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Background: Advances in technology have enabled neck dissection techniques that reduce aesthetic impact while maintaining oncological safety. This study compares perioperative outcomes between robotic neck dissection via retroauricular/modified facelift incision (RNDRM) and conventional neck dissection via anterolateral cervical incision (CND)., Methods: Studies were selected from PubMed, Embase, and Cochrane Library. Data from studies comparing RNDRM and CND were extracted and analyzed using a random-effects model., Results: The meta-analysis included eight studies with 421 cases. The RNDRM group had a longer operative time (mean difference [MD], 69.11; 95 % confidence interval [CI] 37.92 to 100.30) and higher cosmetic satisfaction (MD, 2.03; 95 % CI, 1.48 to 2.57), along with a higher risk of marginal mandibular nerve injury (risk difference [RD], 0.08; 95 % CI 0.01 to 0.15). No significant differences were found in operative blood loss (MD, 15.35; 95 % CI - 7.39 to 38.10), days of drain placement (MD, 0.49; 95 % CI, -0.02 to 1.00), drainage volume (MD, 15.29; 95 % CI, -45.22 to 75.79), overall lymph node yield (MD, -1.09; 95 % CI, -3.18 to 1.00), positive lymph node yield (MD, -0.61; 95 % CI, -2.20 to 0.98), length of hospital stay (MD, 1.07; 95 % CI -0.06 to 2.20), or regional recurrence (RD, 0.00; 95 % CI -0.05 to 0.05), with similar rates of other complications., Conclusion: RNDRM offers better cosmetic outcomes but requires longer operative time and has a higher risk of marginal mandibular nerve injury than CND. It may be an alternative for selected patients, with surgery choice needing discussion between patient and surgeon., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Radiotherapy (RT) has numerous effects on the oral mucosa, primarily genetic alterations and changes in the microenvironment. The characteristics of oral leukoplakia (OL) may differ between patients who have received previous head and neck cancer (HNC) treatment with radiation therapy and those who have not. Due to a lack of data on this scenario, we aimed to investigate the surgical outcomes of OL by comparing these two patient groups., Methods: This retrospective cohort study enrolled a total of 224 OL lesions in 124 patients who underwent carbon dioxide laser (CO 2 laser) surgery from July 2002 to Aug 2021. All patients had received previous treatments for HNC, with 59 patients undergoing only surgical approach, 65 patients undergoing RT, and 46 patients undergoing concurrent chemotherapy during RT. The analysis was performed on a per-lesion basis, not a per-capita basis. We investigated the associations of clinicopathological characteristics and treatment outcomes of OL lesions that developed from irradiated or nonirradiated oral mucosa., Results: The median follow-up time was 5.87 years. Postoperative recurrence of OL occurred in 30 patients. Malignant transformation occurred in 17 patients with the incidence rate 4.19% annually and 13.7% cumulatively. The average time for OL transforming into squamous cell carcinoma was 3.27 ± 3.26 years (median 1.82, range 0.11 - 11.90). In univariate analysis, non-homogeneous morphology (P = 0.042), moderate to high-grade dysplasia (P = 0.041), and nonirradiated oral mucosa (P = 0.0047) were predictors for malignant transformation. However, in the Cox proportional hazard model, only nonirradiated oral mucosa remained an independent prognostic factor related to postoperative malignant transformation of OL (P = 0.031, HR 5.08, CI95 1.16 - 22.25)., Conclusion: In the population whose OL is strongly aetiologically linked to environmental carcinogens such as betel nut and tobacco, OL lesions that develop on previously irradiated oral mucosa have a lower risk for postoperative malignant transformation compared to those that develop on nonirradiated mucosa. This finding highlights the potential impacts of radiation on OL. Further research is needed to confirm this observation and elucidate the underlying mechanism., (© 2024. The Author(s).)

