Neck Surgeons Research Articles

French Military Neurosurgery: At Home and Abroad.

The origins of military neurosurgery are closely linked to those of neurosurgery in France and more particularly in Paris. The history of the field starts with its origins by 2 men, Thierry de Martel and Clovis Vincent. The first note about the creation of military neurosurgery was in 1942, when Marcel David was reassigned from the Sainte Anne Hospital to practice at the Val-de-Grâce Military Hospital. David trained the first military neurosurgeon. The field of military neurosurgery was subsequently developed at the Val-de-Grâce Military Hospital, at Sainte Anne Military Teaching Hospital in Toulon in 1990 and then at Percy Military Teaching Hospital in 1996. Over 29 military neurosurgeons were trained in these institutions. Since 2000, French military neurosurgeons have been deployed from France in the Mobile Neurosurgical Unit. This Mobile Neurosurgical Unit represents 12% of all medical evacuation of casualties categorized as the high dependency level. Neurosurgeons were able to adapt to asymmetrical wars, such as in the Afghanistan campaign where they were deployed in the Role 3 medical treatment facility, and more recently in sub-Saharan conflicts where they were deployed in forward surgical roles. To manage the increasing craniocerebral war casualties in the forward surgical team, the French Military Health Service Academy established a training course referred to as the "Advanced Course for Deployment Surgery" providing neurosurgical damage control skills to general surgeons. Finally, military neurosurgery is reinventing itself to adapt to future conflicts through the enhancement of surgical practices via the addition of head, face, and neck surgeons.

305 Facial Nerve Outcomes Following Malignant Lateral Skull Base Surgery at a Tertiary Centre

Abstract Background Although a rare malignancy, lateral skull base tumours often present a challenge to head and neck surgeons due to complex neurovascular anatomy. Patients also tend to present late with advanced disease. With lateral skull base tumours being a rare occurrence, there is limited knowledge on facial nerve outcomes following surgery. Method Data from 44 patients were collected and analysed. The main outcome collected in this study was facial nerve function at presentation and post op (both immediately and long-term) according to the House-Brackmann scale. Results 90% of patients presented without signs and symptoms of facial nerve involvement. Patients who had no facial pain or paralysis at presentation are more likely to maintain normal facial functions after surgery (20 out of 26 that scored House-Brackmann 1 pre-op maintain a score of 1 in long term post-op review). 80% of those who presented with signs and symptoms of facial nerve involvement required intraoperative nerve sacrifice. Conclusions Patients who presented with facial pain or paralysis tend to have more advanced disease. The majority (80%) of those presenting with facial deficits pre-operatively underwent nerve sacrifice. The purpose of this study is to offer insight into facial nerve outcomes of patients who underwent lateral skull base surgery at a tertiary centre. We collected and analysed the outcomes of surgery for 44 patients, with main outcome measures including facial nerve functions based on the House-Brackmann scale, as well as any postoperative complications, recurrences, types of adjuvant therapy required and survival after the operation.

Virtual Tumor Boards for Remote Learning in Head and Neck Surgical Oncology

In addition to their patient management value, multidisciplinary tumor boards have been recognized as effective learning tools. However, the value of using a virtual tumor board as a learning tool for head and neck surgical oncology fellows has not been studied. To describe the structure and content of the American Head and Neck Society (AHNS) Virtual Tumor Board and assess its educational value as perceived by attendees. All sessions of the AHNS Virtual Tumor Board from April 8, 2020, to June 1, 2022, were reviewed. Topics, presenters, participants, and viewership data were collected as of October 15, 2022, from session recordings posted to an online video sharing and social media platform. Additionally, an anonymous, 14-question online survey was designed to elicit feedback from head and neck surgery trainees on virtual tumor board engagement, strengths, and weaknesses. The survey was electronically distributed in June and July 2022 to the 101 fellows enrolled in AHNS-accredited programs between July 1, 2020, and June 30, 2022. The primary aim was to tabulate online viewership of the sessions. The secondary aim was to qualitatively assess the experience of head and neck trainees with the AHNS Virtual Tumor Board using a survey. Forty-two sessions of the virtual tumor board were held between April 8, 2020, and June 1, 2022. Almost all sessions (41 [98%]) were case based. One hundred and sixteen cases were presented, representing 2 to 3 cases per session, by 75 unique faculty members. Each session was viewed a mean of 217 times (range, 64-2216 views). In the 2021 to 2022 academic year, a mean of 60 viewers (range, 30-92 viewers) attended each live session. In all, 29 survey responses were collected from 101 fellows in AHNS-accredited programs (29% response rate). Most respondents felt the format allowed for excellent teaching (18 of 26 respondents [69%]) and discussion (19 of 26 respondents [73%]). Most respondents (22 of 29 respondents [76%]) believed that practicing head and neck surgeons would benefit from the sessions. This survey study found that the AHNS Virtual Tumor Board was well-attended and well-reviewed by head and neck surgical oncology trainees. The virtual tumor board format could be used as model of remote learning for other organizations.

