Neck Surgeons Research Articles

Multidisciplinary survey on use of feeding tubes in head and neck cancer patients undergoing chemoradiotherapy in Germany—the SUFEETUBE project

Background and objectiveData on enteral tube feeding in head and neck cancer (HNC) patients undergoing chemoradiotherapy vary considerably between German institutions. This survey aims to investigate the management of feeding tubes in an interdisciplinary context across Germany.Materials and methodsBetween December 2022 and May 2023, 70 participants (42 radiation oncologists, 12 medical oncologists, 14 head and neck surgeons, and 2 physicians covering several specialties) responded to our web-based survey. In addition to the type of institution (university hospital, private practice, etc.), their age, and professional experience (in years), participants were asked several questions on the indication and institutional policy for tube placement and management (prophylactic/reactive nasogastric or gastrostomy tube). All questions were mandatory single- or multiple-choice questions, while additional comments were possible by email.ResultsMost participants were employed at a university hospital (n = 52; 74.3%) and came from a radiation oncology background (n = 42; 60%). Fifty-four contributors (77.1%) reported that no nutritional risk screening prior to chemoradiotherapy was routinely performed, and 71.4% (n = 50) stated that no standardized protocol was used at the institution to set the indication for tube placement. Generally, policies and methods of tube feeding vary considerably between the individual institutions and specialties. However, the majority (n = 56, 80%) recommended a prophylactic percutaneous enteral gastrostomy (PEG) tube to their patients before chemoradiotherapy. Still, there was no consistent trend regarding the approach for reactive tube feeding.ConclusionThe policies and methods of tube feeding vary considerably between the individual institutions and specialties in Germany. In the era of individualized medicine, uniform protocols are difficult to establish. However, a baseline nutritional risk screening could simplify decision-making in clinical practice.

Characterizing Long-Term Swallowing and Voice Outcomes Following Anterior Transcervical Approach.

(1) Assess the frequency and severity of long-term swallowing and voice complaints, follow-up care, risk factors for the development of long-term swallowing and voice complications in patients who underwent anterior transcervical approach (ACA). (2) Determine incidence of long-term swallowing and voice complications requiring follow-up otolaryngologic care and assess the frequency of otolaryngologic follow-up for postoperative swallowing and voice complaints. Retrospective cohort study of patients between January 2017 and March 2020 who underwent ACA. Demographic information, data from preoperative evaluation, operative records, and data from postoperative visits were collected. Patients were contacted to complete the Eating Assessment Tool and the "Impairment" subset of the Voice Symptoms Scale. A total of 48 patients (10.6%) followed up with a head and neck surgeon for swallowing complaints and 31 patients (6.8%) for voice complaints. Otolaryngology follow-up for swallowing complaints among patients with at least 3 and 12 months of follow-up was 16.4% and 17.8%, respectively. Otolaryngology follow-up for voice complaints among patients with at least 3 and 12 months of follow-up was 11.7% and 11.9%, respectively. Swallowing function was abnormal in 40.7% at least 3 months after surgery and in 41.8% 12 months after. Voice function was abnormal in 55.7% of respondents at least 3 months after surgery and in 54.5% of respondents 12 months after. ACA is associated with otolaryngologic complications that include dysphagia and dysphonia. This study demonstrates that long-term swallowing and voice dysfunction appear to persist longer than what is noted by patient utilization of follow-up otolaryngologic care. 4 Laryngoscope, 134:3201-3205, 2024.

The College of Otorhinolaryngologists and Head & Neck Surgeons of Sri Lanka: 19th Annual Academic Sessions 10th & 11th of February 2024, Programme and Abtract Book

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Thyroglossal duct cyst carcinoma: Case report

Introduction: Considered the most common congenital anomaly in the development of the thyroid gland, the thyroglossal duct cyst (TDC) has an estimated prevalence of 7% of the population. Although the vast majority of these cysts are benign, around 1% of cases can become malignant. Aim: To report the history, evolution and management of a patient with a thyroglossal duct cyst that developed into a carcinoma, to review the pathophysiology of the disease and the scarce literature on the subject. Case summary: 40-year-old woman diagnosed in 2018 with TDC. She went to a head and neck surgeon in 2020 for a reassessment of the case, to whom she reported an increase in the nodule and local discomfort. Surgery was indicated to remove it. The anatomopathological examination carried out after the surgery revealed a suspicion of malignant transformation. An immunohistochemical test was carried out, which confirmed the suspicion. The patient was asked to return in 6 months and to undergo ultrasound to monitor the pathology. Discussion: The thyroglossal duct results in the thyroid descending from the base of the tongue to its final resting place in the anterior region of the neck in the midline. This tract should obliterate at the beginning of fetal life; failure in this involution can subsequently give rise to a cyst in this duct. The cyst is often noticed after an upper respiratory tract infection and, in rare cases, a carcinoma can develop from the walls of the cyst. Conclusion: CDT carcinoma cases should be discussed due to the scarcity of reports in the literature and their rare incidence in the clinical field.

