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Background: Infection with human papillomavirus (HPV) low-risk type 6 and 11 in the respiratory tract can cause recurrent benign squamous papillomas in the larynx, in children, juvenile-onset recurrent respiratory papillomatosis (JoRRP)., Objectives: This systematic review investigated the impact of national HPV vaccination programs on JoRRP incidence and prevalence., Methods: PubMED was systematically searched for publications between 2010 and March 2024 that assessed the incidence and prevalence of JoRRP post-implementation of HPV vaccination programs., Results: Four studies met the inclusion criteria, comprising 622 patients with JoRRP (range 15-576) from Australia, New Zealand and the Unites States. The majority were girls (F:M ratio 2:1), with a median debut age between three to four years. Two studies ( n  = 591) showed a significant decline in JoRRP incidence after vaccination from 2,0 per 100,000 < 18 years (2004-2005) to 0,5 per 100,000 < 18 years (2012-2013) in the United States, and 0,16 per 100,000 < 15 years (2012) to 0,02 per 100,000 < 15 years (2016) in Australia. Higher vaccination coverage correlated with a reduced JoRRP burden., Conclusion: Our findings indicate implementation of HPV-vaccination programs reduced the JoRRP incidence and prevalence emphasizing the importance of large-scale HPV vaccination. Total impact of HPV vaccination will become fully evident when the vaccinated population reach childbearing ages.

Background: Inverted papilloma is a benign epithelial tumour located in the sinonasal tract with a high recurrence rate and a potential of malignant transformation. From 2017, patients with IP were included in our fast-track regime similar to head and neck cancer patients, including follow-up at 2, 6, 12, 18 and 24 months after surgery, then yearly for a total of 5 years., Aims/objectives: This study aims to compare the recurrence rate and malignant transformation of patients with IP treated at a university centre following the implementation of a fast-track regime including a close follow-up., Methods: A retrospective study was performed on all patients with IP diagnosed between 2018 and 2022., Results: The study included 125 patients, all surgically treated for IP. Eight patients (6%) also presented with SCC at the time of diagnosis. The recurrence rate of benign IP was 17%. Most tumours originated in the maxillary sinus (48/117, 41%). No cases of metachronous cancer were seen during the follow-up., Conclusions and Significance: The majority of recurrences (90%) occurred within the first 2 years after treatment. No cases of malignant transformation were seen in the follow-up period. The rigorous follow-up program potentially contributed to the detection of recurrence before malignant transformation.

Background: Pain is prevalent after most TransOral Robotic Surgery (TORS) procedures and may limit function i.e. swallowing. Currently, there is limited knowledge regarding optimal pain treatment in TORS., Aims/objectives: This clinical trial randomized patients to either a high-dose dexamethasone or low-dose dexamethasone treatment in addition to a multimodal basic analgesic protocol. The aim of the trial was to investigate the pain intensity during rest and swallowing using the Visual Analogue Scale (VAS) after TORS lingual tonsillectomy. Secondary outcomes were acceptable food consistency, nausea, vomiting, opioid rescue usage, length of hospitalization, feeding tube placements, readmissions, blood glucose levels and postoperative complications., Methods: The trial was conducted between August 2020 and October 2022. Eligible patients were patients scheduled for TORS-L treatment of obstructive sleep apnea syndrome or as part of the diagnostic work-up of head and neck carcinoma of unknown primary., Results: Eighteen patients were and randomized 1:1. There were overall no significant differences between groups in the reported VAS scores during rest or swallowing ( p  ≥ .05). Overall, there were no differences in the secondary outcomes., Conclusion: There were no differences in the pain intensity in the two treatment groups allocated to a basic multimodal analgesic package and either high-dose dexamethasone or low-dose dexamethasone treatment. The trial is the first RCT to include pain measurement during a procedure-relevant activity, thus creating a platform for future recovery studies.

Background: In Head and Neck surgery Transoral Robotic Surgery (TORS) is evolving as a key treatment option for benign and malignant lesions in the oropharynx. Even so, postoperative pain is one of the primary early complaints following TORS. Well established evidence-based procedure specific pain treatment guidelines are available for a variety of other surgical specialties. However, there are no guidelines for TORS., Aim: This review describes the available data of early pain intensity following TORS during rest and procedure related activity., Methods: Literature concerning pain in the immediate postoperative phase following TORS were obtained from two literature databases., Results: Most data on pain intensity following TORS are based upon a numeric rating scale, e.g. the Visual Analogue Scale and/or analgesic demands. Only one randomized clinical trial is available reflecting that the literature is mainly based on retrospective and a few prospective studies. Only one study analyzed pain during relevant functionality, i.e. swallowing. Overall, the studies suffer from a non-standardized approach and there is a need for transparent information concerning the timing of pain ratings and methodology., Conclusions: The evidence for optimal pain control is limited, particularly during surgical relevant activity. Postoperative pain rating during activity is a fundamental element in pain trials in order to enhance recovery thereby calling for future consensus on assessment methodology.

