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Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (25 November 2024) | Viewed by 8991

Special Issue Editors

Prof. Dr. Gabriele Molteni

E-Mail Website
Guest Editor
Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Via giuseppe Massarenti 9, 40138 Bologna, Italy
Interests: head and neck surgery; microvascular reconstruction; thyroid and parathyroid; larynx; artificial intelligence
Prof. Dr. Albino Eccher

E-Mail Website
Guest Editor
Department of Pathology, Universitary Hospital Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41125 Modena, Italy
Interests: immunohistochemistry; transplantation pathology; digital pathology; cytopathology; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Head and neck tumors globally have a high impact on patients’ survival and quality of life. The progress in medical devices and artificial intelligence are remarkable and have led to more attention being given to patients’ reported outcome evaluations; now, both clinical and laboratory research should focus on improving patients’ survival and quality of life. Moreover, many topics related to head and neck cancer diagnosis, treatment and management are still widely debated. Therapeutic indications have expanded steadily, and new therapies are being developed and implemented; the early results are promising, but need to be confirmed with more clinical trials and publications. In this Special Issue, we welcome authors to submit papers on clinical updates in terms of the diagnosis, management and prognosis of head and neck tumors. We welcome papers on new treatments, technology, AI and possible future perspectives.

Prof. Dr. Gabriele Molteni
Prof. Dr. Albino Eccher
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • head and neck surgery
  • laryngeal cancer
  • immunotherapy
  • AI
  • head and neck radiology

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Published Papers (9 papers)

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Research

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12 pages, 1284 KiB  
Article
Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Dysphagia Severity and Quality of Life in Nasopharyngeal Cancer Patients after Intensity Modulated Radiotherapy (IMRT)
by Salvatore Cocuzza, Federica Maria Parisi, Corrado Spatola, Ignazio La Mantia, Jerome Rene Lechien, Carlos Chiesa-Estomba, Salvatore Ferlito, Gianluca Albanese, Mario Lentini, Miguel Mayo-Yanez, Nicolas Fakhry, Madalina La Rocca and Antonino Maniaci
J. Clin. Med. 2024, 13(16), 4821; https://doi.org/10.3390/jcm13164821 - 15 Aug 2024
Viewed by 938
Abstract
Background: Patients treated with definitive radiotherapy for nasopharyngeal carcinoma (NPC) develop severe dysphagia, affecting their quality of life. Traditional prognosis biomarkers are insufficient, leading to a search for new predictors like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Methods: We retrospectively [...] Read more.
Background: Patients treated with definitive radiotherapy for nasopharyngeal carcinoma (NPC) develop severe dysphagia, affecting their quality of life. Traditional prognosis biomarkers are insufficient, leading to a search for new predictors like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Methods: We retrospectively enrolled 44 NPC patients who underwent definitive radiotherapy between 2010 and 2018. EQUATOR and STROBE network guidelines were adopted. Pre-treatment evaluations were conducted, and post-treatment oropharyngeal dysphagia was assessed using the Sydney Swallow Questionnaire (SSQ) and FEES, then assigning a Dysphagia Outcome and Severity Scale (DOSS) level. Patients were divided based on NLR and PLR cut-offs, comparing subjective dysphagia (SSQ) scores and DOSS results at baseline and after a 5-year follow-up. Multiple linear regression was used for analysis. Results: At baseline, the mean NLR was 2.52 ± 1.10, and the PLR was 208.40 ± 94.35. Multivariate analysis indicated NLR and PLR as significant predictors of DOSS outcomes (p < 0.001). Conclusions: Baseline inflammation markers, such as NLR and PLR, may be used to predict dysphagia severity in NPC patients undergoing definitive radiotherapy. These markers could help identify patients at higher risk for severe dysphagia and implement tailored therapeutic and rehabilitative strategies to improve their quality of life. Further studies with larger cohorts are needed to confirm these findings and explore additional prognostic factors for dysphagia outcomes in NPC patients. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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10 pages, 10674 KiB  
Article
Confocal Laser Endomicroscopy in Resection of Sinonasal Malignant Melanoma—Preliminary Report on Real-Time Margin Assessment and Support in Surgical Decision-Making
by Nina Wenda, Kai Fruth, Sebastian Wagner, Annette Fisseler-Eckhoff and Jan Gosepath
J. Clin. Med. 2024, 13(15), 4483; https://doi.org/10.3390/jcm13154483 - 31 Jul 2024
Viewed by 804
Abstract
Background/Objectives: Building upon the rising value of Confocal Laser Endomicroscopy (CLE) in squamous cell carcinoma of the head and neck, we present the first application of CLE during the resection of sinonasal malignant melanomas. This study aims to evaluate the potential of CLE [...] Read more.
Background/Objectives: Building upon the rising value of Confocal Laser Endomicroscopy (CLE) in squamous cell carcinoma of the head and neck, we present the first application of CLE during the resection of sinonasal malignant melanomas. This study aims to evaluate the potential of CLE to assist surgeons in intraoperative decision-making, with a particular focus on resection margin assessment within the constrained nasal cavity. Methods: Two cases of sinonasal malignant melanoma were included in this study. CLE was employed to examine visible tumors and their margins, both pre- and post-endoscopic resection. The findings were compared to histopathological results as well as data on squamous cell carcinoma, for which malignancy criteria had already been established in prior projects. Results: CLE provided the real-time visualization of sinonasal malignant melanomas and their margins, successfully differentiating between healthy and neoplastic tissue compared to histopathological findings. Conclusion: CLE offers the potential for real-time assessment, aiding surgeons in more precise tumor resection and potentially improving patient outcomes. This study demonstrates the feasibility of using CLE in the resection of sinonasal malignant melanoma, highlighting its ability to differentiate between healthy and neoplastic tissue intraoperatively. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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Graphical abstract

