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While evidence suggests an increasing incidence of tongue cancer in young adults, published findings regarding the prognostic role of age at diagnosis are inconsistent. We performed a meta‐analysis of the literature to highlight key points that might help in understanding the association between age of oral tongue cancer patients at diagnosis and their prognosis. According to age at diagnosis, a systematic literature review of all published cohort studies assessing the recurrence risks and mortality associated with tongue cancer was conducted. We compared the risk estimates between patients aged >45 years and those aged <45 years at diagnosis. Random‐effects models were used to calculate summary relative risk estimates (SRRs) according to different clinical outcomes and sources of between‐study heterogeneity (I2) and bias. We included 31 independent cohort studies published between 1989 and 2019; these studies included a total of 28,288 patients. When risk estimations were not adjusted for confounders, no significant association was found between age at diagnosis and overall survival (OS). Conversely, after adjustment for confounders, older age at diagnosis was associated with a significantly increased risk of mortality. The difference between SRRs for adjusted and unadjusted estimates was significant (p < 0.01). Younger patients had a significantly higher risk of local recurrence. Younger patients with oral tongue cancer have better OS but a greater risk of recurrence than older patients. These findings should be validated in a large prospective cohort study which considers all confounders and prognostic factors. Although oral tongue cancer is generally considered to affect older patients, increasing evidence suggests an increasing incidence in younger patients. The study results illustrated that age at diagnosis had varying effects on the risks of poor outcomes and local recurrence. We suggest that younger patients with oral tongue cancer should receive personalized follow‐up plans to improve prognosis by identifying disease recurrence at an early stage.

Background Oral squamous cell carcinoma (OSCC) is the sixth most common cancer globally. Patient survival varies depending on tumour stage and oral cavity subsites. Buccal mucosa neoplasia is rare and burdened by worse prognosis than other oral subsites, showing a high rate of loco-regional relapses within six months after treatment. According to NCCN guidelines, the gold standard treatment is radical surgery. In the oral cavity, the buccal mucosa subsite lacks anatomical barriers opposing neoplastic growth. At this level, the tumour cells could hypothetically spread along the fibres of the platysma muscle or the lymphatic networks of the peri-facial vessels without encountering any resistance. Due to the aggressive locoregional spread, radical surgery is mandatory to improve patient survival. Methods This technical note describes the cheek compartmental surgical approach step by step. For intermediate-advanced stage cancer, the surgery should include the resection of the tumour with adequate free margins, the dissection of neck lymph nodes and the lymphatic network with the structures between the tumour (T) and the neck (N), the so-called “T-N tract”. The buccal mucosa compartment may be defined as a three-dimensional space between the oral cavity mucosa, the vessel plane, and the lymph nodes of the neck (levels I-IV). These structures, connected by the platysma muscle and the facial vessels, may be considered the T-N tract of the mucosal cheek compartment. Results By removing all the possible pathways of tumour spread via compartmental surgery ( en-bloc resection of the tumour with T-N tract and lymphatic network and lymph nodes) for buccal mucosa cancers, one could provide better locoregional control of disease in intermediate-advanced stages. Conclusion This surgical technique may enable a more accurate control of the surgical margins, especially the deep margins.

P63, and in particular the most expressed ΔNp63α isoform, seems to have a critical role in the outcome of head and neck cancer. Many studies have been conducted to assess the possible use of p63 as a prognostic marker in squamous cell carcinoma cancers, but the results are still not well-defined. Moreover, a clear relationship between the expression of ΔNp63α and the presence of high-risk HPV E6 and E7 oncoproteins has been delineated. Here we describe how ΔNp63α is mostly expressed in HPV-positive compared to HPV-negative head and neck cancer cell lines, with a very good correlation between ΔNp63α mRNA and protein levels.

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Parapharyngeal space (PPS) tumors are very rare, representing about 0.5% of head and neck neoplasms. An external surgical approach is mainly used. Several recent papers show how transoral robotic surgery (TORS) excision could be a prospective tool to remove mainly benign lesions in PPS; no cases of neurogenic tumors from the retrostyloid space treated with TORS have been reported. We present two cases which underwent TORS for schwannomas from the retrostyloid compartment of the parapharyngeal space. Clinical diagnosis of schwannoma was performed by magnetic resonance imaging (MRI). In the first case a 6 cm neurogenic tumor arose from the vagus nerve and in the second case a 5 cm mass from the sympathetic chain was observed. Both cases were treated successfully by the TORS approach using a new “J”-shaped incision through the mucosa and superior pharyngeal constrictor muscle. Left vocal cord palsy and the Claude Bernard Horner syndrome, respectively, were observed as expected postsurgical sequelae. In case 1 the first bite syndrome developed after three months, while no complications were observed in case 2. Both patients regained a normal swallowing function. TORS seems to be a feasible mini-invasive procedure for benign PPS masses including masses in the poststyloid space.

