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This video introduces a medial-to-lateral neck dissection technique in the management of head and neck cancer, emphasizing the importance of the middle layer of the deep cervical fascia as a key surgical landmark. The technique involves systematic dissection from superficial lymphatic tissue (Paddle 1) to deeper structures (Paddles 2 and 3), offering better visualization and preservation of functionally important structures, such as the cervical nerves. This approach enhances surgical precision, minimizes nerve damage, and optimizes lymphatic tissue removal., (© 2025 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

Introduction: This study aimed to investigate the relationship between DOI (Depth of Invasion) and metastasis to the neck lymph nodes in patients with laryngeal squamous cell carcinoma (LSCC)., Methods: This cross-sectional observational study was conducted on all patients diagnosed with LSCC who underwent total laryngectomy and neck dissection between 2014 and 2021. DOI was measured in millimeters by a pathologist who examined the patients' specimens. Demographic information and tumor characteristics were collected and analyzed., Results: The study included 62 patients with LSCC, of whom 23 (37%) had cervical lymph node metastasis. There were 54 (87%) male. The mean DOI was (9.91 ± 1.60) mm in the metastatic group and (7.56 ± 1.42) mm in the non-metastatic group. The results showed that tumors with a higher DOI had a higher probability of cervical lymph node metastasis ( p < 0.001), but there was no significant correlation between DOI and the number of involved lymph nodes (p = 0.318). The analysis also revealed that poorly differentiated tumors (p. value < 0.001), male patients (p. value < 0.001), and older patients (p. value < 0.001) had a higher DOI., Conclusion: According to our results, DOI can be an important predictive factor in predicting cervical lymph node metastasis in LSCC. Therefore, measuring DOI can assist surgeons in decision-making for neck dissection. It is recommended that DOI be determined during surgery using frozen sections or pre-operatively with deep biopsy samples. Considering that laryngeal cancer with cervical lymph node metastasis has a worse prognosis, it could be concluded that greater DOI predicts worse prognosis., Competing Interests: Declarations. Compliance with ethical: Study protocol was in accordance with the latest Declaration of Helsinki for medical research involving human subjects and was approved by ethics committee of Shahid Sadoughi University of Medical Sciences. This article does not contain any studies with animals performed by any of the authors. Informed consent: was obtained from all participants of the study. Conflicts of interest: Authors have no conflicts of interest., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Diagnostic and therapeutic management of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remains a challenge. The aim of the present phase IV study was to assess adherence to the current Danish guidelines and evaluate the treatment outcome in HNSCCUP patients., Materials and Methods: Prospectively collected data in the DAHANCA database from patients treated between 2014 and 2020 was evaluated. The median follow-up was 6.7 years. Treatment included definitive neck dissection (dND), primary (chemo-)radiotherapy ((C-)RT), neck dissection (ND) followed by postoperative (C-)RT (ND + (C-)PORT). Outcome were reported as five-year estimates of loco-regional failure (LRF), ultimate LRF (ULRF), disease specific mortality (DSM), overall survival (OS), and toxicity scores ≥ 3., Results: A total of 288 patients were treated, of which 254 (88 %) received treatment with curative intent and were eligible for adherence assessment. These were allocated to dND (n = 60), (C-)RT (n = 81) and ND + (C-)PORT (n = 113). The HPV/p16 status was known in 94 % of patients with 109 (43 %) positive cases. The 5-year LRF, DSM, and OS for patients treated with curative intent was 22 %, 15 % and 73 %, and in patients with p16 positive disease 16 %, 5 %, and 85 %. The overall guideline adherence was 76 % (192/254). In the adherent group the LRF, ULRF, DSM, and OS were 22 %, 11 %, 16 %, and 73 %, respectively., Conclusion: The study revealed good treatment outcome measures in HNSCCUP patients subject to the Danish guidelines, comparable to other head and neck cancer patients. The observed guideline-deviations did not affect outcome., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Thyroidectomy with only limited examination of lymph nodes is considered to pose potential risk for harboring occult nodal disease in patients with papillary thyroid cancer (PTC). However, the optimal number of examined lymph nodes (ELNs) in patients with PTC with clinically lateral lymph node metastasis (cN1b) remains unclear., Patients and Methods: Patients with cN1b PTC who underwent therapeutic neck dissection were retrospectively enrolled. A β-binomial distribution was utilized to calculate the likelihood of occult nodal disease as a function of total number of ELNs, and recurrence-free survival analysis was performed using the Kaplan-Meier method., Results: Together 982 patients met the inclusion criteria for this study, of which 853 patients had node-positive disease. The median ELN count was 23 (interquartile range 14-33). Increased ELN counts were associated with a decreased rate of occult nodal disease. The prevalence of nodal metastasis was 84%, while the corrected prevalence was 90%. The estimated probability of false-negative nodal disease was 67% for patients with PTC when only a single node was examined. Survival analysis revealed that populations with higher probability of occult nodal diseases experienced significantly higher recurrence rate. For patient with cN1b PTC, 20 ELNs were required to achieve 95% confidence of having no occult nodal disease. Minimum thresholds of 24, 14, 14, and 15 ELNs were selected for patients with pT1, pT2, pT3, and pT4 diseases, respectively., Conclusions: Our findings robustly conclude that a minimum of 20 ELNs is essential to assess the quality of neck dissection and acquire accurate staging for patients with cN1b PTC., Competing Interests: Disclosure: The authors declare no potential conflicts of interest. Ethical approval and consent to participate: This study was approved by the ethics review committee of Xiangya Hospital, Central South University, and followed the Declaration of Helsinki (202211733). The need for informed consent was waived because of the retrospective and anonymous nature of the study., (© 2024. Society of Surgical Oncology.)

Background: Currently, fine-needle aspiration washout thyroglobulin (FNA-Tg) are mainly utilized to assist in the detection of lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC). However, there is currently no clear definition of the method, procedure, and diagnostic value of FNA-Tg testing., Methods: Prospectively collected data from 215 PTC patients who underwent lateral neck LNs dissection in the 900th hospital from 2022 to 2024. A total of 249 suspicious lymph nodes were included and were categorized into a metastasis group (n = 176) and a non-metastasis group (n = 73) based on postoperative pathological findings., Results: Overall analysis revealed that FNA-Tg demonstrated superior diagnostic efficacy for LLNM in PTC compared to FNAC (area under the curve [AUC] = 0.950 versus 0.766). The optimal diagnostic thresholds were determined to be 16.45 μg/L for the primary LLNM group and 0.15 μg/L for the recurrent LLNM. Subgroup analysis indicated that a statistically significant difference in the diagnostic performance of FNA-Tg and FNAC for PTC LLNM was observed only when the LN short diameter was ≤0.8 cm (p < 0.001). Further more, when thyroglobulin antibody (TgAb) results were negative, the combination of the optimal threshold for FNA-Tg and the FNA-Tg/serum thyroglobulin (sTg) ratio was determined to be the most effective diagnostic criterion (criterion ③; AUC = 0.943)., Conclusion: FNA-Tg has a higher diagnostic value for PTC LLNM, especially in small LNs., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest. All authors have read and approved the final version of the manuscript submitted for publication., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Importance: Distant metastasis (DM) remains the leading cause of death in patients treated for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). An effective treatment strategy needs to address DM while reducing treatment-related toxic effects., Objective: To assess DM-free survival in patients with HPV-OPSCC treated with neoadjuvant chemotherapy followed by transoral robotic surgery (NECTORS) and neck dissection compared with standard of care, concurrent chemoradiation (CCRT)., Design, Setting, and Participants: This multicenter retrospective cohort study compares prospective data from the NECTORS treatment group with a historical cohort of patients treated with CCRT. Patients with American Joint Committee on Cancer seventh edition stage III and IVa HPV-OPSCC treated with NECTORS and CCRT between February 2010 and September 2021 were included. Data were analyzed in September 2024., Exposures: Patients in the NECTORS arm were treated with 3 cycles of neoadjuvant docetaxel and cisplatin followed by TORS and neck dissection. Patients in the radiation therapy arm were treated with concurrent high-dose cisplatin and radiotherapy., Main Outcomes and Measures: DM-free survival was analyzed with Kaplan-Meier and Cox regression after adjusting for age, sex, tobacco and alcohol use, site, and cancer stage., Results: Of 342 included patients, 282 (82.5%) were male, and the mean (SD) age was 61.4 (9.4) years. A total of 232 patients were treated with CCRT and 110 patients were treated with NECTORS. Within the CCRT arm, 11 patients (4.7%) had locoregional recurrence (LRR), 5 (2.2%) had LRR and DM, and 28 (12.1%) developed distant-only metastasis. For patients treated with NECTORS, 5 (4.5%) developed LRR, 1 (0.9%) developed LRR plus DM, and no patients developed distant-only metastasis. With pseudorandomization matching for T and N stages, 209 patients were matched between the 2 treatment groups for further analysis (105 in the CCRT treatment arm and 104 in the NECTORS arm). The median (range) follow-up period for the CCRT and NECTORS groups were 5.8 (3.8-7.5) years and 5.1 (4.0-5.9) years, respectively. The hazard ratio of developing distant recurrence in the CCRT group was 10.77 (95% CI, 1.40-82.90) in univariate analysis and 9.98 (95% CI, 1.29-77.29) in multivariable analysis. In Kaplan-Meier survival analysis, the risk of developing DM was higher in the CCRT group. The hazard ratio for failure anywhere in the CCRT group was 3.32 (95% CI, 1.23-8.97) in univariate analysis and 3.21 (95% CI, 1.18-8.72) in multivariable analysis., Conclusions and Relevance: In this study, neoadjuvant chemotherapy followed by transoral robotic surgery and neck dissection was an effective treatment option for patients with stage III and IVa HPV-OPSCC. Findings from our study suggest lower rates of DM with NECTORS worthy of further investigation in prospective randomized trials.

