Current Advances in Diagnosis and Surgical Treatment of the Head and Neck Disorders

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 12939

Special Issue Editor


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Guest Editor
1. Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, Germany 2. Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816 Neuruppin, Germany
Interests: head and neck cancers; oral and maxillofacial surgery; plastic, reconstructive and aesthetic surgery; surgical oncology; craniomaxillofacial trauma; clinical research; health care research
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Special Issue Information

Dear Colleagues,

Head and neck diseases comprise a very wide range of the spectrum of diseases and often require specific approaches from head and neck/craniomaxillofacial surgeons, general otolaryngologists and plastic surgeons, as well as dentists, ophthalmologists, neurologists/neurosurgeons, and speech and physiotherapists. The appropriate evaluation and treatments by a multidisciplinary team are frequently led by head and neck specialists, who may have initial contact with the patient who presents with diseases or deformities of this unique region of the body. Hence, head and neck specialists should have the expertise and initiative to both treat the diseases and coordinate other requirements of holistic patient care.

Our speciality of head and neck surgery and medicine is currently experiencing a period of active and innovative change in technology and techniques. There have been many different past approaches to certain head and neck diseases (for example, surgical approaches to the temporomandibular joint and practice guidelines on high-risk cutaneous squamous cancers), preferred and popularised by specialists from all over the world. Nowadays, with the increased communications between head and neck specialists in the international community, especially via social media, an insightful and active discussion of these approaches and techniques is enjoyed and undoubtedly has great benefits for this specialist field. On the other hand, such approaches and techniques with the diminishing-returns learning curve must be evidence-based and repeatable by every hand.

As the Guest Editor for this Special Issue, I look forward to accepting high-quality articles that present thorough findings concerning surgical and/or nonsurgical procedures, which are becoming increasingly common in practice, in order to cover this wide range array of the topics, introduce an important and practical reference to our specialty, and provoke productive discussions among academia. I am delighted to provide a well-organised and expert exploration into this growing area of head and neck surgical practice via a Special Issue to our specialist readership.

Dr. Poramate Pitak-Arnnop
Guest Editor

Manuscript Submission Information

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Keywords

  • head and neck injury
  • head and neck trauma
  • head and neck cancer
  • oncology
  • head and neck infection
  • congenital orofacial deformity
  • orofacial pain
  • facial plastic and reconstructive surgery
  • facial aesthetic medicine
  • head and neck reconstruction

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Published Papers (6 papers)

