Geometric Study and Clinical Case Series for Mandible Reconstruction With a Single-Piece Scapular Free Flap.

Background: Virtual surgical planning (VSP) with simple cutting templates could help surgeons preoperatively plan scapula reconstructions in the vertical and horizontal orientations.

Methods: Virtually, eight defects were created in ten healthy mandibles and reconstructed with the subject-specific scapula vertically and horizontally. In the clinical series, 15 single-piece scapula mandible reconstructions planned with in-house VSP and guided with simple templates were compared with 15 freehand reconstructions.

Towards transcervical ultrasound-guided transoral robotic surgery.

Background: In the context of transoral robotic surgery (TORS) for oropharyngeal squamous carcinoma (OPSCC), preoperative imaging and intraoperative visualization plays a pivotal role in optimizing resection margins. Prior work has demonstrated the ability of transoral ultrasound (US) in identifying OPSCC margins and vascular structures. This study evaluates the effectiveness of transcervical ultrasound (TUS), as well as other preoperative imaging modalities, in evaluating OPSCC volumes and compares this to post TORS pathological OPSCC volumes.

Cost Outcomes of Virtual Surgical Planning in Head and Neck Reconstruction: A Systematic Review.

Background: Virtual surgical planning (VSP) is an emerging method in head and neck reconstruction with demonstrated benefits, however, its economic viability is supported with mixed evidence.

Methods: A structured search was performed in five electronic databases. Studies that performed an economic evaluation on VSP in head and neck reconstruction were included.

Predictors of Gastrostomy Tube Placement in Head and Neck Cancer Patients Undergoing Radiation or Chemoradiotherapy: A Systematic Review.

Background: Malnutrition is a major problem in head and neck cancer (HNC) with up to half of patients requiring gastrostomy tube (G-tube) placement. Predicting this need remains complex given mixed evidence surrounding its usage.

Methods: A comprehensive search was performed to identify studies examining risk factors associated with G-tube placement following radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in HNC patients.

Intraoperative Real-Time Image-Guided Fibular Harvest and Mandibular Reconstruction: A Feasibility Study on Cadaveric Specimens.

Background: This study assesses the feasibility of real-time surgical navigation to plan and guide sequential steps during mandible reconstruction on a series of cadaveric specimens.

Methods: An image-guided surgical (IGS) system was designed including customized mandible and fibula fixation devices with navigation reference frames and an accompanied image-guided software. The mandibular and fibular segmental osteotomies were performed using the IGS in all five cadaveric patients.

Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Final Results of the ORATOR Randomized Trial.

Radiotherapy (RT) and transoral robotic surgery (TORS) are both curative-intent treatment options for oropharyngeal squamous cell carcinoma (OPSCC). Herein, we report the final outcomes of the ORATOR trial comparing these modalities, 5 years after enrollment completion. We randomly assigned 68 patients with T1-2N0-2 OPSCC to RT (with chemotherapy if node-positive) versus TORS plus neck dissection (± adjuvant RT/chemoradiation).

Abnormal p53 Immunohistochemical Patterns Are Associated with Regional Lymph Node Metastasis in Oral Cavity Squamous Cell Carcinoma at Time of Surgery.

Most (60%-80%) of the oral cavity invasive squamous cell carcinoma (OSCC) demonstrate molecular alterations in TP53. The presence of TP53 mutations in multiple organ systems has been associated with a more aggressive clinical course. This study aimed to classify OSCC into p53 wild-type OSCC and p53-abnormal OSCC using p53 immunohistochemistry and to determine if abnormal p53 status correlates with a higher risk of lymph node metastasis at the time of surgery.

Predicting Tracheostomy Need on Admission to the Intensive Care Unit-A Multicenter Machine Learning Analysis.

Objective: It is difficult to predict which mechanically ventilated patients will ultimately require a tracheostomy which further predisposes them to unnecessary spontaneous breathing trials, additional time on the ventilator, increased costs, and further ventilation-related complications such as subglottic stenosis. In this study, we aimed to develop a machine learning tool to predict which patients need a tracheostomy at the onset of admission to the intensive care unit (ICU).

Study Design: Retrospective Cohort Study.

Donor site morbidity after scapula free flap surgery of head and neck reconstruction: A systematic review and meta-analysis.

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.

Enabling extracorporeal ultrasound imaging with the da Vinci robot for transoral robotic surgery: a feasibility study.

Purpose: Transoral robotic surgery (TORS) is a challenging procedure due to its small workspace and complex anatomy. Ultrasound (US) image guidance has the potential to improve surgical outcomes, but an appropriate method for US probe manipulation has not been defined. This study evaluates using an additional robotic (4th) arm on the da Vinci Surgical System to perform extracorporeal US scanning for image guidance in TORS.

140-year history of pharyngoesophageal reconstruction.

Objective: For over a century, circumferential pharyngoesophageal junction reconstruction posed significant surgical challenges. This review aims to provide a narrative history of pharyngoesophageal junction reconstruction from early surgical innovations to the advent of modern free-flap procedures.

