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Background: The scapula free flap is becoming increasingly more utilized in head and neck reconstruction due to its natural geometry and soft tissue versatility. This study reviews the incidence rate, risk factors, and treatments of complications of scapula donor site morbidity. Methods: A review was performed for articles published between October 1990 and November 2022 in Medline (OVID), PubMed, Web of Science, and CENTRAL. After screening, 24 articles meeting the criteria were included. Results: Overall, 660 head and neck surgeries with the scapula donor bone across 24 studies were included. Twenty studies of 612 scapula free flaps reported a pooled postoperative complication rate of 10.7%, with no major complications. Seven studies of 199 scapula reconstructions showed a mean Disability of Arm, Shoulder and Hand (DASH) score of 14.39/100. Conclusion: With its low rate of morbidity, the scapula flap presents itself as a good alternative for patients at risk for poor healing. [ABSTRACT FROM AUTHOR]

Background: This study compares patient‐reported functional and aesthetic outcomes of split‐thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flap (RFFF) donor site. Methods: Patients with RFFF (2015–2020) were retrospectively identified. Those willing to participate in patient‐reported outcomes (PRO) filled out Patient‐Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHOQ). Results: 198 patients met our inclusion criteria and 81 participated in PRO. There was a higher rate of tendon exposure in STSG versus hatchet flap (11 vs. 1, p = 0.0019), but a lower rate of skin necrosis (5 vs. 16, p = 0.0190) and epidermolysis (1 vs. 12, p = 0.0028). Scar quality in STSG was superior to hatchet flap in all domains of POSAS. MHOQ scores were similar between both groups with no statistical difference in overall scores (p = 0.2165). Conclusions: STSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure. Level of Evidence: 3 Laryngoscope, 134:4266–4273, 2024 [ABSTRACT FROM AUTHOR]

Background: Oncocytic thyroid carcinoma (OTC) was previously considered a variant of follicular thyroid carcinoma (FTC) but has recently been reclassified as a separate form of thyroid cancer. This study aimed to demonstrate that FTC and OTC are fundamentally distinct entities that can potentially be differentiated preoperatively through cytology and/or molecular testing. Methods: A retrospective chart review of patients diagnosed with FTC and OTC operated upon at two university health centers from January 2016 to September 2023 (n = 3219) was conducted. Molecular testing results were correlated with histopathologic diagnosis. Results: Fifty patients met the inclusion criteria. FTC was identified in 27 (54.0%) patients, and OTC in 23 (46.0%) patients. Patients with OTC were older (61.8 years) than FTC patients (51.2 years) (p = 0.013). Moreover, aggressive tumors were found in 39.1% (9/23) of OTCs compared to 11.1% (3/27) of FTCs (p = 0.021). Amongst Bethesda category III and IV nodules, 17 out of 20 (85.0%) OTC cytology reports demonstrated an oncocytic subtype compared to only 5 out of 24 FTC cytology reports (20.8%) (p = 0.002). On molecular testing, the EIF1AX alteration was exclusively present in OTCs while the PAX8/PPARy and PTEN alterations were exclusively found in FTCs. Copy number alterations (CNAs) were found to be more prevalent in OTC (66.7%) compared to FTC (33.3%), and they were not indicative of tumor aggressiveness. Within the OTC group, all three patients who had a TP53 alteration were diagnosed with aggressive cancer. Lastly, the OTCs exhibited a higher frequency of multiple alterations on molecular testing (66.7%) compared to FTCs (33.3%). Conclusion: To our knowledge, this is the largest study to date comparing the clinical application of abnormalities found on molecular testing for FTC and OTC. It further demonstrates the distinct clinicopathological and molecular characteristics of OTC. [ABSTRACT FROM AUTHOR]

