Neck Oncology Research Articles

Female Representation Among Head and Neck Surgical Oncology Publications.

There is lower female representation within academic medicine. We aimed to investigate female authorship (FA) and female-held chair or program director (PD) positions within head and neck oncology (HNO). Articles authored by females about microvascular and reconstructive surgery (MRS) and transoral robotic surgery (TORS) were identified. A sub-analysis was performed by investigating the gender of HNO fellows, PDs, and chairpersons. These were collected, and FA reported. There were 1227 publications, 656 on MRS and 567 on TORS. Females authored 299 (24%) publications, 139 (23%) about MRS and 160 (30%) about TORS. There was no significant increase in FA or fellowship trends over time (p > 0.05). In our sub-analysis, we identified four HNO chairwomen (3%), and eight (6%) female HNO PDs. HNO chairwomen authored an average of 97 publications, PDs authored 37. FA in MRS and TORS remained stable between 2001 and 2022. Although few HNO females hold program chair or PD positions they perform quality research and serve as senior authors on a large proportion of publications.

Pre-implementation of electronic patient-reported outcomes at reference centers for head and neck oncology : Aroadmap towards patient-centered digitalization

Electronically captured patient reports (electronic patient-reported outcomes, ePROs) are digital questionnaires filled out by cancer patients. Despite indications of improved clinical care, the integration of ePROs into clinical head and neck oncology is uncharted territory. This work outlines the implementation process for ePROs at the University Hospital for Otorhinolaryngology at the Medical University of Innsbruck (ENT Innsbruck). The implementation is carried out by aproject team in apre-implementation phase (needs assessment, implementation planning, identification of intra-hospital barriers, prototype development, testing and adaptation, and user training), an implementation phase (implementation and user training), and apost-implementation phase (quality control and project expansion). The project team at ENT Innsbruck, consisting of 10members, identified the need for digitalization in cancer follow-up. Ahybrid implementation solution (Computer-Based Health Evaluation System, CHES; Evaluation Software Development, ESD, Innsbruck, Austria) was chosen. ePROs (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - 30 items, EORTC-QLQ-C30; Head and Neck Functional Integrity Scale, HNC-FIT scale; and EORTC Head and Neck Cancer Module, EORTC H&N43) will be collected 12times over 5.5years. Atotal of 25users rated the prototype as user friendly (patient perspective: 8.1 ± 1.6, 3-10; user perspective: 8.6 ± 1.1, 6-10). The main advantage was faster medical history taking (72%), and the main disadvantages were alack of personnel, time, and motivation (52%). The feedback on the ePRO prototype at ENT Innsbruck was positive. The implementation phase commenced in the first quarter of 2024. Goal achievement will be evaluated in the post-implementation phase in the fourth quarter of 2024.

Comparing Otolaryngology Subspecialties' Changes in Medicare Reimbursement From 2013 to 2024.

Identify differences in Medicare reimbursement changes for general otolaryngology, pediatric otolaryngology, head and neck oncology, laryngology, rhinology, otology, facial plastic and reconstructive surgery, and sleep surgery subspecialties from 2013 to 2024. Subspecialty-based procedures' facility prices and relative value units (RVUs) were sourced from the Centers for Medicare & Medicaid Services' Physician Fee Schedule. Prices were adjusted for inflation, and the average percent change in facility price and RVUs for each subspecialty was calculated. Each subspecialty's average inflation-adjusted, facility price change was compared to general otolaryngology using t-tests, and differences between subspecialties were assessed using Dunn's test. From 2013 to 2024, general otolaryngology's average percent change was -29.9% and significantly differed from facial plastic and reconstructive surgery (-26.4% [-5.5 to -0.7%]; p = 0.011) and sleep surgery (-23.7% [-19.2 to -2.2%]; p = 0.016). Rhinology (-32.5% [-1.3 to 6.1%]), otology (-30.2% [-6.5 to 7.6%]), laryngology (-29.3 [-4.2 to 2.1%]), head and neck (-27.4% [-5.7 to 0.2%]), and pediatric otolaryngology (-25.8% [-14.6 to 3.8%]) also decreased drastically but were not significantly different from general otolaryngology. For the multiple comparisons test, rhinology was statistically different from sleep surgery and facial plastic and reconstructive surgery. General otolaryngology and rhinology were more negatively affected due to changes in work and practice expense RVUs. Universal decreases were due to inflation and legislative reductions to the conversion factor. Medicare's budget constraints, potential effects on access to otolaryngology services, and continuing inflation warrant lobbying efforts to address these changes to maintain financial viability. NA Laryngoscope, 2025.

