Developments and Innovations in Head and Neck Surgery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: 10 January 2025 | Viewed by 6740

Special Issue Editors


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Guest Editor
ENT Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Interests: head and neck surgery; skull base; oncology

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Guest Editor
ENT, 2nd Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
Interests: head and neck surgery; skull base; oncology

Special Issue Information

Dear Colleagues,

Head and neck surgery is a field under continuous development, where advances in technology have enabled a variety of interventions that are minimally invasive with excellent outcomes, including for patients with cancer. Results have improved considerably over the years in light of these developments and due to the greater expertise of the surgeons. We aim to highlight these improvements that have become the standard of care worldwide over the past few years, and to familiarise our younger colleagues with the current options that are available to them.

Technological developments are also the foundation for better results in multidisciplinary teams, especially when we discuss oncologic patients. The switch from classic open surgery to minimally invasive procedures is directly proportional with patient compliance and an increased adherence to treatment, thus aiding in an end result of a disease-free status.

Dr. Rǎzvan Hainǎroşie
Dr. Dragos Palade
Guest Editors

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Keywords

  • head and neck surgery
  • innovation
  • developments
  • oncology

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Published Papers (6 papers)

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Research

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12 pages, 1973 KiB  
Article
Intravital Position Study of the Clinical Anatomy of the Middle Lobe and Superior Poles of the Thyroid Gland
by Vladislav V. Tatarkin, Andrey I. Shchegolev, Aleksandr M. Bakunov, Yuriy L. Vasil’ev, Mikhail D. Chernyshev, Evgeniy A. Serebryakov, Ksenia L. Kaplieva, Egor O. Stetsik, Tahmina Pulotova, Ellina V. Velichko and Evgeniy M. Trunin
Medicina 2024, 60(9), 1520; https://doi.org/10.3390/medicina60091520 - 18 Sep 2024
Viewed by 447
Abstract
Background and Objectives: This study analyzes the issues of position dislocation of the head of the superior poles and lateral points of the outer edge of the middle divisions of each of the thyroid lobes (TL) changes. The purpose was to provide [...] Read more.
Background and Objectives: This study analyzes the issues of position dislocation of the head of the superior poles and lateral points of the outer edge of the middle divisions of each of the thyroid lobes (TL) changes. The purpose was to provide an intravital position study of the clinical anatomy of the middle and superior poles of the thyroid gland (TG). Materials and Methods: We used data on anthropometry obtained during the study and data from MRI of the neck organs and anatomical formations of 100 healthy individuals, comprising 55 (55%) female and 45 (45%) male participants. To evaluate the data obtained in the examined group, the minimum probability value was 0.95 (95% confidence interval or p < 0.05). Results: Maximum flexion of the neck the distance from the center of the jugular notch to the lateral points of the outer edge of the middle parts of the TL decreases in all groups of but mostly in male ectomorphs; the same distance to the superior poles of the TG changes most in ectomorphic males on the right by 38.9% (p value < 0.001) and mesomorphic females on the left by 37.8% (p value < 0.001); in rotation to the left, the maximum was found in male ectomorphs, which decreased by 9.5% on the left (p value < 0.001) and by 7.3% on the right (p value < 0.001). Conclusions: this study provided new information about the intravital anatomy of the TG position, of the superior poles, and the lateral points of the middle part of its lobes. Full article
(This article belongs to the Special Issue Developments and Innovations in Head and Neck Surgery)
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9 pages, 304 KiB  
Article
Study of Two Sedative Protocols for Drug-Induced Sleep Endoscopy: Propofol versus Propofol-Remifentanil Combination, Delivered in Target-Controlled Infusion Mode
by Narcis-Valentin Tănase, Răzvan Hainăroșie, Lăcrămioara-Aurelia Brîndușe, Cristian Cobilinschi, Madalina Dutu, Dan Corneci and Viorel Zainea
Medicina 2024, 60(7), 1123; https://doi.org/10.3390/medicina60071123 - 12 Jul 2024
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Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing pathology with significant clinical consequences, including increased cardiovascular risk and cognitive decline. Continuous positive airway pressure (CPAP) is the gold-standard treatment, but alternative strategies are sometimes needed for patients intolerant to [...] Read more.
