Multifocal adult rhabdomyoma of the head and neck: case report and systematic review of the literature

Adult-type rhabdomyoma (ARM) is the most frequent extracardiac subtype of rhabdomyoma. In very rare instances ARM presents as multiple cervical lesions, an entity known as multifocal ARM. The aim of this study was to review the clinical characteristics and the best therapeutic options for multifocal ARM. The case of a 73-year-old patient recently diagnosed with multifocal ARM and managed in our institution is reported, followed by a systematic review of the literature. The review was conducted using the PubMed, Scopus, and Google Scholar databases, according to the PRISMA guidelines. All case reports and case series related to multifocal ARM written in English or French were included. A total of 29 cases were included in the qualitative analysis. Mean age at presentation was 65.0 years and the male to female ratio was 13.5:1. Dysphagia was the most common presenting symptom. ARM was most frequently found in the submandibular spaces. In conclusion, multifocal ARM are benign tumours with a predilection for the head and neck region. They become symptomatic with gradual compression of the adjacent structures. No cases of malignant transformation were reported in the literature. We suggest a ‘watchful wait’ approach for small asymptomatic tumours and excision of large symptomatic ones.     

Human papillomavirus and cancerous diseases of the head and neck: a systematic review and meta‐analysis

The increasing incidence of head and neck cancer (HNSCC) highlights the need to better understand the role of human papillomavirus (HPV) in the development of these cancers. The aims of this study were to conduct a systematic review and a meta‐analysis concerning observational studies on the association between HPV infection and HNSCC and to quantify this association, thereby obtaining a reliable estimation of the risk of HPV infection in the development of head and neck cancer. Literature searches were performed using PubMed and Scopus databases. StatsDirect 2.7.8 program was used for the analysis. We found 15 case–control studies, 63 prevalence studies, and no cohort studies. The pooled odds ratio (OR) for all the included case–control studies resulted in a value of 1.63 (95% CI 1.27–2.09; P < 0.0001). The highest pooled OR resulted from the analysis of all the studies that examined HPV 16 genotype in association oral cavity (OR 5.36; 95% CI 1.4–20). The strong evidence of association between HPV infection and HNSCC highlights the importance of the introduction of specific tests in the cancer prevention practices to evaluate the presence of the virus, especially in the oral cavity, and the possibility of an extension of the vaccine anti‐HPV in the male population too.     

Prognostic significance of soft tissue deposits in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Soft tissue deposits, also known as tumour deposits (TDs), have not been studied well in head and neck squamous cell carcinoma (HNSCC) and are not included in any of the staging systems or treatment guidelines. The aim of this systematic review was to determine the prevalence and prognostic implications of TDs in patients with HNSCC. This systematic review of the literature was conducted following the PRISMA guidelines. The PubMed, Embase, and Scopus electronic databases were searched for relevant studies, from inception to August 2022. Although 14 studies qualified for inclusion, only eight were finally included in the review due to the considerable overlap of patients in several studies. Data from 7127 patients were analysed. The pooled prevalence of TDs was 21% (95% confidence interval (CI) 9–33%). The presence of TDs was adversely associated with overall survival and disease-free survival, with hazard ratios of 2.08 (95% CI 1.60–2.70) and 2.56 (95% CI 1.97–3.32), respectively. TDs are detected in a significant number of patients with HNSCC and adversely affect survival. Longitudinal prospective studies are needed to evaluate the prognostic implications of TDs in HNSCC for their potential role in cancer staging and adjuvant treatment planning.     

Pesticides as risk factors for head and neck cancer: A review

Humans may be exposed to pesticides such as fungicides, herbicides, and insecticides, during occupational and non‐occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science, and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred and thirty‐two studies were identified. Thirty‐two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high‐quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure, and type of pesticide.     

NUT carcinoma of the mandible in a child: case report and systematic review

Nuclear protein of the testis (NUT) carcinoma is a rare, undifferentiated carcinoma that is characterized by NUTM1 gene rearrangements. Patients with NUT carcinoma have an overall survival of approximately 5% at 5 years despite a multimodal treatment approach. This report illustrates the management of mandibular NUT carcinoma in a pediatric patient, complemented by a systematic review of head and neck NUT carcinoma. A 5-year-old female presented with an enlarging jaw mass that was diagnosed as BRD4-NUTM1 carcinoma and was treated with hemimandibulectomy and chemoradiation. She remains disease-free 21 months after completion of therapy. A total of 63 patient cases reported in 34 articles were identified in the review. Only 26.9% (14/52) of tumors were correctly diagnosed initially as NUT carcinoma, whereas 73.1% (38/52) were incorrectly diagnosed as another malignancy; the initial diagnosis was not reported for 11 patients. The mandibular tumor subtype was among the rarest reported (n = 1; 1.6%). Combination therapy, including surgery and chemoradiation, was the most common treatment (55.2%). The patient case presented here is a novel case of pediatric mandibular NUT carcinoma. Due to the poor overall survival of patients with NUT carcinoma, aggressive upfront resection with 2-cm margins followed by adjuvant chemoradiation is advocated.     

