Showing papers in "Current Opinion in Otolaryngology & Head and Neck Surgery in 2022"

Sarcopenia and its impact in head and neck cancer treatment

Abstract: The aim of this review is to discuss recent studies on the assessment of sarcopenia and its predictive and prognostic value in head and neck cancer (HNC) patients.There is increasing evidence that low skeletal muscle mass (SMM), often named sarcopenia, can easily be assessed on cross-sectional imaging of the head and neck and is associated with chemotherapy (dose limiting) and radiotherapy toxicity and survival.SMM measurement at the level of the third cervical vertebra (C3) on routine computed tomography and magnetic resonance imaging is easy and robust to perform. Several studies have shown a significantly higher incidence of cisplatin dose limiting toxicity in HNC patients with a low SMM. In HNC patients pretreatment low SMM is associated with acute and late toxicity and adverse events of radiotherapy, complications of major head and neck surgery and decreased disease-specific and overall survival. This information can be used for individualized treatment planning in HNC patients with low SMM.

Is the exoscope ready to replace the operative microscope in transoral surgery?

Abstract: Exoscopes are external digital devices that provide enhanced and magnified visualization of the surgical field. They usually have dedicated digital controls and a more compact mechanical structure than operative microscopes and current robotic surgical systems. This technology has significant potential in otolaryngology - head and neck surgery, especially concerning the field of transoral approaches. We herein analysed the overall technical characteristics of currently available exoscopic systems and contextualized their advantages and drawbacks in the setting of transoral surgery.The actual advantages of exoscopy are still indeterminate, as it has only been applied to limited surgical series. However, its specific properties are herein compared with conventional transoral microsurgery and transoral robotic surgery, discussing the available literature on such a topic, filtered on the basis of the authors' experience and its possible future evolutions. Finally, a summary of current experiences in the field of three-dimensional (3D) transoral exoscopic surgery is presented, highlighting differences compared with standard approaches.3D-exoscopic transoral surgery will possibly play an essential role in future management of early laryngeal and oropharyngeal lesions, significantly shifting the paradigms of this type of procedures.

Sarcopenia and its impact in head and neck cancer treatment

Abstract: Purpose of review The aim of this review is to discuss recent studies on the assessment of sarcopenia and its predictive and prognostic value in head and neck cancer (HNC) patients. Recent findings There is increasing evidence that low skeletal muscle mass (SMM), often named sarcopenia, can easily be assessed on cross-sectional imaging of the head and neck and is associated with chemotherapy (dose limiting) and radiotherapy toxicity and survival. Summary SMM measurement at the level of the third cervical vertebra (C3) on routine computed tomography and magnetic resonance imaging is easy and robust to perform. Several studies have shown a significantly higher incidence of cisplatin dose limiting toxicity in HNC patients with a low SMM. In HNC patients pretreatment low SMM is associated with acute and late toxicity and adverse events of radiotherapy, complications of major head and neck surgery and decreased disease-specific and overall survival. This information can be used for individualized treatment planning in HNC patients with low SMM.

Hidden hearing loss: current concepts

Abstract: The purpose of this review is to offer a concise summary of current knowledge regarding hidden hearing loss (HHL) and to describe the variety of mechanisms that contribute to its development. We will also discuss the various diagnostic tools that are available as well as future directions.Hidden hearing loss often also called cochlear synaptopathy affects afferent synapses of the inner hair cells. This description is in contrast to traditional models of hearing loss, which predominantly affects auditory hair cells. In HHL, the synapses of nerve fibres with a slow spontaneous firing rate, which are crucial for locating sound in background noise, are severely impaired. In addition, recent research suggests that HHL may also be related to cochlear nerve demyelination. Noise exposure causes loss of myelin sheath thickness. Auditory brainstem response, envelope-following response and middle-ear muscle reflex are promising diagnostic tests, but they have yet to be validated in humans.Establishing diagnostic tools for cochlear synaptopathy in humans is important to better understand this patient population, predict the long-term outcomes and allow patients to take the necessary protective precautions.

