Major Neck Research Articles

Comment on: Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction

Comment on: Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction

Sensory Dysfunction, Microbial Infections, and Host Responses in Alzheimer's Disease.

Sensory functions of organs of the head and neck allow humans to interact with the environment and establish social bonds. With aging, smell, taste, vision, and hearing decline. Evidence suggests that accelerated impairment in sensory abilities can reflect a shift from healthy to pathological aging, including the development of Alzheimer's disease (AD) and other neurological disorders. While the drivers of early sensory alteration in AD are not elucidated, insults such as trauma and infections can affect sensory function. Herein, we review the involvement of the major head and neck sensory systems in AD, with emphasis on microbes exploiting sensory pathways to enter the brain (the "gateway" hypothesis) and the potential feedback loop by which sensory function may be impacted by central nervous system infection. We emphasize detection of sensory changes as first-line surveillance in senior adults to identify and remove potential insults, like microbial infections, that could precipitate brain pathology.

(Invited) From Solid-State Li-S to Polysulfide Flow Batteries: Challenges and Opportunities

Despite several decades of research and development work on Li-S batteries, there are still several fundamental issues that limits their performance and life. Controlling the polysulfide dissolution remains the major bottle neck in liquid electrolyte-based system. To alleviate this issue, there has been a steady progress in transitioning to quasi solid-state gel electrolytes and solid-state sulfur. The talk will cover some recent results on soft-chemistry approach by using a polymer gel electrolyte that has high ionic conductivity at RT and buffers volume changes during electrochemical activity. One example relates to fabrication a gel S-cathode on a carbon nanotube (CNT) matrix coated with a crosslinked network of polyethyleneimine -poly (ethylene oxide) (PEI-PEO), and solvated Li salt (LiTFSI). By optimizing the salt and polymer composition the conductivity of gel electrolyte exceeded 1x10-4 S/cm at RT. Design of high-performance solid-state sulfur cathode relies on effective ionic and electronic wiring with optimal composition of solid- electrolyte and electronic diluent such as carbon nanotube of highly graphitic carbon. Achieving high loading solid-state sulfur cathode is challenging due to limited ion-transport. The talk will cover recent work on catholyte design for sulfur cathodes using sulfide based solid electrolytes. In contrast, RT Li/Na polysulfide flow batteries provide a completely different geometry and architecture where the energy and power density is dictated by the solubility of the polysulfide species in the desired solvent and membrane design and stability. Acknowledgment This research is supported by Asst. Secretary, Energy Efficiency and Renewable Energy (EERE), Vehicle Technologies Office (VTO) through the Advanced Battery Materials Research (BMR) Program and Energy Storage Program, Office of Electricity, Department of Energy, USA.

Adrenal gland injury in trauma patients and its impact on clinical outcomes.

Adrenal gland injury (AGI) associated with trauma is an uncommon and often overlooked condition. This study aimed to evaluate the frequency of AGI in individuals with severe trauma injuries and investigate the outcomes of patients with AGI. All patients admitted to a tertiary trauma referral center under the trauma protocol who had a computed tomography (CT) scan between January 2012 and January 2023 were analyzed retrospectively. Patients who were dead on arrival and patients with incomplete data were excluded. They were classified into two main groups, adult and pediatric, and further subcategorized by the presence or absence of radiologically evident AGI. Demographic data, mechanism of injury, injury severity scores (ISS), presence of concurrent abdominal injury, and 30-day mortality rates were compared. A separate analysis was performed for factors affecting mortality rates. A total of 1,253 patients were included: 950 adults and 303 pediatric patients. In the adult group, AGI was detected in 45 (4.7%) patients and was more commonly associated with the following mechanisms of injury: motor vehicle accidents (26.7% vs. 14.3%) and pedestrian accidents (37.8% vs. 15.5%). Injury to the right side was more common (55.6%). Patients with AGI had higher rates of concurrent liver (17.8% vs. 3.9%), spleen (11.1% vs. 3.6%), and kidney injuries (15.6% vs. 1.3%). In the pediatric population, AGI was detected in 30 patients (14.8%), a significantly higher rate compared to the adult group. Similar to the adult group, AGI was more commonly associated with concurrent abdominal injuries and had a right-sided dominance (60%), but the rate of concurrent abdominal injuries was higher in the pediatric group (80% vs. 46%). The 30-day mortality was significantly higher in both adult and pediatric AGI groups compared to patients without AGI (adult: 15.6% vs. 2.9%, pediatric: 10% vs. 1.8%). In patients with AGI, major head and neck injuries and chest injuries were associated with mortality. Adrenal gland injuries due to trauma are not uncommon. They are usually associated with blunt trauma and other concurrent abdominal organ injuries. The major contributors to mortality in patients with AGI were major head and neck injuries and chest injuries.