Background: In surgical simulation, evaluation tools are necessary to allow the overall and specific level of each gesture to be assessed for learners, to allow active feedback and follow-up. The aim of this study was to create and validate a scale for the assessment of competences for neck dissection (ND) and total laryngectomy (TL) in head and neck surgical oncology simulation specific for revascularized cadavers' models., Methods: Two independent scales were created for ND and TL based on a two-round Delphi method. The scales were used during ND and TL simulation sessions on SimLife® (Symedis, Poitiers, France) model. Surgical steps were scored by 2 independent observers. To assess its ease of use, a questionnaire was answered by senior surgeons (SS) at the end of the sessions., Results: Fifteen items were included in the final version for ND scale and 20 for TL scale. The results of 14 lateral ND and 8 TL were included. The mean score was higher for SS (69 ± 6.4; 87.5 ± 8.5) than for residents (36.5 ± 11; 57.5 ± 13.2) for ND ( P = 0.0006) and TL ( P = 0.028) respectively. Six SS strongly agreed that this tool had a positive impact on resident training with stepwise feedback and accurately represented their competences., Conclusion: We developed a pedagogic tool built to assess surgical competence for head and neck surgical oncology on revascularized cadaver models. This tool has a good construct validity thanks to the expert reviewing with Delphi method and appears to have fine acceptability by the SS., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JP. Faure and D. Oriot are patent co-owners of the P4P device enabling revascularization and re-ventilation. All other authors declare that they have no conflict of interest.

Purpose: This study aimed to evaluate the efficacy of postoperative radioactive iodine (RAI) and its impact on recurrence rates and survival benefits in low- to intermediate-risk papillary thyroid carcinoma (PTC)., Methods: This retrospective study involved the examination of 1286 patients diagnosed with low- to intermediate-risk PTC who underwent total thyroidectomy with or without neck dissection, supplemented with postoperative RAI therapy or not between the years 2000 and 2021., Results: From the patient pool, 589 (45%) were classified as low-risk and 697 (55%) as intermediate-risk according to the 2015 American Thyroid Association guidelines. Among the low-risk group, 375 (63.7%) underwent postoperative RAI, while in the intermediate-risk group, 566 (82.2%) underwent the procedure. The overall survival and disease-free survival rates were not statistically different between the groups that received RAI and those that did not, in both the low- and intermediate-risk categories. In a subgroup analysis, within the intermediate-risk category, postoperative RAI was significantly correlated with decreased recurrence in two subgroups: patients over 55 years with pN1b disease (hazard ratio 0.043, 95% confidence interval 0.004-0.500, p = 0.012) and patients over 55 years with five or more metastatic lymph nodes (hazard ratio 0.060, 95% confidence interval 0.005-0.675, p = 0.023)., Conclusion: Our findings suggest that, while post-total thyroidectomy RAI does not substantially influence recurrence or survival rates in most low-risk and intermediate-risk PTC patients, it may be beneficial in specific subgroups, particularly patients over 55 with pN1b disease or those presenting with five or more metastatic lymph nodes., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests. Ethics approval: This retrospective study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Hanyang University Hospital approved this study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas. Data on oncologic and to a lesser extent functional outcomes have been published by mainly European specialized single institutions. TLM for supraglottic carcinomas has never been tested in a multicenter trial on its applicability as surgical standard at every hospital., Objectives: To test the efficacy of TLM supraglottic laryngectomy (TLM-SGL) in terms of swallowing function, oncologic outcome parameters, morbidity, complications of treatment, and quality of life in a multicenter setting., Methods: The study is designed as a multicenter (approximately 25 centers), non-randomized, single-arm study with a targeted number of 200 previously untreated patients with squamous cell carcinomas (SCC) of the supraglottic larynx T2/T3 N0-3 M0; UICC stage II-IVa. The surgical treatment consists of TLM-SGL and elective or therapeutic uni- or bilateral selective neck dissection (SND). After pathologic risk stratification adjuvant radio- (RT) or radiochemotherapy (RCT) is indicated. Patients are followed-up for 2 years post surgically. Swallowing function is assessed by fibreoptic endoscopic evaluation of swallowing (FEES). The primary endpoint is aspiration-free swallowing at 12 months as established using FEES and defined as grade < 6 of penetration-aspiration scale (PAS). Secondary endpoints include local control, larynx preservation, overall and disease-free survival, complications and side effects of treatment, prevalence of tracheostomy and percutaneous endoscopic gastrostomy (PEG)-tube-feeding, and dysphagia-specific quality of life (QoL) assessed by the MD Anderson Dysphagia Inventory (MDADI) as well as voice-related QoL assessed by the Voice Handicap Index (VHI)., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Several studies have described the anatomical course of the spinal accessory nerve (SAN) and its associated landmarks. In particular, the SAN course through the sternocleidomastoid (SCM) has been reported as either intramuscular or branching without penetration of the SCM. However, it remains unclear what the occurrence of either anatomical course is, as various studies have reported inconsistent findings. For example, Lee SH et al. (South Korea) and Kierner SA et al. (Austria) reported that the SAN more commonly penetrates the SCM (54.1% and 63%, respectively) rather than branching in a clinical and cadaveric studies. Yet, Anehosur V. et al. reported that the SAN more commonly branches without penetration (54%) in a clinical study of Indian patients undergoing neck dissection. We performed a cadaveric study on 31 subjects using an anterior triangle approach to visualize the anatomy of the SAN as it courses towards the SCM. All the subjects were White and included 35% male (N=11) and 65% female (N=20). Our study shows that the SAN courses through SCM intramuscularly 65% of the time, while giving off branches without penetration 35% of the time. The observed difference from the previously reported numbers suggests a potential ethnicity-associated variation in the course of the SAN in relation to the SCM. Understanding the SAN anatomy and its variations is critical when performing neck dissection to avoid iatrogenic injuries to the nerve. Taken together, our study demonstrates a preponderance for the SAN to penetrate the SCM prior to coursing toward the posterior triangle of the neck., (Published by Elsevier Ltd.)

Objectives: Transoral robotic surgery (TORS) and transoral laser microsurgery (TOLM) plus neck dissection are viable alternatives to radiotherapy as a treatment modality in select cases of oropharyngeal squamous cell carcinoma. Many centers advocate for elective ligation of the feeding arteries at index neck dissection prior to TORS/TOLM to mitigate the risk of catastrophic perioperative hemorrhage. Although there are multiple cadaveric studies in the literature to identify the lingual artery at multiple points throughout its course, there are no studies on the intraoperative identification of the lingual artery for elective ligation prior to TORS/TOLM., Methods: A retrospective review of all patients undergoing neck dissection with vessel ligation prior to TORS. Lingual artery was identified at its origin, and relation to hypoglossal nerve was recorded. Patient demographics, intraoperative findings including the relation between lingual artery and hypoglossal nerve measured in millimeters, and postoperative complications were extracted from medical records., Results: Of the 33 cases eligible for this study, the lingual artery was identified directly deep to the hypoglossal nerve in 21 cases (63.6%). Of the remaining cases, seven were within 5 mm inferior to the hypoglossal nerve (21.2%), and only two cases (6.1%) were identified superior to the hypoglossal nerve., Conclusion: The hypoglossal nerve is a useful landmark for the intraoperative identification of the lingual nerve in elective neck dissection prior to TORS. The lingual artery can be identified either immediately deep to or within 5 mm inferior to the hypoglossal nerve in majority of cases., Level of Evidence: 4 Laryngoscope, 2025., (© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)

The scope of neck lymph node dissection remains controversial for unilateral papillary thyroid carcinoma (UPTC) patients with no clinical evidence of lymph node metastasis (cN0). This study aims to build and validate a model for predicting central lymph node metastasis (CLNM) in UPTC patients through preoperative basic information and intraoperative rapid frozen pathology results. Retrospective analysis covered 1928 patients with PTC from the Wuhan Union Hospital database (2010-2020), randomly split into training and validation sets in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to assess the risk factors for ipsilateral CLNM and contralateral CLNM in UPTC patients with cN0. Identified six risk factors for ipsilateral CLNM and seven risk factors for contralateral CLNM in cN0 UPTC patients. Two separate nomograms were constructed to visualize the results. The C-index for predicting ipsilateral and contralateral CLNM nomograms is 0.746 (95% CI 0.723-0.768) and 0.712 (95% CI 0.679-0.744), respectively. The calibration curves presented good agreement between prediction by nomograms and actual observation. The clinical decision curves suggest a net benefit from this model. UPTC patients can use these two nomograms to predict the probability of ipsilateral CLNM and contralateral CLNM separately, enabling risk stratification and aiding in surgical decision-making., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: The study follows the 2013 revised Helsinki Declaration and has been approved by the Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (Approval No. 0304-01). This is an observational study that does not involve collecting personal information of patients, therefore the ethics committee of our institution eliminates the need for obtaining informed consent., (© 2025. The Author(s).)