Multidisciplinary care improves outcomes for patients with carotid body paragangliomas-The UCLA experience.

To evaluate the effects and outcomes of multidisciplinary surgical approaches in the management of carotid body tumors (CBT). A single-center retrospective study at the University of California-Los Angeles Medical Center was conducted on patients who presented with CBTs and underwent surgical resections from 1998 to 2020. Statistical analysis was performed using IBM SPSS v27 and Excel. A total of 75 patients with 79 CBT resections were included. Operating surgical subspecialties included: 41.8% vascular surgery, 24.1% otolaryngology head and neck surgeons (OHNS), and 31.6% combined OHNS and vascular. 68.4% of tumors underwent preoperative embolization. EBL was directly correlated with tumor size. CBT size was similar for OHNS (30 mm) and vascular (31 mm) but was significantly larger for combined OHNS and vascular cases (38 mm). EBL was higher in combined cases (301 mL) compared to OHNS (124 mL) or vascular (203 mL) alone. Incidence of postoperative cranial nerve deficits was 7.8%, with combined OHNS and vascular cases having an incidence of 4.0% when compared to OHNS (5.3%) versus vascular surgery alone (12.1%). CBTs can be managed effectively by single surgical specialties with similar outcomes between vascular surgery and OHNS. In larger, higher grade tumors, however, a combined vascular and OHNS approach had lower incidence of postoperative cranial nerve injuries when compared to single specialty resections, despite a larger EBL. Thus, a multidisciplinary surgical approach suggests favorable outcomes with fewer incidence of cranial nerve deficits for larger, more complex CBT resections. 2b-Individual retrospective cohort study.

Surgical management of low-risk papillary thyroid cancer in real life in Spain: a nationwide survey of endocrine neck surgeons and endocrinologists.

The extent of surgery in patients with papillary thyroid cancer (PTC) is a subject of ongoing debate. We aimed to explore the attitude of Spanish specialists (endocrinologists, surgeons, and otolaryngologists) in real life on the surgical management of low-risk PTC. We designed an anonymous, web-based survey to inquire information regarding the preferences of interviewees for hemithyroidectomy (Hem), total thyroidectomy (TT) and prophylactic central neck dissection (pCND) in one standard patient with PTC and six clinical variants. We differentiated between small (1.1-2.5 cm) and large (2.6-4.0 cm) tumors. A total of 278 valid responses were received and divided into two groups: group END (n = 135) and group SUR (n = 143, 101 general surgeons and 42 otolaryngologists). The preference for Hem was low in the standard patient and similar between both groups (40.6 vs 49.0%, NS). This preference decreased for tumors measuring 2.6-4.0 cm, multifocal, with risk location, family history of thyroid cancer, or history of irradiation, and increased in patients older than 65 years or with comorbidity. Preference for pCND ranged from 12.6-71.1% in the group END and from 22.4-65.0% in the group SUR, with few differences between the two. In multivariate analysis, being a high-volume specialist was associated with a lower preference for Hem, while having private practice was associated with a more favorable opinion of Hem. The real clinical practice of Spanish specialists is far from what is recommended by the clinical guidelines in patients with low-risk PTC, especially among high-volume professionals.

Understanding Gender Differences in Research Productivity of Canadian Otolaryngologists-A Comprehensive National Audit.