Conservative management of orbital involvement in malignant tumors: is the paradigm evolving? A critical review

Abstract: Purpose of review Review the recent literature regarding conservative management of orbital invasion in sinonasal cancers. Recent findings Recent data seem to confirm the possibility to preserve the orbital content in a significant number of patients. MRI is the best available imaging tool for evaluating orbital invasion. Limited periorbital and extraconal fat invasion should not be considered an indication for orbital cleaning. Histology-driven neoadjuvant chemotherapy should be attempted whenever possible, and could act as a prognosticator. Summary Orbital preservation strategy can be attempted even in case of limited extraconal fat invasion. When extraocular muscles, massive extraconal fat, lateral wall of the lacrimal sac, eyelids or even optic nerve/globe are invaded, a conservative procedure cannot be offered. Induction chemotherapy and postoperative radiotherapy are invaluable tools for maintaining oncological outcome while preserving ocular function. Frozen section should be used for guiding surgical procedures in borderline situations.

Is the exoscope ready to replace the operative microscope in transoral surgery?

Abstract: Purpose of review Exoscopes are external digital devices that provide enhanced and magnified visualization of the surgical field. They usually have dedicated digital controls and a more compact mechanical structure than operative microscopes and current robotic surgical systems. This technology has significant potential in otolaryngology – head and neck surgery, especially concerning the field of transoral approaches. We herein analysed the overall technical characteristics of currently available exoscopic systems and contextualized their advantages and drawbacks in the setting of transoral surgery. Recent findings The actual advantages of exoscopy are still indeterminate, as it has only been applied to limited surgical series. However, its specific properties are herein compared with conventional transoral microsurgery and transoral robotic surgery, discussing the available literature on such a topic, filtered on the basis of the authors’ experience and its possible future evolutions. Finally, a summary of current experiences in the field of three-dimensional (3D) transoral exoscopic surgery is presented, highlighting differences compared with standard approaches. Summary 3D-exoscopic transoral surgery will possibly play an essential role in future management of early laryngeal and oropharyngeal lesions, significantly shifting the paradigms of this type of procedures.

Nonsurgical rhinoplasty: prevention and management of associated complications

Abstract: Nonsurgical rhinoplasty (NSR) continues to grow in demand and popularity. Consequently, there has been a rise in the number of reported complications. This review will summarize and discuss the current evidence for the prevention and management of adverse events related to NSR with a specific emphasis on practical clinical applications. The review is based on recent systematic reviews and multidisciplinary expert consensus recommendations.First, NSR has overall favorable outcomes with rare complications. Second, vascular compromise is a rare event, but the number of reported severe complications is rising. Third, providers should be intimately familiar with preventive measures, early signs and symptoms, and appropriate management algorithms of all possible complications. Fourth, having a readily available 'toolbox' of recommended therapies may improve timely management of emergent complications.The number of complications associated with NSR is expected to rise congruent with the increased demand for the procedure. Although NSR has a favorable safety profile, complications can occur in the best of hands even when using appropriate risk reduction strategies. Early detection and appropriate treatment of known complications may eliminate or minimize sequelae and allow providers to continue to safely perform NSR.

Mental health considerations in patients undergoing complex head and neck reconstruction

Abstract: Purpose of review To summarize recent advances in the psycho-oncology literature, with a focus on findings relevant to the head and neck cancer patient. Recent findings Patients with cancer are at an increased risk of suicide and self-harm. Head and neck cancer patients are among the highest risk compared with other cancer patients. Unique challenges pertaining to disfigurement and voicelessness may, in part, explain these observations. Patient-reported outcome measures can be used to help identify high-risk patients. Summary Psychosocial support needs are highest for head and neck cancer patients. Patient-reported outcome measures should be integrated within clinical workflows to identify high-risk patients.

Indications of external beams radiation for thyroid cancer

Abstract: The use of external beam radiation therapy (EBRT) for the treatment of the different histologic subtypes of thyroid cancer is a matter of debate. This article provides an up-to-date review on the current evidence concerning the benefits of EBRT in thyroid cancer in specific indications.Based on retrospective studies, adjuvant EBRT lessens the risk of locoregional recurrence in locally advanced differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC) with high-risk features. The effect of EBRT on overall survival remains uncertain. EBRT should also be part of the multimodality treatment in anaplastic thyroid cancer (ATC), as it improves survival rates in incompletely resected ATC.The role of EBRT in thyroid cancer remains unclear. To date, no randomized control studies are available. Retrospective data showed improved outcomes in patients with high-risk features for locoregional recurrence.

