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Objective To compare the differences in set-up errors between human eye positioning and artificial intelligence (AI) positioning guided by fan-beam CT (FBCT) during radiotherapy for head and neck tumors (HNT) . Methods FBCT guided radiotherapy (FBCT-RT) was routinely used for HNT treatment on uRT-linac 506c accelerator. FBCT scans were carried out at specific intervals, including the first three fractions and then once a week. The set-up errors were analyzed in three dimensions. The second FBCT scan was performed using only AI positioning without visual calibration (experimental group), while the third FBCT scan was implemented using human positioning (control group). Self-compared t-test was used to compare the set-up errors and positioning time of the two groups. Analysis of variance was used to compare the set-up errors under AI positioning during the six-week course of radiotherapy. Thirty-five HNT patients were enrolled in the study from September 2022 to November 2022. Results The set-up errors in vertical direction (VRT),longitudinal direction (LNG) and lateral direction (LAT) direction were all statistically significant (P<0.05) between the two groups. It was found that set-up errors could be stably controlled with AI positioning during the first three weeks of radiotherapy for all patients. However, instability of VRT occurred during the last three weeks of radiotherapy for malignancies (P<0.05), althrough set-up accuracy remained stable for orbital tumors. Conclusions AI positioning guided by FBCT not only saved set-up time but also reduced set-up errors during earlier stages of radiotherapy. Compared with other HNTs, orbital benign tumors benefited most from AI positioning due to lower set-up errors. [ABSTRACT FROM AUTHOR]

Nowadays, doctors of almost all specializations have to deal with patients who have one or another voluminous formations of the skin and subcutaneous tissue with localization in the head and neck region, which are heterogeneous in their etiology. It’s important to remember that sometimes neoplasms can turn out to be a manifestation of an infectious disease, in particular helminthosis. One of the representatives from this group of diseases is dyrofilariasis, is a zoonotic transmissible tropical helminth disease caused by roundworms – filarias of the genus Dirofilaria, which parasitize in humans mainly in the subcutaneous tissue and lymphatic system. A single filariasis of the Dirofilaria repens type is found in humans in temperate regions of Russia. Generally, dirofilariosis imitates the clinical picture of some other non-parasitic disease. Because of the lack of awareness of this disease among doctors, the process of making a diagnosis is almost always difficult. Often the correct diagnosis is only made during surgical treatment.The article presents a clinical observation of dirofilariosis with lesions subcutaneous tissue of the dorsum nose.

Background: The journey from radical treatments to the precision of robotic surgery underscores a commitment to innovation and patient-centered care in the field of head and neck oncology. Purpose of review: This article provides a comprehensive overview that not only informs but also stimulates ongoing discourse and investigation into the optimization of patient care through robotic surgery. The literature on current robotic applications within head and neck region was systematically reviewed. Recent findings: Thirty-four studies with a total of 1835 patients undergoing robotic surgery in head and neck region were included. Clinical staging, histological types, operative duration, postoperative complications, functional recovery and survival outcomes were compared and evaluated. Summary: Clinical outcomes have shown promising results and thus the indication on the robotic usage has no longer been limited to oropharyngeal region but from skull base to neck dissection. The latest advancement in robotic surgery further refines the capabilities of surgeons into previously difficult-to-access head and neck regions and heralds a new era of surgical treatment for head and neck oncology. [ABSTRACT FROM AUTHOR]

Background: This investigation sought to cross validate the predictors of tongue pressure recovery in elderly patients' post-treatment for head and neck tumors, leveraging advanced machine learning techniques. Methods: By employing logistic regression, support vector regression, random forest, and extreme gradient boosting, the study analyzed an array of variables including patient demographics, surgery types, dental health status, and age, drawn from comprehensive medical records and direct tongue pressure assessments. Results: Among the models, logistic regression emerged as the most effective, demonstrating an accuracy of 0.630 [95% confidence interval (CI): 0.370–0.778], F1 score of 0.688 [95% confidence interval (CI): 0.435–0.853], precision of 0.611 [95% confidence interval (CI): 0.313–0.801], recall of 0.786 [95% confidence interval (CI): 0.413–0.938] and an area under the receiver operating characteristic curve of 0.626 [95% confidence interval (CI): 0.409–0.806]. This model distinctly highlighted the significance of glossectomy (p = 0.039), the presence of functional teeth (p = 0.043), and the patient's age (p = 0.044) as pivotal factors influencing tongue pressure, setting the threshold for statistical significance at p < 0.05. Conclusions: The analysis underscored the critical role of glossectomy, the presence of functional natural teeth, and age as determinants of tongue pressure in logistics regression, with the presence of natural teeth and the tumor site located in the tongue consistently emerging as the key predictors across all computational models employed in this study. [ABSTRACT FROM AUTHOR]