Objective: To understand the factors contributing to gender disparities in the research productivity of Canadian academic otolaryngologist-head and neck surgeons. Methods: Publicly available sources including departmental websites, SCOPUS, and the Royal College of Physicians and Surgeons of Canada were accessed between February and April 2022 to analyze gender differences in the academic productivity of otolaryngologist-head and neck surgeons across Canada. Gender differences in research productivity metrics, including h-index, i10-index, publication number, and number of first and senior authorships were assessed. Demographic data, including gender, institution, years in practice, and leadership roles were assessed for correlation with increased research productivity. Subgroup analyses were used to evaluate gender differences in productivity metrics, and univariable and multivariable regression analyses were used to evaluate predictors of research productivity. Results: Data were collected for 316 academic otolaryngologists (252 men, 64 women, P < .001). Men had significantly more years of publishing [mean (standard deviation, SD), 15.64 (9.45) vs 12.44 (8.28), P = .014], higher h-indices [12.22 (11.47) vs 7.33 (5.36), P < .001], i10-indices [22.61 (37.88) vs 8.17 (9.14), P > .001], publication numbers [46.63 (65.18) vs 19.59 (23.40), P < .001], and first [8.18 (9.95) vs 4.89 (6.18), P = .001] and senior authorships [12.98 (22.72) vs 3.83 (6.89), P < .001]. Gender differences were most pronounced in head and neck oncology, pediatrics, and the late career stage. Gender disparities in productivity were absent in the early career stage. Multivariate analysis identified only the number publications and number of senior author publications as being significantly influenced by gender. Conclusion: Canadian female otolaryngologist-head and neck surgeons appear to have equivalent research productivity to their male counterparts in the early career stage. This mirrors the recent findings in the United States, and demonstrates progress compared to earlier studies that found women to have lower research productivity in the early career stage.

Incidence of Head and Neck Cancer in East Sudan

This review aims to provide an updated and detailed overview of the incidence of head and neck cancer in the eastern region of Sudan, focusing on studies conducted between 2018 and 2023. It aims to shed light on changes in incidence rates, emerging risk factors, advancements in diagnostic techniques, treatment modalities, and preventive strategies. Accurate knowledge of the latest trends and developments in head and neck cancer incidence is essential for effective public health planning and intervention. One significant aspect that the review highlights is the limited number of head and neck surgeons in East Sudan. It emphasizes the need for specialized training in staging malignancies using head and neck anatomy, as this information is vital for determining appropriate treatment approaches. With a shortage of trained professionals, it becomes even more critical to enhance the anatomic understanding and staging capabilities in order to improve patient outcomes and optimize treatment plans. The review underscores the urgency of addressing this gap in healthcare infrastructure. By increasing the number of head and neck surgeons in East Sudan and providing them with the necessary training, the region can improve its capacity to accurately stage head and neck cancers, leading to more effective treatment decisions and improved patient care. This review provides a comprehensive resource for understanding the current landscape of head and neck cancer incidence in the eastern region of Sudan. It addresses recent trends, emerging risk factors, and the need for improved anatomic understanding and staging capabilities. The findings can guide policymakers, healthcare providers, and researchers in implementing targeted strategies to reduce the burden of head and neck cancer in East Sudan and improve patient outcomes.

Persisting facial nerve palsy or trigeminal neuralgia - red flags for perineural spread of head and neck cutaneous squamous cell carcinoma (HNcSCC).

Perineural spread (PNS) of head and neck cutaneous squamous cell carcinoma (HNcSCC) is a unique diagnostic challenge, presenting with insidious trigeminal (CN V) or facial nerve (CN VII) neuropathies without clinically discernible primary masses. These patients are often sub-optimally investigated and misdiagnosed as Bell's palsy or trigeminal neuralgia. This case series highlights the red flags in history and pitfalls that lead to delays to diagnosis and treatment. A retrospective case series of 19 consecutive patients with complete clinical histories with HNcSCC PNS without an obvious cutaneous primary lesion at time of presentation to a quaternary head and neck centre in Australia were identified and included for analysis. Fifteen had CN VII PNS, 17 had CN V PNS, and 13 had both. The overall median symptom-to-diagnosis time was 12-months (IQR-15 months). Eight patients had CN VII PNS and described progressive segmental facial nerve palsy with a median symptom-to-diagnosis time of 9-months (IQR-11.75 months). Eleven patients had primary CN V PNS and described well localized parathesia, formication or neuralgia with a median symptom-to-diagnosis time of 19-months (IQR 27.5 months). PNS is often mistaken for benign cranial nerve dysfunction with delays in diagnosis worsening prognosis. Red flags such as progressive CN VII palsy or persistent CN V paraesthesia, numbness, formication or pain, particularly in the presence of immuno-compromise and/or a history of facial actinopathy should raise suspicion for PNS. Gadolinium-enhanced MR Neurography should be obtained expediently in patients with persistent/progressive CN V/CN VII palsies in patients with red flags, with low threshold for referral to a Head and Neck Surgeon.