Surgical removal is the treatment of choice for second branchial cleft cysts (SBCCs), which are congenital anomalies. The conventional procedure is performed through a transcervical approach, which would lead to a visible scar in the anterior neck. Conversely, the postauricular approach could keep the scar in the hairline or retroauricular sulcus, rendering it almost invisible after the surgery. The purpose of this meta-analysis was to evaluate the differences between the postauricular and conventional transcervical approaches to SBCC excision. A systematic review was performed using PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes of SBCC surgery via postauricular and conventional transcervical approaches. The data of interest were analyzed with Comprehensive Meta-Analysis software (version 3). The data of interest were analyzed by calculating the risk difference (RD), the standardized mean difference, and the mean difference (MD) with the 95% confidence interval (CI). Three studies were eligible for the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher with the postauricular approach (standardized mean difference, 2.12; 95% CI, 0.68-3.56). The operative duration was significantly longer with the postauricular approach than with the conventional transcervical approach (MD, 12.81; 95% CI, 2.39-23.23). The incidences of postoperative marginal mandibular nerve palsy (RD, 0.00; 95% CI, -0.09 to 0.09), bleeding complications (RD, -0.02; 95% CI, -0.09 to 0.05), salivary complications (RD, -0.00; 95% CI, -0.07 to 0.06), cyst size (MD, 0.02; 95% CI, -0.96-0.99), and length of hospital stay (MD, -2.50; CI, -7.30 to 2.30) were comparable between the 2 groups. The postauricular approach is feasible for use in SBCC excision and yields better cosmetic outcomes, a longer operative duration, and a similar rate of complications., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Background: Neck dissection is an integral component of the treatment of head and neck cancers. The present meta-analysis aimed to compare the use of endoscope-assisted neck dissection (END) with conventional neck dissection (CND) in the existing English literature., Methods: A search of PubMed (MEDLINE), Embase, and the Cochrane Library for articles reporting the results of the two techniques of neck dissection was completed independently by two individuals. The authors analyzed the data from each study using a random-effects model., Results: The pooled analysis demonstrated comparable lymph node yield, intraoperative blood loss, incidence of locoregional recurrence, and incidence of complications between the two groups. A significantly longer operative time but a shorter length of hospital stay was observed in the END group compared with the other group., Conclusions: Compared with conventional techniques, END offers similar oncologic outcomes and complication rates; however, it requires a longer operative time. Future studies with long-term follow-up and assessment of patient satisfaction are needed to confirm the clinical use of END., (© 2022. The Author(s).)

Background: The purpose of this study was to evaluate the impact of the pretreatment Glasgow prognostic score on treatment-related toxicities, tolerance, and survival in patients with advanced head and neck cancers undergoing concurrent chemoradiotherapy (CRT)., Methods: We retrospectively analyzed and compared the clinical characteristics, toxicities, and survival of 143 patients with stages III, IVA, and IVB head and neck cancer treated with concurrent CRT according to their Glasgow prognostic score between 2007 and 2010., Results: The Glasgow prognostic score was correlated with advanced tumor stage and T/N classification. Patients with a higher Glasgow prognostic score were less likely to tolerate concurrent CRT, experienced more weight loss, required tube feeding support more frequently, and had higher percentage of grade ≥3 hematological toxicities, sepsis, and toxic death. Patients with a Glasgow prognostic score of 0 had better overall and recurrence-free survival than those with a Glasgow prognostic score of 1 or 2., Conclusion: Pretreatment Glasgow prognostic score predicts treatment tolerance, toxicity, and survival in patients with advanced head and neck cancer undergoing concurrent CRT., (© 2017 Wiley Periodicals, Inc.)

Background: The purpose of this study was to evaluate the impact of metformin on toxicities and survival in patients with head and neck cancer undergoing concurrent chemoradiotherapy (CRT)., Methods: We retrospectively analyzed and compared the clinical characteristics, treatment tolerance, toxicities, and survival of 252 patients with stages III, IVA, and IVB head and neck cancer undergoing concurrent CRT with and without metformin treatment between 2007 and 2010., Results: Among all patients, 39 patients received metformin whereas 219 patients did not. Both groups had similar clinical characteristics and nearly identical disease-free survival and overall survival. However, the metformin group was less likely to tolerate cisplatin, experienced more weight loss, had a tendency to receive lower doses of radiotherapy, required more feeding tube support, and had grade ≥3 nausea/vomiting and hematological toxicities., Conclusion: Patients with head and neck cancer undergoing concurrent CRT along with metformin treatment require more careful multidisciplinary assessment and supportive care to ensure successful completion of treatment and avoid treatment-related toxicities., (© 2017 Wiley Periodicals, Inc.)