9 pages, 1097 KiB  
Article
Association of the Specimen and Tumor Bed Margin Status with Local Recurrence and Survival in Open Partial Laryngectomy
by Rogério Aparecido Dedivitis, Leandro Luongo de Matos, Mario Augusto Ferrari de Castro and Luiz Paulo Kowalski
J. Clin. Med. 2024, 13(9), 2491; https://doi.org/10.3390/jcm13092491 - 24 Apr 2024
Viewed by 899
Abstract
Background/Objectives: Positive margins are associated with locoregional recurrence in early laryngeal cancer. The aim of this study was to evaluate the impacts of specimen-driven (ex vivo) positive margins on patients with early-stage laryngeal cancer whose tumor bed (defect-driven) margins had been negative. [...] Read more.
Background/Objectives: Positive margins are associated with locoregional recurrence in early laryngeal cancer. The aim of this study was to evaluate the impacts of specimen-driven (ex vivo) positive margins on patients with early-stage laryngeal cancer whose tumor bed (defect-driven) margins had been negative. Methods: A retrospective study was performed on 60 consecutive T1b/T2 glottic cancer patients who underwent open frontolateral laryngectomy. The intraoperative margins were obtained from the tumor bed. Their recurrence and disease-free survival were evaluated. In all cases, negative margins were obtained from the surgical bed. The impact of positive margins from the specimen was evaluated in a paraffin study. Results: Among 10 patients with positive margins in the specimen, six experienced local relapse, and among 50 patients with negative margins in the specimen, three developed recurrence. The 5-year disease-free survival rates were 37.5% and 93.9%, respectively (p < 0.001; log-rank). Even with negative margins in the surgical bed, patients with positive margins in the specimen at the final histopathological examination had a 3.5-fold higher chance of developing local recurrence than those with negative margins (HR = 13.993; 95% CI: 3.479–56.281; p < 0.001; univariate Cox regression). Conclusions: Specimen-driven positive margins represent a significant risk factor for local recurrence, even under negative margins at the tumor bed. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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15 pages, 1317 KiB  
Article
Impact of the COVID-19 Pandemic on Head and Neck Cancer Management: The Experience of the Maxillo-Facial Surgery Department of a French Regional Referral Center in a High-Incidence Area
by Emilien Colin, Agnès Paasche, Alban Destrez, Bernard Devauchelle, Jérémie Bettoni, Julien Bouquet, Stéphanie Dakpé and Sylvie Testelin
J. Clin. Med. 2024, 13(8), 2439; https://doi.org/10.3390/jcm13082439 - 22 Apr 2024
Viewed by 1007
Abstract
Background: Cancer patients are at a high risk of complications in cases of infection, and head and neck cancers (HNC) are no exception. Since late 2019, SARS-CoV-2 has caused a global health crisis, with high rates and severe forms of the disease in [...] Read more.
Background: Cancer patients are at a high risk of complications in cases of infection, and head and neck cancers (HNC) are no exception. Since late 2019, SARS-CoV-2 has caused a global health crisis, with high rates and severe forms of the disease in cancer patients. Hospitalization, surgery and radiotherapy were rapidly described as increasing the risk of infection. Since March 2020, the Amiens University Hospital (France) has been taking care of COVID-19 patients while its maxillofacial surgery department managed HNC patients without interruption, even during lockdown periods. However, many questions concerning the impact on patient care were still pending. The aim of this study is to describe HNC management in our center during the first epidemic peak and to evaluate the impact of containment measures on patient treatment. Methods: We retrospectively included 44 HNC patients treated in our department between 1 March and 31 August 2020. Two groups were defined according to the period of care: lockdown (March to May) and lighter restrictions (June to August). Results: The results show typical epidemiological characteristics, maintained management times and non-downgraded procedures. Conclusions: Thus, during the first epidemic peak, continuity of care and patients’ safety could be ensured thanks to adequate means, adapted procedures and an experienced surgical team. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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12 pages, 4580 KiB  
Article
Digital Pathology Applications for PD-L1 Scoring in Head and Neck Squamous Cell Carcinoma: A Challenging Series
by Valentina Canini, Albino Eccher, Giulia d’Amati, Nicola Fusco, Fausto Maffini, Daniela Lepanto, Maurizio Martini, Giorgio Cazzaniga, Panagiotis Paliogiannis, Renato Lobrano, Vincenzo L’Imperio and Fabio Pagni
J. Clin. Med. 2024, 13(5), 1240; https://doi.org/10.3390/jcm13051240 - 22 Feb 2024
Viewed by 1334
Abstract
The assessment of programmed death-ligand 1 (PD-L1) combined positive scoring (CPS) in head and neck squamous cell carcinoma (HNSCC) is challenged by pre-analytical and inter-observer variabilities. An educational program to compare the diagnostic performances between local pathologists and a board of pathologists on [...] Read more.
The assessment of programmed death-ligand 1 (PD-L1) combined positive scoring (CPS) in head and neck squamous cell carcinoma (HNSCC) is challenged by pre-analytical and inter-observer variabilities. An educational program to compare the diagnostic performances between local pathologists and a board of pathologists on 11 challenging cases from different Italian pathology centers stained with PD-L1 immunohistochemistry on a digital pathology platform is reported. A laboratory-developed test (LDT) using both 22C3 (Dako) and SP263 (Ventana) clones on Dako or Ventana platforms was compared with the companion diagnostic (CDx) Dako 22C3 pharm Dx assay. A computational approach was performed to assess possible correlations between stain features and pathologists’ visual assessments. Technical discordances were noted in five cases (LDT vs. CDx, 45%), due to an abnormal nuclear/cytoplasmic diaminobenzidine (DAB) stain in LDT (n = 2, 18%) and due to variation in terms of intensity, dirty background, and DAB droplets (n = 3, 27%). Interpretative discordances were noted in six cases (LDT vs. CDx, 54%). CPS remained unchanged, increased, or decreased from LDT to CDx in three (27%) cases, two (18%) cases, and one (9%) case, respectively, around relevant cutoffs (1 and 20, k = 0.63). Differences noted in DAB intensity/distribution using computational pathology partly explained the LDT vs. CDx differences in two cases (18%). Digital pathology may help in PD-L1 scoring, serving as a second opinion consultation platform in challenging cases. Computational and artificial intelligence tools will improve clinical decision-making and patient outcomes. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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Review

