Search

Objective: To compare the postoperative complications of the fibular free flap (FFF), scapula free flap (SFF), and osteocutaneous radial forearm free flap (OCRFFF) following osseous reconstruction in the head and neck. Data Sources: PUBMED, EMBASE, Cochrane. Review Methods: A literature search and systematic review were performed using the Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines. A meta‐analysis of proportions was conducted using a random effects model to compare operative time and postoperative complications. Results: The systematic review identified 26 studies comparing at least 1 variable of interest. The odds ratio estimates favored reduced rates of flap failure with the OCRFFF when compared to FFF (0.7, confidence interval [CI]: 0.29‐1.11, P <.001), while FFF and SFF were similar. The mean difference estimates for operative time significantly favored FFF over SFF (−51.04 minutes, CI: −92.73 to −9.35, P =.016) and OCRFFF over FFF (66.77 minutes, CI: 52.74‐80.8, P <.001). The FFF was more prone to hardware exposure, longer hospital stays, and donor site complications. Recipient wound complications and fistula rates were similar for all flap types. Conclusion: Depending on the clinical context, the OCRFFF, FFF, and SFF are all robust options for reconstruction in the head and neck. The OCRFFF is associated with a reduced rate of flap failure and shorter operative times. The SFF requires longer operative times, although significant variation was observed between institutions. The FFF has broad reconstructive indications but is associated with more perioperative and long‐term complications. [ABSTRACT FROM AUTHOR]

Objective: Peritonsillar abscesses (PTAs) are common emergency consultations for otolaryngologists. Medical management alone may offer satisfactory treatment without the risk associated with surgical drainage. Therefore, we performed a systematic review of medical treatment alone compared to surgical drainage for the treatment of PTA. Data Sources: MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov. Review Methods: Studies comparing the outcomes of medically treated to surgically treated patients were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. All screening and data extraction were completed by 2 independent reviewers. Meta-analysis was performed using a random-effects model. Subgroup and sensitivity analyses were performed. Results: Ten cohort studies and 2 randomized studies were included (ntotal = 33,468). Study quality was low, with only 1 study providing multivariable analysis. The combined rate of treatment failure in patients initially treated with medical management alone was 5.7% compared to 5.5% in the surgical group. There was no statistically significant difference in the odds of treatment failure between interventions through random-effects meta-analysis (odds ratio [OR], 1.10; 95% CI, 0.53-2.26; I 2 = 41%; P =.13). Subgroup analysis excluding pediatric-specific studies revealed similar odds of treatment failure when initially managed with medical intervention (OR, 0.92; 95% CI, 0.56-1.50; P =.39; I 2 = 0%). Conclusion: Meta-analysis of available studies demonstrated no difference in odds of treatment failure for patients with PTA managed through medical intervention alone compared to surgical intervention. These findings should be interpreted with caution due to high probability of bias and overall low quality of studies. [ABSTRACT FROM AUTHOR]

Objectives: Quality metrics are an increasingly important means of improving patient care. Variability in the number of lymph nodes removed during central compartment lymph node dissection (CCLND) at the time of thyroidectomy has not been studied. Study Design: A retrospective cohort study was performed using American College of Surgeons National Quality Improvement Program (ACS-NSQIP) data. Setting: Centers in North America and worldwide contributing data to ACS-NSQIP and performing thyroidectomy on adults in inpatient and outpatient settings were included. Subjects and Methods: Adult patients undergoing thyroidectomy with or without CCLND were included. Outcomes of interest were number of nodes removed during CCLND and risks of postoperative hypocalcemia. Results: In total, 6108 patients met inclusion criteria (1565 with CCLND). The median number of lymph nodes removed during CCLND was 2. There was no statistically significant association between postoperative hypocalcemia and CCNLD, regardless of number of nodes removed. However, we were underpowered to detect this association based on the overall low nodal yield of many CCLNDs performed. Conclusion: In many cases where CCLND is documented as part of thyroidectomy, very few lymph nodes are removed. Our ability to draw conclusions regarding the effect of CCLND on postoperative hypocalcemia is restricted due to the limited nature of many CCLNDs performed. [ABSTRACT FROM AUTHOR]