The impact of an enhanced recovery after surgery protocol for major head and neck oncologic surgery on postoperative complications and adjuvant treatment delivery.

The Commission on Cancer (CoC) recently introduced a quality metric to optimize time between major head and neck surgery and adjuvant treatment (TAT) ≤6 weeks, as TAT delay adversely impacts patient survival. This study evaluates whether enhanced recovery after surgery (ERAS) for this population reduces the rate of postoperative complications, length of stay (LOS), and TAT. Patients undergoing larynx or oral cavity resection with free flap reconstruction, ERAS, and adjuvant treatment after 2018 were compared to a historical pre-ERAS cohort. Patients underwent surgery at a single-institution tertiary referral center for complex head and neck oncology. Differences between groups were compared by chi-square, Fisher's exact, or Wilcoxon rank-sum test. TAT >6 weeks was evaluated with univariate and multivariable logistic regression. Thirty-nine pre-ERAS patients were compared to 39 ERAS patients. No demographic differences existed between groups. LOS was improved with ERAS (p = 0.005). ERAS patients were discharged to home and returned to their activities of daily living (ADL) earlier (p = 0.004, 0.001). ADL recovery was associated with on-time TAT ≤42 days on univariate analysis (OR 1.36, 95% CI 1.13-1.63, p = 0.001). TAT delay was less frequent with ERAS (51.3% vs. 69.2%), but this was not significant after multivariable logistic regression (p = 0.11). ERAS decreases LOS and returns advanced head and neck cancer patients to their ADL sooner. Postoperative ADL recovery independently predicts on-time adjuvant treatment. Still, compliance beyond 50% with the TAT ≤6 weeks CoC quality metric remains a major treatment barrier.

The Tumor Risk Score (TRS) – next level risk prediction in head and neck tumor surgery

PurposeHead and neck cancer surgery often requires postoperative monitoring in an intensive care unit (ICU) or intermediate care unit (IMC). With a variety of different risk scores, it is incumbent upon the investigator to plan a risk-adapted allocation of resources. Tumor surgery in the head and neck region itself offers a wide range of procedures in terms of resection extent and reconstruction methods, which can be stratified only vaguely by a cross-disciplinary score. Facing a variety of different risk scores we aimed to develop a new Tumor Risk Score (TRS) enabling anterograde preoperative risk evaluation, resource allocation and optimization of cost and outcome measurements in tumor surgery of the head and neck.MethodsA collective of 547 patients (2010–2021) with intraoral tumors was studied to develop the TRS by grading the preoperative tumor size and location as well as the invasiveness of the planned surgery by means of statistical modeling. Two postoperative complications were defined: (1) prolonged postoperative stay in IMC/ICU and (2) prolonged total length of stay (LOS). Each parameter was analyzed using TRS and all preoperative patient parameters (age, sex, preoperative hemoglobin, body-mass-index, preexisting medical conditions) using predictive modeling design. Established risk scores (Charlson Comorbidity Index (CCI), American Society of Anesthesiologists risk classification (ASA), Functional Comorbidity Index (FCI)) and Patient Clinical Complexity Level (PCCL) were used as benchmarks for model performance of the TRS.ResultsThe TRS is significantly correlated with surgery duration (p < 0.001) and LOS (p = 0.001). With every increase in TRS, LOS rises by 9.3% (95%CI 4.7–13.9; p < 0.001) or 1.9 days (95%CI 1.0-2.8; p < 0.001), respectively. For each increase in TRS, the LOS in IMC/ICU wards increases by 0.33 days (95%CI 0.12–0.54; p = 0.002), and the probability of an overall prolonged IMC/ICU stay increased by 32.3% per TRS class (p < 0.001). Exceeding the planned IMC/ICU LOS, overall LOS increased by 7.7 days (95%CI 5.35–10.08; p < 0.001) and increases the likelihood of also exceeding the upper limit LOS by 70.1% (95%CI 1.02–2.85; p = 0.041). In terms of predictive power of a prolonged IMC/ICU stay, the TRS performs better than previously established risk scores such as ASA or CCI (p = 0.031).ConclusionThe lack of a standardized needs assessment can lead to both under- and overutilization of the IMC/ICU and therefore increased costs and losses in total revenue. Our index helps to stratify the risk of a prolonged IMC/ICU stay preoperatively and to adjust resource allocation in major head and neck tumor surgery.

