The latest medical research on Mouth, Head and Neck Cancer
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about mouth, head and neck cancer gathered by our medical AI research bot.
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Request AccessOlfactory outcomes in skull base surgery.
Mouth, Head and NeckThis review examines the impact of skull base surgery on olfactory function, a critical yet often overlooked aspect of postoperative quality of life. As surgical techniques continue to evolve, understanding their impact on olfaction is key to optimizing patient outcomes.
The relationship between skull base surgery and olfactory function continues to be debated in the literature. With the adoption of transnasal surgical approaches, a significant concern has been its impact on olfaction. Prior studies have shown evidence of olfactory dysfunction following transnasal skull base surgery, though these findings are not universal. A particular area of discussion involves the use of the pedicled nasoseptal flap, which has demonstrated potentially negative short-term olfactory impacts. Additional concerns surround flap design (olfactory strip preservation) and technique of flap harvest (cold knife versus electrocautery). Evidence suggests that olfactory strip preservation may effectively maintain postoperative olfactory performance, while cold knife techniques offer no clear advantage over electrocautery.
The inconsistencies in the literature underscore the need for standardized, large-scale studies that directly compare surgical techniques to better understand the impact of transnasal skull base surgery on olfaction. This is essential to optimizing surgical outcomes and improving patient quality of life postoperatively.
Modern management of distant metastases from head and neck squamous cell carcinoma.
Mouth, Head and NeckThe rate of distant metastases in patients with head and neck squamous cell carcinoma (HNSCC) ranges between 4 and 26%. Their appearance marks a critical stage in disease progression, significantly reducing survival rates. Treatment options require a multidisciplinary approach and differ based on the number and extension of distant metastases. The aim of this narrative review is to provide a comprehensive and updated overview of the current state of the art in management of such a clinical scenario.
Accurate detection and staging of distant metastases are essential to determine prognosis and guide therapeutic strategies. Oligometastatic condition refers to patients with only a few distant metastases (up to 5). Surgery or stereotactic body radiotherapy are the best curative treatment options for oligometastatic. However, the majority of HNSCC has a polymetastatic disease, not amenable to curative approach. Therefore, systemic therapies, including chemotherapy (CHT) or target molecular therapy and/or best supportive care, are usually reserved to these patients. Rarely, head and neck region, in particular supraclavicular cervical lymph nodes, may be a site of distant metastases from non-head and neck cancer, particularly from the genitourinary and gastrointestinal tracts.
The occurrence of distant metastases in HNSCC represents a pivotal point in the disease progression, lowering survival rates. Pattern of distant metastases has been related to survival outcomes. Patients with distant metastases from an HNSCC always require a multidisciplinary approach and an accurate selection is necessary to individualize the best treatment strategy.
Reflux, eosinophilic esophagitis, and celiac disease - the blurred lines.
Mouth, Head and NeckGastroesophageal reflux disease (GERD) is a commonly recognized cause of dysphagia. Conversely, eosinophilic esophagitis (EoE) and celiac disease are rarer and often overlooked as dysphagia culprits. Overlap between these conditions complicates diagnosis and delays appropriate treatment. This review aims to clarify the distinctive dysphagia characteristics in each condition, explore potential overlaps, and offer guidance on differentiation.
Recent studies have advanced our understanding of dysphagia mechanisms in GERD, EoE, and celiac disease, particularly in characterizing disordered motility and dysphagia's natural history. While upper endoscopy, biopsies, and manometry remain crucial in dysphagia assessment, novel diagnostic tools are emerging. New insights highlight the significance of cytokine-induced mucosal injury in all three conditions, revealing potential connections where mucosal damage in one disorder may contribute to the development of others.
GERD, EoE, and celiac disease can coexist and present with similar symptoms. Distinguishing between them often entails upper endoscopy, esophageal biopsies, pH testing, and celiac serologies. EoE should be considered when GERD patients fail proton pump inhibitor therapy or when celiac patients have persistent esophageal symptoms despite a gluten-free diet. Consider celiac disease if dysphagia accompanies iron deficiency anemia, malabsorptive diarrhea, or osteoporosis. Recognizing the potential overlap between these conditions is crucial for guiding clinical evaluation and therapy.
Assessing institutional pediatric airway emergency readiness: key components and practices.
Mouth, Head and NeckThis contemporary review aims to outline the key components and protocols for assessing emergency readiness in institutional pediatric airway management. Emphasis is placed on identifying essential elements that ensure preparedness and effective response in pediatric airway emergencies within healthcare institutions.