Background: The reported hospital length of stay (LOS) following transoral robotic surgery lingual tonsillectomy (TORS-L) is variable, with limited understanding of the factors requiring hospitalization and no evidence-based criteria for discharge., Aims/objectives: This observational cohort study investigated factors hindering discharge following TORS-L in a well-defined postoperative care program., Methods: Patients were included between August 2020 and October 2022. A discharge scheme was filled out twice daily, specifying the factor(s) for hospitalization among patients undergoing TORS-L. This trial was a sub-investigation of a national multicentre randomized clinical trial (RCT) testing the efficiency of high-dose dexamethasone on postoperative pain control. Participation in the RCT demanded admission to the fourth postoperative day as dexamethasone/placebo was given intravenously in repeated dosages till day 4 postoperatively., Results: Eighteen patients were included in the analysis. The main factor for hospitalization was nutritional difficulties, while pain was a limiting factor for discharge only on the first postoperative 1-3 days. More than half of the patients could have potentially been discharged on postoperative day 2 when omitting the RCT treatment plan in the analysis., Conclusion: The study estimates that the majority of patients may be discharged on postoperative day 2 following TORS-L.

Background: Salivary gland cancer is a rare disease, and approximately 20% of tumors in the salivary glands are malignant. Reliable biomarkers may have a role in monitoring salivary gland cancer., Aim: To review the current literature on the role of biomarkers in liquid biopsies and saliva samples in the monitoring of salivary gland cancer., Materials and Method: This study systematically reviewed the literature on studies detecting salivary gland cancer by biomarkers in liquid biopsies and saliva samples by systematically searching PubMed and Embase between 1 January 2013 and 7 March 2023., Results: Five studies covering 64 malignant cases of salivary gland cancer were included, which considered inflammatory biomarkers or markers of genetic material in either blood or saliva. In saliva, there were demonstrated elevations of CA-19-9 in malignant cases, and elevations of miRNA in malignant and benign cases. In blood, there were demonstrated elevations of IL-33 in malignant and benign cases, elevations of ctDNA in malignant cases, and elevations of CTC in malignant cases., Conclusion and Significance: The studies indicate that there is potential in the detection method. The studies detecting genetic material by liquid biopsies showed the most promising results. At present, there is still progression to be made before the method can be implemented for diagnostic use.

Compared to Asian and Latin American populations, sinonasal NK- or T-cell lymphoma is rare in Europe. All patients with sinonasal NK- or T-cell lymphoma in Denmark from 1980 to 2017 were validated histologically, and the disease behavior and demographics were extracted from medical records and national registries. Prognostic factors associated with mortality were determined using survival statistics. We included 56 patients: 40 extranodal NK/T-cell lymphoma (nasal type) (ENKTCL) and 16 peripheral T-cell lymphoma (not otherwise specified) (PTCL). The median age was 66, and most patients were male (72%). The ENKTCL and PTCL 5-year overall survival was 48% and 50%, respectively; progression-free survival was 38% for both. With ENKTCL, stage and performance status increased mortality significantly (HR = 8.6; p  < 0.001 and HR = 4.23; p  = 0.04). In conclusion, disseminated disease had a dismal outcome and the onset of ENKTCL in this ethnically homogeneous European cohort was about a decade later than reported in Asian populations.

Background: Health care workers (HCW) at otorhinolaryngological departments have an increased risk of contracting COVID-19, due to aerosol-inducing diagnostic and surgical procedures in the airways. The ongoing exposure to physical and psychological stressors could impact the mental health of HCW., Aim/objective: To investigate the impact on mental health in an otorhinolaryngological department during the COVID-19 pandemic., Materials/method: Cross-sectional questionnaire study, assessing symptoms of depression (PHQ-9) and anxiety (GAD-10). Physicians, nurses, and secretaries were included at a tertiary department of otorhinolaryngology in the Capital Region of Denmark during the COVID-19 lockdown in spring 2020., Results: Positive screenings for stress reactions were found in 22% for depressive symptoms and 15.5% anxiety. 27% feared becoming infected, 47% feared infecting their families in relation to work. 27% felt others were distancing from them, and 38% isolated themselves from others because of their work. Women had an odds ratio of 9.18 (CI 1.49-179) for depressive stress reactions., Conclusion: HCW were primarily concerned with transmitting COVID-19 to their relatives. Secondarily, there was a concern about becoming infected despite feeling adequately protected by personal protective equipment. Women were at higher risk of more severe depressive symptoms when corrected for professions.

Background: Burkitt lymphoma rarely presents in head and neck (H&N) in Western countries., Aims/objectives: We aimed to characterise clinicopathological features of H&N Burkitt lymphoma in Denmark representing a non-endemic region., Material and Methods: Clinical records were reviewed for a nationwide cohort of patients diagnosed with H&N Burkitt lymphoma in Denmark between 1980 and 2018. The diagnosis was histologically validated., Results: Thirty-four patients with H&N Burkitt lymphoma (highest incidence in age group 0-9 years, male-to-female ratio 4.7:1) were included. Thirty-three lymphomas (97%) were extranodal. The tumour was visible at the clinical examination in 81% ( n  = 22) of the cases. The palatine tonsils were the most frequent location ( n  = 13, 38%) and 52% ( n  = 17) of the patients were diagnosed in advanced stage. Lymphoma was the tentative clinical diagnosis in 23% of the cases. The 5-year overall- and disease-specific survival was 78% and 81%, respectively., Conclusions: Due to the rarity of Burkitt lymphoma of the H&N, there is a high risk of clinical misdiagnosis. Our findings suggest which symptoms and clinical presentations to be aware of in the diagnostics work up that could lead to the diagnosis of Burkitt lymphoma.

