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BACKGROUND:Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined. METHODS:A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 (n = 210). Univariate and multivariate Cox regression analyses were performed. RESULTS:PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] (p = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38-0.96), disease-free survival [DFS] (p = 0.03; HR 0.55, 95% CI 0.31-0.96), and distant DFS survival (p = 0.01; HR 0.29, 95% CI 0.11-0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND (p = 0.19 at discharge, p = 0.17 at last follow-up). CONCLUSIONS:PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.

Objective: To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. Methods: Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. Results: Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P =.0417). Each successive postoperative month, the flap decreased by 1.54% (P <.0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P =.0093), obesity status (P =.0431), and base of tongue involvement (P =.0472). Conclusion: Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction. [ABSTRACT FROM AUTHOR]

This article discusses the creation of a module-based and structurally accurate 3D anatomical model for endoscopic skull base surgery. The model was created using a photogrammetry pipeline, which obtains graphical information about physical objects from photographs. The article explains the methods used to dissect cadaveric heads and acquire still images of the anatomical regions of interest. The 3D model allows for a more effective understanding of the intricate anatomical relationships seen at the ventral skull base and may reduce reliance on wet-laboratory learning environments in surgical education and training. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the relationship between human papillomavirus (HPV) and sinonasal adenoid cystic carcinoma (AdCC). The study analyzed fifteen specimens from patients with AdCC and found that while all the tumors were p16 patchy positive, they were HPV negative for the subtypes tested. The results suggest that there is no correlation between the HPV subtypes tested and AdCC, but indicate that p16 may be dysregulated in AdCC. Further investigation into the role of p16 in sinonasal AdCC is warranted. [Extracted from the article]

This article discusses the management of a rare case of a progressive giant maxillary ameloblastoma, a type of odontogenic epithelial tumor that typically occurs in the jaw. The patient, a 53-year-old male, had previously undergone surgery for ameloblastoma but presented with a massive expansion of the tumor. The article explores the options for managing ameloblastoma and the factors that contribute to its progression. Surgical resection was performed, and targeted therapy was considered for future treatment. The article emphasizes the importance of complete removal of the tumor to minimize the risk of recurrence or progression. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, discusses two cases of frontoethmoidal osteoma, a rare type of benign bone tumor. The patients presented with neurological deficits and cerebral spinal fluid (CSF) leaks. Both cases were successfully treated with different surgical approaches, resulting in complete tumor resection and no complications or signs of CSF leak. The authors emphasize the need for more cases to better understand the epidemiology, clinical presentation, treatment strategies, and outcomes of this condition. The article also includes a literature review of eight previously reported cases. [Extracted from the article]

Introduction Radiation-induced hypopituitarism (RIH) has long been recognized as one of the deleterious side effects of skull base radiation. This study aims to assess the quality of life (QoL) among patients with RIH compared with radiated patients who did not develop hypopituitarism using the validated Anterior Skull Base Questionnaire (ASBQ). Methods This was a single-institution retrospective cohort study. Included patients had a history of anterior skull base tumor, underwent at least one round of radiation to the skull base, and had filled out at least one ASBQ survey after their radiation treatment. Three statistical models were used to determine the effect of hypopituitarism and treatment on QoL scores. Results A total of 145 patients met inclusion criteria, and 330 ASBQ surveys were analyzed. Thirty-five percent (51/145) had evidence of RIH at some point after their radiation treatment. Those with hypopituitarism had significantly lower overall ASBQ scores across all three models even after adjusting for potential confounders and intraperson correlation (average decrease of 0.24–0.45 on a 5-point Likert scale; p -values ranging from 0.0004 to 0.018). The increase in QoL with hormonal replacement was modulated by time out from radiation, with long-term survivors (5+ years out from radiation) gaining the most benefit from treatment (increase of 0.89 on a 5-point Likert scale, p 0.0412), especially in the vitality domain. Conclusion This data demonstrates that hypopituitarism is an independent predictor of lower QoL. Early detection and appropriate treatment are essential to avoid the negative impact of hypopituitarism on QoL. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a custom laryngectomy tube can improve airway symptoms in total laryngectomy patients with atypical anatomy who are unable to use commercial laryngectomy tubes. Furthermore, to exemplify the power of customizable 3D printed medical devices when combined with the expanded access pathway through the FDA. Methods: A custom-fabricated laryngectomy tube, manufactured at in-house clinical engineering labs, was utilized for each patient following typical laryngectomy tube protocols. All participants had previously undergone a total laryngectomy. Patients were selected based on critical airway obstruction posing potentially life-threatening scenarios while using commercially available laryngectomy tubes. Results: For all patients involved, there were no further airway obstruction complications or events, and they reported a subjective, significant improvement in comfort after placement of the custom laryngectomy tube. Conclusion: Custom laryngectomy tubes can provide patients with atypical anatomy relief from airway obstructions and improve comfort when commercial options fail to address the anatomic restriction. The process used to develop custom laryngectomy tubes may be relevant for other diseases and patients with atypical anatomies through the expanded access pathway. [ABSTRACT FROM AUTHOR]