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing pathology with significant clinical consequences, including increased cardiovascular risk and cognitive decline. Continuous positive airway pressure (CPAP) is the gold-standard treatment, but alternative strategies are sometimes needed for patients intolerant to CPAP. Drug-induced sleep endoscopy (DISE) is a key diagnostic tool for assessing upper airway obstruction in OSA patients and subsequently tailoring a surgical approach, with sedation protocols playing a crucial role in its efficacy and results accuracy. This study aimed to investigate the effect of adding remifentanil to a propofol target-controlled infusion (TCI) regimen on the sedation parameters and procedural outcomes of DISE. Materials and Methods: The study was conducted at the Central University and Emergency Military Hospital “Dr. Carol Davila” and Ria Clinic in Bucharest between July 2021 and October 2023. Thirty-one patients were enrolled and randomised into two groups: a propofol group (P group, n= 11) and a remifentanil-propofol group (R-P group, n = 20). DISE was performed using standardised protocols, sedative drugs were administered in TCI mode, and data on sedation levels, respiratory and cardiovascular parameters, and procedural incidents were collected. Results: The addition of remifentanil at 1 ng/mL effect-site concentration significantly reduced the effect-site concentration of propofol required for adequate sedation (3.4 ± 0.7 µg/mL in the P group vs. 2.8 ± 0.6 µg/mL in the R-P group, p = 0.035). The time to achieve adequate sedation was also shorter in the R-P group (7.1 ± 2.5 min vs. 9.5 ± 2.7 min, p = 0.017). The incidence of cough, hypoxemia, and cardiovascular events did not significantly differ between the two groups. Conclusions: Adding remifentanil to a propofol TCI regimen for DISE effectively reduces the required propofol effect-site concentration and shortens sedation time without increasing the risk of adverse events. This combination may enhance the safety and efficiency of DISE, offering a promising alternative for patients undergoing this procedure. Full article
(This article belongs to the Special Issue Developments and Innovations in Head and Neck Surgery)
12 pages, 2218 KiB  
Article
Prognostic Significance of Multifactorial Analysis in Complex Cervical Aero-Digestive Trauma Cases
by Florentina Severin, Radu Danila, Andrei Nicolau, Anisia Iuliana Alexa, Raluca Olariu, Ștefan Roșca, Octavian Dragos Palade, Florin Mocanu, Mihail Dan Cobzeanu and Bogdan Mihail Cobzeanu
Medicina 2024, 60(2), 238; https://doi.org/10.3390/medicina60020238 - 30 Jan 2024
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Abstract
Background and Objectives: In the context of complex aerodigestive cervical traumas, the prognosis and outcome heavily depend on risk factors, particularly injuries to the larynx, trachea, major digestive tissues, cervical vertebrae, and vascular structures. With the increasing prevalence of trauma as a [...] Read more.
Background and Objectives: In the context of complex aerodigestive cervical traumas, the prognosis and outcome heavily depend on risk factors, particularly injuries to the larynx, trachea, major digestive tissues, cervical vertebrae, and vascular structures. With the increasing prevalence of trauma as a public health concern, there is a pressing need for epidemiological research and the implementation of preventative measures. The purpose of this research is to establish the profile of the predictable impact factors that determine the prognosis of patients with complex cervical trauma. Methods and Methods: The study group consisted of 106 patients with complex cervical trauma pathology developed by various mechanisms such as car accidents, home-related accidents, aggression, gunshot wounds, and self-inflicted attempts, resulting in hospitalization in the E.N.T. Clinic at “St. Spiridon” Iași Hospital, from 2012 to 2016; medical records were the source of the collected data. Results: Hemodynamic instability upon admission associated with age, muscle and laryngeal injuries, and anemia were identified as negative prognostic factors. Additionally, the utilization of imaging-based paraclinical investigations for diagnosing traumatic lesions emerged as a positive prognostic factor in managing this pathology. The management of penetrating cervical trauma remains a subject of debate, with some advocating for surgical exploration beyond the platysma layer in all cases, while others argue for a more selective conservative approach due to a high rate of negative explorations. Conclusions: The statistical evaluation of epidemiological, clinical, lesion, paraclinical, and therapeutic parameters is needed to establish predictable risk factors in the prognosis of complex aerodigestive cervical trauma. Full article
(This article belongs to the Special Issue Developments and Innovations in Head and Neck Surgery)
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Review