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19 pages, 2570 KiB  
Review
Head and Neck Cancer (HNC) Prehabilitation: Advantages and Limitations
by Sara Demurtas, Hellas Cena, Marco Benazzo, Paola Gabanelli, Simone Porcelli, Lorenzo Preda, Chandra Bortolotto, Giulia Bertino, Simone Mauramati, Maria Vittoria Veneroni, Ester Orlandi, Anna Maria Camarda, Nagaia Madini, Chiara Annamaria Raso and Laura Deborah Locati
J. Clin. Med. 2024, 13(20), 6176; https://doi.org/10.3390/jcm13206176 - 17 Oct 2024
Viewed by 865
Abstract
Cancer prehabilitation is the process between the time of cancer diagnosis and the beginning of the active acute treatment; prehabilitation consists of various need-based interventions, e.g., physical activity, a nutritional program, and psychological support. It can be delivered as unimodal or multimodal interventions. [...] Read more.
Cancer prehabilitation is the process between the time of cancer diagnosis and the beginning of the active acute treatment; prehabilitation consists of various need-based interventions, e.g., physical activity, a nutritional program, and psychological support. It can be delivered as unimodal or multimodal interventions. Physical activity, including resistant exercise and aerobic activities, has to be tailored according to the patient’s characteristics; nutritional support is aimed at preventing malnutrition and sarcopenia; while psychological intervention intercepts the patient’s distress and supports specific intervention to address it. In addition, multimodal prehabilitation could have a potential impact on the immune system, globally reducing the inflammatory processes and, as a consequence, influencing cancer progression. However, many challenges are still to be addressed, foremost among them the feasibility of prehabilitation programs, the lack of adequate facilities for these programs’ implementation, and the fact that not all prehabilitation interventions are reimbursed by the national health system. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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17 pages, 2937 KiB  
Review
The Anatomy of the Thoracic Duct and Cisterna Chyli: A Meta-Analysis with Surgical Implications
by Dawid Plutecki, Michał Bonczar, Jakub Wilk, Sandra Necka, Miłosz Joniec, Ahmed Elsaftawy, Aleksandra Matuszyk, Jerzy Walocha, Mateusz Koziej and Patryk Ostrowski
J. Clin. Med. 2024, 13(15), 4285; https://doi.org/10.3390/jcm13154285 - 23 Jul 2024
Cited by 1 | Viewed by 1230
Abstract
Background: The thoracic duct (TD) and the cisterna chyli (CC) exhibit a high degree of variability in their topographical and morphometric properties. Materials and Methods: PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to identify all [...] Read more.
Background: The thoracic duct (TD) and the cisterna chyli (CC) exhibit a high degree of variability in their topographical and morphometric properties. Materials and Methods: PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to identify all studies that included information regarding the morphometric and topographical characteristics of the TD and CC. Results: The most frequent location of the TD termination was the left venous angle, with a pooled prevalence of 45.29% (95% CI: 25.51–65.81%). Moreover, the TD terminated most commonly as a single vessel (pooled prevalence = 78.41%; 95% CI: 70.91–85.09%). However, it divides into two or more terminating branches in approximately a quarter of the cases. The pooled prevalence of the CC was found to be 55.49% (95% CI: 26.79–82.53%). Conclusions: Our meta-analysis reveals significant variability in the anatomy of the TD and CC, particularly regarding TD termination patterns. Despite the predominance of single-vessel terminations, almost a quarter of cases exhibit branching, highlighting the complexity of the anatomy of the TD. These findings demonstrate the importance of detailed anatomical knowledge for surgeons to minimize the risk of accidental injury during head and neck, as well as thoracic surgeries. Our study provides essential insights that can enhance surgical safety and efficacy, ultimately improving patient outcomes. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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Other