Endosonography in head and neck imaging and surgery.

This CME article explores the evolving role of endosonography in otorhinolaryngology and head and neck surgery. Endosonography offers significant potential to improve imaging inside the upper respiratory tract, particularly with advancements in probe technology and imaging resolution. Thearticle will describe the sonoanatomy of the oral cavity, pharynx, and larynx and the selection of probes and scanning techniques used for the various anatomical sites. Transoral ultrasound can be used to improve the diagnosis of salivary gland diseases, oropharyngeal abscesses, and ultrasound-guided puncture and biopsy. Endoscopic endolaryngeal ultrasound is used especially for diagnosing small laryngeal cancer and determining infiltration status. The article highlights the role of endosonography in managing oncologic diseases, especially in oral tongue carcinoma, where it aids in surgical planning by assessing the depth of invasion. In cases of HPV-positive carcinoma of unknown primary, high-frequency endosonography is crucial for detecting small tumors in the oropharyngeal region. In summary, the article advocates the broader integration of endosonography in clinical practice, highlighting its potential to enhance diagnostic accuracy and improve patient outcomes in head and neck oncology.

8 Evaluation of shared decision making in head and neck oncology: Quality improvement engagement with CQUIN in a regional cancer centre

8 Evaluation of shared decision making in head and neck oncology: Quality improvement engagement with CQUIN in a regional cancer centre

Construction and verification of prediction model for postoperative hypokalemia in patients with oral cancer.

This study aimed to explore the risk factors of postoperative hypokalemia in patients with oral cancer and to provide a basis for preventing and controlling postoperative hypokalemia. We included 366 patients undergoing oral cancer surgery in the Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University from January 2022 to August 2022. Univariate and multivariate analyses were used to determine the risk factors of postoperative hypokalemia. The receiver operation characteristic (ROC) curve was used to quantify the effectiveness of the factors. A nomogram of the risk factors for postoperative hypokalemia in oral cancer patients was developed and validated. A total of 224 patients (61.20%) had postoperative hypokalemia, the lowest serum potassium level (3.50±0.35) mmol/L on the 4th day after surgery, and the highest incidence of hypokalemia (54.68%). Variables with P<0.05 in the univariate analysis were quantified by ROC curve followed by multivariate logistic regression analysis. Results showed an independent correlation with postoperative hypokalemia as follows: preoperative serum potassium<3.87 mmol/L (P=0.008), preoperative serum calcium<2.31 mmol/L (P=0.033), preoperative PNI<49.16 (P=0.032), postoperative drainage volume>264.25 mL (P=0.002). The above variables were constructed into a postoperative hypokalemia risk nomogram and verified, and a good degree of fit was found. The independent risk factors for postoperative hypokalemia in patients with oral cancer were as follows: preoperative serum potassium<3.87 mmol/L, preoperative serum calcium<2.31 mmol/L, preoperative PNI<49.16, and postoperative drainage volume>264.25 mL. Clinical attention should be paid to managing the above high-risk patients. Preventive potassium supplementation should be performed as soon as possible to reduce hypokalemia occurrence.

97 ‘Pre-Hab.’ Is this the future for improved patients’ outcomes in Head &amp; Neck oncology patients?

97 ‘Pre-Hab.’ Is this the future for improved patients’ outcomes in Head &amp; Neck oncology patients?