Diagnostic Difficulties of Plunging Ranula: A Review of 18 Cases.

Despite advancements in imaging techniques and cytological analysis, plunging ranula remains a challenging surgical, radiologic, and pathologic phenomenon. Of the 18 patients we evaluated at our institution, we highlight three cases that illustrate the high rate of misleading imaging and cytological results when assessing plunging ranula. Imaging results, biopsy findings, operative techniques, and pathological reports were reviewed from patients who had either a preoperative or postoperative diagnosis of ranula and underwent surgery by a single head and neck surgeon at a tertiary care center. Of the 18 identified patients, computed tomography was correct on preoperative imaging 73% of the time and magnetic resonance imaging was correct on preoperative imaging 71% of the time. Two patients underwent preoperative ultrasound and their ultrasound reports did not accurately diagnose the presence of a ranula. Two patients underwent preoperative fine needle aspiration biopsy due to inconclusive preoperative imaging, in which results suggested either a ranula or epidermal cyst. Both ultimately did not match the final pathology. Three of eighteen patients (17%) underwent an inappropriate initial surgery due to incorrect imaging diagnoses and/or biopsy findings. Despite use of preoperative modalities to distinguish plunging ranula from other cystic floor of mouth lesions, surgeons must be aware that no workup modality is fully precise. The potential for revision surgery must be included in all preoperative discussions for presumed plunging ranula. 4 Laryngoscope, 134:2689-2696, 2024.

Surgical Margin Definition and Assessment in Head and Neck Oncology: A Cross-Sectional Survey of Canadian Head and Neck Surgeons.

Head and neck squamous cell carcinomas (HNSCC) are responsible for a significant amount of morbidity and mortality in Canada. Surgical margins are one of the most important factors used to guide treatment; however, currently there is a lack of consensus on the ideal surgical margin definition, sampling, and assessment method. To understand the current perspectives and practice patterns of Canadian head and neck surgeons with respect to surgical margin: (1) definition, (2) sampling, (3) pathological assessment. A 24-question cross-sectional survey was sent via email through the Canadian Society of Otolaryngology-Head & Neck Surgery (CSOHNS), and responses were gathered from December 19, 2023, to March 12, 2024. Responses were aggregated and reported using descriptive statistics. The survey was conducted in Canada among self-reported staff head and neck oncology surgeons with membership in the CSOHNS. A total of 36 staff head and neck oncology surgeons responded from across Canada. The most common (58.3%) definition of a negative surgical margin for oral cavity HNSCC was ">5 mm formalin fixed paraffin embedded distance." To obtain surgical margins, surgeons were split with 44.1% using only a tumor bed approach and 32.4% using only a specimen-driven approach. A dedicated head and neck pathologist is always available more commonly for final pathological assessment (63.6%) versus intraoperative frozen section assessment (15.5%). Finally, most surgeons reported having a synoptic standardized reporting system for annotating margin status (78.8%). The results of this survey provide a current-state analysis of head and neck surgeons across Canada and set the stage for future efforts to be directed toward standardizing the collection method and reporting criteria for surgical margins in HNSCC.

Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management.

The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts. Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology-head and neck surgeons, a pediatrician and family physician. Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling. Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.

Exploring the Role of Artificial Intelligence Chatbots in Preoperative Counseling for Head and Neck Cancer Surgery.