Lymphoma in Sjögren’s syndrome: no need for repetitive screening ultrasounds of the major salivary glands and neck in asymptomatic patients

Objective Patients with primary Sjögren’s syndrome (pSS) have an increased risk of lymphoma, especially mucosa-associated lymphoid tissue (MALT) lymphoma of the salivary glands. Risk factors for lymphoma are well known, but there are no studies on screening by imaging. Therefore, we aimed to assess the usefulness and adverse effects of ultrasound of the major salivary glands and neck as lymphoma screening. Method A retrospective, single-centre, analysis of imaging studies in pSS patients was conducted. Imaging studies were classified as either screening examinations (asymptomatic patients) or occasion-related (imaging due to signs of lymphoma or at least moderate systemic activity). Results were categorized as: not suspicious; requiring control; triggering tissue sampling with exclusion of lymphoma; or triggering tissue sampling with diagnosis of lymphoma. Results The study included 134 patients and covered 1031 patient-years. Lymphoma was diagnosed in 15 patients (11.2%), all of whom had clinical signs of lymphoma at the time of diagnosis. During this period, 569 screening examinations and 179 occasion-related examinations were conducted. None of the screening examinations detected lymphoma, but follow-up imaging was recommended in 17.1% (95% CI 14.2–20.4%) and invasive exclusion of lymphoma was performed in 0.5% (95% CI 0.1–1.5%). In contrast, lymphoma was detected in 6.1% (95% CI 3.5–10.6%) of occasion-related examinations. Conclusion pSS patients with neither signs of lymphoma nor increased systemic disease activity did not benefit from screening. In contrast, patients with symptoms of lymphoma or at least moderate systemic activity can benefit from imaging of the neck and major salivary glands.

Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations.

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.

Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction

The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected. This study looked at variables predicting major complications and flap failure in a single institution with the aim of determining whether the QOMS dataset adequately captures the appropriate data points. A prospective database of head and neck flap procedures and associated postoperative complications has been maintained in the maxillofacial surgery department since August 2009 up to August 2022 (n=1327). A total of 25 putative risk variables were extracted from the health records for each patient. The outcomes of interest were total flap failure and major complications. Independent predictors of flap failure were recipient site (sinonasal/anterior skull base), previous major surgery, previous major surgery and radiotherapy, and flap selection. For major complications ACE-27 comorbidity score, flap type, use of tracheostomy, elevated preoperative plasma C-reactive protein (CRP) and flap selection were independently predictive. Apart from preoperative activated innate immunity all relevant risk stratification variables identified in this study form part of the QOMS dataset. QOMS is therefore likely to adequately risk stratify patients based upon currently collected variables.

Finite Element Analysis of Cervical Spine Kinematic Response during Ejection Utilising a Hill-Type Dynamic Muscle Model.