Background: In 2013, transoral robotic surgery (TORS) was implemented as a protocolled treatment alternative to the traditional radiotherapy (RT) in Denmark for oropharyngeal squamous cell carcinoma (OPSCC). In 2017, we published our first prospective feasibility study, showing that TORS with concurrent neck dissection successfully achieved negative margins in 29 out of 30 patients (97%) with early-stage OPSCC., Aims/objectives: This follow-up study aims to evaluate the five-year overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS)., Methods: Retrospective follow-up study including 30 patients treated with TORS for early-stage OPSCC (T1-T2, N0-N1, M0, UICC 7th edition) from September 2014 to January 2016 at a single head and neck cancer centre in Denmark. The five-year OS, DSS and RFS, including a detailed analysis of the recurrences, were addressed., Results: The five-year OS, DSS and RFS was 90%, 93% and 87%, respectively. Median follow-up was 54.5 months. Four patients developed a recurrence, with one regional, one distant metastatic (M) and two locoregional recurrences. The median time to recurrence was 24 months (range 3-42 months)., Conclusions and Significance: This follow-up study demonstrates good five-year OS, DSS and RFS in a prospective cohort of patients undergoing TORS and neck dissection for early-stage OPSCC.

Background: Patients with HPV-positive (HPV+) oropharyngeal squamous cell carcinomas (OPSCCs) are known to have a better prognosis compared to patients with HPV-negative OPSCCs., Aims/objectives: To investigate the impact of specific HPV genotypes on survival in HPV + OPSCC., Material and Methods: A systematic search of PubMed and Embase for studies addressing the association between specific HPV genotypes and survival among patients with OPSCC was performed., Results: Six studies ( n  = 1385 patients) published between 2013 and 2017 were included. Five studies ( n  = 1290 patients) found a better survival among HPV16 cases compared to other high-risk (HR) HPV genotypes (HPV 33, 18, 35, 31, 39, 52, 59, 45, 56, 67, 29, and 58), of which three studies ( n  = 933 patients) reached significant results. Two of these studies reported a five-year overall survival (OS) of 64.6% and 71.4% in HPV16 OPSCCs vs. 45.6% and 57.1% in HR non-HPV16 OPSCCs ( p  = .001 and p  = .010, respectively), and the last study found a better OS among HPV16 cases with a hazard ratio (HR) of 0.35, 95%. CI [0.14;0.85], p  = .02., Conclusions: Our findings indicate a favorable prognosis among patients with HPV16 OPSCC compared with HR non-HPV16 OPSCC. These results may be important when designing future trials and in the planning of follow-up regimes.

Background: Shoulder pain and impairment are known complications to neck dissections (NDs) as part of the surgical management of head and neck cancer (HNC). The Neck Dissection Impairment Index (NDII) is a validated shoulder function-related quality-of-life instrument and an important patient reported outcome measure after head-neck surgery. The correct translation of questionnaires into other languages is important for both individual assessment of patients and future research., Aims: Translation of the NDII into Danish., Methods: The NDII was translated from English into Danish using forward and backward translational procedures. Pilot-testing was performed on the pre-final version of the translated questionnaire., Results: Pilot-testing found the translation easily comprehensible, but a few changes were made to improve language flow., Conclusions: NDII was successfully translated into Danish using forward and backward translations. Further validation on a larger scale is warranted., Significance: NDII is an important aid to identifying patients with impairments and optimize the aftercare following ND for HNC. Translation of validated questionnaires into other languages is important for future research and international comparison of surgery outcome.

Background: The maxillary swing approach was introduced three decades ago in the head and neck field providing optimal surgical exposure for tumors in the nasopharyngeal and/or the retromaxillary space., Objectives: To report the clinical experience, patient surgical morbidity and survival outcomes following the introduction of the maxillary swing approach in Denmark., Material and Methods: A retrospective study including patients who underwent the maxillary swing approach from January 2012 - January 2020. Baseline and perioperative data, pathology, postoperative morbidity and survival outcomes were registered., Results: Sixteen patients were included of which 15 had a malignant tumor with different histology, while one patient had a benign tumor. Most commonly reported short-term morbidity were trismus, cheek hypoesthesia, nasopalatal fistula, lacrimation and nasal stenosis (<3 months postoperatively) improving markedly at 12 months follow-up. For patients with malignant tumors, the 5-year overall survival and recurrence-free survival rates were 60% and 66.7%, respectively., Conclusions and Significance: The maxillary swing approach was safely implemented by a multidisciplinary team at a high-volume centralized head and neck cancer center in Denmark. The procedure may be considered for salvage surgery of recurrent nasopharyngeal carcinomas and selected malignant and benign tumors located in the nasopharynx and/or retromaxillary space inaccessible by other surgical modalities.

