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Simple Summary: Head and neck cancers of the oropharyngeal subsite can be driven by the human papillomavirus (HPV). In countries such as the United States, the incidence of HPV-associated oropharyngeal cancer has exceeded that of HPV-associated cervical cancer. HPV vaccination is currently the main preventative approach for HPV-associated oropharyngeal cancer. Globally, both the epidemiology of HPV-associated oropharyngeal cancer and HPV vaccine policy vary. This paper aims to describe regional variations in HPV-associated oropharyngeal cancer, variations in gender-neutral vaccine policy, and future areas of policy-relevant research. Global trends in human papillomavirus (HPV)-associated head and neck cancers (HNC), specifically in the oropharynx subsite, have been dynamically changing, leading to new staging and treatment paradigms. Epidemiologic studies have noted regional variations in HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). While HPV vaccination remains the main preventative approach, vaccination policy in relation to gender neutrality is heterogeneous and particularly sparse in low- and middle-income countries, where the burden of global cancer cases and HPV-associated HNC are not well-characterized in certain regions. This review summarizes the existing literature on regional variations of HPV-associated OPSCC and gender-neutral vaccine policies. Based on available data, the incidence of HPV-associated OPSCC is highest in North America, Europe, and Oceania. As of 2022, 122 of 195 (63%) World Health Organization (WHO) member states had incorporated HPV vaccinations nationally; of these, 41 of 122 (34%) member states have introduced gender-neutral vaccine coverage. Future research is needed to describe continued evolving trends in HPV-associated OPSCC, understand underlying risk factors leading to regional variation in disease, and implement gender-neutral policy more broadly. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancers occur predominantly in developing countries where access to care is poor. Sub‐Saharan Africa has <20 head and neck surgeons for >1 billion people and has only two fellowship training programs. Methods and results: The AfHNS Head and Neck Fellowship is being introduced to accelerate training of African surgeons to improve access to resource appropriate cancer care. By avoiding fixed time‐in‐training and single training sites, training can be offered at multiple centers in Africa, even with lower patient volumes. It also creates opportunities for accredited international surgical outreach programs to contribute to training. Conclusions: Having prescribed reading and appropriate Entrustable Professional Activities that are assessed through Workplace Based Assessment, and having a summative virtual oral examination ensures that fellows are fit‐for‐purpose to practice in an African resource‐constrained setting. Other developing countries are encouraged to adopt a similar approach to expanding head and neck cancer services. [ABSTRACT FROM AUTHOR]

Background: International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. Methods: Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. Results: Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. Conclusions: Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources. [ABSTRACT FROM AUTHOR]

Background: There is an extreme shortage of head and neck surgeons in Africa. Fourteen head and neck surgeons have completed fellowships in Cape Town and Cameroon. This study determines whether such Africa‐based fellowships are a good model for developing countries by making a sustainable impact on head and neck cancer care. Methods: An observational study was conducted by emailing questionnaires to past fellows. Results: All fellows had returned to teaching hospitals in their counties. Seven established new multidisciplinary cancer teams. Head and neck operations had increased by >335%, as had complexity of the surgery. There was effective transfer of surgical skills to trainees. All considered head and neck fellowships to be the best model to grow head and neck care. Conclusion: Head and neck fellowships in developing countries are effective models for establishing training programs and for increasing provision of specialized surgical services in a sustainable fashion. [ABSTRACT FROM AUTHOR]

Background: The diagnosis and management of oral cavity cancer has been well described in developed countries, however, in regions with fewer medical resources, alternative methods may need to be used. We outline an approach to evaluation and treatment of oral cavity cancer in low‐resource areas. Methods: Reviews of the Cochrane and Pubmed databases were performed and literature compiled. Expert opinions from the American and African Head and Neck Societies were also provided. Results: Treatment guidelines for managing oral cavity cancer in low‐resource regions are outlined and the level of supporting evidence is defined. Discussion: Successful treatment typically involves the use of upfront surgical resection of the primary lesion and any involved or at‐risk cervical lymph node basins, with adjuvant therapy based on the final pathology findings. In situations where services such as adjuvant therapy and/or appropriate reconstruction are not available, alternative approaches to treatment may be needed. [ABSTRACT FROM AUTHOR]

Introduction. Free flap surgery is a routine procedure in many developed countries with good surgical outcomes. In many developing countries, however, these services are not available. In this paper, we audit free flaps done in a resource constrained hospital in Kenya. Objective. This is a five-year audit of free flaps done in a tertiary hospital in Kenya, between 2009 and 2014. Materials and Methods. This was a prospective study of patients operated on with free flaps between 2009 and 2014. Results. A total of one hundred and thirty-two free flaps in one hundred and twenty patients were performed during the five-year duration. The age range was eight to seventy-two years with a mean of 47.2. All the flaps were done under loupe magnification. The overall flap success rate was eighty-nine percent. Conclusion. Despite the many limitations, free flaps in our setup were successful in the majority of patients operated on. Flap salvage was noted to be low due to infrequent flap monitoring as well as unavailability of theatre space. One therefore has to be meticulous during surgery to reduce any possibilities of reexploration. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To determine the value of a collaborative course for advanced head and neck surgery in East Africa. Study Design Survey of participants. Methods A 3-day course in head and neck surgery was designed for otolaryngologists and trainees from Kenya and surrounding countries through a collaborative effort between Kenyatta National Hospital, the University of Nairobi, and the Head and Neck Divisions from the Vanderbilt Bill Wilkerson Center and the Massachusetts Eye and Ear Infirmary. Topics included neck dissection, parotidectomy, total laryngectomy, parapharyngeal space tumors excision, and pectoralis myocutaneous flaps. A pre- and postcourse self-evaluation survey was administered to measure course impact. Results Eighteen otolaryngologists and trainees participated in the course, with 17 completing course surveys. The majority of participants (72%) were from Kenya. Prior to the start of the course, 41%, 71%, 23%, 12%, and 0% of participants indicated they could complete a neck dissection, parotidectomy, parapharyngeal space mass excision, total laryngectomy, and pectoralis myocutaneous flap, respectively. Following the course, 50%, 94%, 69%, 25%, and 38% of participants indicated they could complete a neck dissection, parotidectomy, total laryngectomy, parapharyngeal space tumors excision, respectively, with a statistically significant increase identified for pectoralis myocutaneous flaps ( P < .001) and total laryngectomy ( P = .009). There was also a trend toward an increase in the number of participants indicating an ability to complete parotidectomy following the course ( P = .085). Conclusions This survey demonstrates the potential value of a collaborative course in advanced head and neck surgery as one useful model for increasing the number of well-trained head and neck surgeons in East Africa. Level of Evidence NA Laryngoscope, 125:883-887, 2015 [ABSTRACT FROM AUTHOR]