Search Results (273)

Purpose: Cervical lymph node status is the strongest prognostic factor in oral squamous cell carcinoma (OSCC). While 18F-FDG-PET and cervical ultrasonography are widely used for preoperative staging, their diagnostic accuracy remains limited for small or equivocal nodes. This study compared both modalities against histopathology on a per-level basis and examined correlations of SUVmax and RECIST values with metastatic involvement. Methods: This retrospective single-centre study included patients with histologically confirmed OSCC who underwent preoperative 18F-FDG-PET and cervical ultrasonography, followed by resection and neck dissection (October 2018–December 2024). Imaging was interpreted independently and blinded to clinical and histopathological data. Histopathology served as the reference standard. Diagnostic accuracy was assessed on a level-by-level basis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated and compared using McNemar’s test and logistic regression. Results: Among 100 patients (mean age 63.5 ± 10.6 years; 54% male, 46% female), the lateral tongue was the most frequent site (44%), and 31% showed nodal involvement on PET imaging. PET imaging yielded 59% sensitivity, 87% specificity, and 77% accuracy; ultrasonography achieved higher sensitivity (76%) but lower specificity (67%). Combined assessment improved sensitivity (78%) and NPV (82%) but reduced specificity. PET imaging was more specific, while ultrasonography was more sensitive. SUVmax and RECIST values were higher in metastatic nodes and independently predicted metastasis, though with substantial overlap and no reliable cut-off. Conclusions: PET imaging offers higher specificity, whereas ultrasonography provides greater sensitivity. Their complementary performance supports a multimodal approach to cervical staging in OSCC. Neither SUVmax nor RECIST values reliably distinguished benign from malignant lymph nodes. Full article

Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity, often necessitating extensive surgical resection. Such interventions may result in complex intraoral defects requiring immediate reconstruction to restore function and aesthetics. Objective: This case report highlights the surgical management of a patient with OSCC involving the tongue, floor of the mouth and mandibular ridge, reconstructed using a radial forearm free flap (RFFF). Case report: A 51-year-old male with a history of heavy smoking presented with a necrotic lesion affecting the left mandibular alveolar ridge, floor of the mouth, and tongue. Methods: Histopathological examination confirmed a diagnosis of moderately differentiated keratinizing OSCC (G2). After oncologic resection and selective neck dissection, the defect was reconstructed using an RFFF harvested from the left forearm. The facial artery and anterior jugular vein served as recipient vessels for microvascular anastomosis. A split-thickness skin graft (STSG) was used to close the donor site. Results: The postoperative course was generally favorable. Minor complications, including a localized hematoma and neck wound dehiscence, were conservatively managed. Functional outcomes such as oral intake and wrist mobility were successfully restored with rehabilitation. The RFFF provided durable, well-vascularized coverage over exposed mandibular bone, critical for minimizing the risk of osteoradionecrosis in the context of planned adjuvant radiotherapy. Conclusions: The radial forearm free flap remains a reliable reconstructive option for complex oral defects post-OSCC resection. Multidisciplinary collaboration and meticulous surgical technique are essential to achieve optimal oncologic, functional, and aesthetic outcomes. Full article

The stylohyoid complex (SHC), comprising the styloid process (SP), stylohyoid ligament, and lesser horn of the hyoid bone, arises from Reichert’s cartilage and plays a central role in head and neck organization. Although anatomically small, it occupies a strategic position in the parapharyngeal space, linking neural, vascular, and visceral compartments. This review integrates embryological, comparative, anatomical, and clinical perspectives to provide an updated synthesis of SHC morphology and significance. Developmental studies highlight the early segmentation of Reichert’s cartilage, its transient relationships with the otic capsule, facial canal, and carotid arteries, and its role in shaping muscular and fascial compartments. Comparative anatomy demonstrates the evolutionary transition from a continuous ossicular chain to a vestigial human structure, reflecting a trade-off between rigidity and vocal tract flexibility. In humans, the SHC exhibits marked variability in length, angulation, segmentation, and ligamentous ossification, which directly influence its spatial relationships with the internal and external carotid arteries, the internal jugular vein, and the lower cranial nerves. These variations underpin the clinical spectrum of Eagle’s syndrome and vascular complications, including carotid artery dissection and jugular compression syndromes. Recognition of these embryological origins, evolutionary trajectories, and anatomical variants is essential for accurate diagnosis, imaging interpretation, and surgical planning. As both an embryological remnant and a clinical landmark, the SHC bridges fundamental anatomy with practical implications for imaging, diagnosis, and surgery. Full article