Background: With the rising incidence of oropharyngeal squamous cell cancer, there is a need to assess the burden of treatment., Aims/objectives: This study assessed 'days alive and out of hospital' (DAOH) in a cohort of patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with either transoral robotic surgery (TORS) or radiotherapy (RT)., Material and Methods: A prospective cohort study conducted between May 2017-June 2019. Primary outcome was DAOH in the first 30 days after treatment (DAOH 30 ). The secondary outcome was DAOH 180 ., Results: Forty-four patients were included, 31 treated with TORS and 13 with RT. Patients treated with TORS had a median DAOH 30 of 25 (IQR 22.8-26) including a required four-day postoperative stay- and a median DAOH 180 of 168 (IQR 163-171.3). In contrast, patients treated with RT had a median DAOH 30 of 30 (IQR 26-30) and a DAOH 180 of 143 days (IQR 135.5-149)., Conclusions and Significance: DAOH has not been examined in oropharyngeal cancer before. We found, patients overall spent 92.5% of the first 180 days alive and out of hospital. Patients treated with TORS had high DAOH 30 , which remained high in DAOH 180 , while patients treated with RT with reduced DAOH 30 , had reduced DAOH 180 calling for further large-scale studies.

Background: Most patients with cystic fibrosis have the risk of pathogenic bacteria being exchanged between their sinuses and lungs., Aims: A method for topical application of antibiotics where the antibiotics persist for a long period of time is needed., Material and Methods: Ten patients with cystic fibrosis and bacterial sinusitis were included. Autologous platelet rich fibrin was mixed with an antibiotic solution and sprayed onto the mucosa at the end of an endoscopic sinus surgery; Colistin, a Ciprofloxacin-Colistin combination or Tobramycin was used. The antibiotic concentration was measured in the sinonasal mucus four, seven and 13 days after surgery., Results: Nine patients had Pseudomonas aeruginosa in their nose/sinuses at the time of surgery; in eight of these P. aeruginosa was not detected by culture at the final visit. In the majority of the ten included patients the antibiotics were continuously released for more than 7 days. No severe side effects were seen., Conclusions: Autologous platelet rich fibrin co-delivered with antibiotics is a feasible method for topical antibiotic treatment in supplementary to sinus surgery., Significance: We expect that this treatment is successful for eradication of sinonasal bacterial infections in immunosuppressed patients suffering from recalcitrant sinus infections. The efficacy should be evaluated in randomized controlled trials.

Background: Days Alive and Out of Hospital (DAOH) has been validated as a suitable clinical trial outcome. It can be used as a proxy for surgical quality and reflects both procedure specific morbidity and mortality., Aims/objectives: We propose DAOH as a supplement to established patient-related and objective outcomes, since it adds information on health care burden. Two upcoming studies incorporating DAOH are planned and will report DAOH for patients undergoing transoral robotic surgery., Methods: Firstly, a multicentre national prospective cohort study investigating DAOH with a 1-year follow-up after TORS is planned. Secondly a retrospective study of DAOH with a 1-year follow-up period will be performed using our institute's, the largest TORS center in Scandinavia, transoral robotic surgery (TORS) database. The database consists of more than 250 patients with more than 300 procedures performed between 2013 and 2018., Conclusion and Significance: The planned studies of DAOH may, when applied to TORS, contribute to a better interpretation of post-treatment morbidity and provide a basis for further interventional studies to enhance recovery, perioperative optimization, and serve as a comparison tool between treatment modalities.

Background: The width of the surgical resection margin impacts recurrence and survival in oral cavity squamous cell carcinoma (OSCC). The most commonly used definition of a clear margin is one larger than 5 mm, although due to anatomical restrictions to e.g. bone or vessels, this size is not always feasible. Margins less than 5 mm affect postsurgical strategies and prognoses, and further knowledge of margins smaller than 5 mm is needed. Aims/objectives: We aimed to systematically review the literature on the impact of surgical resection margins less than 5 mm addressing recurrence and survival in OSCC. Methods/materials: A systematic literature search was performed in the PubMed and EMBASE databases identifying studies regardless of publication date that examined margin less than 5 mm, with or without a comparison to size of 5 mm or greater, in patients with OSCC. We assessed the impact on recurrence and survival. Results: We identified six studies ( n  = 1514 patients); all studies, investigated recurrence, and three ( n  = 768 patients) evaluated survival. The studies had noteworthy variability in, e.g. follow-up times, anatomical sublocations, T- and N-stage classifications, and outcome measures. Five studies ( n  = 1387 patients) reported that margins smaller than 5 mm would be safe and would not affect survival or recurrence negatively compared to their own data on larger margins. One study reported that a clear resection margin greater than five mm was necessary to ensure optimal outcomes. Conclusion/significance: The literature showed significant bias and risk issues. In five of the included studies with 1387 patients, we found in selected cases, where margins larger than 5 mm are not possible, a tendency regarding resection margins less than 5 mm to be sufficient for the surgical treatment of patients with primary OSCC. However, the data is insufficient to enable altered recommendations of resection margins in patients with primary OSCC.