To evaluate the potential use of artificial intelligence (AI) chatbots, such as ChatGPT, in preoperative counseling for patients undergoing head and neck cancer surgery. Cross-Sectional Survey Study. Single institution tertiary care center. ChatGPT was used to generate presurgical educational information including indications, risks, and recovery time for five common head and neck surgeries. Chatbot-generated information was compared with information gathered from a simple browser search (first publicly available website excluding scholarly articles). The accuracy of the information, readability, thoroughness, and number of errors were compared by five experienced head and neck surgeons in a blinded fashion. Each surgeon then chose a preference between the two information sources for each surgery. With the exception of total word count, ChatGPT-generated pre-surgical information has similar readability, content of knowledge, accuracy, thoroughness, and numbers of medical errors when compared to publicly available websites. Additionally, ChatGPT was preferred 48% of the time by experienced head and neck surgeons. Head and neck surgeons rated ChatGPT-generated and readily available online educational materials similarly. Further refinement in AI technology may soon open more avenues for patient counseling. Future investigations into the medical safety of AI counseling and exploring patients' perspectives would be of strong interest. N/A. Laryngoscope, 134:2757-2761, 2024.

Myomucosal island flaps for oropharyngeal reconstruction

The oropharynx represents one of the most challenging areas to reconstruct for the head and neck surgeon. The buccinator myomucosal island flaps pedicled on the facial artery [tunnelized facial artery myomucosal island flap (t-FAMMIF)] or the buccal artery [buccal artery myomucosal island flap (BAMMIF)] are an ideal reconstructive option for moderate size defects measuring up to 8–9cm. Two fresh specimens have been used to show the step-by-step surgical technique of both island flaps. Design and flap extension, dissection plane, identification of the vascular pedicle, flap rotation and insetting are described. Reconstructive indications and the pros and cons of each one are discussed in this article. Myomucosal island flaps represent a very useful and versatile option for the functional reconstruction of the oropharynx. A detailed knowledge of the vascular anatomy of the cheek is key to obtain a large flap while minimizing the risk of complications.

Influence of Otolaryngological Subspecialties on Perception of Transoral Robotic Surgery: An International YO-IFOS Survey.

To investigate perception, adoption, and awareness on the part of otolaryngology and head and neck surgeons (OTO-HNS) of transoral robotic surgery (TORS). Several items assessed: awareness/perception; access to TORS; training; indications and advantages/hurdles to TORS practice. A subanalysis was performed to assess differences according to the identified otolaryngological subspecialties. A total of 359 people completed the survey. Among subspecialties, while for otolaryngologists 30/359 (8.4%) and H&N surgeons 100/359 (27.9%) TORS plays an effective role in hospital stay, laryngologists frequently disagreed (54.3%). There was a lower incidence among rhinologists and otologists (1.9%). Pediatric surgeons (0.8%) reported a positive response regarding the adoption of robotic surgery, and head and neck specialists expressed an even greater response (14.2%). Low adherence was related to perceived cost-prohibitive TORS, by 50% of H&N surgeons. Perception, adoption, and knowledge about TORS play a key role in the application of the robotic system, significantly varying across subspecialties.

Innovations with the scapula and subscapular system for head and neck microvascular reconstruction

Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects. Since the first published description in the mid-1980s, advances have been made to the harvest technique, positioning, use of virtual surgical planning, and endosseous implants. Here, the most recent literature is reviewed for innovations related to the subscapular system. Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed. The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed, and novel applications of the scapula free flap are presented. Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.

Is ChatGPT accurate and reliable in answering questions regarding head and neck cancer?

Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence (AI)-based language processing model using deep learning to create human-like text dialogue. It has been a popular source of information covering vast number of topics including medicine. Patient education in head and neck cancer (HNC) is crucial to enhance the understanding of patients about their medical condition, diagnosis, and treatment options. Therefore, this study aims to examine the accuracy and reliability of ChatGPT in answering questions regarding HNC. 154 head and neck cancer-related questions were compiled from sources including professional societies, institutions, patient support groups, and social media. These questions were categorized into topics like basic knowledge, diagnosis, treatment, recovery, operative risks, complications, follow-up, and cancer prevention. ChatGPT was queried with each question, and two experienced head and neck surgeons assessed each response independently for accuracy and reproducibility. Responses were rated on a scale: (1) comprehensive/correct, (2) incomplete/partially correct, (3) a mix of accurate and inaccurate/misleading, and (4) completely inaccurate/irrelevant. Discrepancies in grading were resolved by a third reviewer. Reproducibility was evaluated by repeating questions and analyzing grading consistency. ChatGPT yielded "comprehensive/correct" responses to 133/154 (86.4%) of the questions whereas, rates of "incomplete/partially correct" and "mixed with accurate and inaccurate data/misleading" responses were 11% and 2.6%, respectively. There were no "completely inaccurate/irrelevant" responses. According to category, the model provided "comprehensive/correct" answers to 80.6% of questions regarding "basic knowledge", 92.6% related to "diagnosis", 88.9% related to "treatment", 80% related to "recovery - operative risks - complications - follow-up", 100% related to "cancer prevention" and 92.9% related to "other". There was not any significant difference between the categories regarding the grades of ChatGPT responses (p=0.88). The rate of reproducibility was 94.1% (145 of 154 questions). ChatGPT generated substantially accurate and reproducible information to diverse medical queries related to HNC. Despite its limitations, it can be a useful source of information for both patients and medical professionals. With further developments in the model, ChatGPT can also play a crucial role in clinical decision support to provide the clinicians with up-to-date information.

