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Rapid advances in the ability to produce nanoparticles of uniform size, shape, and composition have started a revolution in the sciences. Nano-sized structures herald innovative technology with a wide range of potential therapeutic and diagnostic applications. More than 1000 nanostructures have been reported, many with potential medical applications, such as metallic-, dielectric-, magnetic-, liposomal-, and carbon-based structures. Of these, noble metallic nanoparticles are generating significant interest because of their multifunctional capacity for novel methods of laboratory-based diagnostics, in vivo clinical diagnostic imaging, and therapeutic treatments. This review focuses on recent advances in the applications of nanotechnology in head and neck cancer, with special emphasis on the particularly promising plasmonic gold nanotechnology.

This article, published in the Journal of Neurological Surgery, discusses the use of endoscopic nasopharyngectomy (ENP) as a surgical method for treating tumors in the nasopharynx. The study focuses on the application and outcomes of ENP at a North American tertiary-care hospital over the past decade. The results show that ENP is increasingly used for tumors in the nasopharynx, with nasopharyngeal carcinoma (NPC) being the most common indication. The study also highlights common postoperative complications, such as dysphagia and eustachian tube dysfunction, and emphasizes the importance of improved vascularized closure techniques. [Extracted from the article]

This article discusses the predictors of biochemical remission after surgical resection of somatotroph adenomas, which are tumors that produce excessive growth hormone. The study analyzed data from 97 patients who underwent surgery for somatotroph adenomas and found that larger tumor size, cavernous sinus invasion, and higher levels of preoperative growth hormone and IGF-1 were associated with a higher likelihood of remission failure. A machine learning model identified 3D tumor volume and preoperative IGF-1 as important predictors of remission status. The study concludes that patients who achieve postoperative remission typically have preoperative 3D tumor volumes less than 1.51 cm3. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the frequency and significance of hyperenhancement in pituitary neuroendocrine tumors (PitNETs) on preoperative MRI scans. The study involved a retrospective review of patients who underwent transsphenoidal surgery for PitNETs at a single pituitary center from 2012 to 2019. The results showed that 8.5% of PitNETs exhibited hyperenhancement on preoperative contrasted imaging studies. These hyperenhancing tumors were smaller and more commonly microadenomas compared to PitNETs with conventional hypoenhancement. Additionally, patients with hyperenhancing tumors were more likely to present with hypothyroidism and had a higher risk of postoperative diabetes insipidus. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, examines the predictors of postoperative hypopituitarism in patients who undergo surgical removal of nonfunctional pituitary neuroendocrine tumors (PitNETs). The study, which involved a retrospective review of 701 cases, found that 35% of patients experienced new postoperative hypopituitarism. Preoperative factors such as tumor size, serum follicle-stimulating hormone (FSH), prolactin, and cortisol levels were identified as significant predictors of postoperative hypopituitarism. The findings suggest that patients with larger tumors and lower levels of prolactin and cortisol may be at higher risk for this complication. Additionally, women with preoperative serum FSH levels greater than 27.95 mIU/mL were unlikely to experience hypopituitarism after surgery. [Extracted from the article]

Background: A minority of patients with recurrent/metastatic (R/M) salivary gland cancers (SGCs) benefit from immune checkpoint inhibitors (ICIs), necessitating reliable biomarkers for ICI response prediction. Methods: Retrospective observational study of R/M SGC patients treated with pembrolizumab between 2016 and 2022, with a primary outcome of 6‐month progression‐free survival (PFS) and secondary outcome of 2‐year overall survival (OS). Univariate and multivariable Cox proportional hazards models were employed. Results: Twenty R/M SGC patients were included. After adjustment, NLR as a continuous variable was independently associated with 6‐month PFS (HR 1.30, 95% CI 1.10–1.54, p = 0.002) and 2‐year OS (HR 1.33, 95% CI 1.07–1.66, p = 0.010). Similarly, NLR ≥ 5 was associated with higher hazards of progression at 6 months (HR 12.85, 95% CI 2.17–76.16, p = 0.005) and death at 2 years (HR 11.25, 95% CI 1.67–75.77, p = 0.013). Conclusions: Higher pretreatment NLR was independently associated with inferior 6‐month PFS and 2‐year OS in pembrolizumab‐treated R/M SGC patients. [ABSTRACT FROM AUTHOR]