Background: The incidence of oral cancer is approximately 300,000 patients annually. A cancer diagnosis and treatment affect both physical and mental issues., Objectives: The aim of this systematic review was to examine the development of depression in patients who have been treated for oral squamous cell carcinoma (OSCC)., Material and Methods: PubMed and EMBASE were systematically searched for studies addressing depression among patients treated for OSCC and published within the past ten years., Results: We identified three studies comprising 528 patients (range: 75-349), primarily men (66-83%), treated for OSCC from Europe and India. Tumour stage, treatment modality, and scales used to evaluate depressive symptoms varied in the studies. The European studies showed that 28% of the patients experienced depressive symptoms on the Hospital Anxiety and Depression Scale (HADS) and a mean of 8.0 on depression in the Brief Symptom Inventory (BSI). The Indian study showed a significant increase ( p Value < .001) from moderate to severe depressive symptoms on the Depression, Anxiety, and Stress Scale-21 (DASS-21). Conclusion and Significance: This systematic review showed that OSCC patients are at risk of developing depressive symptoms after treatment, though severity of symptoms varied. This knowledge could preferably be implemented in future follow-up regimes.

Background: An association between sexually transmitted diseases (STDs) and occurrence of head and neck cancer (HNC) is proposed. Aims/objectives: We aimed to determine the association between selected STDs (syphilis, gonorrhoea, HIV) and HNC. Materials and methods: Patients diagnosed with HNC in Denmark between 1978 and 2014 identified through the Danish Cancer Registry were included. Patients were age- and sex-matched in a 1:10 ratio with general population controls. Uni- and multivariate analyses were performed using the Cox regression model to assess the correlation between STD and HNC. Results: A total of 39,405 HNC patients (63% men; 63.0 years at HNC diagnosis) and 393,238 controls were included. STD in HNC patients was 0.27%, vs. 0.11% in controls. Patients with cancer of the upper airways had a significantly higher prevalence of an STD prior to the HNC compared to controls. Most HNC patients with a prior STD (64.1%) developed the HNC within five years after the STD diagnosis. Conclusions: Although the studied STDs are rare, patients with cancer of the upper aerodigestive tract more commonly had a previous diagnosis of STD compared to controls. The study promotes the hypothesis that a causal link exists between STD and HNC.

Background: The main indication for transoral robotic surgery (TORS) has been the primary treatment of oropharyngeal squamous cell carcinoma (OPSCC). In the western world this is highly relevant due to the increasing incidence of human papillomavirus (HPV)-positive OPSCC. In Denmark, TORS was implemented in 2013 for use in the protocolled primary treatment of OPSCC. Aims/objectives: To perform a year-by-year comparative analysis of indications for TORS, hospitalization and complication rates to identify optimal future indications for TORS. Methods and materials: This is a retrospective single-centre case review from 2013-2017. Data were collected from patient files through electronic health care systems. Results: Since 2013, there has been a change of indications from performing benign and salvage surgery to mainly primary treatment of OPSCC and diagnostic use in patients with cancer of unknown primary (CUP). The overall complication rates have reduced considerably over time. Conclusions and significance: Lower complication rates may be explained by improved surgical experience, through better patient selection and changes in indications for TORS. Future applications of TORS will be in the management of CUP and as part of a Danish national randomized clinical trial aiming to compare long-term functional outcomes after treatment of early-stage OPSCC with TORS versus radiation treatment.

Background: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been rising in the Western world in recent years. Human papillomavirus (HPV) infection is established as the main explanation. Aims/objectives: This study aims to review the most recently published studies on the repartition of HPV-positive OPSCC in Europe. Method and material: PubMed and Embase were systematically searched for articles addressing the distribution of HPV-positive and HPV-negative cases among OPSCC patients in Europe. Articles published in the period 2014-2018, with a study period including 2013 and the following years were included. The presence of HPV DNA and p16 overexpression, either solely or together, were accepted as indicators of HPV-positivity. Information on the anatomical sublocation of the tumour, definition of HPV-status, HPV type, HPV status, age, sex, TNM-stage, smoking habits and alcohol consumption were extracted. Results: Seven articles ( n  = 2075 patients, range: 22-926 patients per study) from seven European countries were included. The repartition of HPV-positivity ranged from 18% to 65%. The lowest occurrence of HPV-positivity was seen in Greece and the Netherlands, and the highest in Sweden and Denmark. Conclusion/significance: The highest share of HPV-positive patients with up to 65% was found in Nordic countries. The lowest share was found in Central and Southern European countries.