To determine the impact of active muscle on the dynamic response of a pilot's neck during simulated emergency ejection, a detailed three-dimensional (3D) cervical spine (C0-T1) finite element (FE) model integrated with active muscles was constructed. Based on the Hill-type model characterising the muscle force activation mechanics, 13 major neck muscles were modelled. The active force generated by each muscle was simulated as functions of (i) active state (Na), (ii) velocity (Fv(v)), and (iii) length (FL(L)). An acceleration-time profile with an initial acceleration rate of 125 G·s-1 in the 0-80 ms period, reaching peak acceleration of 10 G, then kept constant for a further 70 ms, was applied. The rotational angles of each cervical segment under these ejection conditions were compared with those without muscles and with passive muscles derived from the previous study. Similar trends of segmental rotation were observed with S- and C-curvature of the cervical spine in the 150 ms span analysed. With active muscles, the flexion motion of the C0-C2 segments exhibited higher magnitudes of rotation compared to those without muscle and passive muscle models. The flexion motion increased rapidly and peaked at about 95-105 ms, then decreased rapidly to a lower magnitude. Lower C2-T1 segments exhibited less variation in flexion and extension motions. Overall, during emergency ejections, active muscle activities effectively reduce the variability in rotational angles across cervical segments, except C0-C2 segments in the 60-120 ms period. The role of the active state dynamics of the muscles was crucial to the magnitude of the muscle forces demonstrated. This indicates that it is crucial for pilots to consciously contract their muscles before ejection to prevent cervical spine injuries.

Imaging findings in Giant Cell Arteritis: Don't Turn A Blind Eye To The Obvious!

Giant cell arteritis (GCA) is the most common primary large vessel systemic vasculitis in the western world. Even though the involvement of scalp and intracranial vessels has received much attention in the neuroradiology literature, GCA, being a systemic vasculitis can involve multiple other larger vessels including aorta and its major head and neck branches. Herein, the authors present a pictorial review of the various cranial, extracranial and orbital manifestations of GCA. An increased awareness of this entity may help with timely and accurate diagnosis, helping expedite therapy and preventing serious complications.ABBREVIATIONS: ACR= American College of Rheumatology, AION= Anterior Ischemic Optic Neuropathy, EULAR= European League Against Rheumatism, GCA= Giant Cell Arteritis, LV-GCA= Large vessel GCA, PMR= Polymyalgia Rheumatica, US= Ultrasound, VWI= Vessel Wall Imaging.

The histological spectrum and immunoprofile of head and neck NUT carcinoma: A multicentre series of 30 cases.

Head and neck nuclear protein of testis carcinoma (HN-NUT) is a rare form of carcinoma diagnosed by NUT immunohistochemistry positivity and/or NUTM1 translocation. Although the prototype of HN-NUT is a primitive undifferentiated round cell tumour (URC) with immunopositivity for squamous markers, it is our observation that it may assume variant histology or immunoprofile. We conducted a detailed clinicopathological review of a large retrospective cohort of 30 HN-NUT, aiming to expand its histological and immunohistochemical spectrum. The median age of patients with HN-NUT was 39 years (range = 17-86). It affected the sinonasal tract (43%), major salivary glands (20%), thyroid (13%), oral cavity (7%), larynx (7%), neck (7%) and nasopharynx (3%). Although most cases of HN-NUT (63%) contained a component of primitive URC tumour, 53% showed other histological features and 37% lacked a URC component altogether. Variant histological features included basaloid (33%), differentiated squamous/squamoid (37%), clear cell changes (13%), glandular differentiation (7%) and papillary architecture (10%), which could co-exist. While most HN-NUT were positive for keratins, p63 and p40, occasional cases (5-9%) were entirely negative. Immunopositivity for neuroendocrine markers and thyroid transcription factor-1 was observed in 33 and 36% of cases, respectively. The outcome of HN-NUT was dismal, with a 3-year disease specific survival of 38%. HN-NUT can affect individuals across a wide age range and arise from various head and neck sites. It exhibits a diverse spectrum of histological features and may be positive for neuroendocrine markers, potentially leading to underdiagnosis. A low threshold to perform NUT-specific tests is necessary to accurately diagnose HN-NUT.