Objective: Carotid body tumors (CBTs) are rare neoplasms of the paraganglia at the carotid bifurcation. While typically benign, CBTs occasionally exhibit malignancy, metastasizing to nearby lymph nodes. Histopathologic analysis alone is insufficient to confirm malignancy, requiring metastases to non-neuroendocrine tissue for a definitive diagnosis. The role of selective neck dissections (SNDs) in detecting malignancy and guiding subsequent management remains uncertain., Method: A retrospective case series through electronic chart review was performed on 21 patients undergoing CBT surgeries between 2002 and 2022 at a Canadian institution. SNDs were performed on all 21 patients. Data collection included patient demographics, genetic and laboratory testing results, preoperative imaging, intraoperative and postoperative complications, histologic analysis of neck SND and tumor specimen, and follow-up results., Results: Of the 21 surgical resections, there were three cases (14.3%) of carotid artery injuries and six cases (28.6%) of nerve injuries. One patient (4.8%) experienced three intraoperative strokes. Three patients (14.3%) were found to have lymph node involvement, confirming malignancy, and underwent further treatment with radiotherapy. Interestingly, two patients with carotid injuries had malignant tumors, demonstrating a statistical significance between carotid injury and malignancy (OR 34.00, 95% CI: 1.48, 781.83, p  = .041)., Conclusion: SNDs are a useful adjunct in detecting malignancy during CBT surgeries. The incidence of malignancy in CBT is low but not negligible, and SND should be considered in patients to prevent inadvertent underdetection of metastatic disease. This study's 14.3% incidence of malignancy suggests that there may be a rationale for considering the universal implementation of SND during CBT resections., Level of Evidence: 4., Competing Interests: The authors declare that they have no conflicts of interests., (© 2025 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

The most common complication associated with selective neck dissection is spinal accessory nerve dysfunction and shoulder disability, which result from level IIb dissection. The main objective of this study was to evaluate the incidence of level IIb lymph node metastasis in clinically node-negative (cN0) oral squamous cell carcinoma (OSCC) patients. Patients presenting with cN0 OSCC between November 2012 and November 2023 were included retrospectively. The primary endpoint was the incidence of level IIb lymph node metastasis in these patients. A total of 389 patients (527 supraomohyoid neck dissections) who presented during the 11-year period were included in this study . The incidence of occult cervical lymph node metastasis was 25.2%. The median number of level IIb lymph nodes removed was 5.5. No metastatic lymph node was found at level IIb. The absence of metastatic involvement at level IIb and high prevalence of shoulder dysfunction caused by injury to the spinal accessory nerve during level IIb neck dissection challenges the necessity of level IIb neck dissection in cN0 OSCC., Competing Interests: Competing Interests No conflicts of interest., (Copyright © 2024 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Pre-vascular facial nodes (PV-FNs; perifacial lymph nodes) are supra-mandibular lymph nodes above the inferior border of the mandible. These are not part of routine neck dissection done for OCSCC. These lymph nodes can be sentinel station for metastatic lymph nodes from gingivobuccal complex cancers and are missed during routine neck dissection. It is imperative to include this sentinel station in routine neck dissection to prevent nodal recurrences., Materials and Methods: One hundred thirty-seven patients with GBCC (T1-T4) were prospectively recruited between May 2020 and June 2022 with the intent to evaluate the incidence of PV-FN metastases and clinicopathological factors predicting them., Results: PV-FN metastases were seen in 26 patients (18.9%; 26/137). The occult metastasis rate was 8.7% (12/137). On multivariate analysis, pathological T4 stage (pT4), LVE positivity, and intermediate-high BGS were statistically significant predictors of PV-FN metastases in our study., Conclusions: Incidence of PV-FN metastasis is high (18.9%) in GBCC, which can be potentially the first sentinel station in the lymphatic drainage pattern for this sub-site. Meticulous clearance of this nodal basin is of paramount importance during neck dissection to prevent nodal recurrences., Level of Evidence: 2 (CEBM-Level of Evidence-2.1) Laryngoscope, 135:148-152, 2025., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

The most common sites of distant metastasis (DM) in squamous cell carcinoma (SCC) of the tongue are the lung, bone, and liver; the early identification of metastasis to other sites is difficult. This case report discusses a 48-year-old male initially diagnosed with advanced-stage left tongue SCC, which was treated with wide excision, left radical neck dissection, and adjuvant concurrent chemoradiotherapy. Two months after completing adjuvant therapy, multiple painful nodules without local erythematous changes or warmth were found in the bilateral posterior neck and right medial thigh. Ultrasonography of these nodules revealed a cystic structure. Fine needle aspiration cytology revealed metastatic SCC. The disease progressed despite salvage chemotherapy, and the patient passed away 4 months after the formation of the nodules. Subdermal and intramuscular cysts as the initial presentation of DM have rarely been reported. The identification of unusual cysts, even those outside the head and neck, should raise concern., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Management of clinically unifocal node-negative papillary thyroid carcinoma ≤1 cm (PTMC) is controversial with nonsurgical treatment as a potential alternative to thyroid lobectomy (TL). However, conservative strategies, such as active surveillance or thermal ablation, do not allow the evaluation of biological aggressive features or occult lymph node metastases (LNMs), which play a primary role as prognostic factors., Methods: Among 4216 thyroidectomies for malignancy (between September 2014 and September 2023), TL plus ipsilateral central neck dissection was performed in 203 (4.8%) unifocal N0 PTMCs. Completion thyroidectomy was accomplished in case of positive frozen section examination of removed nodes or within 6 months from index operation in presence of biological aggressive features., Results: Seventy-six out of 203 (37.4%) patients were staged pN1a and extranodal extension was detected in 5 (6.6%) patients. At final histology, biological aggressive features, including multifocality, lymphovascular invasion (LVI), extracapsular invasion, tumor aggressive subtypes, and BRAF-V600E mutation, were detected in 69 (34%), 93 (45.8%), 3 (1.5%), 30 (14.8%), and 7 (3.5%) patients, respectively. A comparative analysis between pN0 and pN1a patients showed younger age (p < 0.001), LVI (p = 0.037), and multifocality (p < 0.001) as risk factors for occult central LNMs. After logistic regression analysis, age (p < 0.001) and multifocality (p < 0.001) were confirmed as independent risk factors for nodal involvement., Conclusions: Although most PTMC has been widely defined as indolent disease, a non-negligible rate of patients may present one or more biologically aggressive features including nodal involvement. Nonsurgical management should be considered with caution to avoid undertreatment especially in the younger population., (© 2024 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Objective: To determine the prevalence of occult contralateral nodal metastasis in tonsillar squamous cell carcinoma (TSCC) in patients who have undergone bilateral neck dissection., Data Source: A systematic review of English articles identified from PubMed, Embase, and Web of Science databases., Review Methods: Search terms included "oropharynx," "carcinoma," "lymph node," and "neck dissection." Two reviewers independently screened abstracts, reviewed full texts, and extracted data from all studies that presented the prevalence of contralateral occult nodal metastasis in TSCC., Results: The overall prevalence of occult contralateral nodal metastasis was 10%. The prevalence was 8% for cT1/T2 tumors, 19% for cT3/T4, 1% for N0 in the ipsilateral neck, and 12% for N+. Occult contralateral lymph nodes were most frequently found in neck level II (81%) and level III (19%). No metastatic nodes were found in level I., Conclusion: Elective neck dissection of the contralateral neck in TSCC is controversial due the historic morbidity caused by the surgery. A widely accepted recommendation suggests performing an elective neck dissection when the prevalence of occult metastasis is between 15% and 20%. The results of this study suggest that elective contralateral neck dissection will identify occult positivity in 19% of patients with T3/T4 tonsil cancer. In T1/T2 or N0 tumors, the diagnostic yield would be considerably lower at 8% and 1%, respectively. Contralateral nodal sampling could be considered based on patient preference after adequate counseling on the risks/benefits of occult nodal detection. More research is needed on other nodal features to formulate treatment guidelines. Laryngoscope, 135:27-33, 2025., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Pleomorphic adenoma is the most common neoplasm of the major salivary glands, and can undergo malignant transformation to carcinoma ex-pleomorphic adenoma (CXPA) in untreated patients., Case Presentation: Our case describes a 56-year-old male with a 15-year history of slowly growing expansive right-sided neck. He underwent excision of the neck mass, neck dissection, and pectoralis flap reconstruction. Final pathology revealed a 22 cm CXPA with myoepithelial and salivary duct carcinoma components. The patient was recommended radiation therapy to receive 66 Gy in 33 fractions., Discussion: CXPA is rare, typically aggressive, and carries a poor prognosis. This case is unique given the location of the tumor arising from the submandibular gland and delayed presentation leading to its massive size. Surgical planning for a lesion of this nature is complex due to structures in the vicinity and additional needs for reconstruction. Another important consideration highlighted by this case includes the need to assess patient reliability and provide resources to reduce the odds of being lost to follow up and enhance patient care., Competing Interests: Declaration of competing interest The authors have no conflicts of interest or financial disclosures., (Copyright © 2024. Published by Elsevier Inc.)