We hereby present a rare case of laryngeal zoster presenting with unilateral odynophagia and hemifacial pain in an immunocompetent host. Visualization of the characteristic vesicles is challenging given their short-lived and at times delayed appearance; thus, laryngeal zoster may be a largely unrecognized cause of laryngitis and cranial neuropathies. Heightened awareness may improve prompt diagnosis, referral and initiation of antiviral therapy, while guiding patient counselling on the associated long-term sequelae such as voice and swallowing impairments, and post-herpetic neuralgia. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism is common postlaryngectomy and is associated with laryngectomy‐specific complications. The objective of this study is to determine the incidence and predictors of hypothyroidism postlaryngectomy and its associated complications. Methods: Systematic review, data extraction, and meta‐analyses were performed following the PRISMA protocol. Six databases were searched for studies reporting on postlaryngectomy thyroid status with incidence, risk factors, management, or complications. Results: Fifty‐one studies with 6333 patients were included. The pooled incidence of postlaryngectomy hypothyroidism is 49% (CI 42%–57%). Subgroup analysis showed postlaryngectomy hypothyroidism rates significantly correlated with hemithyroidectomy and radiotherapy. Patients who underwent laryngectomy, hemithyroidectomy, and radiotherapy had a 65% (CI 59%–71%) rate of hypothyroidism; laryngectomy and hemithyroidectomy 46% (CI 33%–60%); laryngectomy and radiotherapy 26% (CI 19%–35%); and laryngectomy alone 11% (CI 4%–27%) (p < 0.001). Conclusions: Laryngectomized patients with partial thyroidectomy or radiation therapy are at significant risk of postoperative hypothyroidism. Evidence‐based protocols for early detection and (prophylactic) treatment should be established. [ABSTRACT FROM AUTHOR]

Background: Endoscopic percutaneous tracheostomy (PT) is a safe technique that is performed frequently by otolaryngologists and intensivists. New challenges have been identified in order to maintain the safety of this procedure during the COVID-19 pandemic. A novel approach, using a modified demistifier canopy, was developed during the first wave of the pandemic and implemented for 17 consecutive percutaneous tracheostomies in order to enhance procedural safety. Methods: A protocol was developed after performing a literature review of tracheostomy in COVID-19 patients. A multidisciplinary tracheostomy team was established, including the departments of otolaryngology, critical care, and respiratory therapy. Simulation was performed prior to each PT, and postoperative debriefings were done. Results: A protocol and technical description of PT using a modified demistifier canopy covering was written and video documented. Data were collected on 17 patients who underwent this procedure safely in our tertiary care hospital. There were no procedure-related complications, and no evidence of COVID-19 transmission to any member of the health care team during the study period. Conclusion: As patients continue to recover from COVID-19, their need for tracheostomy will increase. The technique described provides a safe, multidisciplinary method of performing PT in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Objective: To examine various factors associated with an increased risk of reoperation for persistent or recurrent malignant thyroid cancers. Study Design: Retrospective cohort study. Setting: Tertiary academic hospital centers. Methods: Patients undergoing surgery for thyroid cancer at 2 tertiary academic institutions from 2006 to 2020 were included. Those who underwent a reoperative procedure were compared with patients only requiring 1 procedure. The Pearson chi‐square and independent t test were used to compare group data accordingly. Furthermore, a binomial logistic regression was performed, while machine learning models were used to construct a predictive algorithm. Results: This study included 2266 patients with surgically managed thyroid malignancy, of which 54 (2.4%) necessitated reoperations. Those requiring a second surgical procedure were more likely to be male (40.7% vs 20.9%, P <.001), undergo bilateral (24.1% vs 3.3%, P <.001) and lateral (16.7% vs 1.8%, P <.001) neck dissections, and have a greater number of metastatic lymph nodes (mean, 9.1 vs 3.5; P <.001) and a larger tumor size (mean, 3.0 vs 2.0 cm; P <.001). According to the binomial logistic regression model, lateral neck dissection, greater number of metastatic lymph nodes, and larger tumor size significantly increased the odds of necessitating a second procedure by 7.8 (95% CI, 2.523‐24.083), 1.1 (95% CI, 1.032‐1.152), and 1.3 (95% CI, 1.064‐1.559), respectively. Last, machine learning models could not significantly predict the occurrence of reoperation. Conclusion: This study identified patient‐ and cancer‐related characteristics associated with an increased risk of requiring reoperation for thyroid malignancies. [ABSTRACT FROM AUTHOR]