Cognitive and behavioral effects of hearing loss

Abstract: Hearing loss is one of the largest modifiable risk factors for developing dementia, accounting for up to 9% of the overall modifiable risk. The neuropsychologic and psychosocial impacts of hearing loss are becoming increasingly appreciated. The objective of this review is to explore the recent literature regarding the cognitive and behavioral effects of hearing loss and the role of hearing rehabilitation, particularly in older adults.Cognitive decline may begin while patients have subclinical hearing loss, earlier than previously thought. Hearing rehabilitation, either via hearing amplification, middle ear surgery, or cochlear implantation, likely plays a role in preventing or slowing the rate of cognitive decline in patients with hearing loss. Hearing loss can increase the likelihood of social isolation, loneliness and depression in older adults, but it is unclear at this time what effect hearing rehabilitation has on these domains.Hearing loss is one of the largest modifiable risk factors for cognitive decline, and hearing rehabilitation can play a significant role in preserving cognitive function. Understanding the cognitive and psychosocial impact of hearing loss can help facilitate the development of approaches for prevention and treatment.

Cognitive and behavioral effects of hearing loss

Abstract: Purpose of review Hearing loss is one of the largest modifiable risk factors for developing dementia, accounting for up to 9% of the overall modifiable risk. The neuropsychologic and psychosocial impacts of hearing loss are becoming increasingly appreciated. The objective of this review is to explore the recent literature regarding the cognitive and behavioral effects of hearing loss and the role of hearing rehabilitation, particularly in older adults. Recent findings Cognitive decline may begin while patients have subclinical hearing loss, earlier than previously thought. Hearing rehabilitation, either via hearing amplification, middle ear surgery, or cochlear implantation, likely plays a role in preventing or slowing the rate of cognitive decline in patients with hearing loss. Hearing loss can increase the likelihood of social isolation, loneliness and depression in older adults, but it is unclear at this time what effect hearing rehabilitation has on these domains. Summary Hearing loss is one of the largest modifiable risk factors for cognitive decline, and hearing rehabilitation can play a significant role in preserving cognitive function. Understanding the cognitive and psychosocial impact of hearing loss can help facilitate the development of approaches for prevention and treatment.

Hidden hearing loss: current concepts

Abstract: Purpose of review The purpose of this review is to offer a concise summary of current knowledge regarding hidden hearing loss (HHL) and to describe the variety of mechanisms that contribute to its development. We will also discuss the various diagnostic tools that are available as well as future directions. Recent findings Hidden hearing loss often also called cochlear synaptopathy affects afferent synapses of the inner hair cells. This description is in contrast to traditional models of hearing loss, which predominantly affects auditory hair cells. In HHL, the synapses of nerve fibres with a slow spontaneous firing rate, which are crucial for locating sound in background noise, are severely impaired. In addition, recent research suggests that HHL may also be related to cochlear nerve demyelination. Noise exposure causes loss of myelin sheath thickness. Auditory brainstem response, envelope-following response and middle-ear muscle reflex are promising diagnostic tests, but they have yet to be validated in humans. Summary Establishing diagnostic tools for cochlear synaptopathy in humans is important to better understand this patient population, predict the long-term outcomes and allow patients to take the necessary protective precautions.

Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes

Abstract: Glossectomy remains a common treatment of oral tongue malignancies, which has a range of functional impacts depending on the extent of resection. This review aims to categorize and provide context for the approach to reconstructing these defects using recent evidence.The reconstruction method of choice should be tailored to the size and location of the glossectomy defect with special consideration to replace tongue volume and preserve mobility. There has been an increasing focus on patient-reported outcomes in oral tongue reconstruction. For defects beyond one-third of the tongue, free tissue reconstruction, and more recently, the submental artery island flap yield excellent results. Advances in reconstruction of larger defects have included preoperative soft tissue planning and assessment of outcomes in total glossectomy patients with laryngeal preservation.Depending on the defect, the appropriate reconstruction may range from healing by secondary intention to large volume free tissue transfer. In general, functional outcomes diminish with increasing size and complexity of the defect regardless of the reconstructive technique.

