Head and Neck Surgery: Clinical Updates and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (20 July 2023) | Viewed by 29639

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Special Issue Editors


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Guest Editor
Department of Otorhinolaryngology, Udine University Hospital, ASUFC, Udine, Italy
Interests: otorhinolaryngology; head and neck surgery; rhinology; skull base surgery

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Guest Editor
Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
Interests: head & neck cancer; surgery; clinical oncology
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Special Issue Information

Dear Colleagues,

The field of head and neck surgery has notably expanded in the last several decades, and the technological advancement of open, microscopic, endoscopic, and robotic techniques has allowed us to achieve unprecedented progress. As we are continuously refining our therapeutic approaches to head and neck disorders, the well-known risk of impairing or even permanently damaging critical structures (nerves, vessels, etc.) and functions (swallowing, voice, sense of smell and taste, etc.) is always present.

Therefore, a comprehensive view on the most recent and cutting-edge strategies in this surgical specialty is of paramount importance. In this Special Issue of the Journal of Clinical Medicine, we invite you to submit your scientific contributions to this field in the form of original research articles, state-of-the-art or systematic reviews, or meta-analyses. Examples of such research include the management of head and neck postoperative infections or fistulas; severe (facial, spinal accessory, recurrent laryngeal, etc.) nerve dysfunction of septal perforations; laryngeal scars or granulomas; and orbital or intradural complications after skull base surgery. Papers reporting the clinical results of innovative head and neck surgical techniques with a particular emphasis on the postoperative functional consequences will be welcomed, as well as practical and evidence-based methods for the surgical treatment of a particular head or neck condition. We are looking forward to receiving your manuscripts.

Dr. Luca Giovanni Locatello
Prof. Dr. Oreste Gallo
Guest Editors

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Keywords

  • head and neck surgery
  • otorhinolaryngology
  • postoperative complications
  • laryngeal surgery
  • endoscopic surgery
  • salivary gland surgery
  • ear surgery
  • surgery of the oral cavity
  • sinonasal surgery

Published Papers (15 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 178 KiB  
Editorial
The Many Faces of Head and Neck Surgery in 2022 and Looking Ahead!
by Luca Giovanni Locatello and Oreste Gallo
J. Clin. Med. 2022, 11(11), 3174; https://doi.org/10.3390/jcm11113174 - 2 Jun 2022
Cited by 3 | Viewed by 979
Abstract
Head and neck (HN) cancer, which mainly presents in the form of squamous cell carcinoma, was the seventh most common cancer worldwide in 2018, with approximately 890,000 new cases and 450,000 deaths [...] Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)

