Effect of Sarcopenia on Swallowing in Patients With Head and Neck Cancer.

OBJECTIVE: Sarcopenia, characterized by decreased skeletal muscle mass, is associated with poorer oncologic outcomes in head and neck cancer (HNC) patients. The effect of sarcopenia on swallowing following HNC treatment is unknown. This study aims to investigate the association of sarcopenia and swallowing dysfunction in patients treated for HNC. STUDY DESIGN: Retrospective cohort study. SETTING: Academic medical center. METHODS: Pretreatment sarcopenia was assessed using the skeletal muscle index calculated from cross-sectional imaging at the third cervical vertebra. Feeding tube dependence, patient-reported dysphagia, and swallowing safety were assessed before and after treatment with the Functional Oral Intake Scale, Eating Assessment Tool-10, and Penetration Aspiration Scale, respectively. The association between sarcopenia and swallowing dysfunction was evaluated. RESULTS: A total of 112 patients were included, 84 males (75%) and 28 females (25%). A total of 69 (61.6%) had sarcopenia prior to initiating HNC therapy. Sarcopenia was significantly associated with an elevated risk of patient-reported dysphagia (odds ratio [OR] = 2.71 [95% confidence interval, CI, 1.12-6.79]; P < .05). Multivariate logistic regression demonstrated that sarcopenia (OR = 15.18 [95% CI, 1.50-453.53]; P < .05) is an independent predictor for aspiration following treatment for HNC. CONCLUSION: Patients with pretreatment sarcopenia had higher rates of dysphagia before treatment and were more likely to develop aspiration after completion of HNC therapy. Sarcopenia is readily measured using cross-sectional imaging and may be useful for identifying patients at risk of swallowing dysfunction and those most likely to benefit from prehabilitation efforts.

A Systematic Review of Primary Temporal Bone Mucosal Melanoma.

OBJECTIVE: Temporal bone mucosal melanomas (MMs) are rare, and patients may experience delays in diagnosis and treatment. Our objective was to better characterize the presentation, diagnosis, treatment modalities, and outcomes of this process. DATA SOURCES: PubMed/Medline, CINAHL (EBSCOhost), and Web of Science databases were searched in all languages without restriction of publication dates. STUDY SELECTION: Inclusion criteria included that the article was either a case report or a case series with individual case data. All non-English articles were excluded if the corresponding abstract lacked data on demographics, initial presentation, and clinical management. DATA EXTRACTION: After full-text analysis, data pertaining to demographics, diagnosis, medical and surgical management modalities, and outcomes were extracted. DATA SYNTHESIS: Data were qualitatively synthesized, and means and averages were obtained for all continuous variables. Overall survival was measured by the Kaplan-Meier method, and significance was measured through log-rank testing. CONCLUSIONS: Clinicians should suspect temporal bone MM in the differential diagnosis of patients with bloody otorrhea in the context of a chronic serous otitis media or an associated cranial nerve palsy. If suspected, physicians should not delay the acquisition of a biopsy or imaging studies. Management is highly variable and must be decided on a case-by-case basis. Outcomes remain poor because of the high propensity for MM to metastasize.