Background: The primary treatment for locoregional recurrent/persistent differentiated thyroid cancer (DTC) is repeated lymph node dissection; however, there are limited reports on the safety and long-term efficacy of multiple operations., Methods: Patients who underwent a cervical lymph node dissection between 1998 and 2022 were included in this study. Demographics, initial thyroid surgery, subsequent lymph node dissections, follow up information, and response to therapy were acquired., Results: After one, two, three and four re-operations, 112/314 (35.7 ​%), 16/79 (20.3 ​%), 3/25 (12 ​%), and 0/3 (0 ​%) patients (p ​< ​0.001) had an excellent response, respectively, resulting in a cumulative rate of 41.7 ​% (131/314). The risk for permanent hypoparathyroidism (2.9 ​%) or recurrent laryngeal nerve injury (2.2 ​%) was 5.1 ​% (14/272). This was higher in patients undergoing re-operative central neck dissection (CNDx) (8.7 ​%, 10/114) versus those who did not undergo a previous CNDx (2.5 ​%, 4/158, p ​< ​0.02)., Conclusions: Surgery remains the primary treatment for recurrent/persistent DTC, however, the likelihood of an excellent response decreases with additional operations. The risk of permanent complications is low but is more likely to occur during redo CNDx., Competing Interests: Declaration of competing interest Martin Jose Barrio: This author does not report any conflict of interest and no funding to disclose. Nikita Pozdeyev: This author does not report any conflict of interest and no funding to disclose. Robert C. McIntyre: This author does not report any conflict of interest and no funding to disclose. Maria B. Albuja Cruz: This author does not report any conflict of interest and no funding to disclose. Bryan Haugen: This author does not report any conflict of interest and no funding to disclose. Christopher D. Raeburn: This author does not report any conflict of interest and no funding to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The patient was a 71-year-old male with hypopharyngeal carcinoma who underwent right-sided neck dissection for lymph node metastasis, adjuvant radiotherapy (70 Gy), and cisplatin chemotherapy, he developed neck inflammation with evidence of free air on computed tomography and subcutaneous fistula formation on laryngoscopy. After total laryngectomy, bilateral neck vessels were obscured by scar tissue secondary to radiotherapy and chronic inflammation. Pedicled pectoralis major (PM) flap was favored for reconstruction. A 20×7 cm PM flap was harvested from the right thoracic region, and the muscle body was harvested caudally to obliterate the dead space in the neck. After complete circumferential suturing, the dead space in the cervical region was filled by suturing the PM muscle body to the exposed cervical spine. A deltoid-pectoral (DP) flap was harvested from the right side and used to create the cephalic aspect of the permanent tracheostoma. In addition, a large right anterior pectoral flap was created lateral to the PM muscle, meticulously preserving the perforating intercostal artery branch during flap elevation. Lastly, the DP flap harvest site and neck defect were temporary. This case report presents a novel technique for laryngeal necrosis reconstruction using a combination of PM, DP, and anterior thoracic flaps. The approach achieved total suture closure of the DP flap harvest site, offering significant advantages. This technique should be considered in patients undergoing reconstruction with DP flaps., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Background: Postoperative complications (PCs) following total laryngectomy remain a significant challenge, with recent investigations directed toward the impact of nutrition status and vitamin D deficiency., Objectives: To elucidate the association between preoperative vitamin D level status, malnutrition risk score, and surgical and survival outcomes in patients with advanced laryngeal cancer following total laryngectomy., Study Design: Prospective cohort study., Methods: Sixty-four patients with advanced laryngeal carcinoma treated with total laryngectomy were included in the study. Serum levels of 25(OH) D 3 were measured employing a commercial chemiluminescent immunoassay kit, while nutrition status was evaluated using the nutrition risk index (NRI) and Malnutrition universal screening tool (MUST)., Results: The mean serum 25(OH) D level was 37.1 ± 19.4 nmol/L (range 11.0-100.6 nmol/L), with 47% of patients exhibiting vitamin D deficiency and 31% displaying insufficiency. Medium/high MUST score had 53% of patients, and moderate/severe NRI was verified in 48% of patients. Univariate logistic regression analysis identified MUST score, GPS score, neutrophil-to-lymphocyte ratio, and circulating 25(OH) D levels as predictive for the occurrence of PCs. In multivariate analysis, MUST score and circulating 25(OH) D levels remained significantly associated with PCs. Patients with high nutrition risk had significantly lower two-year OS rates compared to the medium and low nutrition risk groups, respectively (30% vs. 62% and 83%, p = 0.010)., Conclusion: Early identification of malnourished or patients with vitamin D deficiency and those who would benefit from specific nutritional support could be beneficial for minimizing the risk of development of surgical complications and help improve our clinical outcomes., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval to conduct this single-center retrospective study was achieved from the institutional review board of the Ethics Commission of the Faculty of Medicine, University of Belgrade No 1322/IV-12. The Helsinki Declaration of 1975, updated in 2013 was followed. Consent for publication: Not applicable. Competing interests: The authors declare that they have no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: There is variability in the literature on the role of the depth of invasion (DOI) for recommending an elective neck dissection (END)., Purpose: The purpose of the study is to estimate the DOI threshold for recommending an END., Study Design, Setting, Sample: A retrospective cohort study was performed at McGill University Health Centre from 2008 to 2018 with 5 years of follow-up. The sample was subjects with clinical T1/T2 oral squamous cell carcinoma and clinically negative neck. Subjects with previous head and neck cancer were excluded., Predictor Variable: The primary predictor variable was DOI measured from the basement membrane of the adjacent normal mucosa on final pathology, coded as <4 mm or ≥4 mm. DOI is a continuous variable converted to a binary variable., Main Outcome Variable: The main outcome variable was time to development of neck disease (RD+) defined as the time from surgery to development of pathologic nodes. Time to RD+ for pathologic nodes discovered from the END was considered 0 months. The secondary outcome variable was overall survival., Covariates: Demographics (age, sex, and smoking/alcohol history) and tumor characteristics (tumor location, clinical T, tumor differentiation, perineural invasion, and lymphovascular invasion) were analyzed., Analyses: Time to RD+ and survival were analyzed using Cox hazard ratio, Kaplan-Meier curves, and log-rank test. Student's t-test and χ 2 test were used for bivariate analyses; P ≤ .05 was statistically significant., Results: The final sample were 64 subjects (average age 65.25 [standard deviation 13.06] years and 36 [56.2%] males). Twenty-nine subjects had DOI < 4 mm, and the 5-year RD+ was 3.4% (the 1 occurrence of RD+ was at 5.3 months). Thirty-five subjects had DOI ≥ 4 mm, and the 5-year RD+ was 45.7% (15 subjects had RD+ discovered from the END, and 1 subject had RD+ at 7.6 months). DOI ≥ 4 mm had significantly higher risk of RD+ than DOI < 4 mm (hazard ratio 17.91; 95% confidence interval 2.37 to 135.3; P = .01), which remained significant after adjusting for clinical T, tumor differentiation, perineural invasion, and lymphovascular invasion (hazard ratio 9.53; 95% confidence interval 1.12 to 81.44; P < .05). The shallowest DOI with >20% risk of RD+ was in the DOI 4 mm to 4.9 mm group., Conclusion and Relevance: Among patients with oral squamous cell carcinoma of T1 or T2 and clinically negative necks, END should be considered with DOI ≥ 4 mm., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology., Methods: A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features., Results: Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUV max below blood pool. One patient scored NI-RADS 2; the rest scored 1., Conclusions: On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information., (© 2024 Wiley Periodicals LLC.)

This study aimed to report our experience about endoscopic neck dissection through a post-auricular hairline incision, followed by intraoral resection of oral cancer and free flap reconstruction. Laryngoscope, 135:130-133, 2025., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: This multi-institutional observational study aimed to assess the incidence, severity, and impact of radiotherapy-related late toxicities of the cervical skin and soft tissue in head and neck cancer patients. We also explored patient interest in fat grafting as a potential treatment for skin and soft tissue sequelae., Methods: This study was conducted across 19 institutions in Japan. The study involved head and neck cancer patients who received ≥ 60 Gy of cervical radiotherapy concomitant with a history of neck dissection and were free of cancer recurrence ≥ 3 years after the final treatment. Consenting outpatients completed a self-administered questionnaire to collect data on symptom severity and the attending outpatient physicians reported data on demographics and treatments in a case report form., Results: A total of 222 patients were enrolled. The incidence proportion of late cervical skin and soft tissue toxicities was 96%, with 32% of patients reporting their symptoms as severe, and 69% of patients reporting an impact on quality of life (QOL). An interest in or consideration of fat grafting was reported by 34% of patients, with a greater desire among those with severe symptoms., Conclusion: This study elucidated the incidence, severity, and life impact of late toxicities affecting the cervical skin and soft tissue after radiotherapy for head and neck cancer. These late toxicities were highly prevalent and significantly impacted QOL. There is a substantial demand for new treatments, such as fat grafting, to address these complications and enhance the QOL for survivors of head and neck cancer., Competing Interests: Declarations. Ethics approval: In accordance with the Declaration of Helsinki, the study protocol was approved by the National Cancer Center Institutional Review Board (2022–214) on October 24, 2022, prior to the first inclusion in National Cancer Center Hospital East on November 14, 2022, and subsequently approved by all participating institutions. Ethical approval was obtained from institutional ethics boards before patient recruitment. Consent to participate: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The objective of this study is to provide a retrospective review of the 40-year experience of three oncology referral centers in the field of reconstructive laryngeal surgery., Materials and Methods: A multi-institutional retrospective analysis included adult patients who underwent reconstructive laryngeal surgery for cT2-T4a laryngeal cancer (LC) between 1 June 1987 and 1 July 2019. Patients were stratified according to the European Laryngological Society classification for open partial horizontal laryngectomy (OPHL)., Results: The final study group included 805 patients (668 men and 137 women). 561 tumors were glottic, while 244 showed supraglottic origin; 644 were considered anterior and 161 posterior. Arytenoid motility was normal in 712 patients, while the motility of the vocal folds appeared to be impaired in 501 patients. All patients underwent OPHL, of which 20 patients underwent OPHL I, 636 patients underwent OPHL II, and 149 patients underwent type III OPHL. 257 patients underwent adjuvant RT based on multiple risk factors/pathological findings. The 5-year overall survival rate was 89.7% (95% CI 87.2-94). The 5-year disease-free survival rate was 78.4% (95% CI 76.8-84.9), and the 5-year disease-specific survival was 64.3% (95% CI 62.2-69.6). Complications were observed in 7.5% of patients, while long-term sequelae were observed in 21% of patients., Conclusion: The findings of this work reveal four decades of surgical evolution in the school of Enrico de Campora. Despite the retrospective analysis and the extremely long follow-up, our analysis shows how OPHLs play a crucial role in LC (even cT4a), with excellent results in terms of functional outcome and organ preservation., (© 2024 Wiley Periodicals LLC.)

