Upfront Neck Dissection in Organ Preservation Protocol in Head-Neck SCC : Can it be a Game Changer?

The major prognostic factor in head-neck squamous cell carcinoma is the status of lymph nodes. Though there are studies addressing the role of neck dissection in organ preservation protocol, a lacuna still exists as far as the question of upfront neck dissection arises. Despite the potential benefits of upfront neck dissection; the benefits have not been well researched and thus its place in management of head-neck cancers undergoing organ preservation protocol is still questionable. We conducted an observational study in 22 patients with T1 - 2N2 - 3a biopsy proven squamous cell carcinoma of hypopharynx, oropharynx and laryngopharynx which were eligible for organ preservation protocol for their primary site. The primary outcome was to calculate their overall survival rate at 5 years. Overall 5 year survival rate was 68.12%, 5-year Disease free survival rate was 77.2%. The time to start for the primary site, after neck dissection however had a significant effect on overall survival. Those who had a delay of 21 days or less had 80.1% survival at 5 years compared to those who started at 30 days (61.3%) and drastically reduced in those who started at 39 days (20.4%). Log-rank test for the effect of nodal status showed a significant difference in terms of 5 year survival between the groups(p = .027). The 5 year survival rates for N2A, N3A and N2B nodal status were 88.8%, 50% ,and 54.5% ,respectively. We strongly favour upfront neck dissections in a subset of head-neck squamous cell carcinoma cases with T1 - 2N2 - 3a eligible for organ preservation regimen.

Bilateral Chylothorax Following Neck Dissection: A Systematic Review and Proposed Management Algorithm.

Aims: Bilateral chylothoraces are rare but potentially life-threatening complications of neck dissections (ND). The condition is generally treated with a combination of dietary, medical, procedural, and surgical approaches. The aim of this review is to highlight the management options currently utilized in clinical practice and propose a management algorithm for this condition. Methods: In accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; utilizing the Pubmed, EMBASE, and Web of Science databases, a systematic review of all available literature on bilateral chylothoraces was conducted. Primary outcomes measures included clinical presentations and type of neck dissection performed with interventions employed to manage the condition. Secondary outcome measures included the time to resolution alongside patient outcomes. Results: We identified 37 patients (female n = 27, male n = 10) who presented with bilateral chylothoraces within the years 1951-2018. The mean age was 51.4 ± 16.5 years within the age ranges of 17-78 years. Most common pathologies included papillary thyroid carcinoma (n = 16), squamous cell carcinoma (SCC) of the larynx (n = 3), supraglottic SCC (n = 3). Left sided ND was done in (n = 18); bilateral ND in (n = 17); central/left ND in (n = 2). Chylothorax was treated by surgery in n = 10, n = 5 of which performed lymph node embolization; and n = 5 used lymph node ligation. Resolution was found in all cases. Discharge times ranged from 2 to 40 days. Conclusions: This systematic review highlights the different management modalities in treating bilateral chylothoraces alongside providing a decision algorithm in treating the condition by suggesting diagnostic tools and management modalities to optimize patient care.

Neck Dissection in cT3/T4 Mucoepidermoid Carcinoma of the Oral Cavity and Oropharynx.

Previous research has reported high occult nodal metastases rates for T3/T4 mucoepidermoid carcinoma (MEC) of the oropharynx (OP) and oral cavity (OC). Our study evaluates if there is a benefit of neck dissection (ND) in these patients. The 2004-2016 National Cancer Database was queried for cases of adult MEC of the OC and OP. Patients with clinical T3/T4 disease were included while those with metastatic disease were excluded. Patients were divided into two cohorts: those treated with and without ND. Univariate chi-square, Kaplan-Meier, and multivariable Cox regression analyses were implemented. A total of 243 patients met inclusion criteria, of which 79 (32.5%) underwent ND. The majority of patients were less than 60 years old (60.1%), White (76.2%), and male (53.5%). 92 (37.9%) patients had clinically node-positive (cN+) disease. ND patients had higher rates of cN + disease (53.2% vs. 30.5%, p = 0.002). Of patients undergoing ND, 35 (44.3%) had cN0 disease while 42 (53.2%) had cN + disease. ND patients more commonly had grade III/IV tumors (45.1% vs. 23.4%, p = 0.002). Upon examination of dissected nodes, 20.3% of cN0 patients undergoing ND were found to have occult nodal metastases. There was no significant difference in 5-year overall survival between patients with and without ND (61.8% vs. 53.6%, p = 0.610), even on multivariable Cox analysis (hazard ratio: 1.52, 95% confidence interval: 0.73-3.18, p = 0.269). Our study found patients with cN0 MEC of the OC and OP have a high rate (20.3%) of occult nodal metastasis. In this cohort, patients with ND were not found to have improved survival, possibly due to statistical underpowering. Further research is needed to evaluate the indications and benefit of ND for this rare tumor presentation.