Patient-specific implants in orbital reconstruction

Abstract: Purpose of review Advances in the use of patient-specific implants (PSIs) and virtual surgical planning (VSP) for reconstruction of primary and secondary traumatic orbital defects are explored. Recent findings PSIs and VSP are emerging technologies that promise to make complex orbital reconstructions safer and more predictable for patients. Recent studies highlight principles of implant design, the novel use of multiunit implant constructs, and utility of intraoperative imaging adjuncts to achieve favorable outcomes. Summary This article summarizes recent developments in PSIs for orbital reconstruction. A complete workflow including presurgical planning, execution in the operating room, postoperative analysis, and avoidance of common pitfalls and implant design errors are reviewed.

Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes

Abstract: Purpose of review Glossectomy remains a common treatment of oral tongue malignancies, which has a range of functional impacts depending on the extent of resection. This review aims to categorize and provide context for the approach to reconstructing these defects using recent evidence. Recent findings The reconstruction method of choice should be tailored to the size and location of the glossectomy defect with special consideration to replace tongue volume and preserve mobility. There has been an increasing focus on patient-reported outcomes in oral tongue reconstruction. For defects beyond one-third of the tongue, free tissue reconstruction, and more recently, the submental artery island flap yield excellent results. Advances in reconstruction of larger defects have included preoperative soft tissue planning and assessment of outcomes in total glossectomy patients with laryngeal preservation. Summary Depending on the defect, the appropriate reconstruction may range from healing by secondary intention to large volume free tissue transfer. In general, functional outcomes diminish with increasing size and complexity of the defect regardless of the reconstructive technique.

Defining ‘control’ of chronic rhinosinusitis

Abstract: Purpose of review Control is a global disease metric defined as the extent to which manifestations of a disease are within acceptable limits. Control serves as the goal of treatment for chronic diseases, such as chronic rhinosinusitis (CRS), that cannot be cured. The objective of this review is to summarize recommendations for assessment of CRS control with a specific focus on how these recommendations align with patients’ and healthcare providers’ perspectives of CRS control. Recent findings Several staging systems for CRS control have been developed with the first and most widely recognized by the 2012 European Position Paper on Rhinosinusitis and Nasal Polyps, which was developed through expert opinion. Patients’ and providers’/guideline-based assessments of CRS control frequently do not align. Patients understand the concept of CRS control and their assessment is dominated by the perceived severity of nasal symptoms. In comparison, providers’ and guideline-based assessments of control are more global, incorporating nasal and extra-nasal symptoms, need for systemic antibiotics and corticosteroids, and nasal endoscopy. Summary Although more research is needed, future development of CRS control criteria through consensus around explicitly determined perspectives of healthcare providers and patients may one day serve as the foundation for a standardized approach to treatment of CRS.

Nonsurgical rhinoplasty: prevention and management of associated complications

Abstract: Purpose of review Nonsurgical rhinoplasty (NSR) continues to grow in demand and popularity. Consequently, there has been a rise in the number of reported complications. This review will summarize and discuss the current evidence for the prevention and management of adverse events related to NSR with a specific emphasis on practical clinical applications. The review is based on recent systematic reviews and multidisciplinary expert consensus recommendations. Recent findings First, NSR has overall favorable outcomes with rare complications. Second, vascular compromise is a rare event, but the number of reported severe complications is rising. Third, providers should be intimately familiar with preventive measures, early signs and symptoms, and appropriate management algorithms of all possible complications. Fourth, having a readily available ‘toolbox’ of recommended therapies may improve timely management of emergent complications. Summary The number of complications associated with NSR is expected to rise congruent with the increased demand for the procedure. Although NSR has a favorable safety profile, complications can occur in the best of hands even when using appropriate risk reduction strategies. Early detection and appropriate treatment of known complications may eliminate or minimize sequelae and allow providers to continue to safely perform NSR.

Distant metastasis from head and neck cancer: role of surgical treatment

Abstract: Purpose of review The rates of distant metastases in patients with head and neck squamous cell carcinoma varies from 3 to 50%. Metastases are usually multiple, diagnosed within 24 months after treatment and sited in the lungs, bone or liver. This review highlights the importance of a personalized treatment approach in such patients. Recent findings In patients with primary tumor controlled and with oligometastatic disease, surgical options can be considered, especially for lung metastases. Overall survival for patients who are candidates for lung metastasectomy can be as high as 59%. In bone and liver metastases, resection is not frequently used but radiofrequency ablation is a promising option. Finally, mediastinal and axillary lymph node metastasis are classified as distant metastases, and lymph node dissection is the treatment of choice whenever the disease is limited to these sites. Summary Patients with distant metastases usually are considered incurable; however, an aggressive local treatment of solitary distant metastases should be considered in highly selected patients, with a potential increase of overall survival.