Enhancing the timeliness of EMR documentation in resident doctors: the role of PDCA cycle management

BackgroundThe impact of the Plan-Do-Check-Act (PDCA) cycle in improving the timeliness of electronic medical record documentation (EMRd) remains uncertain. EMRd that is completed beyond the specified time is classified as late EMRd, while unqualified EMRd refers to electronic medical records with important sections that are not completed on time according to the Chinese Basic Norms of Medical Records Writing. This study aimed to evaluate the effectiveness of PDCA management in improving the timeliness of EMRd among resident doctors.MethodThis study utilized a before and after design. Resident doctors rotating in the Head and Neck Oncology Department of West China Hospital, Sichuan University, from November 2021 to August 2022 were classified as the control group and did not receive specific training on the timeliness of EMRd. Those rotating from September 2022 to June 2023 were assigned to the PDCA group, which was managed using the PDCA cycle. The effectiveness of PDCA cycle management was evaluated by comparing the incidence of late EMRd and unqualified EMRd between two groups. Univariate and multivariate binary logistic regression analyses were conducted tocontrol for confounding factors.ResultsA total of 245 resident doctors were included, with 162 doctors in the PDCA group and 152 doctors in the control group. The incidences of late EMRd (5.40% vs. 2.56%, P = 0.005) and unqualified EMRd (1.05% vs. 0.00%, P < 0.001) were significantly lower in the PDCA group than those in the control group. After adjusting confounding factors, PDCA management still significantly reduced the occurrence of unqualified EMRd (P < 0.001) with an adjusted odds ratio (OR) of 0.166 (95% CI 0.067–0.416) and late EMRd (P < 0.001) with an adjusted OR of 0.318 (95% CI 0.181–0.557).ConclusionThis study successfully developed PDCA management and demonstrated its effectiveness in improving the timeliness of EMRd while concurrently reducing the incidence of unqualified and late entries among resident doctors.

An Institutional Experience of Core Needle Biopsy with Cooperative Implementation by Pathologists and Head and Neck Oncologists in Salivary Gland Carcinoma.

A major problem in establishing treatment strategies for salivary gland carcinomas is the difficulty of preoperative histologic subtyping. Core needle biopsy (CNB) allows the collection of a small, intact specimens from the tumor center for detailed analysis. We evaluated the efficacy and limitations of preoperative diagnosis with CNB specimens collected using a newly developed 20-gauge needle designed to popularize its use. Paired preoperative CNB and surgical specimens from 41 patients with malignant salivary gland tumors were retrospectively reviewed. A histologic typing platform, including morphologic and immunohistochemical evaluation and fluorescence in situ hybridization, was evaluated using CNB specimens. Biopsy specimen quality, diagnostic accuracy, and immunohistochemistry concordance rates between biopsy and surgical specimens were analyzed. In 39 of the 41 patients, CNB provided high-quality specimens, enabling adequate morphologic, immunohistologic, and genomic analyses. In two patients, high-quality CNB specimens could not be obtained due to cystic fluid and tumor firmness. The overall accuracy of correct preoperative diagnosis was 75%. The success rate of histologic subtyping and HER2 immunostaining concordance between CNB and surgical specimens was lower in carcinoma ex-pleomorphic adenoma (CXPA) than in de novo carcinoma (histologic subtyping; CXPA vs de novo carcinoma 50% vs 89%, p = 0.016, HER2 concordance; salivary duct carcinoma [SDC] ex-PA vs de novo SDC 16% vs 100%, p = 4.66E-03). No recurrence occurred due to tumor seeding after CNB. Highly accurate histologic subtyping of salivary gland carcinomas can be performed by preoperative CNB; however, specificity can be more challenging in pathologically heterogenous tumors.

TEP in the ER: After Hours Tracheoesophageal Prosthesis Management for the Otolaryngologist.

Tracheoesophageal voice puncture and prosthesis (TEP) is a common method of voice restoration following total laryngectomy. A variety of complications, both minor and major, can be associated with the TEP and require timely intervention/management. Some of those complications include premature leakage, periprosthetic leakage, granulation tissue growth, TEP dislodgement, or embedding of the TEP. Patients may present with problems and/or complications with the voice prosthesis in an emergency setting or after clinic hours when a trained speech pathologist is not present or readily available for evaluation and management. This manuscript aims to provide guidance for management of acute TEP complications to otolaryngology responders, especially those who may be less familiar with TEP troubleshooting. Experiential and literature review was undertaken by a group of head and neck specialized Speech Language Professionals in high volume Head & Neck Oncology practices, to develop consensus guidelines for emergency TEP management. TEP emergencies were categorized as (1) leakage through, (2) leakage around, (3) sudden loss of voicing, (4) loss of prosthesis, still in tract, (5) loss of prosthesis, not in tract. Management strategies for each form of emergency were developed to achieve patient safety and stability until definitive measures could be performed by the patient's Speech Language Professional. The goals of emergency management of TEP problems focused on minimizing risk of aspiration pneumonia, risk of foreign body aspiration, risk of wound complications at the puncture site. A simple management algorithm was developed for emergency or on-call otolaryngology responders.

