Search Results (71)

Background/Objectives: Data on the value of tumor debulking surgery are scarce. We aimed to examine whether tumor debulking surgery followed by non-surgical treatment (cases) improves survival compared to non-surgical treatment alone (controls) in patients with head and neck cancer (HNC). Methods: We performed a systematic review of studies published in the databases PubMed, Scopus and Cochrane Central Register of Controlled Trials up to 10 December 2024. Studies evaluating tumor debulking surgery followed by non-surgical treatment and reporting survival (local recurrence, disease-free survival or overall survival) in subjects with HNC were included; case reports were excluded. We assessed the quality of observational studies with the Newcastle–Ottawa Scale. Results: Among 11 retrospective small studies, three case–control studies (one of high quality, i.e., 7/9, and two of moderate quality, i.e., 6/9 and 5/9) suggested longer survival in 72 cases with predominantly squamous cell carcinoma (SCC) than in 40 controls with predominantly SCC. However, these survival benefits cannot be attributed solely to tumor debulking surgery, as confounding by indication is the most likely explanation. In supraglottic laryngeal SCC, one study reported a local recurrence-free survival rate and overall survival of 80% and 88%, respectively, in 25 cases compared with 86% and 77%, respectively, in 24 controls. In sarcomas, local recurrence-free survival was 25%, 65% and 100% for unknown resection margins, wide local excision and radical excision, respectively. Conclusions: The heterogeneous data indicate the need for higher-quality research. It would be interesting to investigate whether an attempt to surgically debulk paranasal sinus tumors while preserving adjacent vital organs (e.g., the orbit and/or brain) should be incorporated into the treatment strategy for patients with extended paranasal sinus squamous cell carcinoma. Tumor debulking surgery did not improve survival in supraglottic laryngeal SCC or head and neck soft tissue sarcomas. Full article

Ehlers–Danlos syndromes (EDSs) are heritable connective tissue disorders caused by defects in collagen and related extracellular matrix proteins. Because the vocal fold (VF) lamina propria is a collagen-dependent structure, the voice might be expected to be affected, yet voice and laryngeal involvement has received comparatively little attention. This scoping review, conducted according to the Joanna Briggs Institute framework and reported following the PRISMA extension for Scoping Reviews (PRISMA-ScR), mapped the available evidence on voice and laryngeal manifestations in adults with EDS. PubMed, Scopus, and Web of Science were searched to 11 March 2026, and thirteen studies were included: four questionnaire-based and nine clinical or instrumental. Self-reported voice complaints were common across EDS and hypermobility spectrum disorder populations, ranging from mild-to-moderate handicap in large cohorts to frequent, fluctuating difficulties in professional singers, although their prevalence varied with population and assessment method. Direct laryngeal examination revealed a recurring substrate of cricoarytenoid joint subluxation or fixation, arytenoid prolapse, and hyolaryngeal instability, together with microvascular and mucosal fragility, characteristically accompanied by preserved VF mobility. Muscle tension dysphonia was the most frequent diagnosis in high-vocal-demand cohorts. Reflux, vocal load, and autonomic comorbidities such as postural orthostatic tachycardia syndrome were frequently reported and may modulate the clinical picture. The evidence indicates that voice and laryngeal involvement is a plausible, multi-level manifestation of EDS that remains under-recognised. The current literature is limited by small, heterogeneous, and largely uncontrolled studies; prospective research using standardised multimodal assessment is needed to clarify its prevalence, mechanisms, and management. Full article