Objectives: To evaluate previously reported quantitative (tumor thickness 11 mm and depth of invasion [DOI] 7.5 mm) and qualitative (styloglossus/hyoglossus muscle invasion [SHMI]) magnetic resonance imaging (MRI) parameters for predicting occult neck node metastasis in clinical N0 oral tongue squamous cell carcinoma., Methods: This single-center retrospective study included 76 patients. MRI images were independently reviewed by two radiologists for tumor thickness, DOI, and SHMI. Statistical analysis assessed the predictive capability of these parameters for 2-year potential lymph node metastasis., Results: Among the 76 cases, 30.2% developed 2-year potential lymph node metastasis. For tumor thickness ≥ 11 mm, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 0.46, 0.68, 0.37, 0.75, and 0.61, respectively. DOI ≥ 7.5 mm exhibited a sensitivity, specificity, PPV, NPV, and accuracy of 0.73, 0.59, 0.42, 0.84, and 0.63, respectively. SHMI demonstrated a sensitivity, specificity, PPV, NPV, and accuracy of 0.87, 0.51, 0.46, 0.89, and 0.63, respectively., Conclusion: DOI ≥ 7.5 mm and SHMI demonstrated comparable diagnostic accuracy in predicting neck metastasis, surpassing tumor thickness of > 11 mm. These findings underscore their potential utility in guiding decisions concerning elective neck dissection., Competing Interests: Declarations. Conflicts of interest: The authors declare that they have no known conflict financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethics approval: Institutional review board approval was obtained for this retrospective, single-center study from our hospital. Informed consent: The need for informed consent was waived owing to the retrospective nature of this study. ‘All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.’, (© 2024. The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.)

Introduction The role of concomitant chemoradiation therapy (CTRT) or radiation therapy (RT) is not well defined in operated cases of oral squamous cell carcinoma (OSCC) with positive perineural spread. The purpose of the study was to determine whether the use of concurrent CTRT or RT would enhance the five-year disease-free survival of patients with positive perineural invasion (PNI). Materials and methods Data were analysed retrospectively from January 2014 to December 2023. Patients were placed into three groups: surgery only, surgery with RT, and surgery with concomitant CTRT. In all, 180 cases of pT1-3N0 and pT1-3N+ OSCC patients had tumour-free margins, of which 24 cases (13.4%) had perineural invasion. Based on treatment modalities, 45.8% of the cases underwent surgery with CTRT (group III), 33.3% opted for surgery with RT (group II), and 20.9% underwent surgery only (group I). Five-year recurrence-free survival was analysed among the three groups using the Kaplan-Meier model. Results There was no significant difference among the three groups in terms of recurrence (p = 0.817) or five-year survival rate (p = 0.0935). Conclusion Altogether, the data seem to indicate that radical surgical resection alone should be considered sufficient treatment for OSCC patients with pT1-3N0 disease, even in the presence of perineural invasion. Thus, it can be concluded that the addition of concomitant CTRT or RT does not significantly increase the five-year disease-free survival of patients with OSCC with positive PNI., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Ethical Committee of the ITS Dental College, Hospital and Research Centre, Greater Noida issued approval IEC/OS/8/19. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gupta et al.)

Introduction: A growing amount of evidence points at lymph node yield (LNY) and lymph node ratio (LNR) as useful indicators in the prognostic evaluation of patients affected by head and neck squamous cell carcinoma (HNSCC) who require neck dissection. The aim of this study was to assess the importance of LNY and LNR in the prognostic evaluation of head and neck cancer patients., Materials and Methods: Included studies were those examining LNY and/or LNR in head and neck cancer patients. We excluded case reports or case series, thyroid cancer or salivary gland cancer studies, a sample size less than 20, and studies with incomplete or missing survival estimate. Of the 2435 studies identified through a database search, 95 were reviewed for full text and 63 were finally included for the final analysis. Electronic databases, including PubMed (MEDLINE), Embase, and Scopus were screened up to January 1, 2024. The systematic review was conducted according to the MOOSE checklist. A set of sub-group meta-analyses were performed for oral cavity, oropharynx, hypopharynx, larynx, and mixed subsites using a random-effects model. Overall survival (OS), Disease Specific Survival (DSS), and Disease-Free Survival (DFS) Hazard Ratios (HR) related to a prespecified LNR and LNY exact value were chosen as summary statistics. Cumulative Hazard Ratios with 95% Confidence Interval (CI) were presented, calculated through the inverse variance method. Heterogeneity was evaluated with I 2 statistics., Results: Results of the meta-analysis showed increased OS for a higher LNY (HR 1.33 95% CI 1.23-1.45). Regarding the LNR, a lower LNR value has an impact on survival, with an OS HR of 1.96 (95% CI 1.72-2.24). The same was true for DFS (HR 2.43 95% CI 1.82-3.23), and DSS (HR 2.07 95% CI 1.83-2.33)., Conclusions: Our analysis confirms the importance of LNY and LNR as prognostic indicators. Future studies are needed to establish the optimal cut-off values for both factors. LNY and LNR have the potential to be routinely evaluated in patients who undergo neck dissection for HNSCC., Competing Interests: Declaration of competing statement All the authors disclose any conflict of interest related to the present publication., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: The primary endpoint of the study was to quantitatively evaluate the presence of IIB neck level metastases in patients with laryngeal carcinoma, to provide valuable evidence to aid surgeons in the decision-making process for neck dissections. As a secondary aim this study analyzed the presence of factors that may be associated with a higher prevalence of metastasis., Methods: Two independent authors (EE, MVV) searched for articles on PubMed, Cochrane, Embase, and Scopus databases. Review of the articles was carried out following 2020 PRISMA guidelines, all articles were assessed for quality according to NICE guidelines. Afterwards the statistical analysis was performed with STATA 18SE software. Studies were also assessed for heterogeneity and risk of publication bias., Results: A total of 19 studies were included, from which data on 1205 subjects was extracted. Out of 997 patients with a cN0 LC, 21 patients developed metastasis. This meta-analysis found the cumulative rate of metastasis to be 1% (95% CI 0-2%). Also, there is a 51% higher probability (OR: 1.51, 95% CI 0.06, 2.92) of occult IIB metastasis in higher stages (T3/T4) compared to lower stages (T1/T2)., Conclusions: Dissection of level IIB may be safely spared in patients with cN0 laryngeal cancer, possibly leading to improved QoL and shoulder function as well as reducing OR times and costs., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Surgical management of level V in clinically node positive (cN+) oral squamous cell carcinomas (OSCCs) is controversial. The objectives of the study were to identify predictors of level V metastases in cN+ OSCC., Methods: This retrospective study is based on institutional data of operated cN+ OSCC between April 2018 and December 2022. Clinical and pathological parameters were subjected to univariate analysis. Significant parameters in univariate analysis were further subjected to multivariate analysis. A p value of less than 0.05 was considered statistically significant., Results: None of cN1 or pN1 patients had a level V metastasis. No skip metastasis to level-V was noticed. Total number of positive lymph nodes, lymph node ratio (LNR), extranodal extension, pN classification, and the presence of level II and III metastases were found to be significant predictors for level V metastases. The post hoc analysis suggested that ≥5 positive nodes, LNR >0.1, and pN3 status were independent risk factors for level V metastases., Conclusion: Selective neck dissection for N+ OSCC is feasible in the N1 neck, preferably where nodal metastases is limited to level-I only. Patients with a bulky nodal disease, particularly those with N3 neck, ≥5 positive nodes, ENE, and metastatic lymph nodes in levels II and III should be offered comprehensive neck dissection., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Introduction: It is debatable whether neck dissection is necessary in patients with advanced laryngeal carcinoma who are clinically node-negative (cN0). We assessed the effect of neck dissection on overall survival in patients with cN0 undergoing primary or salvage laryngectomy., Materials and Methods: A retrospective evaluation of cN0 patients who underwent primary or salvage total/pharyngolaryngectomy at a French tertiary facility in 2008-2018, with or without neck dissection, was carried out. Patients were divided into two groups: primary (n = 65) and salvage (n = 84)., Results: Comparing subglottic (HR = 3.978; p = 0.023) and hypopharyngeal (HR = 2.958; p = 0.018) malignancies to other tumor subsites, the mortality rates were greater. The primary group had a greater rate of occult metastases (23.07% vs. 14.28%; p = 0.089) than the salvage. The average lymph node ratio was significantly different between the treatment groups (0.05 ± 0.04 vs. 0.17 ± 0.33; p = 0.004). If LNR > 0.05, we found poor survival rates (p < 0.001). Although performing a neck dissection during the primary treatment increased the 5-year OS rate (Yes 89.5% vs. No 83.3%; p = 0.062), there was no discernible difference in the salvage group (Yes 80.3% vs. No 78.6%; p = 0.806; Log-rank p > 0.05). For the predicted survival variables, no significant relationships were detected in the Cox regression analysis (all p-values > 0.05)., Conclusion: Although the primary group had a greater frequency of occult metastases, neither the primary group's survival outcomes nor those of the salvage laryngectomy cases were significantly affected by neck dissection. LNR and the location of the tumor were important variables that could affect survival and the choice to do a neck dissection., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: This study aimed to explore the predictive and prognostic value of tumor-stromal ratio (TSR) and tumor budding (TB) in the recurrence and outcome of patients with Oral tongue squamous cell carcinoma (OTSCC)., Methods: All patients with OTSCC who underwent glossectomy with or without neck dissection in a tertiary center between 2010 and 2020 were included. The pathology slides of all patients were reviewed by a consulting pathologist. All pathologic features including tumor size, tumor grade, tumor thickness, surgical margin status, lymphovascular- and perineural invasion, T-stage, number of dissected, TB, TSR, and involved, tumor budding and tumor-stromal ratio were defined, we categorized the tumors as stroma-rich (low TSR) and stroma-poor (high TSR); as well as TB as low (0-4 buds) and high (≥ 5 buds). The inter-observer reliability of TB and TSR was assessed using the Kappa statistics analysis., Results: A total of 109 patients, with a median age of 62 (range 19-88) years, were included. There was a significant correlation between TSR and tumor budding with other adverse pathologic features and prognostic factors. In univariate analysis, both stromal-rich tumors and tumor budding were poor prognostic factors for disease-free survival (DFS) and overall survival (OS). However, on multivariate analysis, N-stage, adjuvant radiotherapy, tumor size, depth of invasion (DOI) and tumor budding emerged as independent prognostic factors for DFS. Likewise, N-stage, and DOI were recognized as independent prognostic factors for OS., Conclusion: Both TSR and TB are important histopathological parameters strongly linked to other pathologic prognostic indicators. Additionally, they play key roles in predicting tumor behavior, recurrence, and patient survival., Competing Interests: Declarations. Humanal approval statement: In accordance with the code of ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans, the study protocol was approved by the Research Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.DENTAL.REC.1402.013). Competing interest: The authors declare no competing interests. Consent to participate: Written consent was obtained from all patients enrolled in this retrospective study for diagnostic and treatment purposes. All patient information was kept confidential and anonymized to protect their privacy. The study was conducted in compliance with all relevant ethical guidelines and regulations. Conflict of interest: All authors declare that they have no conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study aimed to evaluate the impact of periodic neck ultrasonography (US) on postoperative surveillance for locoregional disease control of patients with low- and intermediate-risk papillary thyroid carcinoma (PTC) who underwent total thyroidectomy. This retrospective cohort study included patients with PTC who underwent total thyroidectomy and central neck dissection at our institution between January, 2000 and December, 2016. The patients were divided into two groups: the physical examination (PE) group (follow-up by PE without periodic US) and the US group (follow-up by PE with periodic US). Serum thyroglobulin levels were measured periodically in both groups. Propensity score matching was used to rigorously balance the significant variables and assess the 10-year postoperative outcomes between the groups. Of the 189 patients, 150 were included after matching (75 in each group). There were no significant differences between the two groups in terms of background characteristics. The median follow-up period was 127.9 months. There was no significant difference in locoregional relapse-free survival between the PE and US groups (97.0 vs. 98.7%, p = 0.541). The overall survival was 96.7% and 98.7% in the PE and US groups, respectively, with no significant difference (p = 0.364). This study demonstrated that the addition of periodic US to PE for postoperative surveillance of patients with low- and intermediate-risk PTC who underwent total thyroidectomy did not significantly affect locoregional control.