The definitive state-of-the-art guide on laryngeal cancer treatment from world-renowned experts Ongoing advances in innovative technologies have improved the diagnosis and treatment of laryngeal cancer, resulting in more optimal oncologic and functional patient outcomes. Laryngeal Cancer: Clinical Case-Based Approaches, by distinguished head and neck surgeon Rogério R. Dedivitis and internationally recognized coeditors, is a comprehensive reference that presents multiple options for similar lesions. Contributions from a diverse group of globally renowned subspecialists reflect the multidisciplinary treatment of laryngeal cancer. The book focuses on diverse primary subsites of laryngeal cancer; local, early-stage, and advanced disease stages; and current available treatment modalities for each type. Case study chapters include insightful discussion of several potential approaches, rationale for surgical decision making, radiographic findings, pearls, and pitfalls. Key Features * Diverse approaches to glottic cancer including radiotherapy, transoral laser surgery, supracricoid laryngectomy (SCL), vertical laryngectomy, transoral laser microsurgery, chemoradiotherapy, and combined SCL and cricohyoidoepiglottopexy. * Treatment modalities for supraglottic cancers such as transoral laser microsurgery, radiation therapy, and horizontal supraglottic laryngectomy. * Salvage surgery, preservation protocol, and reconstructive flap techniques including pectoralis major myocutaneous flap, latissimus dorsi myocutaneous flap, and antebrachial flap. * High-quality images accompanying each case enhance clinical understanding of underlying pathologies and surgical approaches. Otolaryngologist—head and neck surgeons, radiation oncologists, medical oncologists, pathologists, radiologists, speech pathologists, and all clinicians who treat laryngeal disorders will benefit from this highly informative resource.

Purpose The tracheoesophageal puncture for the voice prosthesis (VP) placement is the recognized gold standard in post-laryngectomy voice rehabilitation. Despite the development of specific intraoperative techniques, a subset of patients will suffer from poor functional outcomes due to pharyngoesophageal spasms (PES). This paper evaluates the functional outcomes after transcutaneous botulinum toxin type A (BTX-A) infiltration for PES with a videofluoroscopy-guided technique. Methods Since 2022, eight consecutive patients with VP and affected by PES were treated with BTX-A injection by a standard videofluoroscopic guided technique at the European Institute of Oncology, IRCCS (IEO) in Milan. A lidocaine test was performed pre-operatively to evaluate the potential effect of chemical neurectomy. All patients with positive lidocaine tests were injected with 50 IU of BTX-A (Allergan, Irvine, CA) according to the sites marked during the videofluoroscopy. Reported symptoms (VHI, SECEL), perceptual (INFVo), aerodynamic (MPT) and manometric parameters were collected before and after treatment. Results In all cases, BTX-A was performed as an outpatient procedure without complications. For seven patients, only one BTX-A injection was needed, while one patient required a re-injection. Subjective and perceptive improvement after BTX-A was significant for VHI, SECEL and INFVo. MPT showed significant improvement after a chemical neurectomy. After a mean follow-up of 6 months, all patients maintained a good TES quality. Conclusion The videofluoroscopic guided BTX-A injection of the pharyngoesophageal tract showed to be a feasible and reproducible technique in all cases. The pharyngoesophageal videofluoroscopy allows defining of patients’ anatomical landmarks that help the surgeon to perform a homogeneous injection, empowered by post-injection massage.

We reviewed the current published literature on the impact of oral microbiota on oral cavity leukoplakia (OLK), aiming at clarifying its role in disease transformation. The analysis unveiled that bacterial richness and diversity in the oral cavity tend to be decreased in OLK compared to healthy controls, with a reduction in the prevalent commensals, such as Streptococci, and elevation of anaerobes. Moreover, Fusobacterium nucleatum, Porphyromonas gingivalis and Prevotella intermedia are recurrent findings, and they already have been linked to periodontal disease. These microbial community changes may also represent a marker for the transition from OLK to oral squamous cell carcinoma. Unfortunately, the reviewed studies present several limitations, making an objective comparison difficult. To overcome these biases, longitudinal studies are necessary.

Pleomorphic adenoma is the most common benign tumor of the parotid glands. Rarely it may arise from minor salivary glands of the upper aerodigestive tract. A 57-year-old woman was admitted at our institution presenting with nasal obstruction. Endoscopic evaluation revealed a pedicled mass in the rhinopharynx. After radiological examination, we opted for a transnasal endoscopic-assisted excision of the mass under general anaesthesia. Histological evaluation deponed for pleomorphic adenoma with clear surgical margins. No endoscopic evidence of local recurrence has been shown after 48 months of followup. In the literature, few cases of pleomorphic adenoma arising in the rhinopharynx have been reported. The introduction of endoscopy, as shown by our experience, leads to important benefits in the identification, treatment, and followup of such rhinopharyngeal benign tumors.

Backgrounds. Lateral neck dissection (LND) is standard for thyroid cancer patients with neck metastases, mostly performed at the same time as total thyroidectomy (cLND). We introduced a new delayed LND (dLND), 4 weeks after thyroidectomy to reduce surgical morbidity. This study aims to compare the oncologic/complication outcomes between the two strategies, based on a large retrospective cohort of patients. Methods. Between 1996 and 2024, 215 patients were treated with total thyroidectomy, central neck dissection (CND) and LND, and grouped by surgical strategy (cLND vs. dLND); survival/complication outcomes were analyzed and compared between the two groups. Results. The overall and disease-free survival were comparable between groups. Age, extracapsular extension, and nodal burden predicted recurrence. dLND was associated with a significantly lower risk of vocal fold palsy. Extranodal extension (ECE) strongly predicted nerve injury. Conclusions. dLND offers similar oncologic outcomes to cLND, with reduced risk of vocal fold palsy. A staged approach enhances nerve preservation and might be considered in treatment planning.