Intraoperative Spinal Accessory Nerve Monitoring During Neck Dissection Surgery as a Predictor for Shoulder Dysfunction.

Shoulder dysfunction is one of the most common complications seen in patients who have undergone neck dissection surgery. The prevalence of shoulder dysfunction increases depending on the type and extent of neck dissection surgery. We aim to study the relationship between changes in intraoperative neuromonitoring (IONM) threshold during SAN stimulation, ultrasonographic measurement of muscle size and shear wave elastography with shoulder dysfunction. This is a prospective study. All patients who have undergone neck dissection in our centre have been recruited. Analysis of demographic data, IONM threshold during exposure and pre-closure, shoulder function score, neck disability index score (NDII) and ultrasonographic parameters pre-op and during follow up was done. The cohort was divided into patients who suffered from shoulder dysfunction post op (Group A) and patients with normal shoulder function post op (Group B). Statistical significance were seen in IONM threshold during SAN stimulation and Constant shoulder score for 6 months follow up in Group A. IONM threshold difference during exposure and pre-closure could effectively prognosticate shoulder dysfunction post op. A return of shoulder function could be seen in patients who suffered from shoulder dysfunction if early physiotherapy could be commenced.

Outcomes in Minor Salivary Gland Tumors-A 20+ Year Tertiary-Care Center Experience.

Objective: Minor salivary gland carcinomas are challenging to study due to their rarity and heterogeneity. We aim to further characterize clinical characteristics, treatment, and outcomes over 20 years within a single institution. Study Design: Retrospective chart review was conducted on 210 patients who received primary treatment for minor salivary gland malignancy from 2000 to 2022. Setting: Single tertiary-care center. Methods: Multivariable Cox proportional hazards method was used to examine the relationship between pre-determined clinically important variables and outcomes. Results: Five-year overall survival was 77.8% (72.0-84.1). Advanced clinical T stage portended over a 2 times higher risk of death and recurrence. High pathologic grade was associated with a near 3 times higher risk of death and recurrence. There was a predominance of occult nodal metastases in level II for oral cavity and oropharynx site tumors. Conclusion: Clinical T stage and grade were important for overall survival, local, regional, and distant recurrence-free survival. Occult nodal metastases occurred most often in level II.

Unmasking the rarity of mammary analogue secretory carcinoma of the minor salivary gland - A case report.

INTRODUCTION: Mammary analogue secretory carcinoma (MASC) of the salivary gland was first described by Skálová et al. in 2010. It is often associated with a translocation, t(12;15)(p13;q25), which results in the fusion gene ETV6-NTRK3. Major salivary glands, primarily the parotid gland, are involved in 70 % of cases of MASC, while small salivary glands are involved in less than 25 % of cases. This report aims to consolidate in unveiling, diagnosing, and managing the rarity of MASC in the minor salivary gland and its existing knowledge and encourage new research on this increasingly important salivary gland malignancy. PRESENTATION OF THE CASE: A 27-year-old female reported with a complaint of swelling on the right cheek region of face since 10 weeks. On bimanual palpation, a soft lobulated mass was appreciated beneath the healthy mucosal layer. The radiographic image (orthopantomogram) showed no obvious calcified mass. An excisional biopsy was planned and performed under local anesthesia. Microscopic and immunohistochemistry confirmed the tumor to be a MASC of minor salivary gland. DISCUSSION: Due to their infrequency and multiplicity of histopathology, MASC presents difficulty in diagnosis. A key to determining diagnostic criteria for MASC is to study cellular morphology, cytoplasmic filament expression, and ultrastructural features of the tumor and apply this information to defining MASC. CONCLUSION: MASC is an important molecularly defined entity of the salivary gland with low-grade malignant potential. Correct diagnosis is essential for appropriate treatment and will help to provide better information about this potentially low-grade malignant salivary gland neoplasm.