Research

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6 pages, 1378 KiB  
Communication
Multi-Level 3D Surgery for Obstructive Sleep Apnea: Could It Be the Future?
by Angelo Eplite, Claudio Vicini, Giuseppe Meccariello, Giannicola Iannella, Antonino Maniaci, Angelo Cannavicci, Francesco Moretti, Fabio Facchini, Tommaso Mazzocco and Giovanni Cammaroto
J. Clin. Med. 2023, 12(13), 4173; https://doi.org/10.3390/jcm12134173 - 21 Jun 2023
Cited by 1 | Viewed by 1238
Abstract
(1) Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway, leading to reduced or absent breathing during sleep. A nocturnal upper airway collapse is often [...] Read more.
(1) Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway, leading to reduced or absent breathing during sleep. A nocturnal upper airway collapse is often multi-levelled. The aim of this communication is to describe a 3D multi-level surgery setting in OSA pathology, introducing new surgical approaches, such as 4K-3D endoscopic visualization for the tongue base approach with the aid of a coblator and exoscopic visualization in the palatal approach. (2) Methods: Seven patients affected by OSA underwent 3D Barbed Reposition Pharyngoplasty (BRP) surgery associated with transoral coblation tongue base reduction and nose surgery. (3) Results: No patients experienced intra-operative, post-operative or delayed complications. For OSA multi-level 3D surgery, it took less than 2 h: the median 3D system setting time was 12.5 ± 2.3 min; the overall procedure time was 59.3 ± 26 min. (4) Conclusions: The use of the 4K-3D endoscope and coblator for tongue base resectioning and of the 3D exoscope for lateral pharyngoplasty represents an excellent system in multi-level OSA related surgery that could reduce the time and the costs compared to those of robotic surgery. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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11 pages, 267 KiB  
Article
Functioning Endocrine Outcome after Endoscopic Endonasal Transsellar Approach for Pituitary Neuroendocrine Tumors
by Gabriele Molteni, Nicole Caiazza, Gianfranco Fulco, Andrea Sacchetto, Antonio Gulino and Daniele Marchioni
J. Clin. Med. 2023, 12(8), 2986; https://doi.org/10.3390/jcm12082986 - 20 Apr 2023
Viewed by 983
Abstract
Background: The endoscopic endonasal approach (EEA) is a well-established technique for the treatment of pituitary neuroendocrine tumor Preservation of normal gland tissue is crucial to retain effective neuroendocrine pituitary function. The aim of this paper is to analyze pituitary endocrine secretion after EEA [...] Read more.
Background: The endoscopic endonasal approach (EEA) is a well-established technique for the treatment of pituitary neuroendocrine tumor Preservation of normal gland tissue is crucial to retain effective neuroendocrine pituitary function. The aim of this paper is to analyze pituitary endocrine secretion after EEA for pituitary neuroendocrine tumor to identify potential predictors of functioning gland recovery. Methods: Patients who underwent an exclusive EEA for pituitary neuroendocrine tumors between October 2014 and November 2019 were reviewed. Patients were divided into groups according to postoperative pituitary function (Group 1, unchanged; group 2, recovering; group 3, worsening). Results: Among the 45 patients enrolled, 15 presented a silent tumor and showed no hormonal impairment, and 30 patients presented pituitary dysfunction. A total of 19 patients (42.2%) were included in group 1, 12 (26.7%) patients showed pituitary function recovery after surgery (group 2), and 14 patients (31.1%) exhibited the onset of new pituitary deficiency postoperatively (group 3). Younger patients and those with functioning tumor were more likely to have complete pituitary hormonal recovery (p = 0.0297 and p = 0.007, respectively). No predictors of functional gland worsening were identified. Conclusion: EEA for pituitary neuroendocrine tumor is a reliable and safe technique regarding postoperative hormonal function. Preserving pituitary function after tumor resection should be a primary goal in a minimally invasive approach. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
15 pages, 583 KiB  
Article
Results of Primary Treatment and Salvage Treatment in the Management of Patients with Non-Squamous Cell Malignant Tumors of the Sinonasal Region: Single Institution Experience
by Urszula Kacorzyk, Marek Kentnowski, Cezary Szymczyk, Ewa Chmielik, Barbara Bobek-Billewicz, Krzysztof Składowski and Tomasz Wojciech Rutkowski
J. Clin. Med. 2023, 12(5), 1953; https://doi.org/10.3390/jcm12051953 - 1 Mar 2023
Viewed by 1401
Abstract
Non-squamous cell carcinoma-related malignant sinonasal tract tumors (non-SCC MSTT) are rare and diverse malignancies. In this study, we report our experience in the management of this group of patients. The treatment outcome has been presented, involving both primary treatment and salvage approaches. Data [...] Read more.