Background/objectives: The intraorbital contents are thought to be affected by oedema in the days following a blowout fracture. We posit that this oedema can be detected by Magnetic resonance imaging (MRI) as changes in muscle volume, in muscle cross-sectional area, and in the MRI parameter 'mean grey value' (MGV) of the orbital fat and extraocular muscles (EOMs). Materials and methods: Patients with a blowout fracture underwent an MRI scan within 72 h after the trauma and again after 10-14 days. Measurements of EOMS and fat tissue on the fractured orbit were compared to the unfractured orbit. Results: Eighteen patients were included. Measurements showed significantly larger volume, cross-sectional area and MGV of the EOM closest to the fracture compared to the same muscle in the unfractured orbit. This significance disappeared for some parameters on the second scan. The volume of herniated orbital contents was significantly smaller on the second scan than on the first. Conclusions and significance: Based on the first longitudinal MRI study on patients with blowout fractures, our results indicate post-traumatic oedema in the intraorbital soft tissue which subsides between scans. A watchful waiting period is recommended in the initial post-traumatic days in patients without muscle entrapment.

Objective: To examine pain after Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) versus traditional bilateral tonsillectomy in adults., Methods: Pain evolvement was assessed in a prospective case-control design of 16 consecutive patients treated with TORS for early stage OPSCC versus 12 patients, who underwent bilateral tonsillectomy on suspicion of malignant disease. The TORS group received an optimized analgesia regime of preoperative oral celecoxib and gabapentin, intra- and postoperative high-dose intravenous dexamethasone, and regular postoperative oral contalgin, gabapentin, celecoxib, paracetamol and rescue morphine. The tonsillectomy group received the departmental standard analgesia regime with low-dose preoperative oral dexamethasone, celecoxib and paracetamol. Postoperative regular analgesia consisted of oral NSAID and paracetamol with weak opioids prescribed as required. Pain intensity was recorded at rest and during swallowing twice a day., Results: The median pain intensity on postoperative day (POD) 1-4 was 2 in the TORS group versus 4.5 in the tonsillectomy group. From POD 5-10 median pain intensity was 3.5 and 4, respectively. The median length of stay was 5 days in the TORS group and less than 24 hours in the tonsillectomy group., Conclusion: With an optimized analgesia regime TORS for OPSCC can be performed with postoperative pain levels comparable to bilateral tonsillectomy in adults.

Objectives: Human papilloma virus (HPV) is known to be associated with oropharyngeal squamous cell carcinomas (OPSCC) and may potentially play a vital role in tumor metastasis. The purpose of this study was to correlate HPV status of cervical lymph node metastases with their respective primary OPSCC tumor., Methods: Formalin-fixed, paraffin-embedded (FFPE) tissue samples obtained from 34 patients with cervical lymph node metastases were analyzed with HPV 16 DNA polymerase chain reaction (PCR), p16 immunohistochemistry and HPV typing. The results were correlated with the HPV status and type found in the primary tumors of OPSCC., Results: Comparing HPV DNA status with p16 we found that 21 primary tumors and lymph node metastases were HPV positive (61.8%) and seven primary tumors and lymph node metastases were HPV negative (20.6%). Six patient samples differed when correlating the primary tumor and lymph node metastasis (17.6%)., Conclusions: In this study, HPV status in OPSCCs and their cervical lymph node metastases correlated in the vast majority of cases. However, HPV detection methods may have certain limitations resulting in varying degree of non-correlation. This should be taken into account when stratifying treatment in regard to HPV status.

Conclusions The recurrence rate of IP in the current study is comparable to international and national studies. When the primary tumour was located in the frontal or the sphenoid sinus, the tumour seemed more likely to recur. Some recurrences were more than 2 years after primary surgery, suggesting continued need for long-term follow-up. The rate of malignant transformation in inverted papilloma cases has not changed in Denmark. Objectives Inverted papillomas are benign tumours located in the nasal cavity and paranasal sinuses. They are known for their tendency to recur after surgery and show invasive growth, causing bone remodulation and the association with malignant transformation. The introduction of endoscopic sinus surgery and computer aided sinus surgery over the last decades has made this tumour more approachable with less cosmetic and functional damage. The objective of this study is to establish whether the recurrence rate and the rate of malignant transformation of IP have changed with the application of these new techniques. Method A retrospective study between 1998-2008 including 88 cases with inverted papilloma. Results In total, 25.3% had recurrence. Combined surgical approach with endoscope/open approach had the lowest rate of recurrence. A malignant transformation in the postoperative histological examination was found in 8.9%.

Conclusion: The sinuses should be considered as a bacterial reservoir and a target for surgery and antibiotic treatment in patients with primary ciliary dyskinesia (PCD). The observed decrease in serum precipitating antibodies (precipitins) against Pseudomonas aeruginosa may indicate a beneficial effect of combined endoscopic sinus surgery (ESS) and concomitant medical treatment., Objectives: The purpose of this research, which is the first study addressing bacteriology in the sinuses of patients with PCD, was to examine the association between sinus and lung infections., Methods: We reviewed findings of bacterial pathogens from the sinuses obtained during ESS and the lung infection status in eight PCD patients over a 6 year period. Precipitins against P. aeruginosa were used as a marker of severity of chronic infection and effect of treatment., Results: Preoperatively, seven of the eight patients (88%) exhibited intermittent or chronic pulmonary infection with P. aeruginosa. Sinus cultures were obtained during ESS in seven patients. The sinuses were colonized with P. aeruginosa in four of seven patients (57%). Bacterial sinusitis was found in five of seven patients (71%) and the same bacterium was found in the sinuses and lungs in all cases. Decreasing precipitins against P. aeruginosa were observed postoperatively in three of four evaluable patients.