Methods: The review encompasses three segments: (1) local and/or locoregional flaps, (2) visceral transposition flaps, and (3) free-tissue transfer, focusing on the interplay between pharyngoesophageal junction reconstruction and prevalent surgical trends.

Cost-Effectiveness of the ACR TIRADS Compared to the ATA 2015 Risk Stratification Systems in the Evaluation of Incidental Thyroid Nodules.

Rationale And Objectives: Thyroid nodules are a common incidental imaging finding and prone to overdiagnosis. Several risk stratification systems have been developed to reduce unnecessary work-up, with two of the most utilized including the American Thyroid Association 2015 (ATA2015) and the newer American College of Radiology Thyroid Imaging, Reporting and Data System (TIRADS) guidelines. The purpose of this study is to evaluate the cost-effectiveness of the ATA2015 versus the TIRADS guidelines in the management of incidental thyroid nodules.

To what extent can mastication functionality be restored following mandibular reconstruction surgery? A computer modeling approach.

Statement Of Problem: Advanced cases of head and neck cancer involving the mandible often require surgical removal of diseased sections and subsequent replacement with donor bone. During the procedure, the surgeon must make decisions regarding which bones or tissues to resect. This requires balancing tradeoffs related to issues such as surgical access and post-operative function; however, the latter is often difficult to predict, especially given that long-term functionality also depends on the impact of post-operative rehabilitation programs.

Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery.

Objectives: Virtual surgical planning (VSP) has gained acceptance because of its benefits in obtaining adequate resection, achieving cephalometric accuracy, and reducing operative time. The aim of this study is to compare the rate of union between VSP and free-hand surgery (FHS), identify predictors of non-union and evaluate the difference in operative time.

Methods: Post-operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS.

Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery.

Advanced head and neck cancers involving the mandible often require surgical removal of the diseased parts and replacement with donor bone or prosthesis to recreate the form and function of the premorbid mandible. The degree to which this reconstruction successfully replicates key geometric features of the original bone critically affects the cosmetic and functional outcomes of speaking, chewing, and breathing. With advancements in computational power, biomechanical modeling has emerged as a prevalent tool for predicting the functional outcomes of the masticatory system and evaluating the effectiveness of reconstruction procedures in patients undergoing mandibular reconstruction surgery.

Incidence and complications of hypothyroidism postlaryngectomy: A systematic review and meta-analysis.

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.

Patient-Reported Decisional Regret After Operative Otolaryngology Procedures: A Scoping Review.

Objective: To review the published literature on decisional regret in adult patients undergoing operative otolaryngology procedures. The primary outcome was decisional regret scale (DRS) scores. DRS scores of 0 indicate no regret, 1-25 mild regret, and >25 moderate to strong/severe regret.

Identification of a serum-based microRNA signature that detects recurrent oral squamous cell carcinoma before it is clinically evident.

Background: Survival rates for oral squamous cell carcinoma (OSCC) have remained poor for decades, a fact largely attributable to late-stage diagnoses and high recurrence rates. We report analysis of serum miRNA expression in samples from patients with high-risk oral lesions (HRL, including OSCC/carcinoma in situ lesions) and healthy non-cancer controls, with the aim of non-invasively detecting primary or recurrent disease before it is clinically evident.

Methods: Discovery, test, and validation sets were defined from a total of 468 serum samples (305 HRL and 163 control samples).

Decisional regret, symptom burden, and quality of life following transoral robotic surgery for oropharyngeal cancer.

Background: Transoral robotic surgery (TORS) has equivalent oncologic control to radiotherapy with potential for improved quality of life (QOL) and lower patient-reported decisional regret.

Methods: Cross-sectional study between 2016 and 2021 of TORS patients with early-stage oropharyngeal squamous cell carcinoma who completed the Decision Regret Scale (DRS), M. D.

Individualized risk assessment of distant metastases in oral cavity carcinoma: a validated predictive-score model.

Background: We aimed to develop and validate a risk-scoring system for distant metastases (DMs) in oral cavity carcinoma (OCC).

Methods: Patients with OCC who were treated at 4 tertiary cancer institutions with curative surgery with or without postoperative radiation/chemoradiation therapy were randomly assigned to discovery or validation cohorts (3:2 ratio). Cases were staged on the basis of tumor, node, and metastasis staging according to the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control guidelines.

Development and validation of a novel craniofacial statistical shape model for the virtual reconstruction of bilateral maxillary defects.

Bilateral maxillary defects are a challenge for fibula free flap reconstruction (FFFR) surgery due to limitations in virtual surgical planning (VSP) workflows. While meshes of unilateral defects can be mirrored to virtually reconstruct missing anatomy, Brown class c and d defects lack a contralateral reference and associated anatomical landmarks. This often results in poor placement of osteotomized fibula segments.

Treatment of Laryngeal Verrucous Carcinoma: 28-Year Retrospective Cohort Study and Literature Review.

Objective: Laryngeal verrucous carcinoma (LVC) comprises 1% to 4% of all laryngeal tumors. Although controversial, surgery has been the mainstay of treatment, due to concern about anaplastic transformation with radiotherapy. We aimed to study LVC patients to identify treatment patterns for primary and recurrent diseases.