Postoperative myocardial injury after major head and neck cancer surgery

Background/objective: This narrative review aims to assess the causes and evaluate the scientific evidence concerning the increased risk of postoperative myocardial infarction (PMI) in patients undergoing major head and neck surgery. Method: A comprehensive review of literature was conducted and findings from clinical trials, meta-analysis as well as observational studies were incorporated to explore the risk factors associated with PMI after a major head and neck surgery. Preoperative risk factors, appropriate diagnostic plans, biomarkers, risk stratification strategies, and treatment options were also assessed. Result: The review highlights that patients undergoing head and neck surgery are at a significant risk of developing PMI primarily due to surgical trauma, anesthesia, and the extensive nature of head and neck surgeries. However, pre-existing conditions like renal insufficiency, cerebrovascular diseases, and diabetes may also exacerbate this risk. Moreover, ECG and regular observation of troponin has proven to be successful in detecting PMI, which can be easily masked due to its ambiguous symptoms in postoperative patients that are receiving pain reducing medications. Once diagnosed, PMI is treated with standard medication for myocardial infarction, however, more emphasis has been put on its timely diagnosis through routine troponin testing. Conclusion: Head and neck cancers are prevalent in developing nations such as Pakistan where the use of tobacco is widespread. As a result of such aggressive cancer, patients may undergo surgery, which places them at a risk of developing PMI. This can be avoided through routine troponin testing which still requires further research on localized patient population considering the physiologic differences.

Length of Stay Prediction Models for Oral Cancer Surgery: Machine Learning, Statistical and ACS-NSQIP.

Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to compare the performance of statistical models, a machine learning (ML) model, and The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator in predicting LOS following surgery for OCC. A retrospective multicenter database study was performed at two major academic head and neck cancer centers. Patients with OCC who underwent major free flap reconstructive surgery between January 2008 and June 2019 surgery were selected. Data were pooled and split into training and validation datasets. Statistical and ML models were developed, and performance was evaluated by comparing predicted and actual LOS using correlation coefficient values and percent accuracy. Totally 837 patients were selected with mean patient age being 62.5 ± 11.7 [SD] years and 67% being male. The ML model demonstrated the best accuracy (validation correlation 0.48, 4-day accuracy 70%), compared with the statistical models: multivariate analysis (0.45, 67%) and least absolute shrinkage and selection operator (0.42, 70%). All were superior to the ACS-NSQIP calculator's performance (0.23, 59%). We developed statistical and ML models that predicted LOS following major free flap reconstructive surgery for OCC. Our models demonstrated superior predictive performance to the ACS-NSQIP calculator. The ML model identified several novel predictors of LOS. These models must be validated in other institutions before being used in clinical practice. 3 Laryngoscope, 134:3664-3672, 2024.

Performance Evaluation and Adaptability Study of Fodder Beet (&amp;lt;i&amp;gt;Beta vulgaris L&amp;lt;/i&amp;gt;.) Cultivars in Highlands of Bale Zone South East Ethiopia

Shortage animal feed interims of quality and quantity is the major bottle neck in livestock production through the year in Ethiopia particularly in the highlands of Bale Zone. A study was conducted at Sinana Agricultural Research Center (SARC), South East Ethiopia for three consecutive cropping season (2020/21, 2021/22 and 2022/23) in two locations (Sinana on station and Agarfa subsite) to evaluate the adaptability of four Cultivars of Fodder beet (namely Bircks, Kulumsa, Magnum and Robbos). Experimental plots were laid out in a randomized complete block design with three replications. All cultivars were performed well. However, there is significant variation among the Cultivars. The combined result over locations over years indicated that, Kulumsa cultivars gives the highest shoot fresh biomass yield (41.88 t ha&amp;lt;sup&amp;gt;-1&amp;lt;/sup&amp;gt;), root fresh biomass yield (86.49 t ha&amp;lt;sup&amp;gt;-1&amp;lt;/sup&amp;gt;) and shoot Dry biomass yield (4.52 t ha&amp;lt;sup&amp;gt;-1&amp;lt;/sup&amp;gt;). The remaining cultivars have not statistically significant different. Based on the results of this study, it is concluded that the Fodder beet Kulumsa cultivars was found a promising in terms of grain and biomass yield, than others that could be demonstrated and popularized as an alternative feed resources under smallholder conditions in the study areas and with similar climatic and edaphic conditions.

Six-week postoperative opioid use and pain following a randomized controlled trial evaluating multimodal analgesia for head and neck free flap patients.