Background: Our initial clinical study using simple diffusion kurtosis imaging (SDI), which simultaneously produces a diffusion kurtosis image (DKI) and an apparent diffusion coefficient map, confirmed the usefulness of SDI for tumor diagnosis. However, the obtained DKI had noticeable variability in the mean kurtosis (MK) values, which is inherent to SDI. We aimed to improve this variability in SDI by preprocessing with three different filters (Gaussian [G], median [M], and nonlocal mean) of the diffusion-weighted images used for SDI. Methods: The usefulness of filter parameters for diagnosis was examined in basic and clinical studies involving 13 patients with head and neck tumors. Results: The filter parameters, which did not change the median MK value, but reduced the variability and significantly homogenized the MK values in tumor and normal tissues in both basic and clinical studies, were identified. In the receiver operating characteristic curve analysis for distinguishing tumors from normal tissues using MK values, the area under curve values significantly improved from 0.627 without filters to 0.641 with G (σ = 0.5) and 0.638 with M (radius = 0.5). Conclusions: Thus, image pretreatment with G and M for SDI was shown to be useful for improving tumor diagnosis in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Intraoral adenoid cystic carcinoma (ACC) arising from minor salivary glands (MSG) is a rare malignancy associated with delayed diagnosis and unfavorable outcomes. This study aimed to comprehensively review ACC of MSGs, focusing on clinical characteristics, imaging modalities, treatment approaches, and long-term outcomes. Methods: A systematic search was conducted in PubMed, Web of Science, and MEDLINE databases to identify relevant articles reporting cases of ACC of MSGs between January 1997 and March 2023. The study was registered in PROSPERO (ID: CRD42023449478). A total of 10 studies that met the inclusion criteria were selected for critical review. In total, 902 patients were diagnosed with ACC of MSGs with an age range of 44.3 to 63 years, and an average age of 56.6 years. The female to male ratio ranges from 1:1 to 2.4:1. Regarding the primary site of ACC, the palate was the most common location, accounting for 30.5% to 83.3%, followed by the buccal mucosa, floor of the mouth, and lip and the retromolar area. For histology, the solid mass pattern was the most prevalent, seen in 95.2% of patients, followed by the cribriform pattern. Regarding treatment modalities, surgery was the most common approach, applied in 76.3% of cases, with a combination of surgery and radiotherapy used in 29.0% of cases. A smaller fraction, 3.2%, received a combination of surgery, chemotherapy, and radiotherapy, and 8.3% underwent radiotherapy alone. Local recurrence rates varied between 1% and 28.5%, and distant metastasis occurred in 18.2% to 33.3% of cases, predominantly to lymph nodes (14.5%). An analysis of overall survival across various stages and patient numbers indicated a 5-year survival rate of 68.0%. The findings of this study provide valuable insights for physicians in making treatment decisions and emphasize the need for ongoing research and collaborative clinical efforts to improve the management and outcomes of this challenging disease. Conclusion: ACC of MSGs is a multifaceted condition typically manifesting as asymptomatic enlargement and ulceration. This disease is marked by distinct histopathological patterns and perineural invasion (PNI). Recognizing these distinctive aspects is key in shaping the treatment plan, which can range from surgical procedures to radiation therapy, chemotherapy, and evolving targeted treatments. Continuous research and collaborative clinical efforts remain critical for ongoing progress in the treatment and management of this challenging condition. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ganglioneuroma is a rare benign tumor originating in the sympathetic ganglia, composed of differentiated ganglion cells, nerve sheath cells, and nerve fibers, which tend to occur in the posterior mediastinum, adrenal gland, retroperitoneal, and other locations, occurring in the head and neck is relatively rare, and parapharyngeal space involvement is extremely rare. In our report, we present 2 adult male patients whose preoperative imaging and fine needle cytology did not confirm the diagnosis of a parapharyngeal space mass and who completely resected the tumor through a combined cervical and oral approach. Finally, pathology confirmed ganglioneuroma; we also reviewed the English articles on parapharyngeal ganglioneuroma over the past 40 years, and summarized the diagnostic and treatment characteristics of parapharyngeal ganglioneuroma in combination with our cases to improve understanding of the disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Angiosarcoma is a rare malignant disease with an extremely poor prognosis, showing rapid progression of the local tumor and/or distant metastases. Although multidisciplinary approach including systemic chemotherapy and radiation therapy is ideal for this disease, surgical resection have a role in disease control and should be performed as soon as possible. Angiosarcomas originating from the tongue are rare and have extremely malignant features, leading to a poor prognosis. Herein, we report the case of a patient with angiosarcoma arising from the tongue who was successfully treated surgically. A 71‐year‐old man was diagnosed with a mass on the right side of his tongue and visited the Department of Oral and Maxillofacial Surgery at our hospital. The patient was referred to our department for further examination and treatment after a biopsy of the right edge of the tongue. An irregularly raised tumor 50 mm in length was noted on the right lingual border. The preoperative diagnosis was a primary angiosarcoma of the tongue (clinical stage, T3N2bM0, Stage IV). As his tumor had been growing rapidly, he emergently underwent partial right‐sided tongue resection and right neck dissection without reconstructive surgery. The histopathological diagnosis was pT3N0. Postoperatively, the patient showed no signs of recurrence or metastasis during the 1‐year follow‐up. As for angiosarcomas, surgical resection is the only curative treatment, and surgery should be performed as soon as possible after the final diagnosis. [ABSTRACT FROM AUTHOR]