Background/Objectives: Management of cervical esophageal cancer after induction therapy remains unsettled. Definitive chemoradiotherapy is the guideline default, but a subset of patients with residual but resectable disease may still benefit from surgery. No validated multidisciplinary selection framework exists for this subsite. Methods: We conducted a systematic review registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261369102) and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, using searches of PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library from inception through 14 April 2026. We identified 1779 records, removed 873 duplicates, and screened 906 records; 87 full-text reports were assessed, of which 67 were excluded at the full-text stage (66 on population grounds—disease not cervical esophageal; and 1 because cervical-direct outcomes were not separable within a mixed cervical/thoracic cohort), leaving 20 cervical-direct studies included in the primary synthesis. Thoracic and meta-analytic sources are cited for indirect comparison and biological rationale but are not counted in the included set. Included studies were evaluated using the Newcastle–Ottawa Scale (NOS) and Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I); certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Formal meta-analysis was not performed because study design, treatment approach, and outcome reporting were too heterogeneous. Results: Cervical-specific evidence is predominantly retrospective but consistent in direction. Available cervical-specific observational data suggest benefit mainly in patients with biopsy-confirmed incomplete response, resectable residual disease, preserved performance status, and access to experienced centers. Larynx-preserving resection is feasible in 90% of T1–2 tumors and 54% of T3–4 responders. In thoracic esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy yields pathologic complete response rates of approximately 29–48%; in cervical disease, the SCENIC trial has reported interim clinical response of approximately 50% in 28 patients, but pathology-confirmed response is not yet available. We present a proposed multidisciplinary selection framework integrating response depth, post-induction stage, laryngeal preservation feasibility, sarcopenia, circulating tumor DNA dynamics, and programmed death-ligand 1 (PD-L1) expression. The framework has not been prospectively validated and is presented as a hypothesis-generating, conceptual tool for multidisciplinary discussion rather than a clinically validated instrument. Adjuvant nivolumab is recommended for residual pathologic disease after margin-negative (R0) resection when surgery follows preoperative chemoradiotherapy; after PD-1-based induction, adjuvant checkpoint inhibition remains investigational. Conclusions: The available cervical-direct evidence is predominantly retrospective and selection-prone, and several inputs supporting the framework are extrapolated from thoracic ESCC cohorts; conclusions about the survival benefit of surgery should therefore be read as associations rather than causal claims. Surgery has a role after induction therapy in carefully selected incomplete responders. The proposed framework is designed for multidisciplinary use and requires prospective validation before routine clinical application. Full article

Background/Objectives: Laryngeal leukoplakia and dysplasia carry a variable risk of malignant transformation. Although microlaryngoscopic excision is standard of care, data on voice function are limited. Multidimensional diagnostics, including the Vocal Extent Measure (VEM), were employed to assess pre- and postoperative status while identifying factors associated with vocal outcomes. Methods: This retrospective cohort included 44 patients with histologically confirmed vocal fold leukoplakia or dysplasia. All underwent cold steel or laser-assisted phonomicrosurgery. Voice assessments were conducted pre- and three months postoperatively, comprising videolaryngostroboscopy, auditory-perceptual evaluation of grade, roughness and breathiness (GRB), self-assessment (Voice Handicap Index, VHI-9i), and objective acoustic-aerodynamic measures. Results: Overall, 57% of patients were active smokers; 73% consumed alcohol. Lesions were mostly unilateral (77%), craniomedially localized (65%), and involved up to one-third of the vocal fold (48%), with impaired mucosal wave (76%). Histopathology revealed mainly hyperkeratosis (52%) and dysplasia (35%). Recurrence rate was 14%, with histology unchanged. Postoperatively, subjective measures showed significant improvements (post- vs. preoperative), with decreased VHI-9i scores (10 vs. 14) and GRB ratings (p < 0.05). Objective measures showed positive trends, including enhanced vocal capacity (VEM 85 vs. 82), stability (jitter 0.6 vs. 0.8%), and aerodynamics (maximum phonation time 18 vs. 15 s). Phonosurgical method, histopathology, and age did not significantly affect voice outcomes; however, higher dysplasia grades and younger age showed trends toward greater VEM gains. Conclusions: Phonomicrosurgical excision of laryngeal leukoplakia and dysplasia effectively preserves or enhances vocal function. The VEM provides a reliable, quantitative complement to established voice diagnostics and should be integrated into standardized assessment protocols. Full article