Preoperative Prediction of Occult Level V Lymph Node Metastasis in Papillary Thyroid Carcinoma: Development and Validation of a Radiomics-Driven Nomogram Model.

RATIONALE AND OBJECTIVES: The study aimed to analyze the patterns and frequency of Level V lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC), identify its risk factors, and construct predictive models for assessment. METHODS: We conducted a retrospective analysis of 325 PTC patients who underwent thyroidectomy and therapeutic unilateral bilateral modified radical neck dissection from October 2020 to January 2023. Patients were randomly allocated into a training cohort (70%) and a validation cohort (30%). The radiomics signature model was developed using ultrasound images, applying the minimum Redundancy-Maximum Relevance and Least Absolute Shrinkage and Selection Operator regression to extract high-throughput quantitative features. Concurrently, the clinic signature model was formulated based on significant clinical factors associated with Level V LNM. Both models were independently translated into nomograms for ease of clinical use. RESULTS: The radiomics signature model, without the inclusion of clinical factors, showed high discriminative power with an area under the curve (AUC) of 0.933 in the training cohort and 0.912 in the validation cohort. Conversely, the clinic signature model, composed of tumor margin, simultaneous metastasis, and high-volume lateral LNM, achieved an AUC of 0.749 in the training cohort. The radiomics signature model exhibited superior performance in sensitivity, specificity, positive predictive value, negative predictive value across both cohorts. Decision curve analysis demonstrated the clinical utility of the radiomics signature model, indicating its potential to guide more precise treatment decisions. CONCLUSION: The radiomics signature model outperformed the clinic signature model in predicting Level V LNM in PTC patients. The radiomics signature model, available as a nomogram, offers a promising tool for preoperative assessment, with the potential to refine clinical decision-making and individualize treatment strategies for PTC patients with potential Level V LNM.

Real-World Survival Impact and Utilization of Adjuvant Radiation in Advanced Laryngeal Cancer.

Background: Optimal treatment of locally advanced cancer of the larynx is controversial. In this study, we aim to compare outcomes in patients with T3-4N0-1 cancer of the larynx who underwent surgery alone versus surgery followed by radiation therapy (RT). Materials and Methods: A total of 1820 patients with advanced laryngeal cancer were identified from the national Surveillance, Epidemiology, and End Results Database and stratified based on postoperative RT status, and clinical outcomes were compared between these 2 groups. Propensity score matching was conducted to balance baseline characteristics. Results: The majority of patients (53.4%) received adjuvant RT. N0 patients who received laryngectomy and who did not undergo adjuvant radiation had a 47% higher risk of cancer-specific death than patients receiving adjuvant RT (adj. HR 1.47, 95% CI 1.18-1.84). N1 patients who did not undergo adjuvant radiation had a 90% higher risk of cancer-specific death than patients receiving RT after surgery (adj. HR 1.90, 95% CI 1.27-2.84). After adjusting for propensity scores, adjuvant RT carried a significant overall survival benefit (HR 0.73, 95% CI 0.60-0.87). Conclusions: This study provides real-world support for adjuvant radiation in patients with T3-4N0-1 laryngeal carcinoma. Nearly half of patients did not receive RT, indicating a need for national provider education and process improvement strategies to improve utilization.

Utility of intraoperative Delphian lymph node sampling in pediatric thyroid surgery.