Conclusion: The addition of transoral robotic surgery (TORS) in the diagnostic management of patients classified with head and neck squamous cell carcinoma of unknown primary (SCCUP) is promising and appears to improve detection rates of the primary tumour. The approach presented in this first Scandinavian study could potentially minimize the radiation field to the pharyngeal axis in patients with identified primary tumours., Objectives: The aim of the study was to investigate whether bilateral lingual tonsillectomy performed with TORS is feasible, and whether it could improve the detection rates of primary tumours in patients diagnosed and classified as having SCCUP., Methods: The study was retrospective and included 13 patients with SCCUP who were referred to TORS between October 2013 and January 2015. All 13 patients had previously undergone a full investigation programme following the national guidelines including whole-body PET/CT, examination in general anaesthesia, including random biopsies of the base of the tongue and bilateral palatine tonsillectomy without identification of the primary tumour., Results: The primary tumour was identified by TORS in seven of the 13 patients (54%) at the lingual tonsils. Human papillomavirus DNA and p16 were positive in all identified primary tumour specimens and in the corresponding lymph node metastases.

Background: Oropharyngeal squamous cell carcinoma (OPSCC) is associated with the sexually transmitted human papillomavirus (HPV), smoking and alcohol. In Greenland, a high rate of HPV-induced cervical cancer and venereal diseases are found, which exposes the population for high risk of HPV infection. In Greenland, only girls are included in the mandatory HPV vaccination program., Objective: To investigate the annual incidence of OPSCC and the proportion of HPV-associated OPSCC (HPV+ OPSCC) in Greenland in 1994-2010., Design: At Rigshospitalet, University of Copenhagen, we identified all Greenlandic patients diagnosed and treated for OPSCC from 1994 to 2010. Sections were cut from the patient's paraffin-embedded tissue blocks and investigated for p16 expression by immunohistochemistry. HPV analyses were performed with 2 sets of general HPV primers and 1 set of HPV16-specific primer. HPV+ OPSCC was defined as both >75% p16+ cells and PCR positive for HPV., Results: Of 26 Greenlandic patients diagnosed with OPSCC, 17 were males and 9 were females. The proportion of HPV+ OPSCC in the total study period was 22%, without significant changes in the population in Greenland. We found an increase in the proportion of HPV+ OPSCC from 14% in 1994-2001 to 25% in 2002-2010 (p=0.51). Among males from 20 to 27% (p=0.63) and in females from 0 to 20% (p=0.71). The annual OPSCC incidence increased from 2.3/100,000 (CI=1.2-4.2) in 1994-2001 to 3.8/100,000 (CI=2.4-6.2) in 2002-2010: among males from 2.4/100,000 (CI=1.0-5.7) to 5.0/100,000 (CI=2.9-8.9)., Conclusion: Even though the population is at high risk of HPV infection, the proportion of 22% HPV+ OPSCC in the total study period is low compared to Europe and the United States. This might be explained by our small study size and/or by ethnic, geographical, sexual and cultural differences. Continuing observations of the OPSCC incidence and the proportion of HPV+ OPSCC in Greenland are needed.

Conclusion: The total lymph node yield in neck dissection is highly variable and depends on anatomical, surgical and pathological parameters. A minimum yield of six lymph nodes for a selective neck dissection (SND) as recommended in guidelines lies in the lower range of the reported clinical nodal yields. A future application of a lymph node ratio may improve the risk stratification of head and neck cancer patients. However, this will require a higher number of retrieved lymph nodes., Objectives: To compare the clinical guideline recommendations for nodal yield in SND with the number of lymph nodes obtained from cadavers and the clinical nodal yield reported in the literature., Methods: Lymph nodes retrieved from SND specimens from nine fresh cadavers were quantified histopathologically. The literature on nodal yields reportedly obtained by clinicians performing neck dissections was reviewed. Finally, the discussion makes reference to the six lymph nodes currently recommended in international clinical guidelines., Results: For clinical SNDs (I-III) the lowest mean nodal yield was 19.4, for SNDs (II-IV) it was 26.4. The cadaver SNDs (I-III and II-IV) yielded 8.8 (range 1-15) and 10.4 nodes (range 1-19), respectively.

Conclusion: We consider sphenopalatine artery ligation to be a safe and effective treatment of posterior epistaxis as the long-term need for revision surgery and the complication rates are low. Surgery should be considered earlier in the treatment of posterior epistaxis., Objectives: Posterior epistaxis is common and surgical endoscopic ligation of the sphenopalatine arteries is indicated in severe cases. Knowledge about long-term effects and complications is sparse., Methods: Within 2001-2006, 78 patients underwent endonasal endoscopic-guided surgery for posterior epistaxis in one of the eight ENT clinics in Denmark treating these patients. In 2011, 45 patients were still alive and eligible for the study. Patients were contacted by telephone and invited to complete an interview questionnaire on late adverse affects and recurrence., Results: In all, 42 of 45 patients participated in the mean follow-up. The mean follow-up was 6.7 years: 90% of patients (n = 38) obtained an effect of the treatment during follow-up; 78% (n = 33) had no recurrent epistaxis, 12% (n = 5) had recurrent epistaxis but only needed non-surgical specialized treatment; 10% (n = 4) required revision surgery due to recurrent epistaxis within the 6.7 mean years of follow-up; and 26% of the patients had minor postoperative complications, permanent nasal crusting being most persistent and frequent.