Background/Objectives: The human larynx exhibits marked sexual dimorphism and undergoes age-related structural remodeling, both of which influence voice characteristics and have important implications for diagnostic assessment. While sex-related differences in laryngeal size are well recognized, the extent to which aging contributes to dimensional versus qualitative structural changes remains incompletely defined. This study aimed to analyze sex- and age-related morphometric and histological characteristics of the human larynx, with a focus on features relevant to voice evaluation and diagnostic interpretation. Methods: A cross-sectional anatomical study was conducted on 80 cadaveric human larynges preserved in 10% buffered formalin. Specimens were stratified by sex and age (<30, 30–60, and ≥60 years). Direct morphometric measurements included anteroposterior laryngeal length, thyroid cartilage height, thyroid angle, and relative glottic area. Epiglottic morphology and the presence of laryngeal cartilage calcification/ossification (binary classification: present vs. absent) were recorded. Histological analysis of vocal fold tissue was performed on a stratified subset of specimens. Statistical analysis included t-tests, chi-square tests, two-way ANOVA, effect size estimation, and logistic regression. Results: Male specimens showed significantly greater anteroposterior length, thyroid cartilage height, and relative glottic area, along with a narrower thyroid angle, compared with females (all p < 0.001), with large effect sizes. Age did not significantly influence overall laryngeal dimensions. In contrast, cartilage calcification/ossification increased markedly after the age of 60. Logistic regression identified age ≥ 60 years as the only independent predictor of calcification (OR = 4.37, p = 0.039), while sex was not significant. Epiglottic morphology demonstrated a sex-dependent distribution. Histology revealed age-related muscle atrophy and reduced collagen and elastin density. Conclusions: Sex defines the baseline morphometric framework of the adult larynx, whereas aging, particularly beyond 60 years, drives qualitative structural degeneration. These findings provide a reproducible anatomical reference for distinguishing sex-related variation from age-related changes in diagnostic assessment. Full article

Open partial horizontal laryngectomy (OPHL) is a key conservative option for laryngeal cancer, with established oncological outcomes but limited data on functional results and patient perspectives. Voice preservation is mainly associated with type I OPHL, whereas types II–III often result in significant but broadly comparable impairments, making vocal decline the main limitation of OPHL. Patient-reported outcomes (PROs) help clarify the balance between treatment efficacy and side effects. This single-institution study analyzed 70 consecutive OPHL patients (12 women, 17.1%; 58 men, 82.9%), mean age 65.9 years (SD 8.96), with a median follow-up of 52.5 months (range 2–218). PROs were assessed using the Priority Scale, the V-RQOL, the MDADI, the Decisional Conflict Scale, the Decisional Regret Scale, and the Brief Pain Inventory. The Priority Scale showed that curing cancer (98.6%) and prolonging life (82.9%) were top concerns, while only 34.3% prioritized natural voice preservation. V-RQOL averaged 77.4/100, indicating limited impact of voice on quality of life; MDADI was 78.5/100, reflecting minimal swallowing difficulties. Decisional Conflict averaged 34.3/100, with 30% reporting no difficulty; Decisional Regret was low (13.0/100), with only 1.4% expressing moderate regret. Most patients (78.6%) reported no pain. Overall, OPHL provided satisfactory functional and decisional outcomes, with high patient satisfaction despite the complexity of treatment. Full article