OBJECTIVES: The Delphian lymph node (DLN) is the first lymph node receiving drainage from the thyroid. We aim to determine whether routine DLN sampling with frozen section analysis during pediatric thyroidectomy can alter intraoperative surgical decision making. Additionally, we aim to measure whether DLNs can predict a requirement for central neck dissection (CND) in the clinically node negative (CNN) pediatric population. METHODS: Retrospective chart review for pediatric patients who underwent thyroidectomy between 2014 and 2022. Patients were included if they had prior FNA with a result of: benign nodule, atypia or follicular neoplasm of undetermined significance (AUS/FNUS), follicular neoplasm (FN), or papillary thyroid carcinoma (PTC). All patients had intraoperative DLN analysis via frozen section histopathology. RESULTS: 27 patients were included, 9 males (33 %) and 18 females (67 %). On final pathology 19 patients (70.4 %) had PTC. The DLN was negative for carcinoma in all (n = 8, 100 %) patients with benign pathology. In 10 patients (100 %) with positive DLN on frozen section, postoperative pathology demonstrated central neck metastasis. Nine (90 %) of these patients were CNN and had alterations in the surgical plan based on the DLN. The tenth patient's surgical plan did not change given preoperative clinical disease. Three patients with negative DLNs had central neck metastasis. CONCLUSION: The DLN serves a role in guiding treatment for the pediatric population. Positive DLN altered surgical plans in 60 % of CNN PTC patients, allowing for CND to be performed and reducing need for additional surgical resection. The positive predictive value for DLN status was 100 % in this study, and the negative predictive value was 62.5 %. However, negative DLNs do not rule out central neck disease.

Central Neck Dissection in Papillary Thyroid Carcinoma: Benefits and Doubts in the Era of Thyroid Lobectomy.

INTRODUCTION: Surgery is still the main line of treatment for papillary thyroid cancer (PTC) with a current trend for de-intensified treatment based on an excellent prognosis. The role of a routine prophylactic central neck dissection (PCND) is still debated as its impact on oncologic outcomes has never been cleared by a randomized clinical trial. In this study, we aimed to report our long-standing experience in PCND and its potential contemporary role in the treatment of PTC. METHODS: A retrospective institutional review was performed on all patients who underwent operation for PTC including PCND between 1998 and 2021. The primary outcomes were the rate of central lymph node metastases (CLNMs), cancer recurrence and incidence of complications. Survivals were analyzed using the Kaplan-Meier estimator and Cox proportional hazard models. RESULTS: A total of 657 patients were included in this study with a median follow-up of 78 months (48-114 months). Two hundred and one patients presented occult CLNMs (30.6%). The presence of a pathological node represented the unique reason for a completion thyroidectomy and I131 therapy in 12.5% of the population. Age lower than 55 years, microscopic or macroscopic extra-thyroid extension (ETE) and multifocality were independent factors predicting CLNMs. The rate of recurrence in the whole population was 2.7% (18 patients). Five-year and ten-year disease-free survival (DFS) was 96.5% (94.7-97.7) and 93.3% (90.3-95.5), respectively. Two patients relapsed in the central neck compartment (0.3%). Age (>55 years), pathological staging (pT) and extranodal extension (ENE) were independent factors associated with a worse DFS. The rate of temporary and permanent vocal fold palsy was 12.8% and 1.8%, respectively, and did not depend on the type of surgical procedure performed. Hypoparathyroidism was temporary in 42.2% and permanent in 11.9% of the patients. A sub-analysis upon cT1b-T2 patients treated primarily with thyroid lobectomy and ipsilateral PCND demonstrated a 2.6% rate of permanent hypoparathyroidism. CONCLUSIONS: PCND allows for a high disease-free survival and a proper selection of patients needing adjuvant treatment, in particular, those treated with a unilateral procedure. On the other hand, bilateral approach is burdened by a not-neglectable rate of permanent hypoparathyroidism.

Incidental Parathyroidectomy After Thyroid Surgery: A Single-Center Study.

BACKGROUND: Hypoparathyroidism with hypocalcemia is the most frequent complication after thyroid surgery. Many risk factors have been involved in the development of this complication, with conflicting results. Incidental parathyroidectomy (IP) may be a frequent cause of postoperative hypocalcemia. In this study, we have evaluated the risk factors associated with the IP in a single-center cohort of patients undergoing thyroid surgery. PATIENTS AND METHODS: The incidence and the risk factors for IP were evaluated in 799 patients scheduled for surgical treatment for thyroid disease between January 2018 and December 2023. Parathyroid hormone levels and serum calcium levels, together with the histological specimens, were evaluated in all patients. RESULTS: Post-operative temporary hypocalcemia was present in 239 (29.9%) patients. A total of 144 patients (21.9%) had an incidental parathyroidectomy. Younger patients (<40 years) had the highest risk of having an incidental parathyroidectomy (RR 1.53 (95% CI 1.084-2.161), OR 1.72 (95% CI 1.091-2.710), p = 0.014). Moreover, thyroid cancer (RR 1.4 (95 CI 1.114-1.882) OR 1.68 (95% CI 1.145-2.484), p < 0.05) and the neck dissection (RR 1.75 (95% CI 1.409-2.198) OR 2.38 (95% CI 1.644-3.460), p < 0.001) were strongly associated with the risk of incidental parathyroidectomy. CONCLUSIONS: Younger female patients with thyroid cancer and neck dissection were at the highest risk of incidental parathyroidectomy. A meticulous surgical dissection, together with imaging methods for the detection of the parathyroid glands, may reduce the incidence of this complication.