Objective: Surgical management of the unknown primary head and neck squamous cell carcinoma (UP HNSCC) remains controversial due to challenging clinical diagnosis. This study compares positron emission tomography-computed tomography (PET-CT) findings with intraoperative identification of primary tumors and compares intraoperative frozen-section margins to final histopathology. In addition, adjuvant therapy indications are provided.Study Design: Prospective cohort study.Setting: Academic university hospital.Subjects and Methods: Sixty-one patients with UP HNSCC were included. Patients received PET-CT, followed by oropharyngeal transoral laser microsurgery (TLM). Margins were assessed intraoperatively using frozen sections and afterward by final histopathology. Adjuvant treatment was based on final histopathology.Results: The sensitivity of localizing the primary tumor with PET-CT was 50.9% with a specificity of 82.5%. The primary tumor was found intraoperatively on frozen sections in 82% (n = 50) of patients. Five more tumors were identified on final histopathology, leading to a total of 90% (n = 55). Of the 50 intraoperatively found tumors, 98% (n = 49) had negative margins on frozen sections, and 90% (n = 45) were truly negative on final histopathology. Eighteen patients (29.5%) avoided adjuvant treatment.Conclusion: PET-CT localized the primary tumor in fewer than half the cases. This protocol identified 90% of primary tumors. Intraoperative frozen-section margin assessment has shown potential with a specificity of 92% compared to final histopathology. As a result, adjuvant therapy was avoided in almost one-third of our patients. [ABSTRACT FROM AUTHOR]

Objective: Identify socioeconomic predictors of stage at diagnosis of laryngeal cancer in the United States.Study Design: Retrospective analysis of the North American Association of Central Cancer Registries' Incidence Data-Cancers in North America Deluxe Analytic File for expanded races.Setting: All centers reporting to the US Centers for Disease Control and Prevention's National Program of Cancer Registries.Subjects and Methods: All cases of laryngeal cancer in adult patients from 2005 to 2013 were reviewed. Ordinal logistic regression models were used to evaluate odd ratios (ORs) for socioeconomic indicators potentially predictive of advancing American Joint Committee on Cancer stage at diagnosis.Results: A total of 72,472 patients were identified and included. Analysis revealed significant correlation between advanced stage at diagnosis and: Medicaid insurance, lack of insurance, female sex, older age, black race, and certain states of residence. The strongest predictor of advanced stage was lack of insurance (OR, 2.212; P < .001; 95% CI, 2.035-2.406). The strongest protective factor was residing in the state of Utah (OR, 0.571; P < .001; 95% CI, 0.536-0.609). Once adjusted for regional price and wage disparities, relative income was not a significant predictor of stage at presentation across multiple analyses.Conclusion: Multiple socioeconomic factors were predictive of severity of disease at presentation of laryngeal cancer in the United States. This study demonstrated that insurance type was strongly predictive, whereas relative income had surprisingly little influence. [ABSTRACT FROM AUTHOR]

Objective: Diagnosis of laryngeal cancer is dependent on awareness that persistent hoarseness needs to be investigated as well as access to an otolaryngologist. This study aimed to better classify and understand 3 factors that may lead to variability in stage at presentation of laryngeal cancer: (1) socioeconomic status (SES), (2) differences in access to health care by location of residence (rural vs urban or by province), and (3) access to an otolaryngologist (by otolaryngologists per capita).Study Design: Registry-based multicenter cohort analysis.Setting: This was a national study across Canada, a country with a single-payer, universal health care system.Subjects: All persons 18 years or older who were diagnosed with laryngeal cancer from 2005 to 2013 inclusive were extracted from the Canadian Cancer Registry (CCR).Methods: Ordered logistic regression was used to determine the effect of income, age, sex, province of residence, and rural vs urban residence on stage at presentation.Results: A total of 1550 cases were included (1280 males and 265 females). The stage at presentation was earlier in the highest income quintile (quintile 5) compared to the lower income quintiles (quintiles 1-4) (odds ratio [OR], 0.68; P < .05). There was a statistically significant difference in stage at presentation based on rural or urban residence within the highest income quintile (OR, 1.73; P < .005).Conclusion: There is a relationship between SES and stage at presentation for laryngeal cancer even in the Canadian universal health care system. [ABSTRACT FROM AUTHOR]