Enhanced Recovery after Surgery (ERAS) protocols in craniomaxillofacial surgery: an evidence-based review

Abstract: Purpose of review Enhanced Recovery after Surgery (ERAS) refers to a patient centered, multidisciplinary team developed pathway aimed at reducing the surgical stress response and facilitating expedited patient postoperative recovery. These protocols have been largely developed in the general surgery literature and have led to vast improvements in the patient experience. With a growing shortage of hospital resources during the height of the COVID-19 pandemic there has been a growing push to apply these principles to a wide variety of specialties. Recent findings ERAS protocols are generally substantiated on three phases along the continuum of surgical care: preadmission optimization, intraoperative treatment, and postoperative management. In this article, the evidence for ERAS development in craniomaxillofacial surgery will be reviewed, and recommendations from prior studies for enhanced recovery will be outlined. Summary ERAS protocols have been proven effective in many surgical arenas, however, modification is needed for the craniomaxillofacial population. The implications for widespread implementation of ERAS protocols during these procedures are a potentially shortened length of stay, expedited early return to function, reduction in narcotic dependence, and reduction in postdischarge complications necessitating additional intervention.

Emerging trends in rhinoplasty education: accelerated adoption of digital tools and virtual learning platforms

Abstract: Purpose of review The COVID-19 pandemic catalyzed the rapid adoption of digital tools and virtual learning platforms by rhinoplasty educators and trainees alike. This review provides an overview of the variety of digital software and web-based tools rhinoplasty educators have adopted and highlights the advantages and potential drawbacks of virtual learning via e-content. Recent findings Medical education including subspecialty surgical training has recently undergone a dramatic digital transformation. Rhinoplasty surgeon-educators have been forced to embrace new digital tools, including videoconferencing, podcasts, virtual simulation and social media to reach and teach trainees. Recognizing the advantages of this new, limitless digital space, rhinoplasty surgeons are also engaging in virtual transcontinental collaboration and distance mentorship. Summary The dramatic evolution in how clinical educational materials are now digitally created, curated, disseminated and consumed is likely to far outlast the COVID-19 pandemic itself. Rapid, exponential growth of this digital library, however, places increased responsibility on educators to guide trainees towards evidence-based and state-of-the-art content.

Lack of a coherent theory limits the diagnostic and prognostic value of the (central) auditory processing disorder: a theoretical and clinical perspective

Abstract: To consider pertinent issues towards developing a coherent theory of the auditory processing disorder (APD). By identifying the conceptual and methodological shortcomings that have thwarted development in this area for decades, we propose solutions to achieve a veridical endpoint to advance the field.Concerted efforts in the theoretical, experimental, and clinical domains have focused on validating the APD by demonstrating the " modality specificity " of the deficit. The importance of this conceptual framework is the delineation of auditory-perceptual dysfunctions from more generalized " supra modal" deficits, like those related to attention, memory, and language. Because contemporary schemata have limited the assessment of APD to auditory tasks alone ( unimodal testing), functional dissociations cannot be established, indeterminate diagnoses are problematic, and progress remains unduly constrained. The use of matched tasks in multiple sensory modalities is advocated as a diagnostic imperative to remedy this deficiency.Themes covered by this review include the need to develop a coherent theory of APD, to identify and limit factors which confound a valid diagnosis, and to validate the diagnosis by demonstrating the " modality specificity " of the deficit. Without an obligatory theoretical designation, the APD will remain as an obscure and controversial entity, limited to indeterminate test results and misdiagnoses.