Neck Dissection with Harmonic Instruments and Electrocautery: A Systematic Review.

Introduction The harmonic scalpel (HS) is a technique introduced to reduce blood loss and intraoperative time during neck dissection (ND). Objective To compare the results of HS with traditional hemostasis in ND through a systematic review and metanalysis. Methods A computer-based strategy of systematic literature survey included research in the MEDLINE, EMBASE, and Cochrane Library databases from January 2007 up to August 2022. The survey strategy employed was [harmonic scalpel OR ultrasonic scalpel] AND neck dissection. Results There were 61 articles identified that addressed the use of HS in patients undergoing ND. From those, 10 randomized clinical trials were selected, comprising 264 cases of ND using HS and 262 cases of ND without HS. Conclusion The use of HS for ND significantly reduces the operative time, intraoperative bleeding, volume of draining fluid, and the number of ligatures.

Lymph nodes in oral squamous cell carcinoma: a comprehensive anatomical perspective.

Oral squamous cell carcinoma (OSCC) often exhibits a propensity for metastasis to lymph nodes (LNs), significantly influencing prognosis. Neck dissection (ND) is an important part in the treatment of OSCC. Variations in the preference for and pathways of lymph node metastasis (LNM) in different regions of the oral cavity have been observed. Currently, there is a lack of sufficient emphasis on the anatomical perspectives of LNM and ND. This review elucidates the lymphatic system of the maxillofacial regions from an anatomical standpoint, details the distribution of the sentinel LNs across different subsites, and summarizes the various classifications of the cervical LNs. Additionally, we elaborate on the methods used to study the lymphatic system, particularly imaging techniques. Furthermore, we investigate the pathways of cervical LNM and evaluate the efficacy of ND from an anatomical viewpoint. The overall objective of this review is to provide essential anatomical knowledge for managing LNs in OSCC, in the hope of providing patients with effective treatment modalities to enhance their quality of life.

A multicenter retrospective study on neck dissection and adjuvant radiotherapy with transoral surgery for hypopharyngeal squamous cell carcinoma.

OBJECTIVE: The aim of this multicenter retrospective study was to analyze the impact of prophylactic neck dissection and adjuvant therapy in transoral surgery for hypopharyngeal cancer. METHODS: We compared the impact of surgical margin assessment, neck dissection, and adjuvant treatment on oncologic outcomes in patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma between 2015 and 2021. RESULTS: Two hundred and twenty-one patients were included. The 3-year local recurrence-free survival was 89.1 %, and local recurrence did not significantly impact overall survival. Positive vertical margins resulted in 60 % of patients receiving additional treatment, with no increase in local recurrence and a significant increase in regional recurrence (p = 0.007) and distant metastasis (p < 0.001). Half of the patients with regional recurrence after neck dissection also had distant metastases and worse survival (p = 0.069), while those with regional recurrence without prophylactic neck dissection did not have worse survival. CONCLUSION: In cases of positive vertical margin, careful surveillance for regional recurrence and distant metastasis is also warranted. Prophylactic neck dissection may not be necessary.

Assessment of Surgical Competences for Neck Dissection and Total Laryngectomy on Revascularized Cadaver Models: Onco-Neck-Score and Onco-Larynx-Score.

