Two-team approaches in modern head and neck oncologic and reconstructive surgery: ablative considerations.

Purpose Of Review: Two-team approaches to head and neck cancer ablation and free flap reconstruction now occur concurrently in most centers. While the functional outcomes after head and neck ablation and reconstruction are typically examined through the lens of the reconstructive surgeon, optimizing the patient's functional outcome requires careful considerations of the entire surgical team. This review summarizes important intraoperative considerations for decision making by the surgical team, with a particular emphasis on ablative considerations, to optimize reconstructive outcomes after tumor extirpation.

Next generation of head and neck free flap reconstruction: the future of innovation and refinement.

Purpose Of Review: We briefly review the history of surgical innovation in free flap reconstruction of the head and neck. With a specific focus on maximizing patient QoL by prioritizing a 'precision reconstruction', we then posit novel avenues for surgical refinement to usher in the next generation of head and neck free flap reconstruction.

Recent Findings: Patients undergoing free flap reconstruction of the head and neck increasingly co-prioritize preservation of quality-of-life (QoL) alongside the desire to survive their diagnosis.

Pre-radiotherapy multidisciplinary survivorship care and patient-reported outcomes in head and neck cancer survivors.

Purpose: This study aims to evaluate the association between receiving pre-radiotherapy multidisciplinary survivorship care and patient-reported outcomes measures (PROMs) pertaining to quality of life (QOL), symptom burden, and psychological distress at one-year post-radiotherapy among head and neck cancer (HNC) survivors.

Methods: Survivors who underwent radiotherapy from 2017-2022 and completed PROMs during their one-year post-radiotherapy visit at a multidisciplinary HNC survivorship clinic were included. Survivors with recurrent disease, second primary tumor, and/or distant metastasis were excluded.

Genomic Signatures of Poor Prognosis in Merkel Cell Carcinoma: A Single-Institution Prospective Study.

Merkel cell carcinoma (MCC) is an aggressive disease with poor survival outcomes and increasing incidence. There is a clear and present need for enhanced understanding of cellular mechanisms of tumorigenesis, validation of robust genetic signatures predictive of aggressive disease, and novel informatics tools to simplify analysis of Merkel cell polyomavirus (MCPyV)-host genome interactions. Genomic DNA was harvested from 54 MCC tumors for exome sequencing and in-depth genetic profiling of a 226-gene panel.

Integrating Artificial Intelligence-Driven Digital Pathology and Genomics to Establish Patient-Derived Organoids as a Novel Alternative Model for Drug Response in Head and Neck Cancer.

Patient-derived organoids (PDOs) are emerging as advanced 3D novel alternative method (NAM) preclinical models, offering significant advantages over traditional cell lines and monolayer cultures for therapeutic development. In this study, we established PDOs from surgically resected fresh tissues of human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC) across anatomical sites, tumor T-categories, and sample types. These PDOs faithfully recapitulate the tumor's pathology, mutational profile, and drug response.

Geographic and Socioeconomic Landscape of Veterans With Head and Neck Cancer.

Background: US Veterans experience higher rates and worse outcomes for head and neck squamous cell carcinoma (HNSCC) compared to civilians. Geographic and socioeconomic barriers remain unclear.

Methods: This retrospective descriptive study analyzed VA data nationwide (2012-2022), identifying Veterans with HNSCC using ICD codes.

Donor Site Morbidity of the Medial Sural Artery Perforator (MSAP) Free Flap for Head & Neck Reconstruction.

Background: Minimal donor site morbidity is often cited as one of the main advantages of the medial sural artery perforator (MSAP) free flap; however, few studies have examined functional outcomes.

Methods: This retrospective cohort study analyzed patients undergoing MSAP for head and neck reconstruction from 2022 to 2024. A modified lower extremity functional scale (LEFS), with 80 being a maximum score, was administered to assess functional morbidity.

Drain Fluid Amylase as an Early Negative Predictor of Salivary Fistula Following Free Flap Reconstruction.

Objectives: Salivary fistula is a known complication following head and neck free flap reconstruction involving the aerodigestive tract. We sought to examine the association between surgical drain fluid amylase and salivary fistula formation during postoperative hospitalization.

Methods: Eighty patients who underwent head and neck reconstruction involving the aerodigestive tract at our institution between 2019 and 2023 were included.

Tumor Hypoxia and CD8 T-Cell Infiltration in Patients With Advanced Laryngeal Cancer.

Objective: We assessed correlations between tumor carbonic anhydrase IX (CAIX) staining, as a marker of tumor hypoxia, and CD8 T-cell infiltration in a cohort of patients with advanced laryngeal squamous cell carcinoma undergoing a bioselection approach for definitive treatment.

Study Design: Retrospective cohort study.

Setting: Tertiary care hospital.

Combined Tumor Infiltrating Lymphocytes and PD-L1 Status in Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma.

Objectives: To determine if the assessment of CD8+ tumor-infiltrating lymphocytes (TILs) adds prognostic information to the PD-L1 combined positive score (CPS) in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC).

Methods: A retrospective case series was performed of 77 patients with R/M HNSCC between 2003 and 2019. From pre-treatment biopsies, CD8+ TILs and PD-L1 CPS were quantified on a tissue microarray.

Nerve dissection technique for excision of parotid tumors: Outcomes controlling for tumor size and location.

Purpose: We examined operative efficiency, rate of facial nerve paresis, and post-operative outcomes in patients undergoing retrograde (RGD) vs anterograde dissection (AGD) of the facial nerve controlling for tumor location.

Methods: Single-institution, retrospective analysis of patients with benign parotid tumors undergoing superficial parotidectomy with facial nerve dissection over a six-year period. Operative and pathology reports were reviewed to classify tumor size, location in relation to facial nerve branches, and technique for facial nerve dissection.

CD8 Tumor-Infiltrating Lymphocytes in Head and Neck Cancer: A Review.

CD8 tumor-infiltrating lymphocytes (TILs) are increasingly used in oncology as a prognostic and predictive tool to guide patient management. This review summarizes current literature on CD8 TILs in head and neck squamous cell carcinoma (SCC). Published meta-analyses and clinical trials evaluating CD8 TILs were analyzed.

Hypothyroidism Predicts Fistula Development Following Salvage Oropharyngectomy.

Importance: Previous work demonstrated postoperative hypothyroidism adversely affects wound healing in salvage laryngectomy. Currently, no studies have evaluated the association between wound healing and hypothyroidism in patients undergoing salvage oropharyngectomy.

Objective: The primary objective was studying hypothyroidism and other factors associated with oropharyngocutaneous fistula development and fistula requiring reoperation within 30 days after salvage oropharyngectomy.

Oral cavity obliteration is a novel predictor of functional outcomes after glossectomy reconstruction.

Objectives: The primary goal for reconstruction of oral tongue defects is to improve speech and swallowing. The purpose of this study is to present a new reconstructive metric that uses volume displacement to measure oral cavity obliteration and correlate this metric to outcomes of speech and swallowing.

Methods: 47 patients underwent resection and primary closure or free-tissue reconstruction of oral tongue defects.

Endoscope-Assisted Transcervical Resection of Parapharyngeal Space Tumors.

Objective: We describe a novel technique for endoscope-assisted (EA) transcervical (TC) approach for resection of parapharyngeal space (PPS) tumors and compare perioperative outcomes of this approach to standard TC approaches.

Study Design: Retrospective chart review.

Setting: Single tertiary care center.

3D modeling of anterior 2/3rds glossectomy reconstruction: A volume based donor site evaluation.

Objective: Anterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location.