Milan system for reporting salivary gland cytology in diagnosis and surgery of parotid gland lesions

IntroductionA cytology report is always a challenge for both head and neck surgeons and cytopathologists to diagnose and manage parotid gland (PG) diseases, because of the various similar features between the lesions. ObjectivesThe present study was conducted to assess our practice using the Milan System for Reporting Salivary Cytopathology (MSRSGC) and to evaluate the risk of malignancy (ROM) in different categories. Patients and methodsThe patients with parotid gland lesions were diagnosed by clinical examination, ultrasound, and FNAC under ultrasound guidance at our hospital from 1 May 2019 to 30 April 2021. The FNAC results were divided into six categories according to the Milan system. We calculated the ROM for each category of the Milan system based on histopathological follow-up. ResultsThis study included 204 patients. There were 115 men (56 %) aged 46–60 years. Pathology results were 33 cases for malignant and 182 cases for benign. The rate of malignancy for each category according to the MSRSGC were 23.1 % (non-neoplastic), 20 % (atypical), 50 % (neoplastic), 1 % (benign), 10.3 % (salivary neoplasm of uncertain neoplastic potential), 84.6 % (suspicious for malignancy), and 100 % (malignant) categories. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC with application of Milan system were respectively 90.9 %, 98.2 %, 90.9 %, 98.9 % and 97 %. ConclusionWhen the Milan system was applied, FNAC had a high efficacy, suggesting that MSRSGC can improve the communication between the cytopathologist and the surgeon. This system can allow the surgeon to decide the extent of the surgery.

The RVU Compensation Model and Head and Neck Surgical Education.

The present study aims to quantify the opportunity cost of training residents and fellows for head and neck surgery. A 2005-2015 review of ablative head and neck surgical procedures was performed using the National Surgical Quality Improvement Program (NSQIP). Work relative value units (wRVU) generated per hour were compared among procedures performed by attendings alone, attendings with residents, and attendings with fellows. Among 34,078 ablative procedures, the rate of wRVU generation per hour was greatest for attendings alone (10.3), followed by attendings with residents (8.9) and attendings with fellows (7.0, p < 0.001). Resident and fellow involvement was associated with opportunity costs of $60.44 per hour (95% CI: $50.21-$70.66/h) and $78.98 per hour ($63.10-$94.87/h, 95% CI), respectively. wRVU-based physician reimbursement does not consider or adjust for the extra effort involved in training future head and neck surgeons. NA Laryngoscope, 134:113-119, 2024.

Treatment of buccal mucosal carcinomas: A survey amongst head and neck surgeons in the Netherlands.

Currently, there is no up-to-date guideline for the treatment of buccal mucosal squamous cell carcinoma (BMSCC) in the Netherlands. A questionnaire was used to investigate the opinions of Dutch head and neck surgeons on BMSCC of the cheek treatment. A questionnaire was sent to all 91 head and neck surgeons in the Netherlands. Their opinions on surgical tumor-free margins, through-and-through defects, and indications for local adjuvant therapy were questioned. The response rate was 51%. To prevent a through-and-through defect, 67% of the surgeons would accept a deep clinical (macroscopic) margin of ≤5 mm. The less adverse histological characteristics a tumor has, the less consensus there is amongst the surgeons for local adjuvant treatment in case of close margins. There is no consensus amongst Dutch head and neck surgeons about the optimal treatment for BMSCC of the cheek. There are different opinions on acceptable resection margins, indications for a through-and-through defect, and indications for adjuvant treatment. BMSCC of the cheek treatment should be more uniform and less surgeon dependent. N/A.