Objective: Risk factors for a postoperative cerebrospinal fluid leak (CSF) after surgery include an intraoperative high flow of CSF, elevated body mass index, defect size, and defect site. In our prior series, a high postoperative CSF leak rate for tumors of the central skull base (planum, sella, and clivus) appeared to be due to graft migration. We changed our closure technique from a single layer of collagen +/− fat graft to a novel graft, termed a "Bow tie" (a tri‐layer fat graft with two pieces of collagen matrix), and report our results in this study. Methods: Retrospective temporal epoch study of a single otolaryngologist's experience of closing skull base defects in our skull base center from 2005 to 2017. Results: One hundred and forty‐nine patients met inclusion criteria in two time periods, pre‐ and post‐introduction of the Bow tie technique. In epoch I, from 2005 to 2013, 79 patients had reconstruction with a single layer of dural graft (25 had additional free fat graft). In epoch II, from 2014 to 2017, 70 patients had reconstruction with the Bow tie. Results: CSF leak rates were 8.7% overall: 15.2% in epoch I and 1.4% in epoch II (p = 0.01). After controlling the procedure, defects with a size greater than 2 cm had a 5.7 greater likelihood of failure. Epoch II had a lower incidence of major complications. Conclusion: Using a single surgeon's experience, the multilayer Bow tie has a significant reduction in postoperative CSF leak and associated major complications for defects of the central skull base. Level of Evidence: 3 Laryngoscope, 133:1568–1575, 2023 [ABSTRACT FROM AUTHOR]

Simple Summary: Trismus is a serious sequela of head and neck cancer (HNC) treatment that can profoundly affect quality of life. While the relationship between radiotherapy and trismus in HNC has been established, the surgical risk factors for trismus in HNC patients are largely unclear. This study reports the prevalence of postoperative trismus in a large cohort of patients who underwent mandibulectomy and fibula free flap reconstruction. Patients with a posterior mandibulotomy that involved or removed the ramus had significantly higher rates of persistent trismus >6 months after surgery, which was also demonstrated in a multivariable logistic regression. These findings may inform future surgical planning and potentially optimize functional outcomes in patients undergoing significant mandibular resection. The factors that contribute to postoperative trismus after mandibulectomy and fibula free flap reconstruction (FFFR) are undefined. We retrospectively assessed postoperative trismus (defined as a maximum interincisal opening ≤35 mm) in 106 patients undergoing mandibulectomy with FFFR, employing logistic regression to identify risk factors associated with this sequela. The surgical indication was primary ablation in 64%, salvage for recurrence in 24%, and osteonecrosis in 12%. Forty-five percent of patients had existing preoperative trismus, and 58% of patients received adjuvant radiation/chemoradiation following surgery. The overall rates of postoperative trismus were 76% in the early postoperative period (≤3 months after surgery) and 67% in the late postoperative period (>6 months after surgery). Late postoperative trismus occurred more frequently in patients with ramus-involving vs. ramus-preserving posterior mandibulotomies (82% vs. 46%, p = 0.004). A ramus-involving mandibulotomy was the only variable significantly associated with trismus >6 months postoperatively on multivariable logistic regression (OR, 7.94; 95% CI, 1.85–33.97; p = 0.005). This work demonstrates that trismus is common after mandibulectomy and FFFR, and suggests that posterior mandibulotomies that involve or remove the ramus may predispose to a higher risk of persistent postoperative trismus. [ABSTRACT FROM AUTHOR]