Atlantoaxial rotatory subluxation (AARS), which is characterised by an abnormal alignment of the atlantoaxial joint, is rarely reported after oral and maxillofacial surgery. A four-year-old girl developed AARS after neck surgery. The child initially had treatment for one month in a timely manner. Follow ups revealed reduced symptoms of neck pain and the previous tilt disappeared after serial treatment. This case aimed to increase awareness of AARS and provide a reference for oral and maxillofacial surgeons. [ABSTRACT FROM AUTHOR]

Key Clinical Message Angiosarcoma is a rare malignant disease with an extremely poor prognosis, showing rapid progression of the local tumor and/or distant metastases. Although multidisciplinary approach including systemic chemotherapy and radiation therapy is ideal for this disease, surgical resection have a role in disease control and should be performed as soon as possible. Abstract Angiosarcomas originating from the tongue are rare and have extremely malignant features, leading to a poor prognosis. Herein, we report the case of a patient with angiosarcoma arising from the tongue who was successfully treated surgically. A 71‐year‐old man was diagnosed with a mass on the right side of his tongue and visited the Department of Oral and Maxillofacial Surgery at our hospital. The patient was referred to our department for further examination and treatment after a biopsy of the right edge of the tongue. An irregularly raised tumor 50 mm in length was noted on the right lingual border. The preoperative diagnosis was a primary angiosarcoma of the tongue (clinical stage, T3N2bM0, Stage IV). As his tumor had been growing rapidly, he emergently underwent partial right‐sided tongue resection and right neck dissection without reconstructive surgery. The histopathological diagnosis was pT3N0. Postoperatively, the patient showed no signs of recurrence or metastasis during the 1‐year follow‐up. As for angiosarcomas, surgical resection is the only curative treatment, and surgery should be performed as soon as possible after the final diagnosis.

Objective. Head and neck (H&N) cancers are prevalent globally, and early and accurate detection is absolutely crucial for timely and effective treatment. However, the segmentation of H&N tumors is challenging due to the similar density of the tumors and surrounding tissues in CT images. While positron emission computed tomography (PET) images provide information about the metabolic activity of the tissue and can distinguish between lesion regions and normal tissue. But they are limited by their low spatial resolution. To fully leverage the complementary information from PET and CT images, we propose a novel and innovative multi-modal tumor segmentation method specifically designed for H&N tumor segmentation. Approach. The proposed novel and innovative multi-modal tumor segmentation network (LSAM) consists of two key learning modules, namely L2-Norm self-attention and latent space feature interaction, which exploit the high sensitivity of PET images and the anatomical information of CT images. These two advanced modules contribute to a powerful 3D segmentation network based on a U-shaped structure. The well-designed segmentation method can integrate complementary features from different modalities at multiple scales, thereby improving the feature interaction between modalities. Main results. We evaluated the proposed method on the public HECKTOR PET-CT dataset, and the experimental results demonstrate that the proposed method convincingly outperforms existing H&N tumor segmentation methods in terms of key evaluation metrics, including DSC (0.8457), Jaccard (0.7756), RVD (0.0938), and HD95 (11.75). Significance. The innovative Self-Attention mechanism based on L2-Norm offers scalability and is effective in reducing the impact of outliers on the performance of the model. And the novel method for multi-scale feature interaction based on Latent Space utilizes the learning process in the encoder phase to achieve the best complementary effects among different modalities. [ABSTRACT FROM AUTHOR]

Head and neck tumors (HNTs) constitute a multifaceted ensemble of pathologies that primarily involve regions such as the oral cavity, pharynx, and nasal cavity. The intricate anatomical structure of these regions poses considerable challenges to efficacious treatment strategies. Despite the availability of myriad treatment modalities, the overall therapeutic efficacy for HNTs continues to remain subdued. In recent years, the deployment of artificial intelligence (AI) in healthcare practices has garnered noteworthy attention. AI modalities, inclusive of machine learning (ML), neural networks (NNs), and deep learning (DL), when amalgamated into the holistic management of HNTs, promise to augment the precision, safety, and efficacy of treatment regimens. The integration of AI within HNT management is intricately intertwined with domains such as medical imaging, bioinformatics, and medical robotics. This article intends to scrutinize the cutting-edge advancements and prospective applications of AI in the realm of HNTs, elucidating AI's indispensable role in prevention, diagnosis, treatment, prognostication, research, and inter-sectoral integration. The overarching objective is to stimulate scholarly discourse and invigorate insights among medical practitioners and researchers to propel further exploration, thereby facilitating superior therapeutic alternatives for patients. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 epidemic prevention and control policy has recently been adjusted. The possibility of novel coronavirus infection in patients with head and neck tumors undergoing airway opening related surgery has greatly increased, bringing new challenges for head and neck surgeons. Based on the changes of the national epidemic prevention and control strategy, the relevant literatures and data at home and abroad, China’s national conditions, relevant clinical practice in the early stage and the guidance of peer experts, we put forward the initial clinical practice guidance suggestions for many new specialized clinical issues in COVID-19 related head and neck tumor patients, such as the timing of surgery, indications and disposal process, management of postoperative monitoring indicators, treatment and prevention of various complications, discharge standards and postoperative follow-up management. [ABSTRACT FROM AUTHOR]