BACKGROUND: In surgical simulation, evaluation tools are necessary to allow the overall and specific level of each gesture to be assessed for learners, to allow active feedback and follow-up. The aim of this study was to create and validate a scale for the assessment of competences for neck dissection (ND) and total laryngectomy (TL) in head and neck surgical oncology simulation specific for revascularized cadavers' models. METHODS: Two independent scales were created for ND and TL based on a two-round Delphi method. The scales were used during ND and TL simulation sessions on SimLife® (Symedis, Poitiers, France) model. Surgical steps were scored by 2 independent observers. To assess its ease of use, a questionnaire was answered by senior surgeons (SS) at the end of the sessions. RESULTS: Fifteen items were included in the final version for ND scale and 20 for TL scale. The results of 14 lateral ND and 8 TL were included. The mean score was higher for SS (69 ± 6.4; 87.5 ± 8.5) than for residents (36.5 ± 11; 57.5 ± 13.2) for ND (P = 0.0006) and TL (P = 0.028) respectively. Six SS strongly agreed that this tool had a positive impact on resident training with stepwise feedback and accurately represented their competences. CONCLUSION: We developed a pedagogic tool built to assess surgical competence for head and neck surgical oncology on revascularized cadaver models. This tool has a good construct validity thanks to the expert reviewing with Delphi method and appears to have fine acceptability by the SS.

Effectiveness of prophylactic central compartment neck dissection following Hemithyroidectomy in papillary thyroid cancer: a meta-analysis.

INTRODUCTION: In this study, we aimed to assess the effect of prophylactic central compartment neck dissection (pCCND) in conjunction with hemithyroidectomy (HT) for clinically low-risk node-negative (cN0) papillary thyroid carcinoma (PTC). METHODS: A thorough literature search was performed utilizing PubMed and EMBASE for articles published until October 2023. Subsequently, a meta-analysis was performed on studies involving patients with cN0 PTC, with postoperative locoregional recurrence (LRR) and survival data, treated with HT + pCCND or HT. The study was registered with PROSPERO (CRD42024560962). RESULTS: We included seven studies in this meta-analysis, including 2132 patients who met the inclusion criteria: six retrospective cohort studies and one randomized controlled trial. The HT + pCCND group consisted of 1090 cases, and the HT group had 1042 cases. The LRR rates after HT with or without pCCND were similar (3.58% vs. 4.51%; odds ratio (OR) = 0.65; 95% confidence interval (CI) = 0.41-1.03). Five of the seven studies provided prognostic and survival data, particularly the log hazard ratio (log HR) of disease-free survival (DFS) between the two groups. There was also no significant difference in terms of DFS between the HT + pCCND and HT groups (OR = 0.67; 95% CI = 0.42-1.07). CONCLUSIONS: There was no significant difference in LRR and DFS between the HT + pCCND and HT groups. pCCND did not demonstrate significant efficacy in improving oncological outcomes for low-risk patients with cN0 PTC. Therefore, for patients with low-risk cN0 PTC, thyroid surgeons should make reasonable and individualized decisions regarding the extent of surgical removal.

Factors influencing lymph node yield in head and neck squamous cell carcinoma: A scoping review.

OBJECTIVES: In head and neck cancer surgery, several studies have demonstrated the prognostic significance of lymph node yield (LNY). To our knowledge, no review has evaluated both the contributing factors to LNY and its impact on survival outcomes across all head and neck squamous cell carcinoma (HNSCC) subsites. MATERIALS AND METHODS: A scoping review of LNY in HNSCC was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework to answer the following research questions: 1) Which surgeon, pathologist, and patient characteristics influence LNY? 2) Which anatomic subsites does LNY impact survival? RESULTS: Surgeon experience and variation in pathology protocols and personnel can impact LNY. Extent of nodal dissection, advanced tumor characteristics, and treatment at an academic facility are associated with increased LNY. Patient characteristics such as age <40, male gender, and BMI > 30 are associated with increased LNY. In the oral cavity, LNY > 18 is an independent predictor of improved overall survival (OS), disease free survival (DFS), and disease-specific survival (DSS). In the oropharynx, published studies show mixed results with regards to the impact of LNY on OS, DFS, and DSS. LNY has not been associated with OS or DFS in the larynx, irrespective of nodal threshold. CONCLUSIONS: Provider and patient characteristics may impact LNY. LNY ≥ 18 is associated with a survival benefit in the oral cavity and HNSCC overall. Further investigation of LNY particularly in prospective clinical trials is required prior to its adoption as a quality metric in HNSCC.

Lymphatic mapping in second primary or recurrent oral cavity cancer with prior neck treatment: A case series and scoping review.