Non-squamous cell carcinoma-related malignant sinonasal tract tumors (non-SCC MSTT) are rare and diverse malignancies. In this study, we report our experience in the management of this group of patients. The treatment outcome has been presented, involving both primary treatment and salvage approaches. Data from 61 patients treated radically due to non-SCC MSTT between 2000 and 2016 at the National Cancer Research Institute, Gliwice branch, were analyzed. The group consisted of the following pathological subtypes of MSTT: adenoid cystic carcinoma (ACC), undifferentiated sinonasal carcinoma (USC), sarcoma, olfactory neuroblastoma (ONB), adenocarcinoma, small cell neuroendocrine carcinoma (SNC), mucoepidermic carcinoma (MEC), and acinic cell carcinoma, which were found in nineteen (31%), seventeen (28%), seven (11.5%), seven (11.5%), five (8%), three (5%), two (3%) and one (2%) of patients, respectively. There were 28 (46%) males and 33 (54%) females at the median age of 51 years. Maxilla was the primary tumor localization followed by the nasal cavity and ethmoid sinus in thirty-one (51%), twenty (32.5%), and seven (11.5%) patients, respectively. In 46 (74%) patients, an advanced tumor stage (T3 or T4) was diagnosed. Primary nodal involvement (N) was found in three (5%) cases, and all patients underwent radical treatment. The combined treatment consisted of surgery and radiotherapy (RT) and was given to 52 (85%) patients. The probabilities of overall survival (OS), locoregional control (LRC), metastases-free survival (MFS), and disease-free survival (DFS) were assessed in pathological subtypes and grouped together, along with the ratio and effectiveness of salvage. Locoregional treatment failure was seen in 21 (34%) patients. Salvage treatment was performed in fifteen (71%) patients and was effective in nine (60%) cases. There was a significant difference in OS between patients who underwent salvage and those who did not (median: 40 months vs. 7 months, p = 0.01). In the group of patients who underwent salvage, OS was significantly longer when the procedure was effective (median: 80.5 months) than if it failed (median: 20.5 months), p < 0.0001. OS in patients after effective salvage was the same as in patients who were primary cured (median: 80.5 months vs. 88 months, p = 0.8). Distant metastases developed in ten (16%) patients. Five and ten year LRC, MFS, DFS, and OS were 69%, 83%, 60%, 70%, and 58%, 83%, 47%, 49%, respectively. The best treatment results were observed for patients with adenocarcinoma and sarcoma, while USC gave the poorest results in our set of patients. In this study, we indicate that salvage is possible in most patients with non-SCC MSTT with locoregional failure and that it may significantly prolong their overall survival. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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8 pages, 8750 KiB  
Article
A New Animal Model of Laryngeal Transplantation
by Pierre Philouze, Olivier Malard, Sébastien Albert, Lionel Badet, Bertrand Baujat, Frédéric Faure, Carine Fuchsmann, Franck Jegoux, Jean Lacau-St-Guily, Jean-Paul Marie, Antoine Ramade, Sebastien Vergez, Philippe Ceruse and Olivier J. Gauthier
J. Clin. Med. 2022, 11(21), 6427; https://doi.org/10.3390/jcm11216427 - 30 Oct 2022
Cited by 4 | Viewed by 1327
Abstract
Only three laryngeal transplants have been described in the literature to date, and none of the techniques has enabled a completely satisfactory functional result to be obtained. This article presents a new model of laryngeal transplantation, with quality of revascularisation of the transplant [...] Read more.
Only three laryngeal transplants have been described in the literature to date, and none of the techniques has enabled a completely satisfactory functional result to be obtained. This article presents a new model of laryngeal transplantation, with quality of revascularisation of the transplant being the principal objective and optimisation of the various steps of the procedure, with the integration of a new reinnervation technique as a secondary objective. We present a preclinical animal study. Three pig larynges removed in vivo underwent allotransplantation according to the same protocol. The quality of the revascularisation was examined immediately after the surgery as well as by endoscopy for one animal on the fourth day after the operation. The mean time of cold ischaemia was 3 h 15 min. The anaesthetic tolerance of the pigs was excellent. Revascularisation was achieved and judged to be excellent for the three transplants immediately after the operation and the endoscopy performed for one pig on the fourth day after the operation confirmed this result. The anatomical similarities also enabled the application and integration of an innovative technique of laryngeal reinnervation into the various phases of the operation. We describe a reliable and reproducible animal model for laryngeal transplantation. Its application in humans can be envisaged. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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9 pages, 1215 KiB  