A crucial parameter in determining the prognosis of oral cavity cancer is depth of invasion (DOI). This research aimed to correlate pathological DOI at different intra-oral anatomical sites for oral squamous cell carcinoma (OSCC) with the risk of regional lymph node metastasis (LNM). This study also investigated the correlation of 3-year overall survival (OS) and disease-specific survival (DSS) with tumor depth. DOI measurement of the primary tumor at different intra-oral anatomic sites of clinically node negative patients who underwent curative surgery with elective neck dissection (END) was carried out as per AJCC 8th Edition staging guidelines in 3 DOI groups of ≤5 mm(A), >5 to ≤10 mm(B) and >10 mm(C). Association of groupwise DOI values with histopathological parameters including LNM and 3 years survival was evaluated. Univariate and multivariate logistic regression analysis (Odds ratio (OR) = 1.1 95 % CI: 1.0-1.2, p < 0.05) showed DOI to be a significant predictor for sub-clinical nodal metastasis observed in 136/382 OSCC patients. Receiver operating curve suggested that at 5 mm DOI (4 mm for early-stage OSCC), the risk of occult LNM was >20 % for all intra-oral sites combined. DOI <5 mm group demonstrated a superior 3-year OS (OR = 19.8 % CI: 7.8-49.9) and DSS (OR = 14.7 % CI: 5.9-37.0). Thus, DOI is an independent predictor of nodal metastasis and has significant association with LNM, OS and DSS. Our findings suggest that a DOI of ≥4 mm is an accurate cut-off value for performing END in early-stage OSCC and > 5 mm for advanced cases across all evaluated oral anatomic sites., Competing Interests: Declaration of competing interest The authors declare no competing financial interests or personal relationships that seemed to influence the work disclosed in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The study delves into the distribution of cervical nodal metastasis among patients diagnosed with carcinoma of unknown primary who underwent definitive diagnostic surgical management in form of transoral robotic surgery assisted ipsilateral radical tonsillectomy and tongue base mucosal wedge biopsy with concurrent therapeutic open ipsilateral neck dissection. We conducted a prospective study at a tertiary care center over two-years, enrolling patients with unilateral neck swelling histopathologically confirmed as squamous cell carcinoma neck metastasis. For cases where the primary site remained undetected despite evaluation, patients underwent Transoral Robotic Surgery (TORS) assisted ipsilateral radical tonsillectomy and tongue base wedge biopsy, along with concurrent open ipsilateral neck dissection. The study examines the clinicopathological correlation of nodal metastasis in carcinoma of unknown primary and explores the concepts of Lymph node yield (LNY) and Lymph node density (LND). Clinicoradiologically, the majority of patients exhibited N2b disease ( n  = 10/18, 55.55%). However, histopathological examination of the neck dissection specimen revealed N3b disease in the majority ( n  = 5/17, 29.4%). Neck dissection was aborted for 1 patient with unresectable N3b nodal metastasis during the procedure. The most commonly affected lymph node level clinicoradiologically was level II ( n  = 18/18, 100%), which corresponded to level II pathologically in most cases ( n  = 15/18, 88.2%). Ipsilateral radical neck dissection was required in the majority of cases ( n  = 10/17, 58.82%). The median Lymph Node Yield (LNY) from ipsilateral neck dissection was 30.78 ± 3.52, with the highest Lymph Node Ratio (LNR) detected from level II (11.1 ± 1.56). In the context of carcinoma of unknown primary with secondary neck metastasis, exploring emerging concepts such as Lymph Node Ratio (LNR) and Lymph Node Density (LND) alongside other clinicopathological parameters is crucial. These concepts provide valuable insights into the metastatic burden and may aid in refining prognostication and treatment strategies for patients with this condition., Competing Interests: Competing InterestsNot applicable., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: Lymphatic mapping is an established technique to map drainage patterns in oral cancer. Its utility in patients who have undergone prior radiation or neck dissection is not well studied., Methods: Patients presenting to a single tertiary cancer center between 2021-2023 for a recurrent/second oral cancer that underwent lymphatic mapping were considered. All patients had a history of a head and neck cancer treated with either radiation or neck dissection. We further conducted a scoping review in MEDLINE, Embase, and Web of Science of lymphatic mapping in oral cancer patients with previous neck treatment., Results: In our single center review, a total of 11 patients were included. 73 % received prior radiotherapy and 55 % underwent prior neck dissections for a head and neck cancer. Lymphoscintigraphy-directed neck dissections identified sentinel nodes in 9/11 patients, with only one patient who had positive sentinel node disease. There were no reports of regional recurrence at a median of 10 months follow-up. Our scoping review of 980 studies identified 151 additional patients who underwent sentinel node biopsy for a second oral cancer after previous neck treatment. Overall, the negative predictive value of lymphatic mapping in all studies was 96.7 %., Conclusion: Lymphatic mapping is feasible in secondary or recurrent oral cavity cancers even in patients with prior radiation or surgical management of the neck. The literature to date demonstrates a negative predictive value of ∼ 97 % for sentinel node mapping and warrants further consideration in the management of salvage oral cancer., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Glucose is the main energy substrate of tumor cells. This study aims to assess whether the transcriptional expression of glucose metabolism-related genes is associated with occult lymph node metastases in head and neck squamous cell carcinoma (HNSCC) patients., Methods: We examined the transcriptional expression of a panel of glucose metabolism-related genes in a cohort of 53 patients with HNSCC without cervical lymph node involvement at the time of diagnosis (cN0) and subsequently treated with elective neck dissection., Results: Occult lymph node metastases were found in 37.7% (n = 20) of the patients. Among the analyzed genes, SLC16A7 exhibited the strongest association with the presence of occult lymph node metastases. Patients with occult lymph node metastases (cN0/pN +) had significantly lower SLC16A7 expression values (p = 0.001). Patients with low SLC16A7 expression (n = 17, 32.1%) had a frequency of occult lymph node metastases of 76.5%, while for patients with high SLCA16A7 expression (n = 36, 67.9%) it was 19.4% (P = 0.0001). A multivariable analysis showed that patients with low expression of SLC16A7 had a 12.6 times higher risk of developing occult lymph node metastases., Conclusion: cN0 HNSCC patients with low SLC16A7 expression had a higher risk of occult lymph node metastases., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Locally advanced buccal mucosa cancer is typically treated with surgery and adjuvant postoperative radiation therapy, which includes concurrent Cisplatin 100 mg/m2 on Day 1, plus 5-Fluorouracil 1000 mg/m2 from Day 1 to 4 every three weeks. Ipsilateral face radiotherapy is a de-escalated treatment that spares the opposite side of the face, enhancing post-treatment chewing function. The availability of electron beam radiotherapy for treating recurrences on the opposite side has increased the use of ipsilateral face radiotherapy. This retrospective study aimed to assess treatment outcomes and patterns of disease recurrence in patients with carcinoma of the buccal mucosa treated with different schedules. We retrospectively reviewed records of 54 patients with a pathological diagnosis of buccal mucosa cancers treated between 2018 and 2023. We extracted patients' demographic, disease, and treatment criteria. Indications for postoperative radiotherapy included a close margin of less than 3 mm and lymph node positivity. The primary tumor (face) and neck were considered separately for radiotherapy treatment. One patient who refused surgery, radiotherapy, and chemotherapy but regularly came for follow-up after receiving Ayurvedic treatment died of the disease after 2 years and 1 month. Fifty-three patients received concurrent chemoradiotherapy with Cisplatin 100 mg/m2 on Day 1, plus 5-Fluorouracil 1000 mg/m2 from Day 1 to 4 every three weeks for three cycles. Postoperative patients were treated with radiotherapy fields covering the face (bilateral or ipsilateral wedged fields) and the whole neck field with central shielding for the initial 44 Gy in 22 fractions over 4.5 weeks followed by a boost dose of 16 Gy to the primary tumor and involved neck. For radical radiotherapy, patients received a similar radiation field but the boost dose delivered was 26 Gy in 13 fractions over 2.5 weeks. For ipsilateral radiotherapy fields, the average face anterior field size was 6 W x 8 cm; the thick edge of the wedge