Head and neck malignancy treatment often involves invasive surgeries, necessitating effective postoperative pain control. However, chronic reliance on opioid medications remains a challenge for many patients after surgery. Multimodal analgesia (MMA) within enhanced recovery after surgery protocols has shown success in limiting narcotic pain medications for other cancer types. In a prior study, MMA comprising acetaminophen, ketorolac, gabapentin, and a neurogenic block reduced opioid use in the 7-day postoperative period for major head and neck reconstructive surgery. This study investigates the impact of multimodal analgesia on opioid prescription and pain during the 6-week postoperative period for patients undergoing major head and neck oncologic surgeries, aiming to understand the longer-term effects of narcotic use. The study retrospectively examined participants in a [hybrid type 1 effectiveness-implementation pragmatic trial to assess multimodal analgesia's long-term effectiveness in head and neck free flap surgery. Arm A received scheduled acetaminophen and as-needed opioids, while Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the donor site, scheduled acetaminophen, and as-needed opioids. Retrospective data collection included opioid prescription use and pain scores up to 6 weeks after surgery, gathered from the Kansas prescription drug monitoring program, K-TRACS. Thirty patients participated, 14 in Arm A and 16 in Arm B. The average morphine milligram equivalents per day of filled prescriptions were not significantly different between Arm A and Arm B (7.23 vs. 7.88, p = .845). Additionally, average pain scores at 6 weeks showed no significant difference between the two groups (1.4 vs. 1.9, p = .612). Patients with head and neck cancer treated with multimodal analgesia during the perioperative period did not exhibit significant differences in opioid use and pain within 6 weeks after discharge. To confirm these findings, a re-examination with strict measures of opioid use and scheduled pain assessments in a prospective manner is warranted. 4.

Risk Factors for Postoperative Delirium in Patients Undergoing Major Head and Neck Cancer Surgery: A Meta-analysis.

Postoperative delirium (POD) is a common and serious complication after extensive surgery. Understanding the independent and potential modifiable risk factors leading to POD in patients with head and neck cancer (HNC) can provide information for future intervention trials aimed at reducing this risk. To systematically analyze influencing factors of POD in patients with HNC and identify high-risk individuals for delirium. PubMed, EMBASE, Scopus, OVID, and Cochrane Library were searched for publications prior to June 2023. Comparative studies in which POD risk factors were investigated were identified following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa Scale was used to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. This review included 17 studies with a total of 4188 patients undergoing HNC surgery. The pooled prevalence of POD was 15.44%. Based on pooled analysis, 8 significant risk factors were identified including age older than 70 years, male sex, history of smoking, history of psychiatric disorder, American Society of Anesthesiologists score, albumin level, postoperative insomnia, and fluid intake. In the present study, 8 factors that correlated with POD were identified: 6 preoperative, 1 intraoperative, and 1 postoperative. The influencing factors for POD in patients with HNC were identified that can provide a reference for improving the psychological state of the patient population and further development of effective treatment interventions.

Patient Experience of Head and Neck Surgery With Free Flap Reconstruction

Major head and neck surgery with microvascular free tissue transfer reconstruction is complex, with considerable risk of morbidity. Little is known about patients' experiences, including decision-making prior to, and regret following, free flap surgery. To characterize patient experiences and decision regret of patients undergoing head and neck reconstructive free flap surgery. This mixed-methods cohort study comprising semistructured interviews was conducted June to August 2021 at a single tertiary academic cancer center. Participants underwent head and neck reconstructive surgery with microvascular free tissue transfer (flap) more than 3 months before recruitment (range, 3 months to 4 years). Interview transcripts were qualitatively analyzed for themes. Participants also completed a Decision Regret Scale questionnaire. Microvascular free flap surgery for head and neck reconstruction. Thematic analysis of interviews, decision regret score. Seventeen participants were interviewed. Median (IQR) age was 61 (52-70) years. Overall, 7 participants were women (49%), and 10 of 17 were men (59%). The most common free flap was fibula (8/17, 47%). Three major themes with 9 subthemes were identified: theme 1 was the tremendous effect of preoperative counseling on surgical decision-making and satisfaction, with subthemes including (1) importance of clinical care team counseling on decision to have surgery; (2) emotional context colors preoperative understanding and retention of information; (3) expectation-setting affects satisfaction with preoperative counseling; and (4) desire for diversified delivery of preoperative information. Theme 2 was coexisting and often conflicting priorities, including (1) desire to survive above all else, and (2) desire for quality of life. Theme 3 was perception of surgery as momentous and distressing, including (1) surgery as a traumatic event; (2) centrality of mental health, emotional resolve, and gratitude to enduring surgery and recovery; and (3) sense of accomplishment in recovery. On the Decision Regret Scale, most participants had no regret (n = 8, 47%) or mild regret (n = 5, 29%); 4 had moderate-to-severe regret (24%). In this mixed-methods cohort study, patient experiences surrounding major head and neck reconstructive free flap surgery were described. Opportunities to improve support for this complex and vulnerable population, and to mitigate decision regret, were identified.