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Research

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8 pages, 309 KiB  
Article
Prophylactic Central Neck Lymph Node Dissection Adds No Short-Term Benefit to Total Thyroidectomy for Differentiated Thyroid Cancer
by Rosen Dimov, Gancho Kostov, Mladen Doykov, Luboslav Dimov, Boyan Nonchev, Rositsa Dimova and Bozhidar Hristov
Medicina 2023, 59(2), 239; https://doi.org/10.3390/medicina59020239 - 27 Jan 2023
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Abstract
Background and Objectives: To answer the research question: “Is prophylactic central neck lymph node dissection (pCNLD) beneficial among differentiated thyroid carcinoma (DTC) patients?” Materials and Methods: This was a retrospective cohort study enrolling DTC patients treated at the University Hospital Kaspela, [...] Read more.
Background and Objectives: To answer the research question: “Is prophylactic central neck lymph node dissection (pCNLD) beneficial among differentiated thyroid carcinoma (DTC) patients?” Materials and Methods: This was a retrospective cohort study enrolling DTC patients treated at the University Hospital Kaspela, Bulgaria, from 30 January 2019 to October 2021. The predictor variable was presence of pCNLD (total thyroidectomy with vs. without pCNLD). The main outcome variables were postoperative complications (i.e., vocal cord paralysis, hypoparathyroidism, postoperative bleeding, and adjacent organ injury) and recurrence parameters. Appropriate statistics were computed with the significant level at p ≤ 0.05. Results: During the study period, 300 DTC patients (59.7% with pCNLD; 79.3% females) with an average age of 52 ± 2.8 years were treated. The mean follow-up period of the entire cohort was 45.8 ± 19.1 months. On bivariate analyses, TT with pCNLD, when compared to TT alone, required longer surgical time (mean difference: 9.4 min), caused nearly similar complications (except transient hypothyroidism: p = 0.04; relative risk, 1.32; 95% confidence interval, 1.0 to 1.73), and no significantly different recurrence events, time to recurrence, and recurrent sites. The benefit–risk analyses using the number needed to treat and to harm (NNT; NNH) also confirmed that TT plus pCNLD was not very beneficial in DTC management. Conclusion: The results of this study refute the benefit of pCNLD in DTC patient care with TT. Further well-designed studies in a larger cohort with a longer follow-up period are required to confirm this conclusion. Full article
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9 pages, 294 KiB  
Article
Prospective Assessment of Risk Factors Influencing Facial Nerve Paresis in Patients after Surgery for Parotid Gland Tumors
by Ewa Głuszkiewicz, Paweł Sowa, Maciej Zieliński, Monika Adamczyk-Sowa, Maciej Misiołek and Wojciech Ścierski
Medicina 2022, 58(12), 1726; https://doi.org/10.3390/medicina58121726 - 25 Nov 2022
Cited by 1 | Viewed by 1466
Abstract
Background and objectives: Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of postparotidectomy facial nerve dysfunction; (2) clinical and electrophysiological assessment of the facial nerve function [...] Read more.
Background and objectives: Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of postparotidectomy facial nerve dysfunction; (2) clinical and electrophysiological assessment of the facial nerve function before parotidectomy and at 1 and 6 months postoperatively; (3) assessment of the association of postoperative facial palsy with selected risk factors; and (4) assessment of the correlation between the results of clinical and neurophysiological assessments of facial nerve function. Materials and Methods: This study comprised 50 patients (aged 24–75 years) who underwent parotidectomy at the Department of Otolaryngology and Laryngological Oncology in Zabrze, Poland between 2015 and 2017. The evaluation included neurological, clinical and electrophysiological assessments of the facial nerve prior to surgery and at 1 and 6 months postoperatively. Results: No facial palsy was found preoperatively or 6 months postoperatively. Facial nerve dysfunction was found in 74% of patients 1 month postoperatively. In most cases (54%), paresis was mild or moderate (House–Brackmann grades II and III). The results of electrophysiological tests before parotidectomy were either normal or showed some mild abnormalities. We found a statistically significant correlation between the clinical assessment of the facial nerve function (based on the House–Brackmann scale) one month postoperatively and the latency of the CMAP response from the orbicularis oculi and orbicularis oris muscles. In all three studies, a statistically significant correlation was found between the amplitude of the compound muscle action potential (CMAP) of the orbicularis oris muscle and the degree of facial nerve weakness. Conclusions: The factors that may influence the risk of postoperative facial nerve paralysis (prolonged surgical time and the size and location of the tumor other than in the superficial lobe only) may indirectly suggest that surgery-related difficulties and/or surgeon experience could be crucial to surgery safety. Full article