Background: Papillary thyroid carcinoma in the isthmus (PTCI) remains a subject of surgical debate due to its unique anatomical location and reportedly more aggressive behavior, including higher rates of lymph node metastasis, multifocality, extrathyroidal extension, and capsular invasion. There are currently no definitive guidelines regarding the optimal extent of surgery. Objective: This study aimed to compare the three surgical approaches—total thyroidectomy, lobectomy with isthmusectomy, and isthmusectomy/extended isthmusectomy—in patients with PTCI, focusing on postoperative complications, tumor recurrence, recovery, and identifying risk factors for tumor prognosis and lymph node metastasis. Methods: We retrospectively analyzed data from 215 patients treated surgically across four medical centers from 2016 to 2022, divided into three groups based on surgical extent. We compared baseline characteristics, operative time, intraoperative blood loss, length of hospital stay, postoperative complications, and central lymph node metastasis risk factors. Propensity Score Matching (PSM) was used to create more comparable groups, so as to verify the accuracy and stability of our research results. Results: No significant differences were observed among the three groups in rates of temporary or permanent recurrent laryngeal nerve injury, permanent hypoparathyroidism, or chyle leakage (all p > 0.05). However, transient hypoparathyroidism was more common in the total thyroidectomy group (p < 0.05), which also had longer operative time, greater intraoperative blood loss, and longer postoperative hospital stay (all p < 0.05) The PSM-adjusted analyses further confirmed these findings, except that the previously observed difference in postoperative drainage volume among the three groups was no longer significant (p = 0.791). The Kaplan–Meier curves showed a similar cumulative proportion of recurrence-free survivors in the three groups with no statistically significant difference observed (p = 0.804). Univariate and multivariate logistic regression analysis identified that gender (OR = 4.405, 95%CI: 4.104–4.729, p < 0.001), multifocality (OR = 2.498, 95%CI: 1.064–5.864, p = 0.035), tumor diameter (OR = 1.096, 95%CI: 1.047–1.147, p < 0.001), capsular invasion (OR = 2.666, 95%CI: 2.547–2.791, p < 0.001), and absolute eosinophil count (OR = 1.381, 95%CI: 1.125–1.695, p = 0.002) remained significant independent predictors of central lymph node metastasis in PTCI. A multivariable logistic regression model was developed to predict CLNM, achieving an AUC of 0.777. A probability threshold of 0.50 provided the best balance between sensitivity (77.6%) and specificity (65.5%) and was selected as the clinical cut-off for stratifying high- and low-risk patients. Conclusions: Conservative procedures like lobectomy with isthmusectomy or isthmusectomy/extended isthmusectomy may represent a feasible, function-preserving option in carefully selected low-risk PTCI patients, but further validation is required. In contrast, patients with high-risk features may benefit from central lymph node dissection. The predictive model may provide supportive information for personalized surgical planning. Full article

Background: Laryngeal and hypopharyngeal cancers (LHCs) exhibit heterogeneous outcomes after definitive radiotherapy (RT). Large language models (LLMs) may enhance prognostic stratification by integrating complex clinical and imaging data. This study validated two pre-trained LLMs—GPT-4o-2024-08-06 and Gemma-2-27b-it—for outcome prediction in LHC. Methods: Ninety-two patients with non-metastatic LHC treated with definitive (chemo)radiotherapy at Linkou Chang Gung Memorial Hospital (2006–2013) were retrospectively analyzed. First-order and 3D radiomic features were extracted from intra- and peritumoral regions on pre- and mid-RT CT scans. LLMs were prompted with clinical variables, radiotherapy notes, and radiomic features to classify patients as high- or low-risk for death, recurrence, and distant metastasis. Model performance was assessed using sensitivity, specificity, AUC, Kaplan–Meier survival analysis, and McNemar tests. Results: Integration of radiomic features significantly improved prognostic discrimination over clinical/RT plan data alone for both LLMs. For death prediction, pre-RT radiomics were the most predictive: GPT-4o achieved a peak AUC of 0.730 using intratumoral features, while Gemma-2-27b reached 0.736 using peritumoral features. For recurrence prediction, mid-RT peritumoral features yielded optimal performance (AUC = 0.703 for GPT-4o; AUC = 0.709 for Gemma-2-27b). Kaplan–Meier analyses confirmed statistically significant separation of risk groups: pre-RT intra- and peritumoral features for overall survival (for both GPT-4o and Gemma-2-27b, p < 0.05), and mid-RT peritumoral features for recurrence-free survival (p = 0.028 for GPT-4o; p = 0.017 for Gemma-2-27b). McNemar tests revealed no significant performance difference between the two LLMs when augmented with radiomics (all p > 0.05), indicating that the open-source model achieved comparable accuracy to its proprietary counterpart. Both models generated clinically coherent, patient-specific rationales explaining risk assignments, enhancing interpretability and clinical trust. Conclusions: This external validation demonstrates that pre-trained LLMs can serve as accurate, interpretable, and multimodal prognostic engines for LHC. Pre-RT radiomic features are critical for predicting mortality and metastasis, while mid-RT peritumoral features uniquely inform recurrence risk. The comparable performance of the open-source Gemma-2-27b-it model suggests a scalable, cost-effective, and privacy-preserving pathway for the integration of LLM-based tools into precision radiation oncology workflows to enhance risk stratification and therapeutic personalization. Full article