A novel endoscopic nasopharyngectomy by low-temperature plasma radiofrequency ablation in localized recurrent nasopharyngeal carcinoma.

Endoscopic nasopharyngectomy (ENPG) with en bloc resection has been well accepted in resectable localized recurrent nasopharyngeal carcinoma (rNPC), but it is a difficult technique to master for most otorhinolaryngology head and neck surgeons. Ablation surgery is a new and simplified method to remove tumors. We designed a novel method using low-temperature plasma radiofrequency ablation (LPRA) and evaluated the survival benefit. A total of 56 localized rNPC patients were explained in detail and retrospectively analyzed. The surgery method was ablated from the resection margin to the center of the tumor. The postmetastatic overall survival (OS), local relapse-free survival (LRFS) rate, progression-free survival (PFS) and distant metastasis-free survival (DMFS) were analyzed using the Kaplan-Meier method and compared by the log-rank test. All surgeries were successfully performed without any severe postoperative complications or deaths. The median operation time of ablation and harvested NSFF respectively were 29 min (range, 15-100 min) and 101 min (range, 30-180 min). The average number of hospital days postoperation was 3 days (range, 2-5 days). All cases (100.0%) had radical ablation with negative resection margins. The nasopharyngeal defects were completely re-epithelialized in 54 (96.4%) patients. As of the data cutoff (September 3, 2023), the median follow-up time was 44.3 months (range, 17.1-52.7 months, 95% CI: 40.4-48.2). The 3-year OS, LRFS, PFS and DMFS of the entire cohort were 92.9% (95% CI: 0.862-0.996), 89.3% (95% CI: 0.813-0.973), 87.5% (95% CI: 0.789-0.961), and 92.9% (95% CI: 0.862-0.996), respectively. Cycles of radiotherapy were independent risk factors for OS (p = 0.003; HR, 32.041; 95% CI: 3.365-305.064), LRFS (p = 0.002; HR, 10.762; 95% CI: 2.440-47.459), PFS (p = 0.004; HR, 7.457; 95% CI: 1.925-28.877), and DMFS (p = 0.002; HR, 34.776; 95% CI: 3.806-317.799). Radical endoscopic nasopharyngectomy by using low-temperature plasma radiofrequency ablation is a novel, safe and simplified method to master and disseminate for treating resectable rNPC. However, further data and longer follow-up time are needed to prove its efficacy.

Who Serves Where: A Geospatial Analysis of Access to Endocrine Surgeons in the United States and Puerto Rico

BackgroundThe association between surgical volume and patient outcome is well established, with higher case volume associated with a lower risk of complications. We hypothesized that the geographic distribution of endocrine/head and neck surgeons with an endocrine focus in the United States and Puerto Rico may limit access to many potential patients, particularly in rural areas. MethodsWe used web-based directories from the American Association of Endocrine Surgeons, American Head and Neck Society, and the American Academy of Otolaryngology–Head and Neck Surgery to identify endocrine surgery specialists in the United States and Puerto Rico. Using geographic coordinates and OpenStreetMap and Valhalla software, we calculated the areas within a 60-, 90-, or 120-minute driving distance from specialist offices. We used 2020 U.S. Census Data to calculate census tract populations inside or outside the accessible areas. ResultsExcluding duplicate providers across organizations, we geocoded 603 specialist addresses in the United States and Puerto. We found that 23.76% (78.3 million) of Americans do not have access to a society-affiliated endocrine/head and neck surgeon with an endocrine focus within a 60-minute drive, 14.37% (47.4 million) within a 90-minute drive, and 8.38% (27.6 million) within a 120-minute drive. We observed that the areas of coverage are primarily focused on metropolitan areas. ConclusionNearly one-third of Americans do not have access to a society-affiliated endocrine/head and neck surgeon with an endocrine focus within a 1-hour drive, highlighting a concerning geographic barrier to care. Further work is needed to facilitate patient access and mitigate disparities in quality care.