Objective: Evaluate serum C-reactive protein (CRP) in human papillomavirus (HPV)-positive oropharynx cancer as compared with HPV-negative oropharynx cancer and determine if CRP levels were associated with overall survival and/or recurrence-free survival.Study Design: Prospective cohort study.Setting: Tertiary care academic cancer center between 2007 and 2010.Subjects and Methods: Among patients with oropharynx cancer and confirmed HPV status, plasma CRP levels were measured with a high-sensitivity ELISA kit. Multivariable logistic regression analysis compared 4 categories of CRP (low, moderate, high, very high) between the HPV-positive and HPV-negative groups. Kaplan-Meier methods and Cox regression models were used to determine overall survival and recurrence-free survival by CRP level in both populations.Results: Between 113 HPV-positive and 110 HPV-negative patients, CRP levels were significantly higher in the HPV-positive group, but these levels did not demonstrate a statistically significant dose-response trend. Higher CRP levels were also associated with reduced overall survival ( P = .016) and recurrence-free survival ( P < .001) within the HPV-negative group in univariable analysis; in multivariate analysis, the comparisons were not significantly different. Within HPV-positive oropharynx cancer, CRP levels were not significantly associated with overall survival or recurrence-free survival in univariable or multivariable analyses.Conclusion: Circulating CRP was higher in HPV-positive versus HPV-negative oropharynx cancer. Among HPV-negative patients, higher CRP levels were associated with reduced survival. [ABSTRACT FROM AUTHOR]

The global pandemic caused by severe acute respiratory syndrome coronavirus 2 has upended surgical practice. In an effort to preserve resources, mitigate risk, and maintain health system capacity, nonurgent surgeries have been deferred in many jurisdictions, with urgent procedures facing increasing wait times and unpredictability given potential future surges. Shared decision making, a process that integrates patient values and preferences with the scientific expertise of clinicians, may be of particular benefit during these unprecedented times. Aligning patient choices with their values, reducing unnecessary health care use, and promoting consistency between providers are now more critical than ever before. We review important aspects of shared decision making and provide guidance for its perioperative application during the coronavirus disease 2019 pandemic. [ABSTRACT FROM AUTHOR]

The article offers information on a study which investigates the epidemiological changes in Canada for head and neck cancers (HNCs) from 1992 to 2007. It shows that oropharynx tumors increased in incidence while oral cavity tumors decreased and the median age at diagnosis for the cancer decreased while survival for patients with oral cavity increased between 1992 to 2007. It concludes that human papillomavirus (HPV) infection is in correlation with oropharynx cancer.

Objective: 1) Learn how the incidence of HPV‐related and non‐HPV‐related Head and Neck Cancers (HNC) in Canada has changed in the time period 1992 to 2008. 2) Learn how the age at diagnosis and overall survival for these cancers in Canada has changed over that period. Method: We used Canadian Cancer Registry Data (1992‐2008), categorizing HNCs into 3 groups: (High (HHPV), ie, oropharynx; Moderate (MHPV), ie, oral cavity; and Low (LHPV), ie, larynx); based on the probability that HPV causes the cancer. We calculated age‐adjusted incidence, median age at diagnosis, and survival for each category. Results: HHPV cancers increased in incidence at an average annual rate (AAR) of 1.02% (P =. 010); MHPV and LHPV cancers decreased at an AAR of 2.38% (P =. 000) and 3.67% (P =. 000) respectively. The median age at diagnosis for HHPV cancers decreased by an average of 0.23 years/year (P =. 000). There was no change for MHPV and an increase for LHPV of 0.10 years/year (P =. 008). Survival for patients with HHPV cancers increased by 2.1%/year (P =. 000), compared with an increase of 1.6% per year for MHPV (P =. 003) and a marginal increase in LHPV of 0.6% per year (P =. 002). Conclusion: The prevalence of HPV‐related head and neck cancers in Canada is increasing, while the prevalence of non‐HPV–related head and neck cancers is decreasing. This has been accompanied by a decrease in both age at diagnosis and mortality in HPV related head and neck cancers. [ABSTRACT FROM AUTHOR]