Knowledge, Attitude and Practice of Filipino Surgeons Regarding Clinical Practice Guidelines on Thyroid Nodules and Malignancy: A PCS-PSGS -PAHNSI Collaborative Study

Rationale: In 2008, the Philippine College of Surgeons in collaboration with the Philippine Society of General Surgeons and the Philippine Academy of Head and Neck Surgeons, Inc. had published Evidence-based Clinical Practice Guidelines (CPG) on the Diagnosis and Management of Thyroid Nodules. This was followed by an update in 2013 with a focus on important diagnostic and therapeutic management issues concerning thyroid malignancy. The objective of this study was to assess knowledge gaps and behavioral patterns among users with respect to these CPGs. Methods: A validated 30 item survey assessing knowledge of, attitudes towards, and adherence to the recommendations of different Evidence based Clinical Practice Guidelines was administered to general surgery residents, PSGS fellows, and otorhinolaryngology residents and consultants performing thyroidectomies. Results: There were 343 assessable forms. Of the respondents, 276 (80.47%) were general surgeons, 33 (9.62%) were otorhinolaryngologists. There were 66 (19.24%) consultants, and 277 (80.76%) residents. Otorhinolaryngologists were less aware of the local CPGs than their GS counterparts. GS Residents, compared to their consultants, were more aware of the American Thyroid Association guidelines than the local guidelines. Among all respondents, the local guidelines had about equal preference for usage as the American Thyroid Association guidelines. There were no statistically significant differences on the level of knowledge and attitudes among the respondents. Conclusions: The level of awareness about the PCS Thyroid Guidelines needs to be improved. The dissemination process needs to be reviewed and ensure that all stakeholders will be reached. Key words: thyroid, clinical practice guidelines

A Case of Thyroid Abscess Following Ethanol Ablation for Benign Thyroid Nodule

Recently, non-surgical and minimally invasive treatments, including ethanol ablation (EA) and radiofrequency ablation (RFA), have been commonly used as primary treatments for benign thyroid nodules. While these techniques have been gaining popularity owing to their safety and effectiveness, they may involve various complications such as pain, voice change, and hematoma. A thyroid abscess following EA requiring surgical intervention is extremely rare and, to the best of our knowledge, has been reported only once to date. Herein, we present a case of a thyroid abscess following EA for a benign thyroid nodule that required surgical treatment. This complication is believed to be mediated by chemical necrosis and subsequent inflammatory reactions following EA rather than by bacterial infection. Head and neck surgeons should recognize the risk of thyroid abscess as a complication of EA.

Locoregional Flaps for the Reconstruction of Midface Skin Defects: A Collection of Key Surgical Techniques.

The reconstruction of midface skin defects represents a challenge for the head and neck surgeon due to the midface's significant role in defining important facial traits. Due to the high complexity of the midface region, there is no possibility to use one definitive flap for all purposes. For moderate defects, the most common reconstructive techniques are represented by regional flaps. These flaps can be defined as donor tissue with a pedunculated axial blood supply not necessarily adjacent to the defect. The aim of this study is to highlight the more common surgical techniques adopted for midface reconstruction, providing a focus on each technique with its description and indications. A literature review was conducted using PubMed, an international database. The target of the research was to collect at least 10 different surgical techniques. Twelve different techniques were selected and cataloged. The flaps included were the bilobed flap, rhomboid flap, facial-artery-based flaps (nasolabial flap, island composite nasal flap, retroangular flap), cervicofacial flap, paramedian forehead flap, frontal hairline island flap, keystone flap, Karapandzic flap, Abbè flap, and Mustardè flap. The study of the facial subunits, the location and size of the defect, the choice of the appropriate flap, and respect for the vascular pedicles are the key elements for optimal outcomes.

Are new and young generations of surgeons more aware of transoral robotic surgery than older ones? An international survey.

The objective of this study is to investigate adoption, perception, and awareness of otolaryngologist-head neck surgeons (OTO-HNS) toward transoral robotic surgery (TORS) according to the surgeon experience. A total of 1,383 OTO-HNS of YO-IFOS and IFOS received an online survey dedicated to the adoption, perception, and awareness toward TORS. The following outcomes were compared between residents and fellows, young/middle-aged and older OTO-HNS: awareness/perception; indications; advantages; barriers and expected improvements of TORS practice. From the 357 responders (26%), 147 participants were residents and fellows; while 105 and 105 OTO-HNS reported 10 to 19, and more than 20years of practice. The main barriers of using TORS included the cost and the availability of robot, and the lack of training opportunity. The better view of the operative field and the shorter patient hospital stay were considered as the main advantages. Older surgeons trust more likely in TORS benefits (p = 0.001) and surgical field view advantages (p = 0.037) compared to younger participants. TORS is an important surgical minimal invasive approach for the future for 46% of residents and fellows versus 61% of older OTO-HNS (p = 0.001). Compared to older OTO-HNS, residents and fellows reported more frequently that the lack of training opportunity is the main barrier of TORS (52% versus 12%; p = 0.001). Residents and fellows did not share the same expectations of robot improvement for the future than older OTO-HNS. Experienced OTO-HNS had better perception and trust toward TORS than residents and fellows. Residents and fellows identified the lack of training opportunity as the main barrier to the use of TORS. TORS access and training programs need to be improved in academic hospitals for residents and fellows.