Ameloblastic carcinoma (AC) is an uncommon malignant odontogenic tumor, with about 200 cases published in the literature. Here, we report a case of AC occurring in the maxilla - at the same anatomical location of an ameloblastoma 8 years earlier. A 23-year-old woman with maxillary swelling of 6-month duration was referred to our service. Extraoral examination revealed a swelling over the right side of the face, lifting her lip and nose. Intraorally, a firm, reddish, nodular swelling involving the right maxilla was observed. Computed tomography showed a hypodense image invading the right maxilla, maxillary sinus, and nasal fossa. An incisional biopsy was performed, followed by histopathologic examination and an immunohistochemical panel, which led to the diagnosis of AC. The lesion was treated with partial maxillectomy followed by immediate rehabilitation. Neither local recurrence of the tumor nor distant metastasis was observed during a 4-year follow-up. AC is a highly malignant lesion which requires aggressive therapy. Its diagnosis should be based on combined clinical, imaging, and pathological manifestations in order to improve diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Huge head and neck tumors are known to cause difficult ventilation and difficult intubation. Edentulous mouth can result in difficult mask ventilation. Head and neck tumor resections can also present hemodynamic challenge, due to their proximity to large vessels. We herein report a clinical case of difficult ventilation due to large parotid tumor in an edentulous patient.

The brachial cleft carcinoma is an extremely rare head and neck facial malignancy, and there is some disagreement about its differential diagnosis. In this paper, we report a 63-year-old male patient who had a mass on the left side of the neck and diagnosed as the brachial cleft carcinoma by intraoperative biopsy pathology. However, this patient was diagnosed with the carcinoma of the left soft palate more than 20 days after surgery and esophageal cancer 2 years later, and was treated accordingly. Therefore, it is hard to confirm whether the branchial cleft carcinoma is primary or metastatic. In fact, the diagnostic criteria for primary squamous cell carcinoma of branchial cleft cysts are very rigorous. Confirmation of the diagnosis is based on pathological examination of the branchial cleft cyst epithelium lined with squamous cells, meanwhile, a thorough examination should also be performed to exclude the presence of other primary cancers.

Head and neck tumors can rarely cause carotid sinus syndrome and this often resolves by surgical intervention or palliative chemoradiotherapy. If these modalities are not an option or are ineffective, the most preferred treatment is permanent pacemaker therapy. Here, we present the first case of cardioneuroablation treatment performed in patient with oropharyngeal squamous cell cancer who developed recurrent asystole and syncope attacks due to compression of the carotid sinus on neck movement. [ABSTRACT FROM AUTHOR]

With an incidence of 3–4.5 cases per million, adenoid cystic carcinoma (ACC) of the head and neck is one of the most common tumors of the parotid and sublingual salivary glands. In the clinical course, ACC is shown to have an aggressive long-term behavior, which leads to the fact that radical surgical resection of the tumor with tumor-free margins remains the "gold standard" in treating ACC. Particle radiation therapy and systemic molecular biological approaches offer new treatment options. However, risk factors for the formation and prognosis of ACC have not yet been clearly identified. The aim of the present review was to investigate long-term experience of diagnosis and treatment as well as risk and prognostic factors for occurrence and outcome of ACC. [ABSTRACT FROM AUTHOR]

Purpose: Accurately segmenting head and neck cancer (HNC) tumors in medical images is crucial for effective treatment planning. However, current methods for HNC segmentation are limited in their accuracy and efficiency. The present study aimed to design a model for segmenting HNC tumors in three-dimensional (3D) positron emission tomography (PET) images using Non-Local Means (NLM) and morphological operations. Material and Methods: The proposed model was tested using data from the HECKTOR challenge public dataset, which included 408 patient images with HNC tumors. NLM was utilized for image noise reduction and preservation of critical image information. Following pre-processing, morphological operations were used to assess the similarity of intensity and edge information within the images. The Dice score, Intersection Over Union (IoU), and accuracy were used to evaluate the manual and predicted segmentation results. Results: The proposed model achieved an average Dice score of 81.47 ± 3.15, IoU of 80 ± 4.5, and accuracy of 94.03 ± 4.44, demonstrating its effectiveness in segmenting HNC tumors in PET images. Conclusions: The proposed algorithm provides the capability to produce patient-specific tumor segmentation without manual interaction, addressing the limitations of current methods for HNC segmentation. The model has the potential to improve treatment planning and aid in the development of personalized medicine. Additionally, this model can be extended to effectively segment other organs from limited annotated medical images. [ABSTRACT FROM AUTHOR]

