Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy.

Importance: Controversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy. Objective: To explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy. Design, Setting, and Participants: This cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with recurrent, clinically node-negative larynx or hypopharynx tumors after definitive nonsurgical treatment who were treated with a salvage total laryngectomy were included. Data were analyzed from October 2021 through September 2022. Exposures: Elective neck dissection. Main Outcomes and Measures: Presence and location of occult nodal metastasis in electively dissected necks, along with differences in fistula rates and overall and disease-free survival between patients receiving elective neck dissection vs observation. Results: Among 107 patients receiving clinically node-negative salvage total laryngectomy (median [IQR] age, 65.0 [57.8-71.3] years; 91 [85.0%] men), 81 patients underwent elective neck dissection (75.7%) and 26 patients underwent observation (24.3%). Among patients with elective neck dissection, 13 patients had occult nodal positivity (16.0%). Recurrent supraglottic (4 of 20 patients [20.0%]) or advanced T classification (ie, T3-T4; 12 of 61 patients [19.7%]) had an occult nodal positivity rate of 20% or more, and positive nodes were most likely to occur in levels II and III (II: 6 of 67 patients [9.0%]; III: 6 of 65 patients [9.2%]; VI: 3 of 44 patients [6.8%]; IV: 3 of 62 patients [4.8%]; V: 0 of 4 patients; I: 0 of 18 patients). There was a large difference in fistula rate between elective neck dissection (12 patients [14.8%]) and observed (8 patients [30.8%]) groups (difference, 16.0 percentage points; 95% CI, -3.4 to 35.3 percentage points), while the difference in fistula rate was negligible between 50 patients undergoing regional or free flap reconstruction (10 patients [20.0%]) vs 57 patients undergoing primary closure (10 patients [17.5%]) (difference, 2.5 percentage points; 95% CI, -12.4 to 17.3 percentage points). Undergoing elective neck dissection was not associated with a clinically meaningful improvement in overall or disease-free survival compared with observation. Recurrent hypopharynx subsite was associated with an increased risk of death (hazard ratio, 4.28; 95% CI, 1.81 to 10.09) and distant recurrence (hazard ratio, 7.94; 95% CI, 2.07 to 30.48) compared with glottic subsite. Conclusions and Relevance: In this cohort study, patients with recurrent supraglottic or advanced T classification tumors had an increased occult nodal positivity rate, elective neck dissection was not associated with survival, and patients with recurrent hypopharynx subsite were more likely to have a distant recurrence and die of their disease. These findings suggest that underlying disease pathology rather than surgical management may be associated with survival outcomes in this population.

Imaging of Surgical Free Flaps in Head and Neck Reconstruction.

Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications (including tumor recurrence) is crucial for the interpreting radiologist. Despite the complexity and increasing frequency of free flap reconstruction, there is no comprehensive head and neck resource intended for the radiologist. We hope that this image-rich review will fill that void and serve as a go to reference for radiologists interpreting imaging of surgical free flaps in head and neck reconstruction.

Tympanometric changes after total maxillary osteotomy.

With the frequency of orthognathic surgery increasing each year, more is being learned about this surgical art. Although techniques are improving, more acute and chronic complications are being reported after orthognathic surgery. In our institution, it has been noticed that approximately 25% to 30% of our patients experience unilateral or bilateral otalgia after total (Le Fort I) maxillary osteotomy. Recently, two patients with maxillary osteotomies. In both patients acute otitis media developed postoperatively and myringotomies for relief of symptoms were required. This paper reports changes observed in preoperative and postoperative tympanograms of patients who undergo total maxillary osteotomy and offers a possible explanation for these middle ear changes, which are accompanied by otalgia.

Incontinentia pigmenti: report of case.

A case of incontinentia pigmenti in a 14-year-old girl has been presented. The patient showed classic signs including dermatologic, ophthalmologic, central nervous system, and dental changes. This case also presented a previously unreported occurrence of hemorrhagic bone cyst in the mandible along with ectodermal-mesodermal disorder.

Unilateral mydriasis during general anesthesia.

A healthy 24-year-old woman was taken to the operating room for surgical removal of impacted third molars while under general anesthesia. During surgery, a local anesthetic was administered, resulting in mydriasis, which was initially mistaken for a central nervous system deficit secondary to a complication from general anesthetic.

Frontal lobe abscess of dental origin. Report of a case.

A 52-year-old white man came to our hospital with obscure signs of disease. Multiple laboratory tests, radiographs, and examinations ruled out aseptic meningitis, bacterial endocarditis, cerebral artery aneurysm, and other possibilities. A brain abscess was finally diagnosed. The teeth and their surrounding tissues were implicated as the etiologic factors. The importance of odontogenic sources as potential foci of infection is emphasized. This sequel to odontogenic infection is quite rare, but it can be prevented by removal of chronically carious teeth and periapical pathosis.

Eagle's syndrome. Report of a case.

This case report demonstrates an uncommon, symptomatic elongated styloid process that did not conform to the usual clinical features. The patient was under 30 years of age when the symptoms appeared. He experienced the classic symptoms without prior tonsillectomy; he also experienced carotid artery syndrome symptoms. However, the patient did receive the common diagnosis seen in many cases of unexplained chronic head and neck pain. He was simply labeled a psychotic with no just cause for pain.