Trans-septal Mattress Suture: Securing Naso-Endotracheal Tubes With Enhanced Stability and Aesthetic Preservation.

Securing the endotracheal tube is vital for airway patency, especially in oral surgeries; naso-endotracheal intubation is ideal, but improper fixation risks nasal injury or accidental extubation. This technical note unveils the trans-septal mattress suture technique as a novel approach to secure naso-endotracheal tubes, amplifying stability, reducing trauma, and elevating aesthetic outcomes in head and neck surgeries. This study was performed at the Department of Oral and Maxillofacial Surgery at Kalinga Institute of Medical Sciences, Bhubhaneshwar, Khordha, Odisha, India, from December 2022 to March 2024 with due consent taken from all patients. Naso-endotracheal tube dislodgement during jaw fracture surgeries can cause nasal mucosa trauma and inadequate ventilation. Head and neck oncology cases require secure tube fixation due to prolonged intubation. Adhesive tapes lose adhesiveness, and fixators may obstruct visibility, while sutures offer reliable stabilization. A trans-columellar suture initially anchors the tube, but prolonged surgery risks skin necrosis and nasal deformity. Hence, we advocated a trans-septal mattress technique that relocates the knot to the septal area, preventing necrosis, ensuring stability, and minimizing postoperative deformity. Our trans-septal suture technique secures the naso-endotracheal tube by avoiding columellar scarring, ensuring better cosmesis while minimizing epistaxis risks. It offers a stable, cost-effective airway solution, ideal for prolonged surgeries, balancing function with aesthetics effectively.

Topical Anesthesia in Cutaneous Head and Neck Surgery: A Randomized Controlled Trial.

Cutaneous head and neck surgery can safely and effectively be performed using local anesthetic (LA). However, optimizing pain management during LA administration is paramount for patient comfort and procedural efficacy. The primary objective of this study was to investigate the comparative effectiveness of EMLA cream and ethyl chloride (EC) spray in mitigating pain associated with LA administration in cutaneous head and neck surgery. Randomized controlled trial. University-affiliated tertiary head and neck oncology center. Sample size calculation was performed followed by computer randomization into the following groups: EMLA, EMLA placebo (aqueous cream), EC, and a control group (no topical agent). Demographics, pain, and procedural experience scores were recorded perioperatively. Statistical analysis was performed to analyse differences between groups utilizing the Mann-Whitney U test, Kruskall-Wallis test, Chi-square test, and Spearman's Rho. 121 cutaneous lesions with a median patient age of 76 were analyzed. There were no statistically significant differences in pain scores (median [IQR]) between patients receiving EMLA (4 [3.75]), EMLA placebo (4.8 [3.6]), EC (5.8 [2.8]), and no treatment (5 [4.1], P = .19). Procedural experience scores were clinically similar (P = .02). Risk factors associated with elevated nociceptive sensitivity were surgical site (scalp, P = .01), malignant lesions (P < .01) and lesion surface area (rs = 0.22, P = .01). EMLA and EC did not mitigate LA-associated pain in patients undergoing cutaneous head and neck surgery and as such practitioners should reconsider their use of these in this regard. Patients' operative experience remains excellent regardless of topical anesthetic use. Ib.