Objective: Skull base osteomyelitis may rarely present in the sphenoid bone or clivus without an otologic source. This is referred to as central skull base osteomyelitis (CSBO). Knowledge regarding CSBO is limited to case reports and small case series. Here we present a case series to further describe typical patient characteristics, clinical presentation, and clinical course associated with this rare infection. Methods: All patients treated at a single academic tertiary care institution for CSBO from 2016 through 2020 were identified. Inclusion criteria included culture proven CSBO without an otologic or iatrogenic source. Data were extracted via patient chart review and qualitatively analyzed. Results: Seven patients were identified with CSBO, 5 male and 2 female. Age ranged from 63 to 87 (average 76). Risk factors included advanced age, diabetes, and history of radiation. The most common presenting symptom was headache (6), followed by otalgia (4). Two patients presented with cranial neuropathies. Diagnosis was facilitated by history and exam (including flexible laryngoscope exam), imaging (MRI), and labs (ESR). All patients received endoscopic biopsy and culture (most commonly polymicrobial, with diverse species). Treatment involved IV antibiotics, with a limited role for surgery. All patients survived and achieved resolution of infection. Conclusions: CSBO remains a diagnostic challenge due to its rarity and vague presenting symptoms that overlap with presentation of sinonasal malignancies. A high index of suspicion is required by the evaluating provider to ensure a timely diagnosis with early treatment in order to limit the significant morbidity which can be associated with this infection. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Facial reconstruction is a complex surgical process that requires intricate three-dimensional (3D) concepts for optimal functional and aesthetic outcomes. Conventional reconstruction of structural facial anomalies, such as those including cartilage or bony defects, typically rely on hand-carving autologous constructs harvested from a separate donor site, and shaping that cartilage or bone into a new structural framework. Tissue engineering has emerged in recent decades as a potential approach to mitigate the need for donor site morbidity while improving precision in the design of reconstructive construct. Computer-aided design and computer-aided manufacturing have allowed for a digital 3D workflow to digitally execute the planned reconstruction in virtual space. 3D printing and other manufacturing techniques can then be utilized to create custom-fabricated scaffolds and guides to improve the reconstructive efficiency. Tissue engineering can be paired with custom 3D-manufactured scaffolds to theoretically create an ideal framework for structural reconstruction. In the past decade, there have been several compelling preclinical studies demonstrating the capacity to induce chondrogenesis or osteogenesis in a custom scaffold. However, to date, these preclinical data have not yet translated into significant clinical experience. This translation has been hindered by a lack of consensus on the ideal materials and cellular progenitors to be utilized in these constructs and a lack of regulatory guidance and control to enable clinical application. In this review, we highlight the current state of tissue engineering in facial reconstruction and exciting potential for future applications as the field continues to advance. [ABSTRACT FROM AUTHOR]