Background: Acute invasive fungal sinusitis (AIFS) is an aggressive and dangerous disease of the paranasal sinuses with high morbidity and mortality. The immune response at the level of the nasal mucosa, the site of entry, has not been previously evaluated. Objective: To evaluate differential gene expression in the sinonasal mucosa of AIFS patients as compared to control patients using RNA sequencing. Methods: Sinonasal tissue samples were prospectively obtained from consenting patients undergoing surgery between November, 2020 and November, 2021. RNA extraction and sequencing were performed and differential expression was analyzed to detect transcriptional differences between patient groups. Results: Tissue samples were collected from 4 patients with active AIFS diagnoses, 2 patients with recovered AIFS, 1 patient with a diagnosis of non-invasive fungal ball, and 4 healthy controls. 255 genes were differentially expressed in AIFS patients as compared to control patients. Specific Gene Ontology (GO) biological processes that were identified as differentially expressed in AIFS patients as compared to controls included the following: 1. GO:0007155 (cell adhesion), 2. GO:0030199 (collagen fibril organization) and 3. GO:0001525 (angiogenesis). Conclusion: Transcriptional differences were noted between AIFS and control patients in sinonasal tissue samples. Future work is necessary to determine causes of the differential gene expressions between AIFS and control patients, specifically those who are immunosuppressed, or with preexisting non-invasive forms of fungal sinusitis, to guide treatment and prevention strategies. [ABSTRACT FROM AUTHOR]

Gold nanorods are optically active dual imaging/therapy agents due to their strong absorption and scattering of near infrared light. Using spectroscopy and imaging methods of cancer cells, HSC and HOC malignant cells are easily distinguished from HaCaT nonmalignant cells due to the molecular targeting of overexpressed epidermal growth factor receptors (EGFR) on the malignant cell surface and continuous exposure to red light from the gold nanorods results in requiring half the laser energy to photothermically destroy the malignant cells.

Objectives/hypothesis: For early-stage oral tongue carcinoma and carcinoma in situ (ESOTCCIS), we evaluated patient-reported quality-of-life (QOL) outcomes following resection with primary closure (R-PC).Study Design: Retrospective review at an academic cancer center.Methods: Thirty-nine ESOTCCIS patients (Tis, T1, T2) who underwent R-PC without radiation completed the University of Washington Quality of Life Questionnaire Version 4 (UW-QOL) at least 6 months since R-PC (mean = 2.39 years; range = 0.5-6.7 years). We compared UW-QOL scores for pain, swallowing, chewing, speech, and taste to established normative population scores. Multivariable regression analysis evaluated factors associated with QOL impairment.Results: ESOTCCIS patients who underwent R-PC in comparison to the normative population reported significantly worse mean speech (87.7 vs. 98, P < .001) and taste (85.6 vs. 95, P = .002) scores and no significant differences in mean pain (91.7 vs. 86, P = .96), swallowing (100 vs. 98, P = .98), chewing (97.4 vs. 94, P = .98) scores. For speech and taste, 59% (23/39) reported no postoperative change from baseline, whereas 41% (16/39) and 35.9% (14/39) reported mild impairment, respectively. Overall, postoperative QOL was reported as good, very good, or outstanding by 87.2% (34/39). Higher American Society of Anesthesiologists class, cT1 compared to CIS, and ventral tongue involvement were independently associated with worse speech. Age < 60 years was independently associated with worse taste.Conclusions: ESOTCCIS patients who undergo R-PC without radiation can expect long-term swallowing, chewing, and pain to be in the normative range. Although a majority of patients can expect to achieve normative speech and taste outcomes, R-PC carries the risks of mild speech and/or taste impairments.Level Of Evidence: 4 Laryngoscope, 131:312-318, 2021. [ABSTRACT FROM AUTHOR]

Introduction  As the limits of advanced skull base malignancies that can be managed through an endoscopic endonasal approach continue to be expanded, the resultant anterior skull base defects are of increasing size and complexity. In the absence of nasoseptal or turbinate flaps, the vascularized pericranial flap has been employed at our institution with excellent results. Objective  The study aimed to review the outcomes of patients who underwent endonasal anterior craniofacial resection with anterior skull base reconstruction using a vascularized pericranial flap. Design  Retrospective chart review of patients treated by the University of California – San Francisco minimally invasive skull base service from the years 2011 to 2017. Average duration of follow-up was 16.4 months. Setting  This study was conducted at Academic tertiary referral center. Participants  A total of nine patients with advanced anterior cranial base malignancies were identified who were treated with a minimally invasive, endoscopic anterior craniofacial resection from the years 2011 to 2017. Due to the nature of the resection in these patients, nasoseptal flaps and inferior/middle turbinate flaps were unavailable or insufficient for anterior skull base defect repair. Each patient underwent reconstruction of the anterior cranial base defect using an anteriorly based pericranial flap harvested by bicoronal incision, and tunneled anteriorly to the nasal cavity through a frontoethmoidal incision. [ABSTRACT FROM AUTHOR]