Objective: Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. Methods: As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. Results: Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P <.001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. Discussion: Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. Implications for Practice: This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion. [ABSTRACT FROM AUTHOR]

Tracheostomy is one of the most commonly performed surgical procedures, particularly in adult, intubated, and critically ill patients. This review summarizes the available data as of 2022 concerning the effectiveness and safety of percutaneous tracheostomy compared to open surgical tracheostomy and their associated complications. [Extracted from the article]

Objective: Information technologies may enhance our traditional perioperative teaching by providing more comprehensive information beyond the clinical visit. This quality improvement study aims to assess whether the implementation of an animated surgical video improves caregiver satisfaction for children undergoing adenotonsillectomy., Study Design: Prospective, single-blinded randomized-controlled trial was conducted between March 1 and October 1, 2023., Setting: Tertiary care academic pediatric hospital., Methods: A consecutive series of patients and their primary caregivers were randomly allocated to either the control arm, in which they received traditional patient education, or the intervention arm, additionally gaining access to the multimedia platform summarizing the surgical pathway for an adenotonsillectomy. Outcomes included caregiver satisfaction using the Care Transitions Measures (CTM-15) questionnaire, resource utilization, and qualitative feedback analysis., Results: A total of 100 patients (50 in each arm) completed the postintervention questionnaires (mean age 5.2 ± 3.0 years, female:male: 9:10) after undergoing an adenoidectomy (N = 28), tonsillectomy (N = 3), or both (N = 69). CTM-15 scores were high in both groups, with no observed difference between the intervention and control groups 85.82 ± $\pm $ 12.91 versus 85.41 ± $\pm $ 16.21, respectively, P = .89). Unplanned postoperative visits were comparable between groups, however, caregivers in the intervention arm were less likely to call a medical professional on more than 1 occasion postoperatively (16% vs 2%, P = .042). Most caregivers within the intervention arm agreed that the animated platform was interesting (94%) and useful (98%)., Conclusion: Animated surgical guides are an alluring complementary modality to standard clinician-led teaching and may help reduce perioperative resource utilization., (© 2025 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Importance: Obesity has traditionally been described as a relative contraindication to percutaneous dilatational tracheostomy (PDT). Increased familiarity with the technique and use of bronchoscopy or real-time ultrasonography to enhance visualization have led many practitioners to expand the indication for PDT to patients historically deemed to have high risk of perioperative complications., Objective: To assess the reported complication rate of PDT in critically ill adults with obesity and compare it with that of open surgical tracheostomies (OSTs) in this patient population and with that of PDT in their counterparts without obesity., Data Sources: In this systematic review and meta-analysis, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to March 1, 2022. Key terms related to percutaneous tracheostomy and obesity were included., Study Selection: Original investigations of critically ill adult patients (age ≥18 years) with obesity who underwent PDT that reported at least 1 complication of interest were included. Case reports or series with fewer than 5 patients were excluded, as were studies in a language other than English or French., Data Extraction and Synthesis: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were used, with independent extraction by multiple observers. Frequencies were reported for all dichotomous variables. Relative risks for complications were calculated using both fixed-effects and random-effects models in the meta-analysis., Main Outcomes and Measures: Main outcomes included mortality directly associated with the procedure, conversion to OST, and complications associated with the procedure (subclassified into life-threatening or non-life-threatening adverse events)., Results: Eighteen studies were included in the systematic review, comprising 1355 patients with obesity who underwent PDT. The PDT-related complication rate was 16.6% among patients with obesity overall (791 patients, 17 studies), most of which were non-life-threatening. Only 0.6% of cases (8 of 1314 patients, 17 studies) were aborted or converted to an OST. A meta-analysis of 12 studies (N = 4212; 1078 with obesity and 3134 without obesity) showed that patients with obesity had a higher rate of complications associated with PDT compared with their counterparts without obesity (risk ratio, 1.78; 95% CI, 1.38-2.28). A single study compared PDT with OST directly for critically ill adults with obesity; thus, the intended meta-analysis could not be performed in this subgroup., Conclusions and Relevance: The findings suggest that the rate of complications of PDT is low in critically ill individuals with obesity, although the risk of complications may be higher than in individuals without obesity.