Background and Clinical Significance: Tandem pathology at the dominant-hemisphere middle cerebral artery (MCA)—combining a wide-neck bifurcation aneurysm that shares the neck with both M2 origins and a short dorsal M1 fusiform dilation embedded in the lenticulostriate belt—compresses the therapeutic margin and complicates device-first pathways. We aimed to describe an anatomy-led, microscope-only sequence designed to secure an immediate branch-definitive result at the fork and to remodel dorsal M1 without perforator compromise, and to place these decisions within a pragmatic perioperative framework. Case Presentation: A 37-year-old right-handed man with reproducible, load-sensitive cortical association and capsulostriate signs underwent high-fidelity digital subtraction angiography (DSA) with 3D rotational reconstructions. Through a left pterional approach, vein-respecting Sylvian dissection achieved gravity relaxation. Reconstruction proceeded in sequence: a fenestrated straight clip across the bifurcation neck with the superior M2 encircled to preserve both M2 ostia, followed by a short longitudinal clip parallel to M1 to reshape the fusiform segment while keeping each lenticulostriate mouth visible and free. Temporary occlusion windows were brief (bifurcation 2 min 30 s; M1 < 2 min). No neuronavigation, intraoperative fluorescence, micro-Doppler, or intraoperative angiography was used. No perioperative antiplatelets or systemic anticoagulation were administered and venous thromboembolism prophylaxis followed institutional practice. The bifurcation dome collapsed immediately with round, mobile M2 orifices, and dorsal M1 regained near-cylindrical geometry with patent perforator ostia under direct inspection. Emergence was neurologically intact, headaches abated, and preoperative micro-asymmetries resolved without new deficits. The early course was uncomplicated. Non-contrast CT at three months showed structurally preserved dominant-hemisphere parenchyma without infarction or hemorrhage. Lumen confirmation was scheduled at 12 months. Conclusions: In dominant-hemisphere tandem MCA disease, staged, perforator-sparing clip reconstruction can restore physiologic branch and perforator behavior while avoiding prolonged antiplatelet exposure and device-related branch uncertainty. A future-facing pathway pairs subtle clinical latency metrics with high-fidelity angiography, reports outcomes in branch- and perforator-centric terms, and, where available, incorporates patient-specific hemodynamic simulation and noninvasive lumen surveillance to guide timing, technique, and follow-up. Full article

Background: Contralateral lymph node metastasis (CLNM) in oral squamous cell carcinoma (OSCC) represents a major clinical challenge, in patients with a clinically contralateral node-negative neck. Individualized risk stratification is crucial to guide decisions on elective contralateral neck dissection. This study aimed to synthesize existing evidence and apply Bayesian Monte Carlo Simulation (MCS) to estimate CLNM probability across various clinic-pathological scenarios. Methods: A systematic search of PubMed, PubMed Central, and Embase (2000–2024) identified 26 eligible studies. Effect sizes for seven key risk factors—midline-crossing tumours, extranodal extension (ENE), ≥2 ipsilateral lymph nodes, depth of invasion (DOI) >10 mm, perineural invasion and lymphovascular invasion (PNI-LVI), poor differentiation, and floor of mouth subsite—were computed and incorporated into a Bayesian logistic model. Using the No-U-Turn Sampler (NUTS) in RStan, 100,000 virtual patient profiles were simulated to generate posterior probabilities of CLNM. Results: The baseline CLNM risk for lateralized tumours without additional risk factors was 4.2%. Single risk factors increased probability substantially: midline-crossing tumours (31.7%), ENE (27.4%), and ≥2 ipsilateral nodes (24.9%). Combinations of risk factors amplified the risk non-linearly: the presence of a midline-crossing tumour, ENE, and ≥2 ipsilateral nodes yielded a 76.8% CLNM probability, and the presence of all seven risk factors increased it to 93.7%. Risk tiers were classified from minimal (<20%) to very high (>50%) to guide clinical decision-making. Conclusions: This MCS-based model reveals that CLNM risk increases multiplicatively with the presence of various high-risk features. The simulation supports bilateral neck management in high-risk patients and observation in low-risk cases. Prospective validation is needed to integrate this model into routine clinical practice and to guide patient-specific surgical planning. Full article