laterally; depth 4 cm and lateral 8 W x 8 cm radiation field with a thick edge of the wedge anteriorly; depth 3 cm. The median dose to high-risk clinical target volume was 60 Gy/30 fractions in postoperative cases. Forty-eight patients received radical radiotherapy with a higher dose (66 Gy/33 fractions to 70 Gy/35 fractions); twenty-eight patients received radiotherapy fields of bilateral face and neck with a central spinal shield of 2 cm. Statistical analysis was conducted at the Community Medicine Department using SPSS software version 21.0. The Chi-square test and Fisher Exact test were applied to compare various groups. Fifty-four patients were analyzed. The median follow-up was 9 months. Surgery consisted of Composite Resection (Commando operation) plus Radical Neck dissection in three (5.5%) patients and non-composite resection surgeries (Wide excision of the lesion plus supra-omohyoid dissection) in nine (16.6%) cases, of which six (50%) cases had lymph node involvement but no patient with positive dissection had extracapsular extension. Tumor thickness by histopathology was found to be between 5 and 15 mm. Sixteen (28.1%) patients failed locally and 11 (20.3%) had lymph node recurrences. One patient (1.8%) with mucoepidermoid cancer had bony metastases at D9, L1, and the pelvis after 4 months of treatment. Death occurred in 12 (20.3%; one due to a non-oncologic cause) out of 54 patients during our study. The majority (88%) of patients in our study are male, aged less than 50 (55%). A KPS of 70/>70 was present in 83.3% of patients. The majority of patients in this study are T3 (37%) and T4a (29.6%). Nodal status of patients included 29.6% N0; 27.7% N1, and 35.1% N2. The majority of patients (57.4%) have well-differentiated carcinoma followed by moderately differentiated carcinoma in 38.8% of patients. The difference in death is non-significant when ipsilateral face + neck radiotherapy is compared to bilateral face + neck radiotherapy by Fisher Exact test (statistical value = 0.1246; p  > 0.05, statistically not significant), and in other groups, it could not be compared due to the small number of patients. Our results show the non-inferiority of non-composite resection surgery + bilateral face + neck radiotherapy to non-operative radical radiotherapy (bilateral or ipsilateral face wedged radiotherapy + neck radiotherapy), so the majority of patients can be treated by these modalities of treatment. De-escalation of radiotherapy by the use of ipsilateral face wedged + neck radiotherapy is possible as there is no statistically significant difference in local and nodal relapse when compared to bilateral face + neck radiotherapy, and it results in sparing of the opposite side of the face. Buccal mucosa carcinoma in eastern Uttar Pradesh is a very aggressive disease, with 12 (20.3%; one due to a non-oncologic cause) out of 54 patients dying. Our results are different compared to historical data, possibly due to the use of concurrent Cisplatin + 5-Fluorouracil chemotherapy and the lower number of patients in the composite resection group as the majority of patients were frail and did not consent to composite resection., Competing Interests: Competing InterestsI confirm that all authors of the manuscript have no conflict of interest to declare., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The aim of the study was to assess the involvement of submandibular gland in oral cancer patients undergoing neck dissection. This study reviewed the records and pathologic specimens of patients who were clinically and histopathologically diagnosed as having oral cavity squamous cell carcinoma, from the year 2018 to 2023. A total of 332 patients were included. These patients underwent surgery with primary tumor resection and neck dissection. Pathologic metastasis to submandibular gland was then evaluated. Histopathological data showed that submandibular gland was involved in only 10 cases. Out of these cases, involvement of level IA &B lymph nodes was found in 9 of the cases. Direct extension of primary tumor to submandibular gland was noted in advanced stages (stage IV). Most common primary site for involvement of SMG was buccal mucosa (six patients), with significant correlation with LVI, ENE, DOI and WPOI (p value < 0.05). This study demonstrates that the incidence of submandibular gland metastasis in oral cavity (SCC) is extremely rare. Its involvement is either through direct extension from a primary lesion or in advanced disease. Thus, patients with early-stage oral SCC with preoperative N0 neck, may be candidates for preservation of the submandibular gland., Competing Interests: Ethical ApprovalThe current study complies with the ethical standards. No funding was provided for the current study. There was no conflict of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: Cervical lymph node metastasis (CLNM) frequently occurs in oral cancer patients. This study aims to investigate risk factors associated with CLNM and predict CLNM preoperatively in patients with oral squamous cell carcinoma (OSCC)., Materials and Methods: This population-based, hospital retrospective cohort study included 158 patients with oral cancer. We performed regression analysis to determine risk factors and establish a model for predicting CLNM in patients with OSCC. To distinguish and validate the prediction model, we used the area under the receiver operating characteristic (ROC) curve (AUC)., Results: Lymph node size, tumor size, degree of differentiation, and LVI were risk factors for cancer metastasis. The OR values were 1.245, 2.847, 2.527, and 6.945, respectively. The AUC value for the clinical prediction model was 0.8736 (95% CI: 0.8043-0.9429)., Conclusions: The prediction model for OSCC patients predicts CLNM and provides a new method for preoperative assessment of whether cervical lymph nodes are metastatic, as well as a guide for surgical treatment, including whether to carry out neck dissection and which neck dissection procedure to use., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Oral squamous cell carcinoma (OSCC) often exhibits a propensity for metastasis to lymph nodes (LNs), significantly influencing prognosis. Neck dissection (ND) is an important part in the treatment of OSCC. Variations in the preference for and pathways of lymph node metastasis (LNM) in different regions of the oral cavity have been observed. Currently, there is a lack of sufficient emphasis on the anatomical perspectives of LNM and ND. This review elucidates the lymphatic system of the maxillofacial regions from an anatomical standpoint, details the distribution of the sentinel LNs across different subsites, and summarizes the various classifications of the cervical LNs. Additionally, we elaborate on the methods used to study the lymphatic system, particularly imaging techniques. Furthermore, we investigate the pathways of cervical LNM and evaluate the efficacy of ND from an anatomical viewpoint. The overall objective of this review is to provide essential anatomical knowledge for managing LNs in OSCC, in the hope of providing patients with effective treatment modalities to enhance their quality of life., Competing Interests: Declarations. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethical approval: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: The resection of lymph nodes/neck dissection is a typical part of the surgical treatment of head and neck malignancies. The aim of this study was to compare subcutaneous closure using single knotted, braided suture (Vicryl TM , standard arm) with continuous self-locking, monofilament barbed suture (V-Loc TM , experimental arm)., Methods: Neck Lock was a randomized clinical trial at a single tertiary referral center. It was conducted from 2016 till 2022 with a follow-up period of 3 months. Assessment of safety and aesthetic outcome was double-blinded. 68 patients were randomized after application of exclusion criteria. Subcutaneous wound closure was performed in an intrapatient randomized fashion for suture technique. The primary endpoint was the duration of subcutaneous sutures. Wound healing and scar formation were recorded at multiple postoperative intervals as secondary endpoints., Results: The median age was 61 years, 89.7% were male. 92.6% suffered from a squamous cell carcinoma. There was a significant difference in median subcutaneous suture time (p = 0.024) between the experimental (6:11 ± 2:30 min) and standard (7:01 ± 2.42 min) arms. There was no significant difference in safety when assessing adverse events (AEs). At least one AE occurred in 14.7% vs. 5.9%, for barbed and smooth sutures respectively (p = 0.16)., Conclusion: For neck dissection of head and neck malignancies, subcutaneous wound closure with self-locking sutures offers significant time savings over the single knot technique with similar safety and aesthetic results., Trial Registration Information: The trial was registered with WHO acknowledged primary registry "German Clinical Trials Register" under the ID DRKS00025831 ( https://drks.de/search/de/trial/DRKS00025831 )., (© 2024. The Author(s).)

