Pyriform Aperture Expansion: An Adjunct Technique to Functional Nasal Surgery.

Objectives: Functional nasal surgery is commonly performed to correct obstructed nasal airflow, and our institution implements pyriform aperture expansion (PAE) as an adjunct to surgical correction. The aim of this study was primarily to describe the surgical technique of PAE and demonstrate its safety and feasibility in functional nasal surgery.

Methods: A retrospective review of patients who underwent functional nasal surgery including PAE from April 2022 to May 2023 was conducted.

Effects of Oxygen Manipulation on Myofibroblast Phenotypic Transformation in Patients With Radiation-Induced Fibrosis.

We tested if hyperoxic conditions can reduce the proportion of active myofibroblasts, which are assumed to be a major driver of head and neck radiation-induced fibrosis, as measured by expression levels of pro-fibrotic genes. Radiated, non-cancerous soft tissue from the head and neck and skin/soft tissue from non-radiated flap donor site were collected from each patient. Myofibroblast density was quantified using immunofluorescence staining with α-SMA and DAPI and visualisation under confocal microscopy and compared between baseline non-radiated and radiated tissue from the same patient.

Improved survival with elevated BMI following immune checkpoint inhibition across various solid tumor cancer types.

Introduction/background: Obesity is a well-known risk factor for various cancers, yet emerging research demonstrates its association with improved survival outcomes in cancer treatment, labeled as "the obesity paradox." Studies investigating the clinical benefits of obesity across various cancer types after immune checkpoint inhibition (ICI) are limited.

Methods: Data were queried from the TriNetX database to identify patients with solid tumor malignancies of various organ systems (pulmonary/intrathoracic, cutaneous, head and neck, gastrointestinal, breast, genitourinary) who received ICI between 2012 and 2024.

Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps.

Objective: This study aims to explore outcomes among 2-stage paramedian forehead flaps (PFFs), 3-stage PFFs, and PFFs undergoing accelerated pedicle takedown.

Study Design: A retrospective review.

Setting: A tertiary care institution.

Evaluating the Effects of Timing of Reconstruction of Facial Mohs Defects for Nonmelanoma Skin Cancer on Complications Using Data from a Global Aggregate Health Care Network.

Defects following Mohs micrographic surgery often require complex facial reconstruction, with timing varying between immediate (<24 h) and staged (>24 h) reconstruction. To compare the risk of postoperative complications between immediate and staged reconstruction of Mohs defects for facial nonmelanoma skin cancer (NMSC). Patients with NMSC who underwent Mohs and facial reconstruction were identified using a health network database (TriNetX).

Flow-Through Flaps as a Robust Method for Advanced Free Flap Reconstruction in the Head and Neck: A Multi-Institutional Experience.

Background: Flow-through flaps (FTFs) are an advanced technique in which a free flap is anastomosed to the pedicle of another free flap to reconstruct extensive head and neck defects when recipient vessels are scarce.

Methods: A multi-institutional cohort of FTFs used for head and neck reconstruction were reviewed. For comparison, FTF outcomes were compared to free flaps that required vein grafts (VG) to reach distant recipient vessels.

Patient-Reported Outcome Measures for Mohs Reconstruction: A Systematic Review.

Objective: Mohs micrographic surgery (MMS) and subsequent reconstructive procedures for the treatment of facial nonmelanoma skin cancers (NMSCs) significantly impact quality of life (QoL). A validated patient-reported outcome measure (PROM) for patients who undergo Mohs reconstruction is not yet established. This study aims to systematically assess the quality of existing PROMs to determine their effectiveness in capturing the challenges faced after Mohs reconstruction for facial NMSC.

Obesity and Survival After Immune Checkpoint Inhibition for Head and Neck Squamous Cell Carcinoma.

Importance: For patients treated with immune checkpoint inhibitors (ICIs), recent data suggest that obesity has a beneficial effect on survival outcomes in various cancer types. Reports on this association in head and neck cancer are limited.

Objectives: To compare overall survival (OS) to 5 years and functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with ICIs based on pretreatment body mass index (BMI).

Microvascular reconstruction of midface osteoradionecrosis.

Background: Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population.

Methods: Retrospective multi-institutional review of FF reconstruction for midface ORN (2005-2022; n = 54).

Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study.

Objective: The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population.

Methods: Retrospective study utilizing the TriNetX US-collaborative health records network querying for TORS patients.

A novel staging system to consolidate silent sinus syndrome and chronic maxillary atelectasis: A systematic review and case series.

Silent sinus syndrome (SSS) and chronic maxillary atelectasis (CMA) represent an overlapping clinical entity, both likely lying on the spectrum of one disease process. There is widespread inconsistency of diagnosis in the literature of reported cases of SSS and CMA. We propose a novel, comprehensive staging system to simplify diagnosis and inform management.

Safety of Ambulatory Surgery For Obstructive Sleep Apnea: A Retrospective Review.

Objective: Assess the safety of ambulatory surgery performed for obstructive sleep apnea.

Study Design: Retrospective chart review.

Setting: Tertiary care hospital.

Microvascular reconstruction of medication related osteonecrosis of the head and neck.

Background: Medication related osteonecrosis of the jaw (MRONJ) requiring free flap (FF) reconstruction is uncommon with limited reported findings.