Microaggressions in European versus American Workplace Environments of Otolaryngology-Head and Neck Surgery.

To compare the workplace experience of European and U.S. members of the otolaryngology community. European and U.S. otolaryngologists-head and neck surgeons (OTO-HNS) were surveyed through three otorhinolaryngological societies. We inquired about personal and observed experiences of differential treatment in the workplace related to age, biological sex, ethnicity, disability, gender identity, political belief, and sexual orientation. Results were compared according to the world region. Differential treatment was used as a proxy for microaggressions. A total of 348 practitioners participated in the survey: 148 American and 230 European OTO-HNS. European OTO-HNS reported significantly higher proportions of observed or personal experiences of differential treatment based on age (p = .049), language proficiency (p = .027), citizenship (p = .001), hair texture (p = .017), height/weight (p = .002), clothing (p = .011), and professionalism (p = .002) compared with U.S. OTO-HNS. Differential treatment related to political belief (p = .043), socioeconomic status (p = .018), and ethnicity (p = .001) were higher in the United States compared with Europe. Feelings of exclusion (p = .027) and consideration of leaving their position (p = .001) were significantly higher in the United States compared with Europe. In both the United States and Europe, female OTO-HNS reported more frequent differential treatment related to biological sex than males. Differential treatment, or microaggressions, related to personal characteristics or behavior varied in the United States and Europe with more ethnicity-based microaggressions in the United States and physical characteristic-based microaggressions in Europe. In both regions, females were more subject to microaggressions than males. More efforts are needed to tackle microaggressions and discrimination in the clinical and academic workplace of the Western otolaryngology community. 4.

Acute cervical spinal cord injury after head and neck surgery: A CARE case report

ObjectiveTo describe and analyze a case of acute spinal cord injury after head and neck surgery. DescriptionOne hour after left lobo-isthmectomy under laryngeal neuromonitoring for a 3-cm EU-TIRADS 4 – Bethesda 4 thyroid nodule in a 48-year-old euthyroid male without any known comorbidity, left hemiparesis occurred. Cervical spine MRI showed an anteromedial herniated C6-7 disk with medullary compression. The disk was resected, compression was released and C6-7 fusion was performed via an anterior cervical approach on postoperative day 1. Postoperative course was unremarkable, with complete recovery of motion within 2 days. One month later, neurological clinical examination was normal and interview revealed left cervicalgia with onset a few days prior to lobo-isthmectomy. One year later, at the time of writing, the patient was doing fine. ConclusionOtorhinolaryngologists and head and neck surgeons must be aware of the risk of acute cervical spinal injury after cervical mobilization in head and neck surgery, and should take all measures to avoid this exceptional but dramatic complication.

Pediatric head and neck manifestations associated with multiple endocrine neoplasia syndromes.

Multiple endocrine neoplasia (MEN) syndromes are a group of hereditary cancer syndromes that can predispose children to endocrine neoplasms developing within the head and neck. To examine the neoplastic manifestations of MEN type 1 (MEN1) and MEN type 2 (MEN2) in the pediatric head and neck. Single-institution, retrospective review of pediatric MEN between 2005 and 2022. Fifty-three children were genetically confirmed with MEN (15 MEN1, 34 MEN2A, and 4 MEN2B), while three patients received clinical diagnoses of MEN1. The male to female ratio was essentially equal (1.15:1), and a documented family history of cancer was present in 89% (50/56). After multidisciplinary evaluation, a familial MEN diagnosis was confirmed in 91% (51/56). The mean ages of initial presentation and surgical intervention were 8.9 years (SD 5) and 9.8 years (SD 4.8), respectively. Although patients with MEN2 received surgery earlier than patients with MEN1 (8.7 vs 12.7 years), surgical patients with MEN2 in this cohort were older relative to current American Thyroid Association (ATA) guidelines primarily due to late presentation. Thyroid malignancies were identified in 36% (9/25) of thyroidectomy specimens (21 MEN2A, 4 MEN2B), with medullary thyroid carcinoma (MTC) present in five MEN2A patients and three MEN2B patients (89%), and papillary thyroid carcinoma (PTC) present in one MEN2A patient (11%). Nearly 90% (8/9) of thyroid malignancies were occult, with some occurring earlier than predicted by current guidelines (ATA-MOD and ATA-H). Central neck dissections were performed in 24% (2 MEN1, 2 MEN2A, and 4 MEN2B), with two MEN2B (50%) demonstrating cervical lymph node (LN) metastases. Additional histopathologic findings included C-cell hyperplasia in 57% (12/21) of MEN2A thyroidectomy patients. Of the eight MEN1 parathyroidectomy patients, four demonstrated parathyroid hyperplasia and four presented with parathyroid adenoma. Nearly 60% required head and neck procedures. While MEN1 guidelines were appropriate for our cohort, we identified patients with MEN2 that developed MTC earlier than expected based on current ATA guidelines, including children in categories considered lower risk. In conjunction with a multidisciplinary approach, pediatric head and neck surgeons should be aware of the potential need for earlier surgical intervention in the pediatric MEN2 population.