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18 pages, 798 KiB  
Review
Perspectives in Using Multiple Flaps Reconstructions for Advanced Head and Neck Tumors (Scoping Review)
by Anca-Ionela Cîrstea, Șerban Vifor Gabriel Berteșteanu, Daniela Vrînceanu, Mihai Dumitru, Paula Luiza Bejenaru, Catrinel Beatrice Simion-Antonie, Teodora Elena Schipor-Diaconu, Petra Bianca Taher, Simona-Andreea Rujan and Raluca Grigore
Medicina 2024, 60(8), 1340; https://doi.org/10.3390/medicina60081340 - 18 Aug 2024
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Abstract
Background and Objectives: Patients with advanced head and neck tumors require salvage surgery as a last resort. These extensive surgeries pose the challenge of complex reconstructions. The head and neck surgeon undertaking such complex cases needs to master different flaps. The team managing [...] Read more.
Background and Objectives: Patients with advanced head and neck tumors require salvage surgery as a last resort. These extensive surgeries pose the challenge of complex reconstructions. The head and neck surgeon undertaking such complex cases needs to master different flaps. The team managing these patients needs input from various specialists, along with otorhinolaryngologists, plastic surgeons, maxillofacial surgeons, vascular surgeons, experienced radiologists, dedicated pathologists, oncologists and radiation therapists. We focus on the optimum solution between oncologic resections and the future quality of life of patients and overall survival. Each complex case requires a personalized medicine approach. This scoping review aims to assess the efficacy and outcomes of complex reconstructions using various flaps for head and neck tumors, with a focus on free flaps and emerging techniques. Materials and Methods: A systematic search of the literature was conducted following PRISMA guidelines, resulting in the inclusion of 44 articles that met the predefined criteria in the last 10 years. Results: The included studies encompassed diverse patient populations and evaluated various surgical techniques, outcomes, complications, and advancements in head and neck reconstruction. The review identified a variety of flaps utilized in head and neck tumor reconstruction, including free flaps such as the radial forearm, anterolateral thigh, scapular tip, and myocutaneous flaps, among others. The success rates for free flap reconstructions ranged from 85% to 100%, with notable variations attributed to patient selection, tumor characteristics, and surgical expertise. Conclusions: Complications such as flap necrosis, infection, hematoma, and donor site morbidity were documented across studies, highlighting the importance of meticulous surgical planning and postoperative care. Furthermore, the review revealed emerging techniques such as computer-aided design, virtual surgery, stereolithographic models, customized implants, tissue engineering, and allotransplants, offering promising reconstructive armamentarium. Advances in surgical techniques and emerging technologies hold promise for further enhancing reconstructive outcomes, minimizing morbidity, and improving patient quality of life. Full article
(This article belongs to the Special Issue Developments and Innovations in Head and Neck Surgery)
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Other