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2 pages, 140 KiB  
Comment
Comment on Plutecki et al. The Anatomy of the Thoracic Duct and Cisterna Chyli: A Meta-Analysis with Surgical Implications. J. Clin. Med. 2024, 13, 4285
by Lomani A. O’Hagan, Anthony R. J. Phillips, John A. Windsor and S. Ali Mirjalili
J. Clin. Med. 2024, 13(19), 5663; https://doi.org/10.3390/jcm13195663 - 24 Sep 2024
Viewed by 365
Abstract
We read, with interest, Plutecki and colleagues’ systematic review of the anatomy of the thoracic duct and cisterna chyli, recently published in JCM [...] Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
13 pages, 1480 KiB  
Systematic Review
Risk Factors Contributing to Symptomatic Miniplate Removal following Orthognathic Surgery: Systematic Review and Meta-Analysis
by Mohamed Jaber, Nadin Abouseif, Mawada Hassan and Alaa Mohamed El-Ameen
J. Clin. Med. 2024, 13(11), 3335; https://doi.org/10.3390/jcm13113335 - 5 Jun 2024
Viewed by 798
Abstract
Background/Objectives: The use of miniplates for stabilizing bones post orthognathic surgery has surged in popularity due to their efficacy in ensuring stability and hastening recovery. However, controversy exists regarding what should be done with these miniplates after surgery. Some surgeons advocate for [...] Read more.
Background/Objectives: The use of miniplates for stabilizing bones post orthognathic surgery has surged in popularity due to their efficacy in ensuring stability and hastening recovery. However, controversy exists regarding what should be done with these miniplates after surgery. Some surgeons advocate for their removal, while others suggest leaving them in place. This study sought to assess the frequency, causes, and potential risk factors linked with miniplate removal in orthognathic procedures. Methods: A thorough meta-analysis was conducted by scrutinizing studies from various databases including PubMed, Google Scholar, Embase, and Scopus, focusing on publications spanning from 1989 to 2023. Results: Ten studies meeting the inclusion criteria, encompassing 1603 patients, were chosen for inclusion in the meta-analysis. The male-to-female ratio varied from 0.7:1 to 4:1. Overall, 5595 miniplates were inserted, with 294 (5.3%) being subsequently removed. Primary reasons for miniplate removal included infection (161 cases, 2.9%), exposure of miniplates (34 cases, 0.6%), and palpable plates (23 cases, 0.4%). Other indications comprised pain, patient preference, and temperature sensitivity. Less frequent causes for miniplate removal included sinusitis, secondary surgery, and dental pathology. The mean duration of miniplate removal was 5.5 months, with the majority (56.1%) being removed from the mandible rather than the maxilla. In conclusion, this meta-analysis underscores the importance of miniplate removal when hardware causes complications and physical discomfort. The primary reasons for removing miniplates were infection and plate exposure, with the mandible being the most common removal site. Conclusions: These findings emphasize the need for continued monitoring to assess the fate of miniplates in orthognathic surgery and provide valuable information for future clinical decision-making. Full article
(This article belongs to the Special Issue Head and Neck Surgery: Clinical Updates on Diagnosis, Management and Prognosis)
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