Recent studies highlight several critical components of pediatric airway emergency readiness: dedicated pediatric airway teams, availability of specialized pediatric airway equipment, and simulation-based training to enhance the skills of healthcare providers. Additionally, interdisciplinary team coordination and regular drills have been shown to improve readiness and outcomes in pediatric airway emergencies.
Effective emergency readiness in pediatric airway management requires a multifaceted approach. Key components include availability of appropriate and accessible equipment, adherence to standardized protocols, and ongoing education and training. Regular simulation exercises and interprofessional collaboration are essential for maintaining high levels of preparedness. Implementing these strategies can significantly improve the quality of care and patient outcomes in pediatric airway emergencies.
Level 3.
Management of pediatric thyroid carcinoma.
Mouth, Head and NeckThe incidence of thyroid carcinoma is increasing among children and adolescents, particularly in female individuals. Children and adolescents require special considerations in management as the molecular genetics of pediatric thyroid tumors are inherently different from their adult counterparts. The increased risk of malignancy, nodal metastases, and pulmonary metastases in pediatric patients warrants pediatric-specific management recommendations and pediatric-specific multidisciplinary teams.
This article highlights the molecular origins of pediatric thyroid carcinoma and the implications of tumor genetics for the course of disease and treatment considerations. We highlight specific surgical considerations to optimize outcomes while minimizing lifelong risks of vocal paralysis and hypoparathyroidism. The landscape of treatment options is rapidly evolving with development of sophisticated molecular approaches to understand the genetic landscape, and this review features updated recommendations and systemic treatment options for the management of pediatric thyroid malignancy.
Pediatric thyroid carcinoma is a lifelong burden and the treatment tailored to optimize outcomes minimizes long-term risks of treatments, surgery, radiation and targeted systemic therapies. Multidisciplinary teams that treat pediatric thyroid carcinoma should focus surgical experience and use the most updated guidelines and treatments available, particularly considering the landscape of molecular genetics in pediatric thyroid carcinoma.
Management of paediatric sialorrhea.
Mouth, Head and NeckTo summarize current understanding of and recent literature on the management of sialorrhea in children.
Sialorrhea is a symptom of oropharyngeal dysphagia and reduced clearance. Sialorrhea can be anterior, with forward overflow of saliva, causing skin rash, social embarrassment and spillage on communication devices; or posterior, where there is pharyngeal pooling of saliva, which may cause aspiration.Assessment of sialorrhea involves a clinical evaluation, focusing on the individual's age, development, underlying medical condition and whether the sialorrhea is anterior, posterior or both. Craniomaxillofacial structure, posture, airway patency, neuromotor control, level of social awareness, motivation and caregiver concerns are assessed. To manage sialorrhea, integration of multiple strategies is usually needed. There is good evidence for behavioral intervention, oral appliances, anticholinergic medications, botulinum toxin injection and surgery. The role of various options of surgery in providing a longer lasting effect is supported. Adjunctive airway and craniomaxillofacial surgery may be indicated.
Sialorrhea is a modifiable condition with multifactorial causes requiring multimodal therapy by an inter-disciplinary team. There is increasing evidence on the role of saliva surgery in improving the quality of life for the person with sialorrhea and their caregivers.
Long-term complications of extracranial pericranial flaps in skull base reconstruction.
Mouth, Head and NeckNasoseptal flaps are a frequently used and well characterized means of reconstruction following endoscopic endonasal approach surgery (EEA). However, there are alternative means of reconstruction, including the extracranial pericranial flap (ePCF), that while used infrequently fulfill a specialized need in larger or salvage reconstructions. This review aims to better characterize long-term outcomes using ePCF where there is currently a paucity of objective data on use and outcomes.
A traditional pericranial flap involves elevating and rotating the flap through a craniotomy defect to reconstruct defects of the ventral skull base. The ePCF is implemented without performing a craniotomy, and instead tunnels the flap through a bony opening created at the level of the nasion. This review presents outcomes in a large single-center cohort of patients with ePCFs to better characterize the short- and long-term success, risks, and complications of this reconstructive method.
Long-term follow-up demonstrates that obstruction of the frontal sinus outflow may occur but rarely requires surgical intervention. ePCF are a reasonable alternative to consider in cases where local tissue would be insufficient, is not available, or has already failed. There is a low risk of flap complications.
Platelet-rich plasma applications in the larynx: snake oil or stupendous?
Mouth, Head and NeckTo explore and summarize recent work examining the use of platelet-rich plasma (PRP) applications for vocal fold disorder.
Intrachordal PRP injections have recently emerged as a treatment option for patients with damage to the lamina propria of the vocal fold (scar, atrophy, sulcus and inflammatory lesions). Studies support significant improvements in patient-reported and clinician-reported outcomes, and objective phonatory parameters. PRP demonstrates a good safety profile, absence of immune reactions, affordable cost model and improvement in mucosal wave features with resultant improved voice quality up to 12 months following treatment.