Characterization of a Diverse Set of Conditionally Reprogrammed Head and Neck Cancer Cell Cultures.

To establish and characterize a diverse library of head and neck squamous cell cancer (HNSCC) cultures using conditional reprogramming (CR). Patients enrolled on an IRB-approved protocol to generate tumor cell cultures using CR methods. Tumor and blood samples were collected and clinical information was recorded. Successful CR cultures were validated against banked reference tumors with short tandem repeat genotyping. Cell morphology was archived with photodocumentation. Clinical and demographic factors were evaluated for associations with successful establishment of CR culture. Human papilloma virus (HPV) genotyping, clonogenic survival, MTT assays, spheroid growth, and whole exome sequencing were carried out in selected cultures. Forty four patients were enrolled, with 31 (70%) successful CR cultures, 32% derived from patients who identified as Black and 61% as Hispanic. All major head and neck disease sites were represented, including 15 (48%) oral cavity and 8 (26%) p16-positive oropharynx cancers. Hispanic ethnicity and first primary tumors (vs. second primary or recurrent tumors) were significantly associated with successful CR culture. HPV expression was conserved in CR cultures, including CR-024, which carried a novel HPV-69 serotype. CR cultures were used to test cisplatin responses using MTT assays. Previous work has also demonstrated these models can be used to assess response to radiation and can be engrafted in mouse models. Whole exome sequencing demonstrated that CR cultures preserved tumor mutation burden and driver mutations. CR culture is highly successful in propagating HNSCC cells. This study included a high proportion of patients from underrepresented minority groups. Not Applicable Laryngoscope, 134:2748-2756, 2024.

Bridging the gap: a simulation-based education programme to improve the management of postoperative neck haematomas

Postoperative neck haematomas have a reported incidence of 3.4%. They result in a longer length of hospital stay, higher costs and a higher mortality rate. Consensus guidelines provide an algorithm for the management of a suspected neck haematoma and recommend that staff are trained to recognise the symptoms and signs of a neck haematoma. They also suggest the introduction of a post thyroid surgery emergency box. Our aims were to provide education in the form of simulation scenarios and to introduce a neck haematoma evacuation box. This quality improvement project was carried out in a large tertiary referral hospital, with over 1000 beds. It is the major head and neck surgical centre in Ireland. Ethical approval was granted by the hospital. Four simulation training sessions were carried out with Ear, Nose and Throat (ENT) nurses and interns. Voluntary surveys were conducted before and after the sessions. A sample neck haematoma evacuation box was used for the simulation scenarios. 50 staff participated in simulation training. 7% of staff had seen a neck being evacuated on the ward. 37% had received prior teaching on the management of neck haematomas. Significantly more participants reported to know the symptoms and signs of a neck haematoma and the required management of a neck haematoma after completion of the simulation sessions. All participants agreed neck haematoma evacuation boxes were necessary and would improve patient outcomes. The pre-simulation survey demonstrated that an unacceptably low amount of staff had previous training on this topic. Simulation training resulted in more participants being able to identify the signs and symptoms of a neck haematoma and more participants feeling confident regarding the necessary actions. The results show the positive impact of simulation training and provide a basis for advocating for this training to continue on a regular basis. Simulation works to increase participants confidence and familiarity with a given situation. Simulation training also improves technical skills and teamwork. There was unanimous support for the introduction of the post neck surgery haematoma evacuation boxes, which suggests that these would be a valuable introduction in our hospital.