Article
Salvage Partial Laryngectomy after Failed Radiotherapy: Oncological and Functional Outcomes
by Mélanie Gigot, Antoine Digonnet, Alexandra Rodriguez and Jerome R. Lechien
J. Clin. Med. 2022, 11(18), 5411; https://doi.org/10.3390/jcm11185411 - 15 Sep 2022
Cited by 3 | Viewed by 1989
Abstract
Objective: To investigate oncological and functional outcomes in patients treated with salvage partial laryngectomy (SPL) after failed radio/chemotherapy. Study design: Retrospective multicenter chart review. Methods: Medical records of patients treated with SPL from January 1998 to January 2018 in two University Medical centers [...] Read more.
Objective: To investigate oncological and functional outcomes in patients treated with salvage partial laryngectomy (SPL) after failed radio/chemotherapy. Study design: Retrospective multicenter chart review. Methods: Medical records of patients treated with SPL from January 1998 to January 2018 in two University Medical centers were retrieved. The SPL included horizontal supraglottic laryngectomy, hemi-laryngectomy and crico-hyoido-epiglottopexy. The following outcomes were investigated: histopathological features; overall survival (OS); recurrence-free survival (RFS) local and regional controls; post-operative speech recovery; and the oral diet restart and decannulation. Results: The data of 20 patients with cT1–cT3 laryngeal cancer were collected. The mean follow-up of patients was 69.7 months. The mean hospital stay was 43.0 days (16–111). The following complications occurred in the immediate post-operative follow-up: neck fistula (N = 6), aspiration pneumonia (N = 5), and chondronecrosis (N = 2). Early or late total laryngectomy was carried out over the follow-up period for the following reasons: positive margins and local recurrence/progression (N = 7), chondronecrosis (N = 2) and non-functional larynx (N = 1). The restart of the oral diet was carried out in 12/15 (80%) SPL patients (five patients being excluded for totalization). All patients recovered speech, and decannulation was performed in 14 patients (93%). The 5-year OS and RFS were 50% and 56%, respectively. The 5-year local and regional control rates were 56% and 56%, respectively. Conclusions: Partial laryngectomy is an alternative therapeutic approach to total laryngectomy in patients with a history of failed radiation. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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10 pages, 717 KiB  
Article
Post-Operative Infections in Head and Neck Cancer Surgery: Risk Factors for Different Infection Sites
by Giancarlo Pecorari, Giuseppe Riva, Andrea Albera, Ester Cravero, Elisabetta Fassone, Andrea Canale and Roberto Albera
J. Clin. Med. 2022, 11(17), 4969; https://doi.org/10.3390/jcm11174969 - 24 Aug 2022
Cited by 4 | Viewed by 1413
Abstract
Background: Post-operative infections in head and neck cancer (HNC) surgery represent a major problem and are associated with an important increase in mortality, morbidity, and burden on the healthcare system. The aim of this retrospective observational study was to evaluate post-operative infections in [...] Read more.
Background: Post-operative infections in head and neck cancer (HNC) surgery represent a major problem and are associated with an important increase in mortality, morbidity, and burden on the healthcare system. The aim of this retrospective observational study was to evaluate post-operative infections in HNC surgery and to analyze risk factors, with a specific focus on different sites of infection. Methods: Clinical data about 488 HNC patients who underwent surgery were recorded. Univariate and multivariate analyses were performed to identify risk factors for post-operative infections. Results: Post-operative infections were observed in 22.7% of cases. Respiratory and surgical site infections were the most common. Multiple site infections were observed in 3.9% of cases. Considering all infection sites, advanced stage, tracheotomy, and higher duration of surgery were risk factors at multivariate analysis. Median hospital stay was significantly longer in patients who had post-operative infection (38 vs. 9 days). Conclusions: Post-operative infections may negatively affect surgical outcomes. A correct identification of risk factors may help the physicians to prevent post-operative infections in HNC surgery. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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13 pages, 2275 KiB  
Article
Olfactory Neuroblastomas: What Actually Happens in the Long-Term?
by Konstantinos Mantsopoulos, Michael Koch, Heinrich Iro and Jannis Constantinidis
J. Clin. Med. 2022, 11(9), 2288; https://doi.org/10.3390/jcm11092288 - 20 Apr 2022
Cited by 2 | Viewed by 2494
Abstract