PRP injection of the vocal folds is a novel repurposing of a previously validated technique, and emerging data shows consistent results across multiple centres, increasing confidence in use of this freely available material. Current published studies confirm improved voice outcomes compared with pretreatment measures and high patient satisfaction. Further research is required to properly assign the role of and ideal candidate for PRP applications, and to delineate durability of treatment.
Evaluation of balloon sinuplasty for the treatment of pediatric chronic rhinosinusitis.
Mouth, Head and NeckThis year marks 10 years from the publication of the clinical consensus statement on pediatric chronic rhinosinusitis (CRS). Balloon sinuplasty did not meet criteria for consensus at that time because there was insufficient evidence on its efficacy and safety. The purpose of this review is to summarize the current evidence on balloon sinuplasty treatment for pediatric CRS.
Balloon sinuplasty is not a cost-effective measure compared to adenoidectomy and endoscopic sinus surgery (ESS). In the pediatric population, benefits include short operative time, reduced tissue manipulation, and potential for decreased antibiotic courses. Alternatively, balloon dilation has increased equipment costs and there is a lack of robust prospective data that fully elucidates balloon sinuplasty's role in the management of pediatric CRS.
Pediatric otolaryngologists should continue to perform first-line adenoidectomy and consider ESS based on imaging and other validated clinical scoring systems. Balloon sinuplasty has not yet been proven as an effective treatment for pediatric CRS and further large-scale investigations are required to overcome its lack of cost-effectiveness.
Imaging approach for fungal sinusitis.
Mouth, Head and NeckThis article provides a comprehensive review of the computed tomography (CT) and magnetic resonance (MR) imaging findings of invasive fungal sinusitis with an emphasis on pattern recognition and approach to interpretation.
Fungal sinusitis is categorized into invasive (acute, chronic, and granulomatous) and noninvasive forms (allergic fungal sinusitis and mycetoma). CT is superior for detecting bony erosion and hyperdense fungal elements, while MRI excels in evaluating soft tissue and mucosal involvement. Key radiologic signs such as bone destruction, sinus wall thickening, and 'black turbinate sign' aid in early diagnosis, especially in invasive cases. Early imaging signs can be subtle. Early detection is necessary, particularly in immunocompromised patients with acute invasive fungal sinusitis, where rapid intervention is critical.
Pattern recognition and adequate interpretation of fungal sinusitis are possible using CT and MRI. Imaging can also help identify complications, aiding with reliable diagnosis and prompt intervention.
Postoperative management following endoscopic skull base surgery.
Mouth, Head and NeckThe purpose of this opinion is to review current evidence regarding postoperative management following endoscopic skull base surgery.
Postoperative management encompasses consideration of level of care, laboratory tests, analgetic and antiemetic therapy, antibiotic, antithrombotic and antiepileptic prophylaxis, pharmacological and nonpharmacological cerebrospinal fluid (CSF) pressure reduction measures, including CSF diversion, activity restrictions, nasal packing removal, nasal debridement and toilet, nasal glucocorticoid administration, positive pressure ventilation, imaging, CSF leak diagnosis, and future perspectives.
Although significant effort has been put into research of postoperative measures after endoscopic skull-base surgery, there is a heterogeneity of practices and deficit of high-level studies, which would enable highly powered systematic reviews and meta-analyses.
Hearing preservation in pediatric cochlear implantation.
Mouth, Head and NeckPediatric cochlear implantation has evolved considerably over the past three decades to include more patients at earlier ages with greater degrees of residual hearing. As an extension, a significant focus of research over the past decade has surrounded preservation of existing acoustic hearing.
Multiple studies published within the last 5 years demonstrate aidable acoustic hearing preservation in 60-90% of pediatric patients, with 40-60% experiencing complete hearing preservation following cochlear implantation. Durability of preserved hearing varies among patients, with some patients losing residual hearing within 1 year of surgery whereas others maintain acoustic hearing through at least 5 years of follow-up. Speech outcomes appear superior among patients with preserved acoustic hearing, particularly in the presence of background noise. Several recent studies suggest a music appreciation advantage in children with preserved acoustic hearing following cochlear implantation.
Hearing preservation rates during cochlear implantation in children matches, if not often exceeds, hearing preservation rates observed among adults. Preservation of acoustic hearing during cochlear implantation confers multiple advantages for the pediatric population. Beyond improved speech understanding and music appreciation, minimizing intracochlear trauma and resultant scarring facilitates potential future regenerative treatments or revision surgery.
