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Objectives: Tracheostomy in the setting of head and neck cancer may be performed either electively for prophylactic airway protection in an ablative procedure, or as an emergency due to impending airway obstruction in the setting of an obstructing upper aerodigestive tract malignancy. Tracheostomy care has biopsychosocial implications, which may require a higher level of care from carers, post-acute care, or placement into care facilities. Existing database studies have largely excluded patients with a history of head and neck cancer. This study aims to examine and compare discharge destinations for head and neck cancer patients requiring either elective or emergency surgical tracheostomies., Methods: Retrospective cohort study (January 2010-December 2019) of adult head and neck cancer patients undergoing surgical tracheostomy in a tertiary Australian hospital network. Primary outcome was discharge destination. Secondary outcomes were mortality, morbidity, and decannulation timing., Results: Of 188 patients (47 emergency, 141 elective), 83.0 % returned to their pre-morbid accommodation, either directly home (54.6 %), or with additional community-based services (27.7 %). There was a significant difference in post-discharge destination (p = 0.012). Emergency patients were less likely to return home compared to elective patients (OR 0.76, 95 % CI 0.32-1.79), and more likely to require additional supports on discharge(67.6 %) compared to elective(41.9 %) patients. However, these outcomes did not demonstrate statistical significance. Emergency tracheostomy patients were at higher risk of permanent tracheostomy, unplanned readmission within 30 days, and longer time to successful decannulation., Conclusion: Emergency tracheostomy patients are likely to return to their pre-morbid place of residence but may require additional support., Competing Interests: Declaration of competing interest There were no conflicts of interest declared for this study., (Copyright © 2024. Published by Elsevier B.V.)

Background: Utilization of positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose is increasing in use for a variety of indications, including surveillance of cancer patients. There is a paucity of evidence pertaining to the significance of incidental PET-avid oropharyngeal lesions. This study aims to examine the clinical and radiological features of these incidental oropharyngeal lesions in patients undergoing PET for indications other than head and neck cancer., Methods: Retrospective cohort study of three Australian tertiary hospitals, from 2015 to 2021, on adult patients undergoing biopsy of incidental PET-avid oropharyngeal lesions. Primary outcome of interest was the incidence of malignancy. Patients with a previous history of, or undergoing investigations for, head and neck cancer were excluded., Results: Thirty-one patients were included, wherein 21 patients had tonsillar uptake, and 13 patients had base of tongue uptake. Tonsillar disease was mostly asymmetrical (n = 15/21), bilateral (n = 11/21), and had median SUV max 9.35 (n = 12, IQR 7.4-11.15). Base of tongue was mostly asymmetrical (n = 7/13, 54%), bilateral (n = 8/13, 62%), and had median SUV max 8.2 (n = 10, IQR 6.9-12.65). Seven patients had malignancy confirmed on tissue biopsy: five biopsies confirmed the tissue diagnosis of suspected lymphoma, and two incidental findings of unexpected malignancies: one p16 positive tonsillar squamous cell carcinoma, and one metastatic breast cancer., Conclusion: In 31 patients undergoing tissue biopsy for incidental PET-avid oropharyngeal lesions, there were two unexpected malignancies. Our study results indicate that although unexpected malignancies are uncommon, a malignant diagnosis cannot be excluded from clinical features alone., (© 2023 Royal Australasian College of Surgeons.)

Background: Management of the node-negative neck in oral maxillary squamous cell carcinoma (SCC), encompassing the hard palate and upper alveolar subsites of the oral cavity, is controversial, with no clear international consensus or recommendation regarding elective neck dissection in the absence of cervical metastases., Aim: To assess the occult metastatic rate in patients with clinically node negative oral maxillary SCC; both as an overall metastatic rate, and a comparison of patients managed with an elective neck dissection at index surgery, compared to excision of the primary with clinical observation of the neck., Methods and Results: A systematic review was performed by two independent investigators for studies relating to oral maxillary SCC and analysed according to PRISMA criteria. Data were extracted from Pubmed, Ovid MEDLINE, EMBASE, and SCOPUS via relevant MeSH terms. Grey literature was searched through Google Scholar and OpenGrey. Five hundred and fifty-three articles were identified on the initial search, 483 unique articles underwent screening against eligibility criteria, and 29 studies were identified for final data extraction. Incidence of occult metastases in patients with clinically node negative oral maxillary SCC was identified either on primary elective neck dissection or on routine follow up. Meta-analyses were performed. Of 553 relevant articles identified on initial search, 29 were included for analysis. The pooled overall rate of occult metastases in patients initially presenting with clinically node-negative disease was 22.2%. There is a statistically significant effect of END on decreasing regional recurrence demonstrated in this study (RR 0.36, 95% CI 0.24, 0.59)., Conclusion: The results of this systematic review and meta-analysis suggest elective neck dissection for patients presenting with hard palate or upper alveolar SCC, even in a clinically node negative neck., (© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.)