Background/Objectives: The optimal extent of lateral lymph node dissection in cN1b differentiated thyroid cancer remains controversial. This systematic review aimed to assess the frequency of lymph node involvement across neck levels I to V. Materials and Methods: A systematic review was conducted following PRISMA guidelines. PubMed was searched for studies on lateral neck dissection in differentiated thyroid cancer. Included studies reported level-specified metastatic rates. Data on patient numbers and metastatic events were extracted. A random-effects meta-analysis with Freeman–Tukey double arcsine transformation was performed for each neck level to calculate pooled prevalence proportions and 95% confidence intervals. Heterogeneity was assessed using the I² statistic. Results: Meta-analysis of 57 studies revealed that level III (68%, 95% CI: 63–73) and level IV (66%, 95% CI: 61–70) had the highest metastatic prevalence, followed by level IIA (46%, 95% CI: 37–56). Level V demonstrated an overall prevalence of 22% (95% CI: 18–26), with sublevel VB (19%, 95% CI: 11–28) significantly higher than VA (4%, 95% CI: 1–9). Level I (6%, 95% CI: 2–11) and sublevel IIB (14%, 95% CI: 9–20) showed the lowest risk. Significant heterogeneity (I² 71–94%) was observed across all levels. Conclusions: Our findings support sparing level I, and sublevels IIB and VA during lateral neck dissection. Current guidelines recommend systematic dissection of IIA, III, IV, and VB, although VB involvement was found to be only 19% in our study. Future personalization of the extent of neck dissection, based on individual risk factors, may be key to optimizing oncologic and functional outcomes. Full article

Background/Objectives: Head and neck cutaneous squamous cell carcinoma (HNcSCC) has the potential to metastasize to local lymph nodes, which can significantly impact prognosis. However, the optimal management of patients with clinically node-negative (cN0) disease remains unclear. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, Scopus, CINAHL, and Web of Science databases were searched from inception to 7 August 2025. Two parallel searches were conducted: one to capture management strategies and outcomes of cN0 patients with HNcSCC and one to capture occult nodal metastasis rates of the same population. Results: A total of 38 studies were included. Post-excision management strategies included observation, sentinel lymph node biopsy (SLNB), elective dissection (ED), and elective nodal irradiation. The pooled rate of occult lymph node metastasis was 13.9% in 1673 HNcSCC tumors overall and 12.5% when limited to 977 high-risk tumors. Overall recurrence in the SLNB group (8.3%) was significantly lower than both the observation (16.9%, p < 0.0001) and ED (23.7%, p < 0.0001) groups. Additionally, overall mortality in the SLNB group (6.1%) was significantly lower than observation (29.9%, p < 0.0001) and ED (31.4%, p < 0.0001). Conclusions: We found that SLNB was associated with lower recurrence and mortality compared with observation and ED. While not assumed to be causative, our findings support the role of SLNB in diagnosing occult metastasis and staging disease in this population. Full article

Background/Objectives: Papillary cancer is the most common thyroid cancer. The development of lateral cervical lymph node metastases (I–V levels) is considered a major cause of recurrence. The aim of this study is to investigate the potential predictive factors for lateral cervical lymph node metastasis and disease recurrence, in order to tailor the clinical approach to these patients. An ROC (Receiver Operating Characteristic) curve has been set to search out a cut-off value for the lymph node ratio (LNR), a ratio of involved lymph nodes-to-examined lymph nodes, that could serve as an index of tumor recurrence. Methods: This was an observational retrospective study. The clinical charts of 43 patients with histopathological diagnosis of papillary thyroid cancer who underwent thyroidectomy with lateral and central neck dissection have been reviewed. These results have also been compared with those who underwent total thyroidectomy alone that served as a control group. Results: Extrathyroidal extension (p-value < 0.001), tumor size (p-value = 0.015), number of lymph nodes involvement (p-value = 0.022), and LNR (p-value = 0.004) were identified as potential predictors of tumor recurrence. The ROC curve revealed that an LNR value exceeding 0.205 is indicative of disease recurrence, with an Area Under the Curve (AUC) of 0.818, a sensitivity of 82%, and a specificity of 81%. Furthermore, fT4 value (p-value = 0.008), tumor size (p-value = 0.019), and alcohol consumption (p-value < 0.001) may serve as potential predictors of lymph node metastasis. Conclusions: Extrathyroidal extension, vascular invasion, tumor size, number of pathological lymph nodes, and LNR are associated with recurrence of papillary thyroid carcinoma; in particular, the lymph node ratio can be considered an effective indicator of recurrence risk. Full article