Background: We aim to describe the management and outcomes of patients with persistent lymphadenopathy (LAD) after primary chemoradiation for head and neck squamous cell carcinoma (HNSCC) based on post-treatment PET/CT results., Methods: Retrospective chart review was conducted of all patients who underwent primary concurrent chemoradiation for HNSCC at a tertiary care center from 2010 to 2022 and had persistent post-treatment LAD., Results: Nearly 62% of patients were managed conservatively, and 27.0% underwent neck dissection. PET-positive patients were more likely to undergo neck dissection than PET-negative patients (p = 0.042). Positive predictive value (PPV) and negative predictive values (NPV) of PET/CT in detecting residual disease in the neck were 48.0% and 73.7%, respectively., Conclusions: PPV and NPV of PET/CT for detecting residual neck disease in patients with post-treatment LAD was lower than those of HNSCC patients with and without persistent LAD reported in other studies., (© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

Objective: The aim of this multicenter retrospective study was to analyze the impact of prophylactic neck dissection and adjuvant therapy in transoral surgery for hypopharyngeal cancer., Methods: We compared the impact of surgical margin assessment, neck dissection, and adjuvant treatment on oncologic outcomes in patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma between 2015 and 2021., Results: Two hundred and twenty-one patients were included. The 3-year local recurrence-free survival was 89.1 %, and local recurrence did not significantly impact overall survival. Positive vertical margins resulted in 60 % of patients receiving additional treatment, with no increase in local recurrence and a significant increase in regional recurrence (p = 0.007) and distant metastasis (p < 0.001). Half of the patients with regional recurrence after neck dissection also had distant metastases and worse survival (p = 0.069), while those with regional recurrence without prophylactic neck dissection did not have worse survival., Conclusion: In cases of positive vertical margin, careful surveillance for regional recurrence and distant metastasis is also warranted. Prophylactic neck dissection may not be necessary., Competing Interests: Declaration of competing interest The authors have no funding, financial relationship, or conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier B.V.)

Background: Advances in technology have enabled neck dissection techniques that reduce aesthetic impact while maintaining oncological safety. This study compares perioperative outcomes between robotic neck dissection via retroauricular/modified facelift incision (RNDRM) and conventional neck dissection via anterolateral cervical incision (CND)., Methods: Studies were selected from PubMed, Embase, and Cochrane Library. Data from studies comparing RNDRM and CND were extracted and analyzed using a random-effects model., Results: The meta-analysis included eight studies with 421 cases. The RNDRM group had a longer operative time (mean difference [MD], 69.11; 95 % confidence interval [CI] 37.92 to 100.30) and higher cosmetic satisfaction (MD, 2.03; 95 % CI, 1.48 to 2.57), along with a higher risk of marginal mandibular nerve injury (risk difference [RD], 0.08; 95 % CI 0.01 to 0.15). No significant differences were found in operative blood loss (MD, 15.35; 95 % CI - 7.39 to 38.10), days of drain placement (MD, 0.49; 95 % CI, -0.02 to 1.00), drainage volume (MD, 15.29; 95 % CI, -45.22 to 75.79), overall lymph node yield (MD, -1.09; 95 % CI, -3.18 to 1.00), positive lymph node yield (MD, -0.61; 95 % CI, -2.20 to 0.98), length of hospital stay (MD, 1.07; 95 % CI -0.06 to 2.20), or regional recurrence (RD, 0.00; 95 % CI -0.05 to 0.05), with similar rates of other complications., Conclusion: RNDRM offers better cosmetic outcomes but requires longer operative time and has a higher risk of marginal mandibular nerve injury than CND. It may be an alternative for selected patients, with surgery choice needing discussion between patient and surgeon., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The digastric muscles have important roles in swallowing, chewing, speech, and landmark identification during neck dissection. The posterior belly of the digastric muscle (PBDM) is often useful for defining boundaries in surgical neck dissection as it contributes to the carotid, submandibular, and submental triangles. The cadaveric prevalence rate of anatomic variations in the digastrics has been reported to be 31.4% of the population with most occurring in relation to the anterior belly of the digastric muscle (ABDM). Few reports describe variations in the PBDM. While anatomic variants of the digastric muscles do not present with clinical manifestations, they can be mistaken as neck masses and contribute to intraoperative complications., Methods: We present a case report of a 73-year-old male with a past medical history significant for Parkinson's Disease, who was incidentally found to have a duplicate PBDM intraoperatively while receiving surgical management of a left buccal squamous cell cancer., Results: Nine months prior to surgery, the patient began experiencing trismus and some mild dysphagia that were eventually worked up to reveal left buccal squamous cell carcinoma (SCC). Prior to this, the patient did not have clinical symptoms demonstrating dysfunction that could be related to or indicative of this anatomical abnormality preceding symptoms related to left buccal SCC growth. The procedure included a wide local excision, left modified radical neck dissection and left submental artery island flap with suprahyoid neck dissection. The superior duplicate PBDM was found to be overlying the stylohyoid muscle., Conclusions: It is important for surgeons operating in the head and neck to be aware of the possibility of this rare variation, and to be conscientious when it is identified so that it does not prohibit or limit a thorough dissection of the neck structures where oncologic clearance is paramount., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Squamous cell carcinoma of the oral cavity is the most common malignancy of head and neck cancer in India. With nodal dissemination, there is a significant decrease in survival. This study is aimed at studying the impact of occult metastasis on an estimated overall survival in clinically N0 patients post neck dissection. In a prospective study with 110 patients with squamous cell carcinoma of the oral cavity, clinically N0 with all T stages were included in the study. operated on for both primary and neck followed up for a median of 5 years after completion of definitive treatment. The impact of surgery on patients with occult metastasis was questionable in our study with a difference in estimated overall survival of around 11 months, which was not significant statistically. Subset analysis had shown the correlation of overall survival with a grade of tumor, T stage and depth of invasion which was statistically insignificant. Correlation of occult metastasis with the depth of invasion, T stage was statistically significant. we conclude that even after addressing the neck in clinically N0 patients with oral cancer, there is a difference in the overall survival of the patients with occult metastasis which might not be statistically significant with a p-value of 0.68. We conclude that with neck dissection in patients with occult metastasis, improved survival might not be comparable to pathological N0. Level of Evidence: LEVEL -2., (© The Author(s) 2024.)

Objectives: In head and neck cancer surgery, several studies have demonstrated the prognostic significance of lymph node yield (LNY). To our knowledge, no review has evaluated both the contributing factors to LNY and its impact on survival outcomes across all head and neck squamous cell carcinoma (HNSCC) subsites., Materials and Methods: A scoping review of LNY in HNSCC was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework to answer the following research questions: 1) Which surgeon, pathologist, and patient characteristics influence LNY? 2) Which anatomic subsites does LNY impact survival?, Results: Surgeon experience and variation in pathology protocols and personnel can impact LNY. Extent of nodal dissection, advanced tumor characteristics, and treatment at an academic facility are associated with increased LNY. Patient characteristics such as age <40, male gender, and BMI > 30 are associated with increased LNY. In the oral cavity, LNY > 18 is an independent predictor of improved overall survival (OS), disease free survival (DFS), and disease-specific survival (DSS). In the oropharynx, published studies show mixed results with regards to the impact of LNY on OS, DFS, and DSS. LNY has not been associated with OS or DFS in the larynx, irrespective of nodal threshold., Conclusions: Provider and patient characteristics may impact LNY. LNY ≥ 18 is associated with a survival benefit in the oral cavity and HNSCC overall. Further investigation of LNY particularly in prospective clinical trials is required prior to its adoption as a quality metric in HNSCC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)