Characterizing gender trends in head and neck fellowship graduates from 2008 to 2018.

Evaluation of potential gender gaps among Head and Neck (H&N) surgeons can highlight areas for increased support of female H&N surgeons and improve gender diversity within the subspecialty. To evaluate gender trends in representation and career trajectory among recent H&N surgery fellowship graduates. This cross-sectional analysis included graduates from Head and Neck Surgery fellowships accredited by the American Head and Neck Society (AHNS) from 2008 to 2018. Additional demographic data was collected via publicly available websites including gender, years in practice, practice location, type of practice, h-index, and academic rank. The primary outcomes were the proportion of female Head and Neck fellowship graduates and gender trends in career trajectory and academic productivity (via h-index). Between 2008 and 2018, 449 surgeons graduated from Head and Neck surgery fellowship with females comprising 99 of 449 graduates (22%). Female representation increased from 1 of 30 (3%) graduates in 2008 to 17 of 52 (33%) in 2018. A proportionally similar number of women graduating fellowship also practiced in an academic setting (23%). There were fewer female assistant, associate and full professors compared with their male counterparts. Women had lower h-indices compared with men even when controlling for years in practice (mean 11.4 vs. 8.2, p < 0.03). Despite the increase in women graduating from H&N surgery fellowships, gender disparities within academic rank and academic productivity as measured by h-index remain. While a proportional number of women completing fellowship are entering academic practice, additional investigation and support is needed to address the potential gender gaps identified within academic H&N surgery.

Intracapsular Enucleation of Brachial Plexus Schwannoma With Intraoperative Neuromonitoring: A Case Series Study and a Review of Literature.

Brachial plexus schwannoma (BPS) is a rare clinical entity that poses a significant challenge for head and neck surgeons due to its neuroanatomical complexity and potential severe complications, such as major motor or sensory neurological deficits or pain of the corresponding upper extremity. This article summarizes our experience in its diagnosis and intracapsular enucleation with intraoperative neuromonitoring (INM). A retrospective review of BPS cases treated at our tertiary medical institution was conducted between April 2020 and May 2023. The clinical and demographic data were retrieved from case notes. Totally, 3 cases were included. All 3 patients were male, aged 43 to 54 years (median age = 52). The presenting symptom was a palpable supraclavicular mass in all these cases (2 on the left side and 1 on the right side). Neuromonitoring was performed with a 4-channel nerve integrity monitor, with the electrodes placed in the upper arm and forearm muscles, as demonstrated in the literature. After exposing the mass and identifying its origin from the brachial plexus, a unipolar stimulating probe was used to stimulate the tumor surface or the nerves with a 1.0-mA current, and a longitudinal incision into the tumor capsule was made along a carefully mapped line with no INM response. Then the mass was carefully exposed and meticulously dissected from its capsule to achieve an intact enucleation. Immediate postoperative neurological deficit was documented in Case 1 as a mild grasping weakness. The recovery of the other 2 patients was uneventful. The follow-up duration was 7 to 38 months (median = 8 months). The minor motor deficit of Case 1 recovered completely 1 month after surgery. No recurrence of BPS was observed. Intracapsular enucleation with INM could result in complete removal of BPS and minimal postoperative neurological deficit, whose recovery was quick and satisfactory.

Head and Neck Surgery—The Call to Joyful Sacrificial Giving

This Viewpoint explores the role of the servant leader and its implications as a leadership model for head and neck surgeons.