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10 pages, 2037 KiB  
Systematic Review
A Systematic Review Evaluating the Diagnostic Efficacy of Narrow-Band Imaging for Laryngeal Cancer Detection
by Ileana Alexandra Sanda, Razvan Hainarosie, Irina Gabriela Ionita, Catalina Voiosu, Marius Razvan Ristea and Adina Zamfir Chiru Anton
Medicina 2024, 60(8), 1205; https://doi.org/10.3390/medicina60081205 - 25 Jul 2024
Viewed by 704
Abstract
Background: Narrow-band imaging is an advanced endoscopic technology used to detect changes on the laryngeal tissue surface, employing a comparative approach alongside white-light endoscopy to facilitate histopathological examination. Objective: This study aimed to assess the utility and advantages of NBI (narrow-band [...] Read more.
Background: Narrow-band imaging is an advanced endoscopic technology used to detect changes on the laryngeal tissue surface, employing a comparative approach alongside white-light endoscopy to facilitate histopathological examination. Objective: This study aimed to assess the utility and advantages of NBI (narrow-band imaging) in identifying malignant laryngeal lesions through a comparative analysis with histopathological examination. Methods: We conducted a systematic literature review, utilizing databases such as PubMed, the CNKI database, and Embase for our research. Results: We analyzed the articles by reviewing their titles and abstracts, selecting those we considered relevant based on determined criteria; in the final phase, we examined the relevant studies according to the specific eligibility criteria. Conclusions: Narrow-band imaging is an advanced endoscopic technology that demonstrates its efficacy as a tool for diagnosing malignant laryngeal lesions and comparing them to premalignant lesions. The European Society of Laryngology has implemented a standardized classification system for laryngeal lesions to enhance data correlation and organization. Full article
(This article belongs to the Special Issue Developments and Innovations in Head and Neck Surgery)
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12 pages, 1908 KiB  
Case Report
Laryngeal Paraganglioma—A Case Report
by Dragos Octavian Palade, Florentina Severin, Daniela Vrinceanu, Razvan Hainarosie, Alma Maniu, Huzafa Ahmed, Felicia Manole, Florin Mocanu and Catalina Voiosu
Medicina 2024, 60(2), 198; https://doi.org/10.3390/medicina60020198 - 24 Jan 2024
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Abstract
Background and Objectives: Paragangliomas of the head and neck are rare neuroendocrine tumors originating from the paraganglia, which might be sympathetic or parasympathetic. Laryngeal paragangliomas are the rarest subtype of these tumors, with only 1.41% of all paragangliomas, arising from the supraglottic [...] Read more.
Background and Objectives: Paragangliomas of the head and neck are rare neuroendocrine tumors originating from the paraganglia, which might be sympathetic or parasympathetic. Laryngeal paragangliomas are the rarest subtype of these tumors, with only 1.41% of all paragangliomas, arising from the supraglottic or subglottic paraganglia of the larynx. The vast majority of them are benign, but there are some cases in which they turn out to be malignant, and the only way to know with certainty the difference between them is when we identify distant metastases. The aim of this article is to share our experience with a rare case of laryngeal paraganglioma and review the clinical characteristics, methods of diagnostic, necessary investigation prior to the operation, and surgical management of this type of tumor. Materials and Methods: We present the case of a 68-year-old female patient, a non-smoker, who accused dysphagia, dysphonia, foreign body sensation, chronic cough, and hoarseness for six months. We performed a tracheostomy prior to biopsy to secure the airways in case of bleeding and then took a few biopsy samples. The histopathological exam revealed the presence of a laryngeal paraganglioma. An enhanced CT scan was performed in order to describe the localization, size, and invasion of the tumor. We also measured the vanillylmandelic acid from the urine to determine if the tumor produced catecholamines alongside a full cardiology and endocrinology examinations. In order to prevent massive bleeding during the operation, chemoembolization was attempted before surgery, but it was unsuccessful due to an anatomical variation of the left superior thyroid artery. She underwent surgery, first through transoral endoscopic microsurgery; however, we decided to undertake an external approach because of poor bleeding control, even though we had ligated both the superior thyroid artery and the external carotid artery, with a thyrotomy and laryngofissure achieving the complete resection of the tumor. Results: The patient was discharged 10 postoperative days later, with the recommendation of introducing food step-by-step from liquids to solids. She was decannulated after 30 days, with no complications regarding breathing, phonation, or deglutition. Twelve months after the surgery, we did not identify any local relapses of distant metastases. Conclusions: Laryngeal paragangliomas are rare neuroendocrine tumors that arise from the laryngeal paraganglia. Surgery is the best treatment option available, and it can be done by either an external approach or by transoral endoscopy. Enhanced CT or MRI, as well as full cardiological and endocrinological evaluation are mandatory prior to the operation. Measuring the catecholamines levels show the if the tumor is secretory. Controlling the bleeding poses the biggest challenge in performing the resection of the tumor, especially when a transoral endoscopic approach is chosen. Further standardized follow-up guidelines are required in the future. Full article
(This article belongs to the Special Issue Developments and Innovations in Head and Neck Surgery)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Intravital Position Study of the Clinical Anatomy of the Middle Lobe and Superior Poles of the Thyroid Gland
Author: Vasil'ev
Highlights: with maximum neck flexion, the distance from the center of the jugular notch to the lateral points of the outer edge of the middle sections of the thyroid lobes decreases in all groups of subjects

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