Objective: To describe risk of recurrence and recurrence characteristics between ever- and never-smoking patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) when stratified by primary tumor subsite. Study Design: Retrospective observational study. Setting: Tertiary care center. Methods: Retrospective chart review of 171 patients with HPV+ OPSCC with primary treatment between 2008 and 2019. Five-year recurrence-free survival and risk of recurrence were evaluated through Kaplan-Meier curves with log-rank test and Cox proportional hazards models, respectively. Results: Of 171 patients with HPV+ OPSCC, 81.9% were male, and the average age was 63.9 years. Eighty patients (46.8%) had a smoking history (average, 17.7 pack-years), including 4 current smokers. Recurrence occurred in 31 patients (18.1%), 19 of whom were ever smokers. The recurrence rate for ever smokers with primary base of tongue (BOT) cancer was 41.7%, while 5.1% of never smokers with BOT primaries had recurrence. For primary tonsillar disease, 9.1% of ever smokers had recurrence versus 19.2% of never smokers. Five-year recurrence-free survival for BOT primaries was lower in ever smokers than never smokers (P =.001) but did not differ between ever and never smokers for tonsillar primaries (P =.215). In multivariable analysis across this period, ever-smoking status was associated with higher risk of recurrence than never-smoking status in BOT primaries (adjusted hazard ratio, 7.36; 95% CI, 1.61-33.68; P =.010) but with lower risk of recurrence after tonsillar primaries (adjusted hazard ratio, 0.23; 95% CI, 0.06-0.89; P =.033). Conclusion: Smoking may uniquely interact with tumor subsites within the oropharynx to influence recurrence risk. Understanding the association between smoking and HPV+ OPSCC recurrence could lead to personalized, evidence-based treatments to improve oncologic outcomes. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Compare treatment-related quality of life (QOL) impact for early-stage human papillomavirus-associated oropharynx squamous cell carcinoma (HPV+ OPSCC) patients.Study Design: Retrospective cohort at a tertiary center.Methods: Stage I (T0-2/N0-1) HPV+ OPSCC patients (n = 76) with pretreatment Karnofsky scores ≥80 reported QOL after surgery alone (n = 17, 22%), surgery with adjuvant radiation ± chemotherapy (S-a[C]XRT) (n = 23, 30%), or definitive radiation ± chemotherapy (d[C]XRT) (n = 36, 47%) with the University of Washington QOL version 4 (UW-QOL); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (EORTC QLQ-C30) and Head and Neck Module (EORTC QLQ-HN35); University of Michigan Xerostomia, and Neck Dissection Impairment Index questionnaires (median follow-up = 2.2 years, interquartile range = 1.0-4.2 years). Treatment adverse events and gastrostomy tube rates were assessed.Results: Over 87% of each treatment group reported good or better overall QOL. Each group had low gastrostomy tube and treatment-specific complication rates. S-a(C)XRT and d(C)XRT patients had similar mean scores with wide ranges for most individual and all composite categories. S-a(C)XRT compared to d(C)XRT patients reported significantly fewer dental problems (EORTC QLQ-C30/HN35 means = 10.1 vs. 34.3, P = .007), worse appearance (UW-QOL means = 72.8 vs. 82.6, P = .02), and worse coughing (EORTC QLQ-C30/HN35 means = 31.9 vs. 15.7, P = .007). Surgery alone compared to d(C)XRT and S-a(C)XRT patients reported significantly better salivary/taste/oral functions and less pain, financial, oral/dental, and sexual problems.Conclusions: For early-stage HPV+ OPSCC, patients usually achieve acceptable QOL regardless of treatment. S-a(C)XRT and d(C)XRT patients report generally similar QOL including neck/shoulder pain/function, but with a wide range in a limited patient sample. Surgery alone should be considered, when oncologically and functionally safe, given the better associated QOL.Level Of Evidence: 4 Laryngoscope, 130:E48-E56, 2020. [ABSTRACT FROM AUTHOR]