Exosome-derived microRNAs (miRNAs) have been proposed as minimally invasive biomarkers for laryngeal squamous- cell carcinoma (LSCC). Because oral and maxillofacial surgeons are integral to head-and-neck oncologic and reconstructive pathways, such liquid-biopsy signals could support perioperative decision-making (selection for organ-preserving surgery), margin surveillance, and reconstructive planning. We conducted a preregistered, protocol-driven search of PubMed/MEDLINE, Web of Science, and Scopus from inception to 1 June 2025. Given the very small number of clinically comparable diagnostic studies, discordant index tests/thresholds, and high heterogeneity, we did not perform quantitative pooling or publication-bias testing. Instead, we undertook a narrative synthesis and constructed an evidence map; risk of bias tools (QUADAS-2; ROBINS-I) were applied descriptively to inform qualitative confidence. Nine studies were formally analysed based on eligibility to the study topic. Two serum-based case–control investigations (111 LSCC, 80 controls) reported areas under the ROC curve of 0.876 (miR-21 + HOTAIR) and 0.797 (miR-941), with corresponding sensitivities of 94% and 82%. Seven mechanistic papers showed that vesicular cargos—including miR-1246, circPVT1, and LINC02191—drive STAT3-dependent M2 polarisation, NOTCH1-mediated stemness, Rap1b-VEGFR2 angiogenesis, and glycolytic re-programming, producing 1.6–2.6-fold increases in invasion, tube formation, or xenograft growth. Only three studies fulfilled MISEV-2018 characterisation criteria, and none incorporated external validation. This narrative review and evidence map identifies promising but preliminary diagnostic signals and biologically plausible mechanisms for exosomal miRNAs in LSCC; however, the evidence is sparse, single-region, methodologically inconsistent, and at high risk of bias. Findings do not support clinical implementation at this stage. Priorities include harmonised EV workflows, prespecified thresholds, and prospective, multi-centre validation. Full article

Background: Thyroidectomy is one of the most performed endocrine operations worldwide; among the most significant and feared complications are hypoparathyroidism and recurrent laryngeal nerve (RLN) injury. The purpose of this study is to analyze clinical outcomes and complication rates in thyroid surgery performed at a single high-volume center, with a specific focus on the impact of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve. Methods: A retrospective observational study was conducted on 1263 patients who underwent thyroid surgery between 2009 and 2024. Data on demographics, surgical procedures, and postoperative complications were collected. Outcomes were compared between the pre-IONM (2009–2017) and post-IONM (2018–2024) periods. Statistical analysis included descriptive measures, chi-square or Fisher’s exact tests, and Kaplan–Meier survival analysis with log-rank comparison. Results: Among the 1263 procedures, 76.7% were total thyroidectomies. The overall incidence of transient and permanent hypoparathyroidism was 2.37% and 0.79%, respectively. RLN injuries included 2 bilateral palsies (0.16%, pre-IONM only), 37 transient unilateral palsies (2.93%), and 10 permanent unilateral palsies (0.79%). After IONM introduction, the incidence of RLN injuries significantly decreased (p = 0.03), and no bilateral injuries were observed (p = 0.04). Kaplan–Meier analysis showed that 92% of transient RLN palsies resolved within 4 months, with significantly faster recovery in the post-IONM group (log-rank p = 0.02). Conclusions: Thyroid surgery in high-volume centers is associated with low complication rates. The implementation of IONM, particularly continuous monitoring, has significantly improved RLN preservation and enhanced recovery from transient injuries. These findings support the routine integration of IONM in thyroid surgery to maximize safety and functional outcomes. Full article

