findings of this study suggest that, over the past 20 years, the AHNS funding mechanism has resulted in 80% of awards generating publications and 63% resulting in future funding. The additional benefits of AHNS grant awards on the culture of research is also substantial. Continued analysis of these data may help guide future AHNS funding and award decisions.

The patient’s imaging features, especially the honeycomb pattern of ossific changes in the geniculate fossa, were virtually pathognomonic for ossifying hemangioma of the facial nerve.

The intraparotid facial nerve schwannoma: a diagnostic and management conundrum

Jeffrey N. Myers, MD, PhD, president of the American Head and Neck Society (AHNS) for 2016 to 2017, offered his perspectives on the AHNS’s history, present-day activities, and future plans at this year’s annual meeting of the society. The society was created from the 1998 merger of 2 societies, the Society for Head and Neck Surgeons (SHNS), founded in 1954, and the American Society for Head and Neck Surgery (ASHNS), founded in 1959, to become the largest organization in North America for the advancement of research and education in head and neck oncology. At a recent AHNS leadership retreat, a clear mission statement and core values were codified: the mission of the AHNS is to advance education, research, and the quality of care for head and neck oncology patients, and the core values are patient-centric, ethical, collaborative, innovative, value-based, and global. The educational mission of the society includes its annual meeting held at the Combined Otolaryngology Spring Meetings, and an International Conference on Head and Neck Cancer and hands-on instructional courses in head and neck ultrasonography and transoral robotic surgery. There are also web-based educational opportunities, including surgical videos and a journal club, as well as the oversight of the training of Fellows in Oncologic Head and Neck Surgery through the Advanced Training Council (ATC). The ATC conducts site visits to evaluate each training program every 5 years and is currently focused on developing core curricula for our training programs. Research is another mission critical activity of the AHNS. Each year, the research committee reviews applications from established researchers and trainees for several grants totaling more than $80 000 annually. Prior to this year, the money to support these awards has come from general operating funds from the AHNS annual budget. However, the Research and Education Foundation of the AHNS recently completed one of its major goals of raising $3 million. The interest on this corpus will now provide enough money to make these awards every year in perpetuity, thereby freeing up the AHNS’s general operating funds to support other mission critical activities. Given these significant advances in education, research, and fundraising, the AHNS is in “great health” and has a tremendous future in the hands of a talented and diverse group of current and emerging leaders.