Objectives: To investigate how different types of dental prosthesis perform in patients with head and neck tumors. Materials and methods: In this retrospective clinical cohort study, the impact of different patient-related factors was analyzed as influencing factors on the survival probability of dental prosthesis using Kaplan–Meier estimate. For analysis, the dental prosthesis was divided into groups: group 1 (fixed dental prosthesis), group 2 (removable dental prosthesis), group 3 (implant-supported dental prosthesis), and group 4 (prostheses anchored using wrought wire clasps and obturators). The incidental aftercare measures were also evaluated. Results: Two hundred seventy-nine restorations were observed (mean observation: 2.7 ± 3.0 years, max.14.8 years) out of which 49 (17.6%) had to be replaced during the observation. After 5 years, 100% of group 1 restorations, 79.9% of group 2 restorations, 91.4% of group 3 restorations, and 30% of group 4 restorations were still functional. Four hundred eighty-eight dental implants were observed, of which 77 (15.8%) failed. Conclusions: Groups 1, 2, and 3 restorations showed good survival times after 5 years in function, whereas group 4 presented the worst survival times. Group 2 restorations showed the highest amount of necessary aftercare measures. Clinical relevance: The current investigation shows that groups 1, 2, and 3 restorations should be preferred in the prosthetic treatment planning of patients with head and neck tumors. A treatment with group 4 restorations should only be considered if no other prosthetic treatment is possible or as temporary treatment. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Simple Summary: Definitive radiochemotherapy is the treatment of choice for locally advanced nasopharyngeal carcinoma. Due to the vicinity of the nasopharynx to the inner ear and the use of ototoxic platinum-based chemotherapy, there is a risk for irreversible damage to the auditory system. To avoid or minimize these critical side effects, radiation exposure to each inner ear must be balanced between target volume coverage and toxicity. However, normal tissue complication probability (NTCP) models of the inner ear validated by clinical data are rare. In this retrospective study of 46 patients, an NTCP model and a cutoff dose logistic regression model (CDLR) were created. There is a sigmoidal relation between radiation dose and incidence of inner ear toxicities. Dose constraints for the inner ear of <44 Gy (Dmean) or <58 Gy (Dmax) are suggested to limit the probability of inner ear toxicity < 25%. Background: Definitive radiochemotherapy is the treatment of choice for locally advanced nasopharyngeal carcinoma. Due to the vicinity of the nasopharynx to the inner ear and the use of ototoxic platinum-based chemotherapy, there is a risk for irreversible damage to the auditory system. To avoid or minimize these critical side effects, radiation exposure to each inner ear must be balanced between target volume coverage and toxicity. However, normal tissue complication probability (NTCP) models of the inner ear validated by clinical data are rare. Patients and Methods: This retrospective study investigates the inner ear toxicity of 46 patients who received radio(chemo-)therapy for nasopharyngeal carcinoma at our institution from 2004 to 2021 according to CTCAE 5.0 criteria. For each inner ear, the mean (D m e a n) and maximum (D m a x) dose in Gray (G y) was evaluated and correlated with clinical toxicity data. Based on the data, an NTCP model and a cutoff dose logistic regression model (CDLR) were created. Results: In 11 patients ( 23.9 % ) hearing impairment and/or tinnitus was observed as a possible therapy-associated toxicity. D m e a n was between 15– 60 Gy, whereas D m a x was between 30– 75 Gy. There was a dose-dependent, sigmoidal relation between inner ear dose and toxicity. A D m e a n of 44 Gy and 65 Gy was associated with inner ear damage in 25 % and 50 % of patients, respectively. The maximum curve slope (m) was found at 50 % and is m = 0.013 . The Dmax values showed a 25 % and 50 % complication probability at 58 Gy and 69 Gy, respectively, and a maximum slope of the sigmoid curve at 50 % with m = 0.025 . Conclusion: There is a sigmoidal relation between radiation dose and incidence of inner ear toxicities. Dose constraints for the inner ear of < 44 Gy (D m e a n) or < 58 Gy (D m a x) are suggested to limit the probability of inner ear toxicity < 25 % . [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Simple Summary: Current planning techniques, including computer-aided design/computer-aided manufacturing (CAD/CAM), offer ways to plan reconstructive surgery that optimize aesthetic outcomes and functional rehabilitation. In addition, the use of these techniques promotes safety and reduces the duration of operations. This study compares both the cost of CAD/CAM technology and the clinical results with those of the conventional technique in remodeling the fibula for mandibular reconstruction. (1) Background: A decrease in operative time can not only improve patient outcomes through a reduction in the risk of developing complications but can also result in cost savings. The aim of this study is to determine whether there an intraoperative time gain can be achieved by using the preoperative virtual planning of mandibular reconstruction using a free fibula flap compared with freehand plate bending and osteotomies. (2) Methods: A retrospective comparative study was carried out in the Oral and Maxillofacial Department of La Paz University Hospital, Madrid, Spain. The study compared 18 patients in the CAD/CAM group with 19 patients in the conventional freehand group. A comparison was made between the total surgical time, the comorbidities, and the hospital stay. The resource consumption was estimated using a cost analysis. (3) Results: Although CAD/CAM was a statistically more expensive procedure in the perioperative phase, no significant differences were observed in total health care costs between the two groups. There was a non-significant trend towards an increase in complications with conventional reconstruction plates compared to patient-specific plates (PSI). (4) Conclusions: CAD/CAM technology and a 3D printed cutting guide offer a significantly shorter surgical time, which is associated with a reduction in hospital days, PACU days, and complications. The cost of CAD/CAM technology is comparable to that of the conventional freehand technique. [ABSTRACT FROM AUTHOR]