Objective: The aim of this study was to investigate the long-term oncologic outcome and review the state of the art in the management of olfactory neuroblastomas. Material and Methods: The records of all patients treated for olfactory neuroblastomas in two academic departments between [...] Read more.
Objective: The aim of this study was to investigate the long-term oncologic outcome and review the state of the art in the management of olfactory neuroblastomas. Material and Methods: The records of all patients treated for olfactory neuroblastomas in two academic departments between 1975 and 2012 were evaluated retrospectively. Data on epidemiological parameters were collected (age, gender), along with staging (Kadish, Morita), histologic grading (Hyams), time and form of treatment, locoregional control, and disease-specific and overall survival. Patients with other malignant diseases, distant metastases of olfactory neuroblastomas at the time of initial diagnosis, a follow-up time of less than 5 years, or insufficient clinical-pathological data were excluded from further analysis. Results: In total, 53 cases made up our final study sample (26 men, 27 women; male–female ratio 0.96:1). Their mean age was 48.6 years (range: 10–84 years). The mean follow-up time was 137.5 months (4–336 months, SD: 85.0). A total of 5 out of 53 study cases (9.4%) showed metastatic involvement of the neck at the time of initial presentation. Local recurrence was detected in 8/53 (15.1%) and regional recurrence in 7/53 of our study cases (13.2%). Three patients (42.8%) from the group of cases with surgery as the sole form of management (7/53, 13.2%) died due to the disease. The cumulative disease-specific survival and overall survivalfor the whole group of patients were 88.6% and 63.6%, respectively. The cumulative disease-specific survival stratified by Kadish A/B vs. Kadish C/D as well as Hyams I/II vs. Hyams III/IV showed superior results for limited tumors, albeit without significance, and low-grade tumors (highly significant difference). Conclusion: Craniofacial or sometimes solely endoscopically controlled resection can warrant resection of the olfactory neuroblastoma with wide margins. However, locoregional failures and distant metastases can occur after a long period of time. The non-negligible incidence of regional recurrences, partly in unusual localizations, leads us to consider the need to identify the “recurrence-friendly” cases and to perform individualized elective irradiation of the neck in cases with high-risk features. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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9 pages, 233 KiB  
Article
Accumulation of Experience and Newly Developed Devices Can Improve the Safety and Voice Outcome of Total Thyroidectomy for Graves’ Disease
by Cheng-Hsun Chuang, Tzu-Yen Huang, Tzer-Zen Hwang, Che-Wei Wu, I-Cheng Lu, Pi-Ying Chang, Yi-Chu Lin, Ling-Feng Wang, Chih-Chun Wang, Ching-Feng Lien, Gianlorenzo Dionigi, Chih-Feng Tai and Feng-Yu Chiang
J. Clin. Med. 2022, 11(5), 1298; https://doi.org/10.3390/jcm11051298 - 27 Feb 2022
Cited by 1 | Viewed by 1620
Abstract
Total thyroidectomy (TT) in patients with Graves’ disease is challenging even for an experienced thyroid surgeon. This study aimed to investigate the accumulation of experience and applying newly developed devices on major complications and voice outcomes after surgery of a single surgeon over [...] Read more.
Total thyroidectomy (TT) in patients with Graves’ disease is challenging even for an experienced thyroid surgeon. This study aimed to investigate the accumulation of experience and applying newly developed devices on major complications and voice outcomes after surgery of a single surgeon over 30 years. This study retrospectively reviewed 90 patients with Graves’ disease who received TT. Forty-six patients received surgery during 1990–1999 (Group A), and 44 patients received surgery during 2010–2019 (Group B). Major complications rates were compared between Group A/B, and objective voice parameters were compared between the usage of energy-based devices (EBDs) within Group B. Compared to Group B, Group A patients had higher rates of recurrent laryngeal nerve palsy (13.0%/1.1%, p = 0.001), postoperative hypocalcemia (47.8%/18.2%, p = 0.002), and postoperative hematoma (10.9%/2.3%, p = 0.108). Additionally, Group A had one permanent vocal cord palsy, four permanent hypocalcemia, and one thyroid storm, whereas none of Group B had these complications. Group B patients with EBDs had a significantly better pitch range (p = 0.015) and jitter (p = 0.035) than those without EBDs. To reduce the major complications rate, inexperienced thyroid surgeons should remain vigilant when performing TT for Graves’ disease. Updates on surgical concepts and the effective use of operative adjuncts are necessary to improve patient safety and voice outcome. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)