The relationship between sarcopenia, dysphagia, malnutrition, and frailty: making the case for proactive swallowing exercises to promote healthy aging

Abstract: Purpose of review The purpose of this review is to summarize current evidence regarding the relationship between sarcopenia of the swallowing muscles, dysphagia, malnutrition, and frailty in the context of aging. Further, this review will provide preliminary support for proactive swallowing exercises to reverse and/or prevent sarcopenia of the swallowing muscles. Recent findings Recent studies lend support to a cyclic relationship between sarcopenia of the swallowing muscles, dysphagia, malnutrition, and frailty. Unfortunately, all studies are limited by their study design and lack instrumental imaging of swallowing function. Research (in the limbs) supports the use of proactive exercises and protein supplementation to reverse sarcopenia, especially in prefrail individuals. This provides a foundation to design and test similar preventive exercises for the swallowing muscles. Summary As the population is rapidly aging, it is vital to understand how the natural loss of muscle in aging impacts swallowing function and the downstream impact on nutritional and physical function. Prospective, longitudinal research with sophisticated outcome measures are required to fully understand this cycle and provide an opportunity to test methods for interrupting the cycle.

The remaining obstacles for a totally implantable cochlear implant

Abstract: Purpose of the review For years, the development of a totally implantable cochlear implant (TICI) has faced several technical challenges hindering any prototypes from reaching full commercialization. This article aims to review the necessary specifications for a viable TICI. An overview of the remaining challenges when designing TICIs will be provided, focusing on energy supply and implantable microphones. Recent findings The literature review highlights how research efforts to generate sufficient power to supply a fully implantable CI could take advantage of microelectromechanical systems (MEMS)-based energy harvesters incorporating piezoelectric materials. Using one of the various energy sources in the vicinity of the temporal bone would allow the development of a self-sufficient implant, overcoming the limitations of electrochemical batteries. Middle ear implantable microphones could also use similar fabrication techniques and transduction mechanisms to meet the sensor requirements for a TICI. Summary Recent breakthroughs in power supply using MEMS-based energy harvesting technologies and piezoelectric implantable microphones may make TICIs become a more practical reality in the foreseeable future. Once available, TICIs will have major impact on our patients’ quality of life and may help to make hearing rehabilitation a more appealing option to a greater proportion of those who fulfill our candidacy criteria.

Updates in paediatric cholesteatoma

Abstract: Purpose of review The management of paediatric patients with cholesteatoma is complex, as the disease process is more aggressive in children than adults. New technologies and practice adaptations currently help optimize the surgical management and monitoring of these challenging patients. Recent findings Several options of surgical management are available and are associated with equal if not improved outcomes. Technologic advancements in endoscopic ear surgery, the discovery of chemical-assisted dissection of cholesteatoma and advanced imaging protocols have enabled surgeons to better care for patients with this complex disease process. Summary The advances in endoscopic ear surgery, the discovery of Mesna as a chemically assisted dissection agent to improve recidivism rates and the use of specific diffusion-weighted MRI protocols enable the otologic surgeon to better care for these paediatric patients.

Mandibular osteosarcoma: diagnosis and treatment

Abstract: Purpose of review This article presents a review of the literature on mandibular osteosarcoma, focusing on the main aspects of its management, including diagnosis, histotype, and treatment. The literature published in the last 5 years was considered but because of the rarity of mandibular osteosarcoma, major publications from the past have also been included. Recent findings Management of mandibular osteosarcoma still lacks a clear standard of care, and treatment has not changed markedly over the past several years. The mainstay of treatment is surgical resection with free margins, but chemotherapy has recently begun to play a role in both adjuvant and neoadjuvant settings. Summary Mandibular osteosarcoma is a rare tumor and extensive randomized trials are not available in the international literature. Therefore, the standard of care is not defined, and diagnosis and treatment protocols have been extrapolated from analysis of multiple reports that are often discordant. This makes an interdisciplinary approach mandatory for the management of these patients, to provide the best care possible based on tumor size, site, and patient characteristics.

The relationship between sarcopenia, dysphagia, malnutrition, and frailty: making the case for proactive swallowing exercises to promote healthy aging

Abstract: The purpose of this review is to summarize current evidence regarding the relationship between sarcopenia of the swallowing muscles, dysphagia, malnutrition, and frailty in the context of aging. Further, this review will provide preliminary support for proactive swallowing exercises to reverse and/or prevent sarcopenia of the swallowing muscles.Recent studies lend support to a cyclic relationship between sarcopenia of the swallowing muscles, dysphagia, malnutrition, and frailty. Unfortunately, all studies are limited by their study design and lack instrumental imaging of swallowing function. Research (in the limbs) supports the use of proactive exercises and protein supplementation to reverse sarcopenia, especially in prefrail individuals. This provides a foundation to design and test similar preventive exercises for the swallowing muscles.As the population is rapidly aging, it is vital to understand how the natural loss of muscle in aging impacts swallowing function and the downstream impact on nutritional and physical function. Prospective, longitudinal research with sophisticated outcome measures are required to fully understand this cycle and provide an opportunity to test methods for interrupting the cycle.

