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Transoral robotic surgery (TORS) has been introduced to head and neck surgery as a minimally invasive techqniques to improve the functional outcomes of patients. Compare the functional outcome for swallowing and speech in each site of TORS within the head and neck. Retrospective cohort study for patients who underwent TORS within the head and neck unit. Patients were assessed at four different time points (one day, one month, six months and twelve months, respectively) with bedside/office testing. Methods of testing for swallowing assessment were by the International Dysphagia Diet Standardization Initiative (IDDSI), and speech assessments were carried out using the Understandability of Speech score (USS). Outcomes were compared to patient-specific pre-treatment baseline levels. 68 patients were included. 75% and 40% of the patients resumed normal fluid intake and normal diet immediately after surgery. 8.8% required a temporary feeding tube, with 1% required gastrostomy. There was a steep improvement in diet between 3 and 6 months. Fluid and diet consistency dropped significantly following the majority of transoral robotic surgery with more noticeable diet changes. Early deterioration in diet is temporary and manageable with a modified diet. Rapid recovery of swallowing is achieved before the first year. There is no long-term effect on speech. [ABSTRACT FROM AUTHOR]

Background and Objective: Head and neck carcinoma of unknown primary is a diagnostic dilemma. The clinical and imaging workup remains ineffective in two-thirds of patients. Transoral robotic surgery has shown an advantage in the primary detection over the previous standard panendoscopy. Methods: This is an observational cohort study that took place at a large healthcare centre with robotic surgery experience in head and neck over six-years. All included carcinoma of unknown primary patients followed the standard recommendation for primary identification. Final diagnostic step of robotic tongue base mucosectomy with or without tonsillectomy was introduced. The cancer detection rate in tongue base only, the functional outcome and the effect on the cancer pathway were evaluated. Results: Carcinoma of unknown primary was reported in 44 per cent of patients. All identified specimens were human papillomavirus positive. There was no significant effect on functional outcome of swallowing and the national 62-day cancer pathway. Robotic surgery allowed optimum treatment of carcinoma of unknown primary in early nodal disease. Conclusion: Robotic surgery is a useful paradigm in the management of carcinoma of unknown primary. It is safe with minimal morbidity and good functional outcome after the surgery. [ABSTRACT FROM AUTHOR]

A woman in her 70s presented to a tertiary otorhinolaryngology outpatient department with a 25-year history of right-sided subcutaneous neck lesion that had steadily grown over the preceding 6 months, now with skin involvement. The patient was asymptomatic except for some mild tenderness. The 3 × 3 cm mass lay fixed to deep tissues adjacent to the sternocleidomastoid muscle, though no associated lymphadenopathy was found on palpation, with imaging confirming no regional or distant metastases. Biopsy confirmed the lesion to be primary cutaneous adenoid cystic carcinoma, a malignancy not previously described as a primary on the neck, which was treated by wide local excision after multidisciplinary team discussion. The lesion was completely excised with negative margins, and after surveillance over 3 years, the patient is still well with no signs of recurrence., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)