To analyze the dosimetric effects of shoulder position shift on target volumes and organs at risk (OARs) during radiotherapy for head and neck cancer, 14 patients with different types of head and neck cancer were selected. Based on original positioning CTs (o-CTs), the shoulder position was moved toward the superior inferior (SI) direction, anterior posterior (AP) direction, and the left right (LR) direction by 3 mm, 6 mm, and 15 mm, then 252 new CTs (n-CTs) were produced. After setting the movement, the new adipose tissue density was set to 1 g/cm3, and the movement of the bone tissue was also considered. The original plan (o-plan) on the o-CT was copied to the n-CTs and recalculated to obtain 252 new plans (n-plans). The differences between the o-plan and n-plan target volumes and OARs in field-fixed intensity modulated radiotherapy and the volumetric modulated arc intensity (VMAT) were studied, and the dose changes of the target volume D95% and spinal cord Dmax were compared with the movement of the shoulder position. It was proved that the effects of the shoulder position shift on the target volume and OARs for head and neck cancers are substantial, especially a 15 mm shift toward the superior direction had the greatest influence, reaching 4.16% (VMAT). The closer the target area is to the shoulder, the more serious the impact. The spinal cord dose increased greatly, reaching a maximum of 72.8 cGy, 100 cGy and 212 cGy (VMAT), respectively, for shift of 3 mm, 6 mm, and 15 mm towards the inferior direction. The o-plan and p-plan were analyzed using a 3D γ passing rate (3%/3 mm), that was more than 95% except for the 15 mm shift towards the superior direction. Radiotherapy technicians should pay attention to ensure that the shoulder is lightly touching the thermoplastic mold during radiotherapy positioning for head and neck tumors to prevent patients from shrugging their shoulders. The OAR dose limit should be considered in the planning design, and a sufficient margin should be left to prevent the excessive dose caused by the positioning.

Background and purpose: Free flap has become the main way of reconstruction after surgery for head and neck tumor. Vascular crisis is easy to cause skin flap necrosis, and hypercoagulability is the main cause of vascular crisis. This study explored the factors influencing postoperative hypercoagulability of free flap reconstruction for head and neck tumor, and provided reference for the prevention and treatment of hypercoagulability. Methods: A retrospective analysis was conducted according to the medical records of 243 patients admitted to Department of Otolaryngology, Second Affiliated Hospital of Fujian Medical University from Apr. 2017 to Jul. 2020 who underwent free flap reconstruction for head and neck tumor. The patients were divided into the hypercoagulable group and the non-hypercoagulable group according to whether postoperative hypercoagulable state occurred, and the incidence of postoperative hypercoagulable state and related influencing factors were statistically analyzed. Results: Among the 243 patients, 128 patients had postoperative hypercoagulability, and the incidence was 52.7% (128/243), including 73.4% (94/128) of two postoperative coagulation abnormalities, 21.1% (27/128) of three abnormalities and 5.5% (7/128) of four abnormalities. Results of single factor analysis showed that gender, age, alcoholism, diabetes, tumor stage, surgical repair, intraoperative blood loss, intraoperative blood transfusion, operative time, postoperative leukocyte, postoperative triglyceride, postoperative high-density lipoprotein and postoperative Ca 2+ were the possible influencing factors of postoperative hypercoagulability (all P

Purpose: Different embolization techniques and materials are available for the pre-operative embolization of carotid body paragangliomas. In this study, we report the first experience of the direct percutaneous puncture technique under fluoroscopic guidance using the low-viscosity formula of SQUID-12. The additional use of a transitory balloon-blockage at the origin of the external carotid artery aims to confer higher protection by limiting the risk of non-target embolization and subsequent neurological sequelae. Materials and Methods: We retrospectively reviewed all cases of carotid body paragangliomas that have undergone pre-surgical embolization with a direct puncture technique and balloon-assistance at our institution between 2019 and 2020. The use of the liquid EVOH-based SQUID-12 as the sole embolic agent was the main inclusion criteria. Results: A total of 9 patients with 9 carotid body paragangliomas were enrolled in this case series. The mean volume of the lesion was 309 mm3. The mean embolization-session time amounted to 88 min. The average number of needles inserted was 2, and the mean volume of SQUID-12 used per case was 23 ml. Successful total devascularization was obtained in all cases. No long-term sequelae due to the embolization procedure occurred. Conclusions: Pre-operative paraganglioma embolization with SQUID-12 using a direct puncture and balloon-assisted technique is a safe and efficient method with few complications. [ABSTRACT FROM AUTHOR]