Background/Objectives: The global incidence of thyroid cancer has been increasing, necessitating improved diagnostic strategies for detecting lymph node metastases. Fine-Needle Aspiration Biopsy (FNA) is a widely used diagnostic tool; however, its accuracy is sometimes limited, particularly in cases with non-diagnostic results. Washout Thyroglobulin (Washout Tg) measurement has emerged as an important adjunctive tool in refining thyroid cancer diagnosis. Methods: This retrospective study analyzed 723 patients who underwent thyroid cancer surgery at Samsung Medical Center from 2013 to 2023. The patients were categorized based on their thyroid status into three groups: 1. total thyroidectomy with modified radical neck dissection (mRND); 2. completion thyroidectomy with mRND; and 3. mRND or selective neck dissection (SND) without thyroidectomy. The Washout Tg levels and their diagnostic performance were evaluated using Receiver Operating Characteristic (ROC) analysis, determining the optimal cutoff values for predicting lymph node metastasis. Results: Washout Tg demonstrated high sensitivity for detecting metastases, with the optimal cutoff values varying based on thyroid status. For the patients who had total thyroidectomy, the cutoff was 23.3 ng/mL (AUC = 0.85, sensitivity = 82.6%, and specificity = 75.0%). In completion thyroidectomy cases, a threshold of 7.2 ng/mL (AUC = 0.879) achieved 98.4% sensitivity and 80.0% specificity. For patients without thyroidectomy (mRND/SND group), a cutoff of 0.1 ng/mL (AUC = 0.766) yielded 98.9% sensitivity but lower specificity (60.0%). Additionally, the Washout Tg/serum Tg ratio demonstrated high diagnostic accuracy with a cutoff of >1 (sensitivity = 97.09% and specificity = 63.64%). Conclusions: The Washout Tg measurement and the Washout Tg/serum Tg ratio play a crucial role in detecting lymph node metastases, particularly in patients post-thyroidectomy. The findings emphasize the necessity of adjusting the Washout Tg cutoff values based on thyroid status to enhance diagnostic accuracy. Further prospective studies are required to validate these thresholds and optimize their clinical application. Full article

Introduction: Tumors of the lateral skull base, particularly those arising from the external auditory canal and peri-retroauricular regions, present considerable surgical and reconstructive difficulties due to their intricate anatomy and aggressive nature. The anterolateral thigh (ALT) free flap offers a viable reconstruction option, enhancing oncological radicality while minimizing morbidity. Materials and Methods: A retrospective analysis was conducted on five cases of malignant tumors involving the external auditory canal and adjacent soft tissues, treated at a tertiary center from March 2023 to March 2025. All patients underwent radical resection, which included lateral or subtotal temporal bone resection, along with parotidectomy and neck dissection when necessary. Reconstruction was performed using myocutaneous anterolateral thigh free flaps. The study evaluated clinical outcomes, complications, and esthetic results. Results: The ALT flap was used in all cases without major postoperative complications. Two patients received adjuvant radiotherapy; one did not start treatment due to early recurrence. At follow-up, three patients were disease-free, while two had died from unrelated causes. Esthetic and functional outcomes were satisfactory in all patients. Conclusions: The ALT free flap is a universal and reliable option for the reconstruction of complex lateral skull base defects, especially in patients following the radical removal of tumors of the external auditory canal and peri-retroauricular areas. It offers excellent tissue coverage, facilitates adjuvant treatment, and has a low complication rate. While our experience supports its use in aggressive oncological resection, larger studies are needed to confirm these findings. Level of evidence: 4. Full article