Review

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14 pages, 3177 KiB  
Review
Narrative Review of Classification Systems Describing Laryngeal Vascularity Using Advanced Endoscopic Imaging
by Peter Kántor, Lucia Staníková, Anna Švejdová, Karol Zeleník and Pavel Komínek
J. Clin. Med. 2023, 12(1), 10; https://doi.org/10.3390/jcm12010010 - 20 Dec 2022
Cited by 1 | Viewed by 1502
Abstract
Endoscopic methods are critical in the early diagnosis of mucosal lesions of the head and neck. In recent years, new examination methods and classification systems have been developed and introduced into clinical practice. All of these new techniques target the notion of optical [...] Read more.
Endoscopic methods are critical in the early diagnosis of mucosal lesions of the head and neck. In recent years, new examination methods and classification systems have been developed and introduced into clinical practice. All of these new techniques target the notion of optical biopsy, which tries to assess the nature of the lesion before histology examination. Many methods suffer from interpretation issues due to subjective interpretation of the findings. Therefore, multiple classification systems have been developed to assist the proper interpretation of mucosal findings and reduce the error rate. They provide various perspectives on the assessment and interpretation of mucosa changes. This article provides a comprehensive and critical view of the available classification systems as well as their advantages and disadvantages. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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11 pages, 2539 KiB  
Review
Open Partial Laryngectomies: History of Laryngeal Cancer Surgery
by Stéphane Hans, Robin Baudouin, Marta P. Circiu, Florent Couineau, Quentin Lisan, Lise Crevier-Buchman and Jérôme R. Lechien
J. Clin. Med. 2022, 11(18), 5352; https://doi.org/10.3390/jcm11185352 - 12 Sep 2022
Cited by 8 | Viewed by 5181
Abstract
Historically, surgery was the first-choice therapy for early, intermediate and advanced laryngeal squamous cell carcinoma (LSCC). Partial laryngeal surgery has evolved in recent decades and was influenced by many historic events and the development of new technologies. Partial laryngectomies may be performed by [...] Read more.
Historically, surgery was the first-choice therapy for early, intermediate and advanced laryngeal squamous cell carcinoma (LSCC). Partial laryngeal surgery has evolved in recent decades and was influenced by many historic events and the development of new technologies. Partial laryngectomies may be performed by open, endoscopic or transoral robotic approaches. In this historic paper, we describe the evolution of open partial laryngectomy techniques, indications and surgical outcomes. Since the first partial laryngectomy in 1788, many U.S., U.K. and European surgeons, including Henry Sands, Jacob da Silva Solis-Cohen and Theodor Billroth, performed this surgical procedure under local anesthesia for tuberculosis, cancer or syphilis. Partial laryngectomy gained reputation in the medical community in 1888 due to the laryngeal cancer and death of the prince of Prussia, Frederick III. Frederick III’s death represented the turning point in the history of partial laryngectomies, calling attention to the importance of semiotics, biopsy and early diagnosis in laryngeal cancers. Hemi-laryngectomy was indicated/proposed for lateral laryngeal tumors, while thyrotomy was indicated for cancers of the middle part of the vocal fold. The second landmark in the history of partial laryngectomies was the discovery of cocaine, novocaine and adrenaline and the related development of local anesthetic techniques, which, together with the epidemiological and hygienic advances of the 19th century, allowed for better perioperative outcomes. General anesthesia was introduced in the second part of the 20th century and further improved the surgical outcomes. The diagnosis of laryngeal cancer was improved with the development of X-rays and direct laryngoscopies. The 20th century was characterized by the development and improvement of vertical partial laryngectomy procedures and the development of horizontal partial laryngectomies for both supraglottic and glottic regions. The history and the evolution of these techniques are discussed in the present historical paper. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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11 pages, 658 KiB  
Review
Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature
by Luca Giovanni Locatello, Giuseppe Licci, Giandomenico Maggiore and Oreste Gallo
J. Clin. Med. 2022, 11(1), 100; https://doi.org/10.3390/jcm11010100 - 24 Dec 2021
Cited by 17 | Viewed by 3652
Abstract
Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review [...] Read more.
Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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Other