• Radiation-induced mucositis affects the patient's quality of life. • We examined the relationship between mucositis and oral bacterial counts. • The temporal patterns of oral bacterial counts and mucositis were similar. • High bacterial counts may lead to a faster onset of mucositis and slower healing. • Our study will help define clinical strategies for C-ion RT of the head and neck. Acute adverse events, such as oral mucositis, can affect treatment success in patients undergoing head and neck radiotherapy. In this study, we aimed to identify the relationship between oral mucositis and oral bacterial counts during carbon ion radiotherapy (C-ion RT) in patients with head and neck cancer. This prospective study included patients with head and neck tumors treated with C-ion RT between 2017 and 2019. C-ion RT consisted of treatment at 57.6, 64.0, or 70.4 Gy (relative biological effectiveness) in 16 fractions. Bacterial counts in the saliva and the back of the tongue were measured using a rapid oral bacteria quantification system. The relationship between the oral bacterial count and oral mucositis was subsequently analyzed. In total, 46 patients were included in the analysis. The bacterial count in the saliva gradually increased from the commencement of C-ion RT and peaked at 16 fractions. Bacterial counts at the back of the tongue were already high at the beginning of C-ion RT; however, they decreased with continued treatment, peaked at 16 fractions, and subsequently decreased again. Patients with bacterial counts exceeding the mean before C-ion RT (high-count group) did not experience more severe mucositis than those with counts below the mean (low-count group). However, patients in the high-count group tended to experience faster-onset mucositis and slower healing than those in the low-count group. Bacterial counts may aid in the development of clinical strategies for C-ion RT-induced oral mucositis. [ABSTRACT FROM AUTHOR]

Background: Virtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success. Method: This retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply. Result: A total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs' vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP. Conclusion: In general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome. [ABSTRACT FROM AUTHOR]

To explore the clinical significance and mechanisms of altered miRNAs in squamous cell carcinoma of head and neck (SCCHN) and provide references for SCCHN diagnosis and prognosis.

BackgroundVirtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success.MethodThis retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply.ResultA total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs’ vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP.ConclusionIn general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome.

We present a case of diagnostic interest; we present the differential diagnosis and the complementary tests necessary to reach it, in addition to highlighting the importance of a correct collection of background and clinical history. A 54-year-old woman with a history of carcinoma of the floor of the mouth treated with radiotherapy and chemotherapy develops ischemic retinopathy. It was necessary to perform a systemic study and differential diagnosis with entities such as ocular ischemic syndrome and radiation retinopathy, due to the similarity in the clinical findings found. Radiation retinopathy should be ruled out in any patient with visual impairment and a history of radiotherapy treatment. A broad differential diagnosis and systemic study are required to rule out entities such as ocular ischemic syndrome and diabetic retinopathy, in addition to early treatment to avoid possible complications., (Copyright © 2024 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Myocardial metastasis of nasopharyngeal carcinoma (NPC) is rarely reported in the literature. Some autopsy studies found metastases in more than 10% of cases with malignant neoplasm. However, patients are often diagnosed during the postmortem because myocardial metastasis is often asymptomatic, and its Cardiac complications tend to be severe and fatal. Patients with Cardiac metastases are often treated with chemotherapy or surgical intervention, although the prognosis is poor. Immunotherapy with anti-programmed cell death receptor-1 or ligand-1 (PD-1 or PD-L1) inhibitors has recently been reported to be therapeutically significant in multiple cancers, including melanoma, nonsmall cell lung cancer, and NPC, but the treatment of myocardial metastasis of NPC has not been reported. This study described the case of a 50-year-old male patient who presented initially with NPC and received radiotherapy as first-line therapy. For 20 years, he had recurrent Cardiac metastasis of NPC. The pathological examination suggested tPD-L1 expression. Therefore, off-label sintilimab (200 mg every 21 days) was administered. After 10 cycles of treatment, myocardial metastasis shrank and the enlarged mediastinal lymph nodes disappeared. This case report demonstrated that Cardiac metastasis of NPC expressing PD-L1 might have a sustained response to PD-L1 inhibitor–directed therapy. [ABSTRACT FROM AUTHOR]

Interdigitating dendritic cell sarcoma is an extremely rare tumor and typically originates from lymph nodes. Here, we report a patient with tumor originated from the oropharynx who received successful surgical treatment. [ABSTRACT FROM AUTHOR]