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7 pages, 4165 KiB  
Case Report
Point-of-Care Ultrasonography Helped to Rapidly Detect Pneumomediastinum in a Vomiting Female
by Yun-Hao Chen, Po-Chen Lin, Yu-Long Chen, Giou-Teng Yiang and Meng-Yu Wu
Medicina 2023, 59(2), 394; https://doi.org/10.3390/medicina59020394 - 17 Feb 2023
Cited by 2 | Viewed by 1585
Abstract
Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large [...] Read more.
Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large overlap of symptoms accompanying Boerhaave syndrome and the Macklin effect, including retrosternal chest pain, neck discomfort, cough, sore throat, dysphagia, dysphonia, and dyspnea. Boerhaave syndrome is a dangerous condition. Delayed diagnosis of Boerhaave syndrome may worsen sepsis and cause mortality. Therefore, early diagnosis and timely management are important to prevent further complications. Here, we present a case of vomiting-induced pneumomediastinum, which supports the use of bedside ultrasonography to aid in the diagnosis and rapid differentiation of etiology of pneumomediastinum. Full article
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7 pages, 1893 KiB  
Case Report
Patient with Aberrant Internal Carotid Artery in the Middle Ear Presenting with Rare Symptoms of Mixed Hearing Loss and Postauricular Pain: A Case Report
by Bo-Nien Chen
Medicina 2022, 58(11), 1672; https://doi.org/10.3390/medicina58111672 - 18 Nov 2022
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Abstract
Aberrant internal carotid artery in the middle ear (aICA) is a rare congenital malformation in which the internal carotid artery passes through the tympanic cavity without being separated by bone. A pulsatile vascular mass can be observed in the tympanic cavity of patients [...] Read more.
Aberrant internal carotid artery in the middle ear (aICA) is a rare congenital malformation in which the internal carotid artery passes through the tympanic cavity without being separated by bone. A pulsatile vascular mass can be observed in the tympanic cavity of patients with aICA. The diagnosis of aICA may be challenging because improper surgery or treatment can lead to iatrogenic injury, including massive hemorrhage. The aim of this case report was to describe a 39-year-old woman with aICA presenting with mixed hearing loss and postauricular pain. We provided detailed clinical images of the patient to illustrate how aICA can be diagnosed. Because this patient’s aICA had no risk of bleeding, close observation, pharmacological therapy, and regular follow-up were applied. The patient’s postauricular pain was significantly improved after treatment with oxcarbazepine. At the time of this manuscript’s preparation, the patient had been monitored for 10 years and had stable mixed hearing loss with no other complications. Based on the management of this patient, oxcarbazepine can improve aICA-associated postauricular pain, and conservative treatment should be prioritized in cases of aICA without a risk of bleeding. Further studies in a large cohort are required to confirm our findings and recommendations. Full article
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7 pages, 3390 KiB  
Case Report
Unique Characteristics and Applications of Reverse Superior Labial Artery Island Flaps: A Case Series
by Aleksander Zwierz, Krystyna Masna, Marcin Perczak and Paweł Burduk
Medicina 2022, 58(8), 1012; https://doi.org/10.3390/medicina58081012 - 28 Jul 2022
Cited by 1 | Viewed by 3267
Abstract
Background: The reverse superior labial artery (rSLA) island flap can be used to reconstruct the cheek, ala, columella and vestibule of the nose when other techniques appear insufficient or impractical. The aim of this case series was to present applications of rSLA [...] Read more.
Background: The reverse superior labial artery (rSLA) island flap can be used to reconstruct the cheek, ala, columella and vestibule of the nose when other techniques appear insufficient or impractical. The aim of this case series was to present applications of rSLA pedicle flaps in the post-ablative oncologic reconstruction of the face. Patients and Methods: Using a retrospective case-series study design, the investigators enrolled a cohort of patients undergoing procedures involving rSLA flaps treated at a Polish Otolaryngology Department for facial reconstruction after tumour excision. The main outcomes were functional and aesthetic aspects. Descriptive statistics were computed as appropriate. Results and Conclusions: The use of rSLA flaps allows surgeons to obtain a large skin island with only minimal cosmetic and functional alterations. In all of the cases in this series, the use of this pedicle flap resulted in both optimal healing and satisfactory cosmetic and functional outcomes. Full article
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6 pages, 1288 KiB  
Case Report
Eosinophilic Angiocentric Fibrosis of the Nasal Cavities: A Report of an Uncommon Lesion with Emphasis on the Etiology and Differential Diagnosis
by Jessica Farina, Giuseppe Broggi, Carmelo Federico, Magda Zanelli, Andrea Palicelli and Rosario Caltabiano
Medicina 2022, 58(7), 865; https://doi.org/10.3390/medicina58070865 - 28 Jun 2022
Cited by 1 | Viewed by 1515
Abstract
Background and Objectives: Eosinophilic angiocentric fibrosis (EAF) is an indolent but sometimes locally destructive lesion with a predilection for the sinonasal tract. Although it was first described in 1983, its etiology remains unknown. Some authors initially attributed EAF to trauma, hypersensitivity, and/or [...] Read more.
Background and Objectives: Eosinophilic angiocentric fibrosis (EAF) is an indolent but sometimes locally destructive lesion with a predilection for the sinonasal tract. Although it was first described in 1983, its etiology remains unknown. Some authors initially attributed EAF to trauma, hypersensitivity, and/or surgical manipulation, while it has been recently suggested to include EAF within the spectrum of IgG4-related systemic diseases. Materials and Methods: We report an uncommon case of idiopathic EAF in a 76-year-old male who developed two bilateral tumefactive masses in the nasal cavities. Results: As the histological examination showed a subepithelial proliferation of fibroblasts along with sclero-hyaline fibrosis around small-sized vessels (an “onion skin-like” pattern) and an eosinophils-rich inflammatory infiltrate, a diagnosis of EAF was rendered. The differential diagnosis included granuloma faciale, Wegener’s granulomatosis, and Churg–Strauss syndrome. Conclusions: Pathologists should be aware of the possibility that this lesion can be part of the wide spectrum of IgG4-related systemic diseases by performing IgG4 investigations to assess adherence to IgG4-related systemic disease criteria. Full article
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