Donor site morbidity of composite free flaps in head and neck surgery: a systematic review of the prospective literature

Composite free flaps represent the cornerstone for the repair of osseous defects in the head and neck. For many patients, there are often multiple defect-suitable donor sites that may be utilised as part of the reconstructive process. Therefore, to optimise patient outcomes, an evidence-based approach to donor site selection is required to maximise quality of life and long-term functionality. A systematic review of the literature was conducted in accordance with PRISMA guidelines to evaluate the evidence for donor site selection based on minimising the associated donor site morbidity and optimising patient functionality postoperative. The fibula is associated with the greatest potential risk for wound healing complications. Fibula and scapula harvest has the potential to have a significant impact on physical performance. The iliac crest is most favourable in terms of aesthetic scar healing outcomes. Overall, however, the quality and quantity of evidence for all donor sites is limited. Each site is associated with specific complications and morbidity, of which the surgeon and patient must both be aware. Whilst a cross-sectional informed opinion of the likely advantages/disadvantages of one donor site over another can thus be made, there are few head-to-head studies available that directly compare donor sites.     

Non-technical skills in oral and maxillofacial and head and neck surgery: systematic review

The importance of teams’ and individuals’ non-technical skills in reducing adverse events is well-recognised. We undertook a systematic review of the published literature to assess the research undertaken to date on non-technical skills and behaviours within oral and maxillofacial, and head and neck (OMFS-H&N) surgery. The aim was to assess the applicability of published studies to current practice, to look at how these studies could guide future research, and look for areas that could be developed further. The search terms included ‘non technical skills’, ‘nontechnical skills’, ‘NOTSS’, ‘non-technical skills for surgeons’, ‘oral surgery’, ‘oral maxillofacial surgery’, ‘OMFS’, ‘maxillofacial surgery’, ‘head and neck surgery’, ‘microsurgery’, ‘behavioural markers’, ‘behavioural assessment tool’, and ‘behavioural ratings system’. Three publications were included, involving 83 participants. Participants consistently achieved the highest scores in the ‘situational awareness’ category and showed a tendency to achieve lower mean scores in the ‘communication and teamwork’ and ‘decision-making’ categories. The majority of research into surgeons’ non-technical skills has occurred in simulated environments and not in the genuine environments in which actual surgery is being performed on patients. Research involving ‘real’ patients has been done in the field of OMFS-H&N and this places the specialty in a stronger position than many other surgical specialties.     

Diagnostic value of intraoperative bone marrow assessment for bone margins in patients with head and neck squamous cell carcinoma: a systematic review and meta-analysis

A clear bone margin is essential for complete resection of the bone-involved tumour, but the evaluation of hard tissue takes time and is impractical intraoperatively. Bone marrow assessment remains controversial. The aim of this study was to investigate the diagnostic value of intraoperative bone marrow assessment for bone margins. PubMed and Web of Science were searched for studies published between 1990 and 2017. A systematic review was conducted. After quality assessment, 10 articles with 11 cohorts and 404 patients were identified. Sensitivity, specificity, and other measures were pooled for meta-analysis; the estimates for intraoperative bone marrow assessment were as follows: sensitivity 0.82 (95% confidence interval (CI) 0.62–0.93), specificity 0.99 (95% CI 0.96–1.00), positive likelihood ratio 109.79 (95% CI 22.99–524.34), negative likelihood ratio 0.18 (95% CI 0.08–0.42), and diagnostic odds ratio 241.82 (95% CI 90.33–647.38). Furthermore, sensitivity and specificity at the summary operating point of the summary receiver operating characteristic curve were 0.82 and 0.99, respectively, and the area under the curve was 0.99. Intraoperative bone marrow assessment was investigated by meta-analysis and shown to have a high level of overall accuracy for the diagnosis of bone margins.     