Update on HPV-associated head and neck cancers-highlights of the 2024 ASCO Annual Meeting

Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is becoming increasingly important in head and neck oncology. At this year's conference of the American Society of Clinical Oncology (ASCO), alarge number of papers were presented on the topic of HPV-associated HNSCC, particularly with regard to neoadjuvant treatment approaches, radiation de-escalation strategies, therapeutic vaccines, and treatment monitoring. In this context, study results on the treatment of HPV-related recurrent respiratory papillomatosis (RRP) were also presented. Based on contributions to the 2024 ASCO Annual Meeting, an insight into the latest developments in HPV-associated diseases of the head and neck is provided. The papers were reviewed for clinical relevance and contextualized based on current therapeutic concepts. Alarge number of studies on liquid biopsies (LB) were presented. It was shown that although the methods for analyzing LBs for HPV-positive patients are well developed and can be used for diagnostics, risk classification, treatment management, or tumor follow-up, the methods vary considerably, and their clinical application has not yet been sufficiently validated. With regard to therapeutic HPV vaccination, three large studies were presented for the treatment of recurrent/metastatic HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). The only randomized study was on the vaccine ISA101b (peltopepimut-S) and did not reach its primary endpoint; however, the vaccine seemed to be highly effective in patients with a combined positive score (CPS) ≥ 20. Furthermore, data from aphaseIstudy on PRGN2012, an adenovirus-based immunotherapy used therapeutically for the treatment of recurrent respiratory papillomatosis (RRP), were presented. PRGN2012 led to areduction in surgical interventions for RRP, and the US Food and Drug Administration (FDA) designated PRGN2012 as abreakthrough therapy and orphan drug. However, the vaccine is not yet approved for the treatment of RRP.

Assessing Complications and Outcomes of Pectoralis Major Myocutaneous Flap in Head and Neck Oncology: Insights from 150 Cases

Assessing Complications and Outcomes of Pectoralis Major Myocutaneous Flap in Head and Neck Oncology: Insights from 150 Cases

Delta Radiomics — Potential role in Head Neck Cancer

IntroductionDelta radiomics is a tool used to assess the response of oncologic patients undergoing immunotherapy. It extracts high-dimensional quantitative features from medical images, providing information about cancer's phenotype, genotype, and tumoral microenvironment. This analysis could help avoid invasive procedures and help choose the most suitable therapeutic in multiple therapeutic options. Radiomics has gained interest as an imaging biomarker for predicting response to various immunotherapies. Delta radiomics assesses feature variations from one time point to another based on subsequent images, offering higher value for treatment-outcome prediction or patient stratification into risk categories. It has potential benefits for clinical endpoints in oncology, such as differential diagnosis, prognosis, treatment response prediction, and evaluation of side effects. Further research with prospective and multicentre studies is needed for clinical validation of delta radiomics approaches. Statement of clinical significanceIn head and neck oncology, delta radiomics can be used to enhance the precision of diagnosis, assess tumor response, forecast normal tissue toxicity, predict clinical outcome, and pinpoint characteristics for treatment modification. Patients' quality of life may be enhanced by it. It can support post-treatment surveillance. Additionally, it can support the delivery of individualized care based on a patient's reaction to medication and radiation.

Frank’s Sign which is a Marker of Coronary Heart Disease

In today's clinical practice, the importance of a thorough clinical examination of the patient is emphasised in the article. There are 2 real-world instances of diagonal earlobe creases, commonly referred to as Frank's sign. The patients in both cases have ischemic heart disease, however they differ in terms of age and Frank's sign severity. Data from the literature are presented regarding the frequency of Frank's disease in various population groups, as well as its clinical importance and potential underlying pathophysiological causes. In the medical literature, the diagonal ear lobe crease (DELC) is termed as a substitute sign that can detect high-risk individuals with hidden atherosclerosis. However, there hasn't been any research on this subject in the dentistry or medical literature. Most clinical, angiography, and postmortem data are in favour of the idea that DELC is a useful extravascular physical marker that can determine individuals who are at risk of dying from coronary artery atherosclerosis. Some research findings have failed to support the theory linking DELC to certain health conditions. However, recent studies utilizing B mode ultrasonography have indicated a connection between DELC and the development of carotid artery atherosclerosis. Another study has also associated DELC with the existence of calcified carotid artery atheromas visible on panoramic radiographs. Notably, DELC is highly noticeable on head and neck oncology screening examinations. When the patient's vital signs, medical examination, and panoramic radiograph are combined, the results are DELC can aid to assess the patient's risk of atherosclerosis.

From Bench to Bedside: A Team's Approach to Multidisciplinary Strategies to Combat Therapeutic Resistance in Head and Neck Squamous Cell Carcinoma.

