Cognitive Function and Postoperative Outcomes in Patients with Head and Neck Cancer.

OBJECTIVE: Determine the relationship between cognitive function and postoperative outcomes. METHODS: This IRB-approved retrospective cohort study included all patients treated between August 2015 and March 2020 undergoing major surgery for aerodigestive cancer or cutaneous/thyroid cancer that required free-flap reconstruction at Henry Ford Hospital. Routine administration of the Montreal Cognitive Assessment (MoCA) was completed as part of preoperative psychosocial evaluation. Outcomes included postoperative diagnosis of delirium, discharge disposition, return to the emergency department within 30 days of surgery, and readmission within 30 days of surgery. Univariate and multivariate logistic regression were used to determine the associations between preoperative MoCA score and each outcome measure. RESULTS: One hundred thirty-five patients with HNC were included in the study (mean [SD] age, 60.7 [±10.8] years; 70.4% [n = 95] male; 83.0% [n = 112] White, 16.3% [n = 22] Black). The average preoperative MoCA score was 23.4 (SD ± 4.5). Based on the MoCA score, 35% (n = 47) scored ≥26 (i.e., normal cognitive status), 55.6% (n = 75) scored between 18 and 25 (i.e., mild impairment), 8.1% (n = 11) scored between 10 and 17 (i.e., moderate impairment), and 1.5% (n = 2) scored <10 (i.e., severe impairment). After adjusting for other variables, a lower MoCA score was associated with discharge disposition to a location other than home and prolonged length of hospital stay. CONCLUSIONS: Preoperative cognitive function in patients undergoing major head and neck surgery for head and neck cancer was associated with discharge destination and length of stay. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:2999-3005, 2023.

Sentinel Node Biopsy for Head and Neck Cutaneous Melanoma.

Sentinel lymph node biopsy is the most precise and accurate staging technique for malignant melanoma. This resulted from international collaborations and technical innovations across subspecialties and systematic and methodical study of real-time clinical problems. This article describes sentinel node biopsy from conception to current techniques. Indications for the procedure and evidence of its prognostic value are discussed. Controversies surrounding results of Multicenter Selective Lymphadenectomy Trial I and II and German Dermatologic Cooperative Oncology Group Selective Lymphadenectomy trial are reviewed. Head and neck melanoma is presented as a unique subsite for performing sentinel node biopsy and when considering completion cervical lymphadenectomy.

Chemoselection: a paradigm for optimization of organ preservation in locally advanced larynx cancer.

Definitive chemoradiation (CRT) and laryngectomy followed by postoperative radiotherapy (RT) are both considered standard-of-care options for the management of advanced laryngeal cancer. While organ preservation with chemoradiotherapy is often the preferred up-front approach for appropriately selected candidates, the functional benefits of organ preservation must be carefully balanced against the considerable morbidity of salvage laryngectomy in patients who fail primary chemoradiation. Up-front identification of patients who are likely to require surgical salvage, therefore, is an important aim of any organ preserving approach in order to minimize morbidity while maximizing organ preservation. To this end, a strategy of 'chemoselection', using the primary tumor's response after 1 cycle of induction chemotherapy as an in vivo method of selecting responders for definitive chemoradiation while reserving primary surgical management for non-responders, has been employed extensively at our institution. The rationale, treatment results and future directions of this approach are discussed.

Sinocutaneous fistula secondary to chronic frontal rhinosinusitis: case series and literature review.

OBJECTIVES: The purpose of this study was to describe the clinical features of a series of patients in whom sinocutaneous fistula developed in the setting of chronic frontal sinusitis. METHODS: We performed a retrospective case review of patients with sinocutaneous fistula. Clinical records, imaging, and operative reports were carefully examined. A complete literature review for relevant studies was performed to examine similar cases and possible pathophysiology. RESULTS: Three patients with sinocutaneous fistula secondary to frontal sinusitis were identified. All patients underwent successful endoscopic sinus surgery with computer-assisted stereotactic localization and closure of the fistula. CONCLUSIONS: Development of sinocutaneous fistula secondary to frontal sinusitis is rare, but still occurs in the modern antibiotic era. Definitive management of this disease process requires 1) a frontal sinusotomy ensuring patency of the outflow tract and 2) fistula excision and multilayer closure.