Background and Objectives: Laryngeal cancer is a common head and neck tumor burden, with no significant improvements in long term patient survival. Despite the progress of molecular genetics and oncology strategies, there is still a lack of biomarker use in routine clinical practice for early laryngeal cancer screening or diagnosis. miRNAs are explored as promising molecules, that could serve as liquid biopsy. Our goal is to explore the screening potential of miR-31-3p and miR-196a-5p in early- and advanced-stage laryngeal HPV-negative plasma samples. Methods: In this study, 50 plasma samples obtained from early and advanced HPV-negative laryngeal cancer patients were included. The expression levels of mir-31-3p and miR-196a-5p were analyzed via TaqMan RT-qPCR. SPSS v27.0 was used for statistical analysis. Results: For the first time, miR-31-3p and miR-196a-5p were analyzed in plasma samples from early HPV-negative primary LSCC patients. Both circulating miRNAs showed significantly elevated expression levels in early and advanced laryngeal cancer samples. miR-31-3p was significantly associated with T stages (p < 0.001) and N stages (p = 0.009). The ROC analysis revealed that miR-31-3p could significantly discriminate early-stage from advanced-stage LSCC with an AUC of 0.850 (95% CI: 0.743–0.956, p < 0.001) at an RQ cutoff of 2.03, achieving a sensitivity of 95.5% and a specificity of 64%. Nevertheless, miR-196a-5p was found to be significantly overexpressed in early-stage LSCC, which could contribute to the development of its screening potential. For the first time, both miRNAs revealed a significant positive correlation, which indicates that miR-31-3p and miR-196a-5p could coregulate cancerogenesis. Conclusions: In conclusion, the data revealed that miR-31-3p has greater potential as an LSCC screening marker in comparison to miR-196a-5p. Still, miR-196a-5p also showed promising results in early-stage laryngeal cancer monitoring. The utilization of circulating miR-31-3p or miR-196a-5p analysis could enable liquid biopsy approaches, with results potentially informing treatment monitoring strategies, personalized oncological protocols, and early diagnosis. These advancements could ultimately benefit patient outcomes by improving laryngeal organ preservation and survival rates. Full article

(1) Background: The early detection of laryngeal cancer is crucial for achieving superior patient outcomes and preserving laryngeal function. Artificial intelligence (AI) methodologies can expedite the triage of suspicious laryngeal lesions, thereby diminishing the critical timeframe required for clinical intervention. (2) Methods: We included all studies published up to February 2025. We conducted a systematic search across five major databases: MEDLINE, EMCARE, EMBASE, PubMed, and the Cochrane Library. We included 15 studies, with a total of 17,559 patients. A risk of bias assessment was performed using the QUADAS-2 tool. We conducted data synthesis using the Meta Disc 1.4 program. (3) Results: A meta-analysis revealed that AI demonstrated high sensitivity (78%) and specificity (86%), with a Pooled Diagnostic Odds Ratio of 53.77 (95% CI: 27.38 to 105.62) in detecting laryngeal cancer. The subset analysis revealed that CNN-based AI models are superior to non-CNN-based models in image analysis and lesion detection. (4) Conclusions: AI can be used in real-world settings due to its diagnostic accuracy, high sensitivity, and specificity. Full article

Background/Objectives: Laryngeal cancer (LC), predominantly squamous cell carcinoma (SCC), represents a considerable health burden worldwide. Tumour subsite heterogeneity (supraglottic, glottic, subglottic) influences clinical behavior and outcomes. This review synthesizes current knowledge on epidemiology, risk factors, diagnostics, histological variants, biomarkers, treatment modalities, and survival. Results: This narrative review synthesizes current literature on the epidemiology, risk factors, diagnosis, histological variants, biomarkers, and prognosis of LC. The review highlights the critical influence of tumour sites (supraglottic, glottic, subglottic) on metastatic patterns and survival. Key risk factors of LC include tobacco and alcohol use, human papillomavirus (HPV) infection, and occupational exposures. The diagnostic process encompasses clinical examination, endoscopy, biopsy, and imaging. Several biomarkers that aid in diagnosis, treatment plan determination, and prognosis prediction have been established. These biomarkers include long noncoding RNAs, cell cycle regulators, apoptosis regulators, oncogenes, tumour suppressor genes, growth factor pathway components, angiogenic factors, structural proteins, sex hormone receptors, and immunological markers. Current treatment modalities range from organ-preserving surgery and radiotherapy to combined chemoradiotherapy and total laryngectomy. Finally, survival data are presented and stratified by stage and subsite. Conclusions: The review underscores the need for a multidisciplinary approach to LC management, integrating clinical, pathological, and molecular information to optimize patient outcomes. Full article