Solitary Bone Plasmacytoma Mimicking Oral Cavity Neoplasm – A Rare Case

Plasmacytomas are localized monoclonal plasma cell lesions with no evidence of systemic involvement which are divided into solitary bone plasmacytoma (SBP) and extra-medullary plasmacytoma (EMP). The diagnosis of plasmacytomas (PCM) in the oral regions is challenging given the atypical clinical manifestations and low frequency. Here, we report an extremely rare case of plasmacytoma in an elderly male which initially appeared to be arising from the left buccal mucosa on clinical examination but after radiological imaging and intra-operative findings, the epicentre was found to be in the left infratemporal fossa (ITF). The patient underwent en-bloc compartment resection with high clearance of the ITF which proved to be an effective management strategy. It is crucial for the head and neck surgeon to be aware of the solitary bone plasmacytoma in the oral and maxillofacial region in order to identify it early and provide these patients with the best care possible before complications arise.

Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons.

Background: Research has not explicitly explored differences between male and female microvascular head and neck (MHN) surgeon burnout, which should be identified and addressed to ensure career satisfaction and longevity. Objective: To measure and compare the prevalence of burnout among male versus female MHN surgeons. Methods: A prospective questionnaire based on the Maslach Burnout Inventory (MBI) was distributed through a web-based survey to the American Association of Facial Plastic and Reconstructive Surgeons and American Head and Neck Society in 2021 and 2022. Additional variables collected included demographics, relationship and parental status, academic rank, annual salary, and COVID-19-related questions. Results: One hundred thirteen surveys were collected. Twenty-nine (25.7%) were women and all completed MHN surgery fellowships. Women trended toward more emotional exhaustion than men (2.8 mean MBI vs. 2.3 mean MBI) but reported similar personal achievement (4.8 mean MBI vs. 4.9 mean MBI). Men experienced less workplace sexual harassment (p < 0.001). Women experienced more burnout (69% vs. 39%, p = 0.006) during the COVID-19 pandemic. Conclusion: Female MHN surgeons reported in this survey to experience more workplace sexual harassment and higher COVID-19-related burnout than their male counterparts.

Commentary on: "Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons" by Benjamin et al: Addressing Burnout in Otolaryngology.

Facial Plastic Surgery & Aesthetic MedicineAhead of Print Commentary on: “Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons” by Benjamin et al: Addressing Burnout in OtolaryngologyAlexandra E. Tunkel and Theda C. KontisAlexandra E. Tunkelhttps://orcid.org/0000-0002-0452-4974School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA.Search for more papers by this author and Theda C. Kontis*Address correspondence to: Theda C. Kontis, MD, Aesthetic Center at Woodholme, 1838 Greene Tree Road, Suite 370, Baltimore, MD 21208, USA E-mail Address: tckontis@aol.comAesthetic Center at Woodholme, Baltimore, Maryland, USA.Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Search for more papers by this authorPublished Online:10 May 2023https://doi.org/10.1089/fpsam.2022.0428AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Commentary on: “Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons” by Benjamin et al: Addressing Burnout in Otolaryngology." Facial Plastic Surgery & Aesthetic Medicine, , pp. FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Alexandra E. Tunkel and Theda C. Kontis.Commentary on: “Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons” by Benjamin et al: Addressing Burnout in Otolaryngology.Facial Plastic Surgery & Aesthetic Medicine.ahead of printhttp://doi.org/10.1089/fpsam.2022.0428Online Ahead of Print:May 10, 2023PDF download

Shear's Cysts of the Oral and Maxillofacial Regions, Fifth editionby Paul M.Speight, John Wiley &amp; Sons, 2022.