12 pages, 1449 KiB  
Systematic Review
Radiomics-Based Analysis in the Prediction of Occult Lymph Node Metastases in Patients with Oral Cancer: A Systematic Review
by Serena Jiang, Luca Giovanni Locatello, Giandomenico Maggiore and Oreste Gallo
J. Clin. Med. 2023, 12(15), 4958; https://doi.org/10.3390/jcm12154958 - 28 Jul 2023
Cited by 4 | Viewed by 1178
Abstract
Background: Tumor extension and metastatic cervical lymph nodes’ (LNs) number and dimensions are major prognostic factors in patients with oral squamous cell carcinoma (OSCC). Radiomics-based models are being integrated into clinical practice in the prediction of LN status prior to surgery in order [...] Read more.
Background: Tumor extension and metastatic cervical lymph nodes’ (LNs) number and dimensions are major prognostic factors in patients with oral squamous cell carcinoma (OSCC). Radiomics-based models are being integrated into clinical practice in the prediction of LN status prior to surgery in order to optimize the treatment, yet their value is still debated. Methods: A systematic review of the literature was conducted according to the PRISMA guideline. Baseline study characteristics, and methodological items were extracted and summarized. Results: A total of 10 retrospective studies were included into the present study, each of them exploiting a single imaging modality. Data from a cohort of 1489 patients were analyzed: the highest AUC value was 99.5%, ACC ranges from 68% to 97.5%, and sensibility and specificity were over 0.65 and 0.70, respectively. Conclusion: Radiomics may be a noninvasive tool to predict occult LN metastases (LNM) in OSCC patients prior to treatment; further prospective studies are warranted to create a reproducible and reliable method for the detection of LNM in OSCC. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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10 pages, 2025 KiB  
Systematic Review
Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review
by Marta Rogalska, Lukasz Antkowiak, Anna Kasperczuk, Wojciech Scierski and Maciej Misiolek
J. Clin. Med. 2023, 12(8), 3007; https://doi.org/10.3390/jcm12083007 - 20 Apr 2023
Cited by 1 | Viewed by 1236
Abstract
This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG [...] Read more.
This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022. Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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Brief Report
Post-Laryngectomy Voice Prosthesis Changes by Speech-Language Pathologists: Preliminary Results
by Stéphane Hans, Grégoire Vialatte de Pemille, Robin Baudouin, Aude Julien-Laferriere, Florent Couineau, Lise Crevier-Buchman, Marta P. Circiu and Jérôme R. Lechien
J. Clin. Med. 2022, 11(14), 4113; https://doi.org/10.3390/jcm11144113 - 15 Jul 2022
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Abstract
Background: In the present study, we assess the feasibility and success outcomes of voice prosthesis (VP) changes when performed by a speech-language pathologist (SLP). Methods: Patients treated with total laryngectomy (TL) from January 2020 to December 2020 were prospectively recruited from our medical [...] Read more.
Background: In the present study, we assess the feasibility and success outcomes of voice prosthesis (VP) changes when performed by a speech-language pathologist (SLP). Methods: Patients treated with total laryngectomy (TL) from January 2020 to December 2020 were prospectively recruited from our medical center. Patients benefited from tracheoesophageal puncture. The VP changes were performed by the senior SLP and the following data were collected for each VP change: date of placement; change or removal; VP type and size; reason for change or removal; and use of a washer for periprosthetic leakage. A patient-reported outcome questionnaire including six items was proposed to patients at each VP change. Items were assessed with a 10-point Likert-scale. Results: Fifty-two VP changes were performed by the senior SLP during the study period. The mean duration of the SLP consultation, including patient history, examination and VP change procedure, was 20 min (range: 15–30). The median prosthesis lifetime was 88 days. The main reasons for VP changes were transprosthetic (n = 34; 79%) and periprosthetic (n = 7; 21%) leakages. SLP successfully performed all VP changes. He did not change one VP, but used a periprosthetic silastic to stop the periprosthetic leakages. In two cases, SLP needed the surgeon’s examination to discuss the following indication: implant mucosa inclusion and autologous fat injection. The patient satisfaction was high according to the speed and the quality of care by the SLP. Conclusions: The delegation of VP change from the otolaryngologist–head and neck surgeon to the speech-language pathologist (SLP) may be achieved without significant complications. The delegation of VP change procedure to SLP may be interesting in some rural regions with otolaryngologist shortages. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates and Perspectives)
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