Even with multidisciplinary treatment, the prognosis and quality of life of patients diagnosed with head and neck squamous cell carcinoma (HNSCC) are still not satisfactory. Previously, 19-Nor-2α-(3-hydroxypropyl)-1α,25(OH)2D3 (MART-10), the new brand 1α,25(OH)2D3 analog, has been demonstrated to be an effective drug to inhibit HNSCC growth in vitro. Since most cancer patients die of metastasis, in this study, the antimetastatic effect of MART-10 on HNSCC was investigated. Our results reveal that both 1α,25(OH)2D3 and MART-10 effectively repressed the migration and invasion of HNSCC cells, with MART-10 being much more potent than 1α,25(OH)2D3. The antimetastatic effect of 1α,25(OH)2D3 and MART-10 was mediated by attenuation of epithelial-mesenchymal transition (EMT), which was supported by the finding that the expression of EMT-inducing transcriptional factors, Sail and Twist, was inhibited by 1α,25(OH)2D3 and MART-10. The upregulation of E-cadherin and downregulation of N-cadherin in FaDu cells induced by both drugs further confirmed the repression of EMT. In addition, 1α,25(OH)2D3 and MART-10 treatment inhibited intracellular MMP-9 expression and extracellular MMP activity in FaDu cells. Collectively, our results suggest that the less-calcemia 1α,25(OH)2D3 analog, MART-10, is a promising drug for HNSCC treatment. Further clinical studies are warranted.

Aim: To evaluate treatment tolerance, toxicities and survival in elderly patients with advanced head and neck cancer who received inpatient-based intensive nutritional support with concurrent chemoradiotherapy in comparison with younger patients undergoing the same treatment., Methods: We retrospectively analyzed the records of 126 stage III, IVA and IVB head and neck cancer patients who were treated with concurrent chemoradiotherapy between 2007 and 2009 under an inpatient-based nutritional support program. The clinical characteristics, treatment tolerance, toxicities and survival of patients older than 65 years were compared with those of identically treated patients younger than 65 years., Results: There were 21 patients older than 65 years and 105 patients younger than 65 years. Clinical characteristics and treatment toxicities were similar between the groups, except that the elderly were less likely to tolerate cisplatin, experienced more weight loss, required more feeding tube support and tended to have >grade 3 hematological toxicities and to develop sepsis during the period of chemoradiotherapy. The 1- and 2-year disease-free survival and disease-specific survival rates were nearly identical., Conclusion: Age alone should not be considered a contraindication to aggressive chemoradiotherapy for advanced head and neck cancer. Older patients require more careful multidisciplinary assessment of their supportive care needs to ensure successful completion of treatment and avoid further treatment-related toxicity., (© 2014 Wiley Publishing Asia Pty Ltd.)

Unexpected fatal events in patients with head and neck cancers undergoing concurrent chemoradiation therapy are a clinical concern. Malnutrition, which is reported frequently in head and neck cancer patients, are associated with immunity derangement. The purpose of this study was to identify risk factors for early death of patients undergoing chemoradiation. We retrospectively analyzed the records of 194 stage III, IVA, and IVB head and neck cancer patients who were treated with chemoradiation between 2007 and 2009. We defined early death as death while receiving chemoradiation or within 60 days of treatment completion. Risk factors for early death were tested using univariate and multivariate analyses. Fourteen patients (7.2 %) experienced early death, 78.6 % of whom died of infection. Univariate analysis revealed significant correlations between early death and several pretreatment variables, including Eastern Cooperative Oncology Group performance status (PS) >1, hemoglobin <10 g/dL, albumin <3 g/dL, body mass index (BMI) <19 kg/m(2), and peripheral blood total lymphocyte count <700/μL. Multivariate analysis showed that PS >1, BMI <19 kg/m(2), and peripheral blood total lymphocyte count <700/μL were independent variables associated with early death. Poor performance status and malnutrition before chemoradiation independently predict early death in locally advanced head and neck cancer patients undergoing chemoradiation. Cautious management of head and neck cancer patients with these risk factors is required throughout chemoradiation period.