It was a great privilege for me to be able to read and be invited to comment on this new edition of “Cyst of the oral and maxillofacial regions”, a book that over the years, from my beginnings as a dental student and later as an oral pathologist, has always been present in my academic and work life. The oral and maxillofacial region is the site of formation of various lesions, some of which are unique and exclusive to this region; the cysts described in this book are a clear example of this. For many years the book “Cyst of the oral and maxillofacial regions” by Prof. Mervyn Shear has been dedicated to deepening the knowledge of these lesions. The first edition of this book was published in 1976 and, from that year on, all the new knowledge that was emerging about cysts of the oral and maxillofacial region became part of the subsequent editions in 1983, 1992, and 2007, until reaching this fifth edition written entirely by Prof. Paul M. Speight. Thus, throughout the years this book has consolidated its reputation as a classic, a basic text and a mandatory reference within the area of oral pathology and medicine. The function of a textbook is to collect all the relevant information on a specific topic and update the new knowledge that exists on the specific field of study. This fifth edition emphasizes the careful selection of recent investigations that contribute new information to the knowledge of the pathogenesis of these lesions, as well as showing clinical and diagnostic relevance. The book consists of 18 chapters (367 pages) covering in a complete, detailed, and clear way the current knowledge about all the cysts of the oral and maxillofacial region. Each chapter covers clinical features, radiological features, pathogenesis, histopathology, and treatment, as well as some specific concepts about each lesion, making special reference to differential diagnoses. The text is supported by clinical and histological images (photomicrophotography), as well as radiographic images of all the lesions studied. For this, the editor had the collaboration of some of the most outstanding colleagues in the area of pathology and oral medicine from various regions. of the world, achieving a book that is also very attractive visually. Before delving into an individual description of each cyst by specific chapter, the book reviews in the first two chapters the classification of cysts in the oral and maxillofacial region, proposes a simple classification that can be shared and understood by both clinicians and pathologists, then describes considerations on cysts in general that are very useful for the diagnosis of each type of cyst. The odontogenic keratocyst is without a doubt the cyst that has attracted the most interest and debate in recent years, especially in terms of its terminology and the possible neoplastic nature of the lesion. This edition dedicates its largest chapter to this cyst (Chapter 7), where information is added throughout 56 pages, making it the most in-depth and comprehensive review and discussion to be found in the current literature on this controversial lesion. Personally, this was the chapter I enjoyed the most in the book. The progress that molecular pathology has had in recent decades is reflected in this new edition, providing information on the molecular mechanisms of some of these lesions, emphasizing studies of immunohistochemistry, molecular biology, cell biology, and genetics that provide useful information for understanding the pathogenesis and biological behavior of cysts in the oral and maxillofacial region. All information is presented in a clear and accessible manner for everyone involved in oral medicine and pathology, from a dental student to a general practitioner, maxillofacial surgeon, head and neck surgeon, general pathologist, or specialist. in pathology and oral medicine. The information is presented in a very accessible and easy to consult manner, the book contains very clear diagrams and tables that simplify the understanding of the information, and the use presence in each chapter of boxes that summarize and highlight the most relevant information is a very useful feature. All of this means that this book is currently considered the gold standard for those who want to delve into the knowledge of cysts in the oral and maxillofacial region, a book that should always be present in the library of those of us dedicated to diagnosis., treatment or research in the field of pathology and oral medicine.

Augmented-Reality Surgery to Guide Head and Neck Cancer Re-resection: A Feasibility and Accuracy Study.

Given the complex three-dimensional (3D) anatomy of head and neck cancer specimens, head and neck surgeons often have difficulty relocating the site of an initial positive margin to perform re-resection. This cadaveric study aimed to determine the feasibility and accuracy of augmented reality surgery to guide head and neck cancer re-resections. This study investigated three cadaveric specimens. The head and neck resection specimen was 3D scanned and exported to the HoloLens augmented reality environment. The surgeon manually aligned the 3D specimen hologram into the resection bed. Accuracy of manual alignment and time intervals throughout the protocol were recorded. The 20 head and neck cancer resections performed in this study included 13 cutaneous and 7 oral cavity resections. The mean relocation error was 4 mm (range, 1-15 mm) with a standard deviation of 3.9 mm. The mean overall protocol time, from the start of 3D scanning to alignment into the resection bed, was 25.3 ± 8.9 min (range, 13.2-43.2 min). Relocation error did not differ significantly when stratified by greatest dimension of the specimen. The mean relocation error of complex oral cavity composite specimens (maxillectomy and mandibulectomy) differed significantly from that of all the other specimen types (10.7 vs 2.8; p < 0.01). This cadaveric study demonstrated the feasibility and accuracy of augmented reality to guide re-resection of initial positive margins in head and neck cancer surgery.