Myocardial metastasis of nasopharyngeal carcinoma (NPC) is rarely reported in the literature. Some autopsy studies found metastases in more than 10% of cases with malignant neoplasm. However, patients are often diagnosed during the postmortem because myocardial metastasis is often asymptomatic, and its Cardiac complications tend to be severe and fatal. Patients with Cardiac metastases are often treated with chemotherapy or surgical intervention, although the prognosis is poor. Immunotherapy with anti-programmed cell death receptor-1 or ligand-1 (PD-1 or PD-L1) inhibitors has recently been reported to be therapeutically significant in multiple cancers, including melanoma, nonsmall cell lung cancer, and NPC, but the treatment of myocardial metastasis of NPC has not been reported. This study described the case of a 50-year-old male patient who presented initially with NPC and received radiotherapy as first-line therapy. For 20 years, he had recurrent Cardiac metastasis of NPC. The pathological examination suggested tPD-L1 expression. Therefore, off-label sintilimab (200 mg every 21 days) was administered. After 10 cycles of treatment, myocardial metastasis shrank and the enlarged mediastinal lymph nodes disappeared. This case report demonstrated that Cardiac metastasis of NPC expressing PD-L1 might have a sustained response to PD-L1 inhibitor–directed therapy.

Background: Neuroendocrine neoplasms (NENs) are a rare type of tumor that arise from neuroendocrine cells. Primary neuroendocrine tumors of the head and neck are exceedingly rare and range from benign-behaving neoplasms to aggressive neuroendocrine carcinomas (NEC). Objectives: The main purpose of this article is to report a rare case of well-differentiated neuroendocrine carcinoma (WD-NEC) (Grade 1) of the jugular foramen with uncharacteristic high-grade features and aggressive pattern of spread reminiscent of poorly-differentiated neuroendocrine carcinoma (PD-NEC). In addition, we review the scientific literature and describe differences in current World Health Organization (WHO) classification system for various organ systems. Methods: A 49-year-old man with right ear infections developed acute facial paralysis. Imaging showed otomastoiditis and incidental right jugular foramen (JF) tumor suspicious for meningioma. After facial nerve decompression, he developed right vocal cord paralysis and dysphagia. His facial nerve function recovered completely; however, repeat imaging showed rapid growth of the JF mass. The patient underwent transtemporal approach for definitive resection. Results: Pathology showed Grade 1, WD-NEC with aggressive features: mitotic index up to 2, focal necrosis, Ki-67 > 20%. Nuclear medicine scans confirmed the jugular foramen was the primary site. Chemoradiation was initiated; however, the patient developed metastasis and passed away. Conclusion: We present a rare case of WD-NEC of the jugular foramen with atypical presentation and aggressive features. We review diagnostic work-up, WHO classification systems for NEC, and highlight the potential role of Ki-67 in NECs of the head and neck.

Abstract Interdigitating dendritic cell sarcoma is an extremely rare tumor and typically originates from lymph nodes. Here, we report a patient with tumor originated from the oropharynx who received successful surgical treatment.

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Background: Thoracic duct injury is a rare complication of head and neck surgery. Thoracic duct embolization (TDE) has been proposed to manage postoperative chyle leaks. Methods: Twelve patients who underwent lymphangiography for a chyle leak after head and neck surgery (M:F = 5:7, mean 55 years) were retrospectively reviewed. Lymphangiographic findings, technical success, complications, and clinical outcomes were analyzed. Results: Chyle leak was identified and TDE attempted in 11 of 12 patients. Three patients required repeat TDE. Technical success of TDE was 86% (12/14). Clinical success for patients with technically successful TDE was 90% (9/10). Median time until drain removal was 2.1 days in nine patients with clinical success. Two major complications were encountered, chylothorax after initial TDE, requiring additional TDE and in one case surgical TD ligation. Conclusions: TDE is a safe treatment for chyle leaks after head and neck surgery with high technical and clinical success rates. [ABSTRACT FROM AUTHOR]

Aim. The study objective is studying the possibility of endosonography in the diagnosis of tumor and pretumor pathology of the larynx, oropharynx and laryngopharynx. Materials and methods. Endosonographic study was conducted in 20 patients with tumors and suspected tumors of the larynx, laryngopharynx and oropharynx. Results. The use of endoscopic ultrasound (EUS) method was useful and important in determining the thickness and structure of the tumor, with hyperplasia of the lingual and palatine tonsils. Endosonographic picture of fibrous changes after surgery and post-radiation changes, lack of blood flow in the fibrous tissue and blurred contours gave additional information in the differential diagnosis of tumor and non-tumor changes. The results of the ultrasound examination performed in the standard B-mode for the presence of tumors, cysts and formations, suspicious of the tumor of the submucosal layer of the oropharynx and larynx, which were not determined by endoscopic examination, were confirmed. Conclusion. Obtaining a sonographic image simultaneously with endoscopic examination of the formations in the submucosal layer of the oropharynx and larynx will shorten the diagnostic algorithm of the study in patients with pathological changes in this area. The use of endosonography made it possible to confirm the data obtained by ultrasound examination in B-mode and which were not confirmed by endoscopic examination.