Mandibular reconstruction with the fibula free flap is the gold standard for large defects, with virtual surgical planning becoming integral to the process. The localization and dissection of critical vessels, such as the recipient vessels in the neck and the perforating vessels of the fibula flap, are demanding steps that directly impact surgical success. Augmented reality (AR) offers a solution by overlaying three-dimensional virtual models directly onto the surgeon’s view of the operative field. We report the first case in Latin America utilizing a low-cost, commercially available holographic navigation system for complex microsurgical mandibular reconstruction. A 26-year-old female presented with a large, destructive osteoblastoma of the left mandible, requiring wide resection and reconstruction. Preoperative surgical planning was conducted using DICOM data from the patient’s CT scans to generate 3D holographic models with the Medicalholodeck^® software. Intraoperatively, the primary surgeon used the AR system to superimpose the holographic models onto the patient. The system provided real-time, immersive guidance for identifying the facial artery, which was anatomically displaced by the tumor mass, as well as for localizing the peroneal artery perforators for donor flap harvest. A free fibula flap was harvested and transferred. During the early postoperative course and after 3-months of follow-up, the patient presented with an absence of any clinical complications. This case demonstrates the successful application and feasibility of using a low-cost, consumer-grade holographic navigation system. Full article

Background/Objectives: Lymph node metastases represent the most important prognostic factor for survival in patients with localized squamous cell carcinoma (SCC) of the oral cavity. In patients with carcinoma of the tongue or floor of the mouth, elective neck dissection (END) has been the standard of care, but it has been replaced at many centers by sentinel lymph node biopsy (SLNB). This study’s purpose was to measure and compare recurrence rates between END and SLNB in patients with early SCC of the oral cavity. Methods: Patients were included in this retrospective monocenter cohort study, performed at the University Hospital of Zürich, if they underwent either END or SLNB for oral squamous cell carcinoma (OSCC) of the tongue or floor of the mouth between January 2008 and December 2018. Only patients with early-stage tumors and a clinically negative neck (T1 or T2; cN0) who had a follow-up period of at least 5 years were included. Patients with a T3 or T4 tumor or a clinically positive neck were excluded, as were those who previously underwent therapy for another head and neck carcinoma. The predictor variable was the surgical treatment used, with subjects divided into two groups: END and SLNB. The main outcome variable was the time to recurrent disease, defined as the time between the primary surgical treatment and the diagnosis of recurrence. The covariates were primary tumor location, pT status, pN status, histopathological grade and postoperative radiotherapy. We used descriptive analysis, univariate analysis and the logrank test, with a p-value < 0.05 considered statistically significant. We deliberately refrained from multivariate analysis due to insignificant statistical results in the univariate analysis. Results: In total, 82 patients (46 male, 36 female; median age at the time of surgery: 58.9 years) were included, with a median observation period of 4.3 years. The main primary tumor location was the floor of the mouth (62.2%). The SLNB cohort had smaller primary tumors in comparison to the END cohort (20% vs. 37% pT2, respectively). Furthermore, pN+ disease was more prevalent in the END group in comparison to the SLNB group (81.8% vs. 74.1% pN0, respectively). Recurrence-free survival was not significantly different between the two groups. Subgroup analysis demonstrated a higher risk of recurrent disease in pN+ groups undergoing SLNB compared to those undergoing END. Conclusions: We demonstrate that SLNB is a useful tool for assessing lymph nodes of the neck. In cases of pN+ necks after SLNB and subsequent neck dissection, patients need to be closely followed up with due to the risk of recurrent disease. Full article