OBJECTIVES: Lymphatic mapping is an established technique to map drainage patterns in oral cancer. Its utility in patients who have undergone prior radiation or neck dissection is not well studied. METHODS: Patients presenting to a single tertiary cancer center between 2021-2023 for a recurrent/second oral cancer that underwent lymphatic mapping were considered. All patients had a history of a head and neck cancer treated with either radiation or neck dissection. We further conducted a scoping review in MEDLINE, Embase, and Web of Science of lymphatic mapping in oral cancer patients with previous neck treatment. RESULTS: In our single center review, a total of 11 patients were included. 73 % received prior radiotherapy and 55 % underwent prior neck dissections for a head and neck cancer. Lymphoscintigraphy-directed neck dissections identified sentinel nodes in 9/11 patients, with only one patient who had positive sentinel node disease. There were no reports of regional recurrence at a median of 10 months follow-up. Our scoping review of 980 studies identified 151 additional patients who underwent sentinel node biopsy for a second oral cancer after previous neck treatment. Overall, the negative predictive value of lymphatic mapping in all studies was 96.7 %. CONCLUSION: Lymphatic mapping is feasible in secondary or recurrent oral cavity cancers even in patients with prior radiation or surgical management of the neck. The literature to date demonstrates a negative predictive value of âˆ¼ 97 % for sentinel node mapping and warrants further consideration in the management of salvage oral cancer.

Incidental Finding of Double Posterior Belly of Digastric Muscle in Head and Neck Cancer Patient.

OBJECTIVES: The digastric muscles have important roles in swallowing, chewing, speech, and landmark identification during neck dissection. The posterior belly of the digastric muscle (PBDM) is often useful for defining boundaries in surgical neck dissection as it contributes to the carotid, submandibular, and submental triangles. The cadaveric prevalence rate of anatomic variations in the digastrics has been reported to be 31.4% of the population with most occurring in relation to the anterior belly of the digastric muscle (ABDM). Few reports describe variations in the PBDM. While anatomic variants of the digastric muscles do not present with clinical manifestations, they can be mistaken as neck masses and contribute to intraoperative complications. METHODS: We present a case report of a 73-year-old male with a past medical history significant for Parkinson's Disease, who was incidentally found to have a duplicate PBDM intraoperatively while receiving surgical management of a left buccal squamous cell cancer. RESULTS: Nine months prior to surgery, the patient began experiencing trismus and some mild dysphagia that were eventually worked up to reveal left buccal squamous cell carcinoma (SCC). Prior to this, the patient did not have clinical symptoms demonstrating dysfunction that could be related to or indicative of this anatomical abnormality preceding symptoms related to left buccal SCC growth. The procedure included a wide local excision, left modified radical neck dissection and left submental artery island flap with suprahyoid neck dissection. The superior duplicate PBDM was found to be overlying the stylohyoid muscle. CONCLUSIONS: It is important for surgeons operating in the head and neck to be aware of the possibility of this rare variation, and to be conscientious when it is identified so that it does not prohibit or limit a thorough dissection of the neck structures where oncologic clearance is paramount.

Comparison of actual prognosis between unilateral and bilateral central neck dissection in modified radical neck dissection patients with no clinical central lymph node metastasis: a retrospective cohort study.

Purpose: This study aimed to evaluate the long-term prognosis of contralateral central neck dissection (CND) in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We compared the actual recurrence rate according to the extent of CND-ipsilateral and contralateral sides. Methods: A total of 708 PTC patients who underwent total thyroidectomy and concomitant ipsilateral or bilateral CND with ipsilateral lateral neck dissection between January 1997 and December 2022 at Samsung Medical Center were retrospectively analyzed. Results: The median follow-up time was 118 months. Locoregional recurrence was observed in 26 patients (7.9%) and 30 patients (7.9%) in the ipsilateral and bilateral CND groups, respectively. There were 6 contralateral recurrence cases (1.8%) in the ipsilateral CND group and 6 cases (1.6%) in the bilateral CND group. There was only 1 contralateral central neck recurrence in the ipsilateral CND group. The incidence of hypocalcemia (P = 0.007) was higher in the bilateral CND group compared to the ipsilateral CND group. Conclusion: Surgeons may consider performing only unilateral CND-the side where tumor is for therapeutic purposes to reduce surgical complications.