Background: Intraoperative nerve monitoring (IONM) is increasingly recognized as an essential technique in thyroid surgery to preserve the integrity of the recurrent laryngeal nerve (RLN) and prevent postoperative complications. Although widely adopted, several technical and anesthetic factors can significantly affect the reliability and interpretation of electromyographic (EMG) signals. Methods: This narrative review summarizes the principles and methodologies of IONM in thyroid surgery, focusing on the mechanisms of RLN injury, the clinical benefits of IONM, and its limitations. Particular emphasis is placed on the anesthesiologic considerations, including the effects of neuromuscular blocking agents and anesthetic maintenance methods for EMG signal quality. Recent advances in alternative IONM techniques are also discussed. Results: IONM facilitates early detection of RLN injury and improves surgical outcomes. However, signal loss and technical errors occur in up to 23% of cases. Appropriate anesthetic management, such as the judicious use of neuromuscular blocking agents and the use of reversal agents like sugammadex, can significantly improve IONM accuracy. Alternative approaches, such as transcutaneous or thyroid cartilage electrode-based monitoring, show promise in overcoming current limitations. Conclusions: IONM is a valuable tool in modern thyroid surgery, aiding in the prevention of RLN injury. Anesthesiologists play a crucial role in optimizing IONM quality by managing factors that affect EMG signals. Ongoing research into novel monitoring techniques is expected to further enhance patient safety and surgical precision. Full article

Background: Laryngeal cancer affects quality of life (QoL), speech, and swallowing. Total laryngectomy (TL) causes severe impairments, while partial laryngectomy (PL) and chemoradiotherapy (CRT) preserve the organ but yield variable outcomes. This study assesses QoL, speech rehabilitation, swallowing, and social reintegration across these treatments. Methods: This prospective observational cohort study was conducted at the ENT Clinic, Victor Babeș University of Medicine and Pharmacy, Timișoara; recruitment was conducted between October 2019 and January 2024. Seventy-five patients diagnosed with laryngeal squamous cell carcinoma (LSCC) were initially enrolled but only 15 patients (20%) completed the 12-month follow-up, with an attrition rate of 80%. Tumor stages ranged from T1 to T4a, with TL patients having a higher proportion of advanced-stage disease (Stage III–IV: 76%) compared to PL (45%) and CRT (50%). Validated instruments, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Head and Neck Cancer (EORTC QLQ-H&N35), the Voice Handicap Index-30 (VHI-30), the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Outcome and Severity Scale (DOSS), were used to assess QoL, voice function, swallowing function, and psychological impact. Results: At 12 months, the global QoL score from the EORTC QLQ-H&N35 was lowest in TL patients (49.8 ± 10.9), significantly lower than both PL (61.2 ± 9.6, p = 0.002) and CRT (64.1 ± 7.8, p < 0.001). Post hoc Bonferroni analysis confirmed significant pairwise differences between TL vs. PL (p = 0.002) and TL vs. CRT (p < 0.001), while the difference between PL and CRT was non-significant (p = 0.14). TL patients had higher speech-related disability (VHI: 88.3 ± 12.6) and dysphagia prevalence (DOSS: 4.0 ± 1.2), with 16% remaining enteral feeding-dependent. Anxiety (HADS-A: 7.5 ± 2.9) and depression (HADS-D: 9.0 ± 3.2) were highest in TL patients, with 36% meeting clinical depression criteria at 12 months. Multivariable regression identified TL (OR = 3.92, 95% CI: 2.14–5.79, p < 0.001) and advanced tumor stage (OR = 2.85, 95% CI: 1.79–4.21, p = 0.002) as strong predictors of poor QoL. Kaplan–Meier analysis showed no significant OS differences (p = 0.12), but CRT patients had lower DFS (78%) compared to TL (82%) and PL (85%) (p = 0.048). Conclusions: TL patients experience the most significant impairments in QoL, speech, and social reintegration despite rehabilitation. CRT patients show higher recurrence rates but better QoL, while PL offers the best balance of function and survival. These findings highlight the need for long-term survivorship support tailored to treatment type. Full article