Cervical lymph node metastasis is the strongest prognostic factor in oral tongue carcinoma, yet current clinical guidelines rely primarily on depth of invasion to guide elective neck dissection. This approach results in unnecessary surgery in up to 70% of patients. Cancer-testis antigens (CTAs) are a family of genes associated with tumor aggressiveness and may serve as predictive biomarkers for nodal spread. A multi-step analysis integrating large-scale public datasets, including microarray (GSE78060), bulk RNA-seq emerging from the cancer genome atlas (TCGA), and single-cell RNA-seq (GSE103322), was employed to identify CTA genes active in oral tongue cancer. Selected genes were validated using NanoString nCounter RNA profiling of 16 patients undergoing curative glossectomy with elective neck dissection. Machine learning algorithms, including decision trees, t-distributed stochastic neighbor embedding (t-SNE), and convolutional neural networks (CNN), were applied to assess predictive power for nodal metastasis. Computational analysis initially identified 40 cancer-active CTA genes, of which four genes (LY6K, MAGEA3, CEP55, and ATAD2) were most indicative of nodal spread. In our patient cohort, NanoString nCounter profiling combined with machine learning confirmed these four genes as highly predictive. We present a proof-of-concept CTA-based genetic diagnostic tool capable of discriminating nodal involvement in oral tongue cancer. This approach may reduce unnecessary neck dissections, minimizing surgical morbidity. Full article

Background and Objectives: Oral squamous cell carcinoma (OSCC) is characterized by a high propensity for cervical lymph node metastasis, which remains a strong predictor of patient outcome. Despite advances in management, the prognosis for OSCC has not significantly improved, and the identification of reliable predictors for occult lymph node metastasis (OLNM) in clinically node-negative (cN0) patients is crucial for optimizing treatment strategies. Lymphovascular density (LVD) immunohistochemically assessed by podoplanin (D2-40) has been proposed as a potential biomarker for regional metastasis, but its prognostic value remains controversial. This study aimed to evaluate the prognostic significance of intratumoral (ILVD) and peritumoral lymphovascular density (PLVD) for OLNM in OSCC. Materials and Methods: A retrospective analysis was conducted on 43 cN0 patients with primary OSCC who underwent surgical resection and elective neck dissection (END) at a tertiary care cancer center. LVD was assessed by immunohistochemical staining for podoplanin (D2-40) in both intratumoral and peritumoral regions. Clinicopathological data were collected and statistically analyzed. Results: In observed cohort peritumoral LVD was significantly higher than intratumoral LVD. PLVD was also significantly higher in early-stage tumors (pT1/pT2) compared to advanced stages (pT3/pT4). Higher ILVD was significantly associated with the presence of OLNM. Neither ILVD nor PLVD demonstrated a statistically significant influence on overall survival, although a trend toward poorer outcomes was observed in patients with higher ILVD. Conclusions: ILVD was significantly associated with occult nodal metastasis, whereas PLVD was not. However, neither LVD parameter independently predicted overall survival. Results suggest that ILVD may serve as a useful marker for identifying cN0 OSCC patients at higher risk for occult metastasis. Full article

Background/Objectives: We investigated whether cervical sensitive nerves (CSN) provide motor input to the trapezius muscle and how this relates to short-term functional outcomes after neck dissection. Methods: A total of 22 neck dissections were performed in 17 patients; the SAN was preserved. CSN roots (C2–C4) were stimulated intraoperatively using IONM. Shoulder and neck function were evaluated preoperatively and at 3 months in 15 operated necks using goniometry, an IMU-based motion analysis system (iSen), trapezius isometric strength, the Modified Constant–Murley Score (MCMS), and the Shoulder Pain and Disability Index (SPADI). Results: CSN-evoked trapezius responses were detected in 10/22 (45.5%) dissections (C2: 6/22, 27.2%; C3: 4/22, 18.2%; C4: 0/22). Postoperatively, neck extension/rotation and shoulder abduction/external rotation decreased significantly within groups; upper and middle trapezius strength and MCMS also declined. Shoulder flexion loss was smaller when CSN motor participation was present. Median shoulder flexion (goniometry) changed from 162°→140° in CSN(+) vs. 170°→131° in CSN(−) (between-group p = 0.024). With iSen, shoulder flexion changed 120°→116° in CSN(+) vs. 122°→97° in CSN(−) (p = 0.033). Conclusions: Approximately half of the neck dissections exhibited CSN-related motor responses. Short-term shoulder flexion was better preserved when CSN motor participation was present, suggesting that documenting CSN motor input intraoperatively may inform early rehabilitation planning. Full article