Head and neck squamous cell carcinoma (HNSCC) is diagnosed in more than 71,000 patients each year in the United States, with nearly 16,000 associated deaths. One significant hurdle in the treatment of HNSCC is acquired and intrinsic resistance to existing therapeutic agents. Over the past several decades, the University of Wisconsin has formed a multidisciplinary team to move basic scientific discovery along the translational spectrum to impact the lives of HNSCC patients. In this review, we outline key discoveries made throughout the years at the University of Wisconsin to deepen our understanding of therapeutic resistance in HNSCC and how a strong, interdisciplinary team can make significant advances toward improving the lives of these patients by combatting resistance to established therapeutic modalities. We are profoundly grateful to the many scientific teams worldwide whose groundbreaking discoveries, alongside evolving clinical paradigms in head and neck oncology, have been instrumental in making our work possible.

Personalized Treatment Strategies via Integration of Gene Expression Biomarkers in Molecular Profiling of Laryngeal Cancer.

Laryngeal cancer poses a substantial challenge in head and neck oncology, and there is a growing focus on customized medicine techniques. The present state of gene expression indicators in laryngeal cancer and their potential to inform tailored therapy choices are thoroughly examined in this review. We examine significant molecular changes, such as TP53, CDKN2A, PIK3CA, and NOTCH1 mutations, which have been identified as important participants in the development of laryngeal cancer. The study investigates the predictive and prognostic significance of these genetic markers in addition to the function of epigenetic changes such as the methylation of the MGMT promoter. We also go over the importance of cancer stem cell-related gene expression patterns, specifically CD44 and ALDH1A1 expression, in therapy resistance and disease progression. The review focuses on indicators, including PD-L1, CTLA-4, and tumor mutational burden (TMB) in predicting immunotherapy responses, highlighting recent developments in our understanding of the intricate interactions between tumor genetics and the immune milieu. We also investigate the potential for improving prognosis accuracy and treatment selection by the integration of multi-gene expression panels with clinicopathological variables. The necessity for uniform testing and interpretation techniques is one of the difficulties, in implementing these molecular insights into clinical practice, that are discussed. This review seeks to provide a comprehensive framework for promoting personalized cancer therapy by combining the most recent data on gene expression profiling in laryngeal cancer. Molecularly guided treatment options may enhance patient outcomes.

Radiation therapy fractionation in the modern era of head and neck oncology towards an improved therapeutic window

Radiation therapy fractionation in the modern era of head and neck oncology towards an improved therapeutic window

Perioperative Management for Microvascular Free Tissue Transfer for Head and Neck Reconstruction – Commentary

Le et al. provided a comprehensive commentary on perioperative management for head and neck oncologic patients undergoing microvascular reconstructive surgery. This commentary is based on a detailed review and consensus statements from the Society for Head and Neck Anesthesia (SHANA), an international organization dedicated to enhancing perioperative care for these patients. The consensus statement, published in 2021 by Healy et al., addressed preoperative, intraoperative, and postoperative considerations to optimize clinical outcomes. It included 14 statements from 16 SHANA members across 11 institutions, following two rounds of literature reviews. The commentary emphasized the importance of preoperative nutrition optimization, tobacco cessation, and early recognition of alcohol withdrawal symptoms. In the intraoperative phase, key aspects such as airway management in cases of extensive tumor burden (including awake fiberoptic intubation and tracheostomy), fluid management, hemodynamic monitoring, and multimodal analgesia were briefly discussed. Notably, vasopressors can be used to optimize hemodynamic management without compromising flap perfusion. Additionally, careful fluid resuscitation is crucial to avoid fluid overload, which could increase the risk of flap failure. Multimodal pain management strategies were highlighted, including inhalational anesthetics, anti-inflammatories, narcotics, and regional anesthesia. In the postoperative period, effective communication between healthcare provider teams is essential. Airway management was linked to three of the five consensus statements, underscoring the need for clear and concise communication between the anesthesia and surgical teams. This includes coordinating ventilatory support weaning, extubation planning, and preparation for reintubation if necessary. Such measures help reduce intensive care unit (ICU) utilization, minimize airway-related adverse events, and shorten the length of hospitalization. Overall, the commentary hopes to serve as a guide for multidisciplinary head and neck oncology units across all international centers in managing this complex patient population.