头颈部血管外皮瘤:1例报道及文献复习

报告1例29岁女性左侧咽旁间隙血管外皮瘤病例,并复习头颈部血管外皮瘤的相关文献。头颈部血管外皮瘤发病率低,缺乏特征性临床表现。病理学检查可见紧密排列的肿瘤细胞围绕丰富的不同口径的薄壁血管腔,同时缺乏特异性的免疫标识。广泛切除是治疗血管外皮瘤的有效方法。预后因肿瘤性质不同而有所不同,并存在一定复发率。恶性血管外皮瘤可发生远处转移。婴幼儿(先天性)血管外皮瘤生物学行为良好,局部切除可治愈。     

Prognostic value of elective neck dissection in adenoid cystic carcinoma of head and neck: a meta-analysis: A call for randomized trials and international consensus

Adenoid cystic carcinoma of head and neck (AdCCHN) is an uncommon salivary gland cancer characterized for infrequent neck metastases, and high rate of local and distant recurrence. The aim of this meta-analysis was to analyse the significance of elective neck dissection (END) in terms of overall survival (OS) in patients with AdCCHN. A systematic literature search and meta-analysis was performed. Endpoint assessed by this meta-analysis included 5-year OS (death from any cause). Statistical heterogeneity was assessed using the Cochrane Q test and I² statistic. A pooled odds ratio (OR) was reported with 95% confidence interval (CI). There were 1934 patients in the END arm and 3083 in the observation group. The pooled OR, calculated for END vs. observation, was 0.94. Patients receiving END had similar risk for death compared to observation cohort (P = 0.76). No significant difference in final outcome after patient stratification based on T stage was identified (OR for T1/T2 1.27, P = 0.39; OR for T3/T4 0.95, P = 0.90). Observation for cN0 neck is a reasonable option in AdCCHN. These findings suggest the need for prospective trials on indications and extent of END in AdCCHN.     

头颈部腺样囊性癌的研究进展

涎腺腺样囊性癌是头颈部较少见的恶性肿瘤,但却是涎腺最常见的恶性肿瘤之一,具有局部侵袭性生长,早期易沿神经扩散,且容易侵入血管,造成血行性转移的独特的生物学特性。鉴于涎腺腺样囊性癌的独特生物学特性,本文对其流行病学、临床表现、病理学、诊断检查及治疗和预后研究进展作一综述,以期为该病的诊断和治疗有所帮助。     

Infrahyoid myocutaneous flap in head and neck reconstruction: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to analyse the literature on the infrahyoid myocutaneous flap (IHMCF) and evaluate its clinical outcomes. The MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus databases were searched (inception to December 31, 2021). Meta-analyses were then conducted to estimate the overall rates of partial flap loss, total flap loss, salivary fistula, and surgical revision. The 21 studies that met the inclusion criteria included 768 patients undergoing head and neck reconstruction with 773 IHMCF. The oral cavity (77.7%) and oropharynx (13.0%) were the most reconstructed sites. The meta-analyses estimated a pooled partial flap loss rate of 10.4% (99% confidence interval (CI) 5.4–16.7%), total loss rate of 1.8% (99% CI 0.8–3.2%), salivary fistula rate of 3.0% (99% CI 1.3–5.3%), and surgical revision rate of 1.9% (99% CI 0.7–3.7%). Fast flap harvesting and low donor site morbidity were other flap features. Previous thyroid surgery or neck dissection and advanced lymph nodal stage were considered contraindications to IHMCF reconstruction by most authors, while prior neck radiotherapy was reported as a relative contraindication. This pedicled cervical flap is a versatile and reliable reconstructive option for medium-sized head and neck defects. Careful preoperative assessment of the neck condition allows for its safe use.     

Surgical management of vascular lesions of the head and neck: a review of 115 cases

Vascular anomalies are amongst the most common congenital abnormalities observed in infants and children. Their occurrence in the head and neck region is a source of functional and aesthetic compromise. This article reviews the surgical management of 115 cases of vascular anomalies involving the head and neck area treated by the authors between 1998 and 2009. It discusses the diagnostic aids, treatment protocol and the results obtained. A new classification based on the anatomical location and depth of the lesion has been proposed. This allows guidelines for surgical ablation of the vascular lesions. The complications encountered are discussed. The use of external carotid artery control as opposed to pre-surgical embolization has proved effective and the technique is described. The location and extent of a vascular malformation should dictate the preoperative investigations, surgical procedure and subsequent outcome.