Methods: Multicenter, retrospective case series of 49 consecutive adult patients presenting with advanced MRONJ requiring FF reconstruction from 2010 to 2022. Perioperative complications and outcomes were analyzed.

The Impact of Surgical and Nonsurgical Interventions on Overall Oral, Palpebral Fissure, and Brow Height Symmetry in a Patient with Facial Synkinesis.

The treatment of facial nerve synkinesis remains complex and variable. To compare oral, palpebral fissure, and brow symmetry among surgical and nonsurgical interventions in patients with facial synkinesis. Patients with facial nerve synkinesis at a single tertiary care center between 2008 and 2022 were analyzed before and after interventions using Emotrics software.

Evaluating ChatGPT Responses on Thyroid Nodules for Patient Education.

ChatGPT, an artificial intelligence (AI) chatbot, is the fastest growing consumer application in history. Given recent trends identifying increasing patient use of Internet sources for self-education, we seek to evaluate the quality of ChatGPT-generated responses for patient education on thyroid nodules. ChatGPT was queried 4 times with 30 identical questions.

Association of Smoke and Nicotine Product Consumption With Sensorineural Hearing Loss: A Population-Level Analysis.

Objective: To test the hypothesis that use of cigarettes or other products with either cigarette-like smoke profile or high nicotine content by young populations increases the odds of developing sensorineural hearing loss (SNHL).

Study Design: Retrospective cohort study.

Setting: TriNetX US Collaborative Network (2003-2022).

Effect of preoperative programmed death-1 or programmed death ligand-1 immune check point inhibition on complications after surgery for primary head and neck cancer.

Background: There is sparse literature on the effect of preoperative immunotherapy on complications after surgery for primary head and neck squamous cell carcinoma (HNSCC). The objectives are to compare complication rates in patients receiving surgery with and without neoadjuvant immune checkpoint inhibitors (nICI) for primary HNSCC and to evaluate factors associated with increased odds of surgical complications.

Methods: A retrospective review of patients who underwent ablation and free flap reconstruction or transoral robotic surgery (TORS) for primary HNSCC between 2017-2021 was conducted.

Complications and Functional Outcomes After Esophageal Reconstruction with an Intact Larynx.

Background: Esophageal defects can result from primary pathologies such as malignancy or stricture, or secondary ones such as perforation due to trauma or iatrogenic injury. Techniques, management, and outcomes of reconstruction in this setting are poorly understood. Herein, we aim to highlight surgical outcomes in patients undergoing local and free flap reconstruction of esophageal defects in the setting of an intact larynx.

Evaluating ChatGPT responses on obstructive sleep apnea for patient education.

Study Objectives: We evaluated the quality of ChatGPT responses to questions on obstructive sleep apnea for patient education and assessed how prompting the chatbot influences correctness, estimated grade level, and references of answers.

Methods: ChatGPT was queried 4 times with 24 identical questions. Queries differed by initial prompting: no prompting, patient-friendly prompting, physician-level prompting, and prompting for statistics/references.

Differences in Functional and Survival Outcomes Between Patients Receiving Primary Surgery vs Chemoradiation Therapy for Treatment of T1-T2 Oropharyngeal Squamous Cell Carcinoma.

Importance: Due to lack of data from high-powered randomized clinical trials, the differences in functional and survival outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing primary transoral robotic surgery (TORS) vs primary radiation therapy and/or chemoradiation therapy (RT/CRT) are unclear.

Objectives: To compare 5-year functional (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) and survivorship outcomes in patients with T1-T2 OPSCC receiving primary TORS vs RT/CRT.

Design, Setting, And Population: This national multicenter cohort study used data from a global health network (TriNetX) to identify differences in functional and survival outcomes among patients with OPSCC who underwent primary TORS or RT/CRT in 2002 to 2022.

Volumetric Analysis of the Sinus and Orbit in Silent Sinus Syndrome After Endoscopic Sinus Surgery.

Objective: The term "silent sinus syndrome" (SSS) describes spontaneous enophthalmos secondary to subclinical maxillary sinus atelectasis. Debate remains on whether treatment with endoscopic maxillary antrostomy alone is adequate in reversing atelectasis and globe displacement. This study aims to determine the degree of volume change of the diseased sinus and orbit as well as the change in orbital height in patients treated with endoscopic antrostomy without orbital floor augmentation.

Metformin Effects on FOXP3 and CD8 T Cell Infiltrates of Head and Neck Squamous Cell Carcinoma.

Objectives: Alterations of cellular metabolism have been implicated in immune dysfunction in the tumor microenvironment (TME) of head and neck squamous cell carcinoma (HNSCC). Metformin has recently emerged as a candidate of interest for combination with immunotherapy in HNSCC. This study investigated the effect of metformin on immune cell infiltrates of HNSCC.

Metformin Clinical Trial in HPV+ and HPV- Head and Neck Squamous Cell Carcinoma: Impact on Cancer Cell Apoptosis and Immune Infiltrate.

Metformin, an oral anti-hyperglycemic drug which inhibits mitochondrial complex I and oxidative phosphorylation has been reported to correlate with improved outcomes in head and neck squamous cell carcinoma (HNSCC) and other cancers. This effect is postulated to occur through disruption of tumor-driven metabolic and immune dysregulation in the tumor microenvironment (TME). We report new findings on the impact of metformin on the tumor and immune elements of the TME from a clinical trial of metformin in HNSCC.