Clinical considerations for open versus endoscopic approaches in skull base surgery

Abstract: Purpose of review We aim to distill the current body of evidence to consider when selecting an endoscopic versus open approach to address cranial base disease. We evaluate the evolution of modern surgical techniques and their respective limitations. Recent findings Greater understanding of the role of tumor biology in relation to patient outcomes has led to increasingly sophisticated treatment algorithms. This combined with further development of advanced instrumentation and technique has led to the adoption of new surgical corridors previously unapproachable via traditional surgery. Summary Endoscopic and open craniofacial approaches both remain important surgical techniques in the management of cranial base tumors. The modern skull base surgeon may employ a combination of approaches to optimize tumor extirpation while preserving functional outcomes. Patient history, anatomic tumor extent, histology, and functional goals should be considered thoroughly when planning any surgical intervention.

Oropharyngeal reconstruction after transoral robotic surgery

Abstract: Transoral robotic surgery (TORS) has experienced an evolution in recent years. This technique has proved to be a safe and effective method for extirpation of select oropharyngeal tumors. Advances in technology as well as improved surgeon experience allow for the resection of larger, more complex cancers. Although healing by secondary intention remains the current standard for limited oropharyngeal defects, larger resections demand reconstruction with vascularized tissue to minimize morbidity and optimize functional outcomes. The objective of this review is to evaluate recent literature regarding oropharyngeal reconstruction after TORS.A variety of reconstructive options to manage oropharyngeal defects exist. Several reconstructive algorithms have been suggested; however, careful consideration must be used to select the most ideal flap type. Locoregional flaps have shown excellent functional outcomes with limited morbidity. An increase in free flap reconstruction has been demonstrated, particularly among patients with larger TORS defects and following chemoradiation therapy. Despite limited data, robotic-assisted flap inset and microvascular anastomosis has recently shown promise.Reconstruction and flap selection following TORS should be tailored to the patient and unique oropharyngeal defect. Functional outcomes are promising with low complication rates among these patients.

An integrated care systems model approach for speech and language therapy head and neck cancer services in England: service development and re-design in Cheshire and Merseyside

Abstract: The incidence of head and neck cancer (HNC) is increasing globally and changes in treatment mean that patients are living longer with the condition. It is recognised that while there have been improvements at the diagnostic phase of the pathway, follow-up and on-going care can be fragmented and inequitable. Integrated care models (ICMs) are acknowledged as beneficial. The National Health Service in England is moving to a model whereby services are being re-organised to integrated care systems. This paper reviews the literature and discusses potential models of care to enhance speech and language therapy (SLT) provision for patients with HNC in line with the emerging ICS.The COVID-19 pandemic has provided an opportunity to review service provision and SLT teams quickly adapted to offering remote support. Discussions are currently on-going to explore the potential for patient initiated follow-up via the PETNECK 2 trial and the Buurtzorg 'neighbourhood model' holds promise.ICMs put the patient at the centre of care and have reported benefits for experience of care and clinical outcomes. Navigating organisational structures is complex. The Buurtzorg model provides a practical and theoretical framework to support organisational change.

Paediatric mandibular distraction: optimizing outcomes

Abstract: Purpose of review The purpose of this review is to summarize current evidence surrounding the use of mandibular distraction osteogenesis in children and to highlight recent advances in our knowledge of this subject. Recent findings Distraction osteogenesis of the mandible has gained in popularity since its initial description about 30 years ago. Its efficacy and safety have been well described. More recently, proper patient selection, technique modifications and long-term outcomes have been the subject of much discussion around this revolutionary technique. Summary Distraction osteogenesis of the mandible is a powerful tool for surgeons. Technological advances and high-quality research have allowed for optimization of this technique within the field of craniomaxillofacial surgery.