Conclusion: In this study we found localized malignant lymphomas of the head and neck to be highly treatable and to have a significantly improved prognosis with recent treatment methods. The head and neck surgeon should keep in mind that the prognosis, especially for diffuse large B-cell lymphoma, has improved if the patient receives the optimal treatment., Objectives: The purpose of this study was to ascertain the current prognosis of localized malignant lymphoma of the head and neck given recent advancements in treatment and diagnostic features, as well as adding histological subtypes to the literature according to the 2001 classification., Methods: We present a retrospective study including a cohort of 100 consecutive patients who had localized malignant lymphoma within the head and neck region diagnosed at a single centre from 2000 to 2007., Results: The histology was revised according to the WHO classification and showed 58% with diffuse large B-cell lymphoma. The estimated 5-year overall survival rate was 83%, which should be seen in contrast to survival rates of 40-70% 25 years ago.

Conclusions: Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor in young males, with a non-negligible potential for recurrence. Preoperative embolization is a safe procedure that diminishes the peroperative blood loss and the need for blood transfusion. The endoscopic approach was used with good results in JNA stage I and II (Chandler)., Objectives: To estimate the incidence rate of JNA in the Danish population and to describe symptoms and treatment., Patients and Methods: This was a national retrospective cohort study. All cases of JNA diagnosed in Denmark from 1981 to 2003 were identified. Data were extracted from medical records., Results: Forty-five male (no female) JNA cases were identified. In 43 cases, clinical data were recovered. Median age was 15 years. The incidence rate in Denmark was 0.4 cases per million inhabitants per year and 3.7 cases per million males (aged 10-24) per year. All patients underwent surgery, and the endoscopic approach was increasingly being used. The embolization procedure proved to be safe and decreased the intraoperative blood loss statistically to 650 ml in the embolized group from an average of 1200 ml in the non-embolized group (p<0.05). Similarly, the need for peroperative blood transfusion was reduced (p<0.005). The primary recurrence rate was 23% and no patients died.

Conclusion: SPECT-CT may improve the localization of sentinel nodes (SNs) in patients with oral squamous cell carcinoma (OSCC). Compared with planar lymphoscintigraphy SPECT-CT detected more SNs and provided additional anatomical and spatial information about their localization. New generation SPECT with higher resolution CT scanners are expected to provide more accurate information about the localization of SNs., Objective: To assess the role of combined SPECT-CT in SN identification in the clinically negative neck of patients with OSCC., Materials and Methods: Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 34 consecutive patients with OSCC stage I and II (T1-2N0M0) prior to sentinel node biopsy (SNB) and selective neck dissection. The number of SNs and anatomical location was recorded according to lymphoscintigraphy and operative findings., Results: SNB was conducted in 33 patients. SNs were identified in 94% (32/34) of the patients using SPECT-CT. In 91% (29/32) of the patients SNs were harvested from all of the levels involved on SPECT-CT. SPECT-CT imaging demonstrated extra SNs compared with planar lymphoscintigraphic imaging in 47% (15/32) of patients. In seven cases the anatomical level of SN according to SPECT-CT was reclassified during surgery. The overall incidence of lymph node metastases was 19% (6/32). There were no false negative SNs.

Objective: A retrospective review of all diagnosed cases of esthesioneuroblastoma registered in Denmark between 1978 and 2000 was carried out in order to obtain epidemiological data and optimize national treatment guidelines., Material and Methods: Forty cases were verified histologically and included in the analysis Epidemiological and histopathological data were evaluated in relation to the clinical outcome., Results: The 40 cases represent an incidence rate of 0.4 cases/million inhabitants per year. Eight (20%) patients were classified as Kadish stage A, 13 (32.5%) as stage B and 19 (47.5%) as stage C. The histopathological findings were classified according to the grading system of Hyams The median follow-up time was 2.3 years (range 0.3-11.1 years). The 5-year crude survival rate was 61%, with a median survival of 3.1 years (range 0.3-19.2 years). The 5-year disease-free survival rate was 50%, with a median survival of 1.7 years (range 0-19.2 years). Only 3 (7%) patients had positive cervical lymph nodes at presentation. A nationwide consensus regarding treatment was seen in patients classified as Kadish stages A and B. The longest duration before the first recurrence of esthesioneuroblastoma was 5(1/2) years., Conclusions: The following therapeutic guidelines are suggested: Kadish stage A patients, surgical tumour resection and radiotherapy; Kadish stage B, surgical tumour resection and radiotherapy; Kadish stage C, surgical tumour resection via a craniofacial resection and radiotherapy combined with chemotherapy. Long-term follow-up of esthesioneuroblastoma patients is mandatory.