World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

{"title":"Speech Recognition Deficits in Presbyacusis: Links to Cortical Structural and Functional Alterations.","authors":"Xiao-Qian Ren, Lan Lan, Xiao-Long Li, Xiang-Bing Bian, Jin Li, Lan Yu, Dan-Yang Li, Xin Lou, Qiu-Ju Wang","doi":"10.1002/wjo2.70121","DOIUrl":"10.1002/wjo2.70121","url":null,"abstract":"<p><strong>Objective: </strong>To characterize speech recognition in presbyacusis and its associated neurophysiological and cortical structural features, and to explore structure-function-behavior relationships within the presbyacusis phenotype.</p><p><strong>Methods: </strong>Thirty elderly patients with presbyacusis(HI) and thirty-three healthy young controls(NH) completed a behavioral task involving Putonghua monosyllabic word recognition. Additionally, mismatch negativity (MMN) responses using the oddball paradigm to assess neurophysiological sensitivity, and acquired 3D T1-weighted MRI combined with Freesurfer to quantify cortical thickness (CTh) in six auditory-related regions of interest (ROIs) were recorded. Between-group differences were assessed, and exploratory associations were examined within the HI group; key associations were further evaluated using hierarchical regression adjusting for sex, age, and pure-tone average (PTA).</p><p><strong>Results: </strong>The HI group exhibited significantly poorer speech recognition performance, with prolonged MMN latency and increased amplitude compared to the NH group. CTh was generally thinner (except for the right supratemporal gyrus), with a left-hemisphere bias in the planum polare (PP). Within the HI group, exploratory unadjusted correlations suggested associations of speech recognition rate maximum (SRRmax) with MMN amplitude and right heschl's gyrus (HG) CTh; however, after adjustment for sex, age, and PTA, MMN amplitude and right HG CTh were not significant predictors, and adding these predictors did not improve model fit, whereas PTA remained independently associated with SRRmax. However, no significant associations were found between MMN features and the anatomical characteristics of the ROIs.</p><p><strong>Conclusions: </strong>Presbyacusis is associated with altered speech recognition, neurophysiological responses, and auditory-related cortical structure compared with young controls. Within the HI group, peripheral hearing thresholds accounted for a major proportion of variance in speech recognition, while MMN/MRI associations observed in exploratory analyses were attenuated after covariate adjustment, warranting replication in larger and better age-matched cohorts.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic Effects of Prolonged Apneic Oxygenation in Laryngologic Surgery: A Randomized Controlled Pilot Trial.","authors":"Vladimir Nekhendzy, Hendrikus J Lemmens, Amit R Saxena, Brita M Mittal, Edward J Damrose, C Kwang Sung, Raffick Bowen","doi":"10.1002/wjo2.70154","DOIUrl":"https://doi.org/10.1002/wjo2.70154","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on cardiocirculatory responses associated with extended periods of apnea during administration of high-flow nasal oxygen for laryngologic surgery (apneic oxygenation with HFNO, AO-HFNO). The possibility of hemodynamic compromise in the settings of acute hypercapnia, respiratory acidosis, hyperoxia, and IV anesthesia requires further investigation. This trial investigated the hemodynamic safety profile of prolonged AO-HFNO in adult patients undergoing laryngologic surgery.</p><p><strong>Methods: </strong>Using invasive hemodynamic monitoring, we conducted prospective, randomized, patient-blinded, two-arm parallel pilot trial in 20 adult patients (ASA physical status 1-3) undergoing elective laser laryngologic surgery expected to last over 40 min. The patients were randomly assigned to receive either AO-HFNO or conventional mechanical ventilation using a laser endotracheal tube (ETT). The primary outcome was the effect of prolonged permissive hypercapnia and IV anesthesia on intraoperative cardiocirculatory responses.</p><p><strong>Results: </strong>Extended AO-HFNO led to the development of moderate to severe hypercapnia with PaCO₂ reaching as high as 113 mmHg and pH as low as 6.96. These changes were accompanied by induction of hyperdynamic state characterized by increase in heart rate (maximum median changes of ~38%), cardiac index (~36%) and decrease in systemic vascular resistance index (~46%). Maximum median decrease in mean arterial pressure was ~28% and was not associated with the need for extra vasopressor support compared to ETT group. There were no intraoperative or immediate postoperative complications.</p><p><strong>Conclusions: </strong>Prolonged AO-HFNO is associated with a safe intraoperative hemodynamic profile during extended periods of apnea for selected patients undergoing laryngologic surgery.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Characteristics of the Facial Nerve in Patients With Cochlear Hypoplasia.","authors":"Shu-Jin Xue, Xing-Mei Wei, Biao Chen, Ying Kong, Yong-Xin Li","doi":"10.1002/wjo2.70134","DOIUrl":"https://doi.org/10.1002/wjo2.70134","url":null,"abstract":"<p><strong>Objective: </strong>To quantitatively characterize the spatial relationships between intratemporal facial nerve segments and key cochlear implantation (CI) landmarks in cochlear hypoplasia (CH), and to compare these features with age-matched CI recipients with normal inner ear anatomy, thereby informing preoperative planning and facial nerve preservation strategies.</p><p><strong>Methods: </strong>CI recipients were reviewed retrospectively, and high-resolution temporal bone CT datasets were reconstructed. The measured parameters comprised cochlear-facial partition width (CFPW) of the labyrinthine segment, the distance between the tympanic facial nerve and oval window (FN‑OW), the distance between the mastoid facial nerve and round window (FN‑RW), the angle between the FN‑RW line and the anteroposterior axis (α), and the distance from the mastoid facial nerve to the posterior external auditory canal wall (FN‑EAC).</p><p><strong>Results: </strong>The CH cohort included 48 patients (91 ears: 40 CH‑Ⅱ, 43 CH‑Ⅲ, 8 CH‑Ⅳ); controls comprised 45 patients (90 ears). The median CFPW was larger in CH patients than in controls (0.7 vs. 0.57 mm; <i>p</i> < 0.01). Cochlear-facial dehiscence occurred at similar rates (CH 4.40% vs. controls 4.44%). FN-OW did not differ significantly between the two groups (2.33 vs. 2.37 mm; <i>p</i> = 0.198). A low‑lying tympanic segment was observed in 23.07% of CH ears but in none of the control ears. For the mastoid (vertical) segment, the CH group exhibited a shorter FN-RW (5.74 vs. 6.08 mm; <i>p</i> < 0.05) and a larger angle α (60.4° vs. 57.8°; <i>p</i> < 0.05). FN-EAC was slightly smaller in the CH group without reaching statistical significance (4.08 vs. 4.35 mm; <i>p</i> = 0.087).</p><p><strong>Conclusion: </strong>In CH, intratemporal facial nerve segments exhibit substantial positional variability. Anterior displacement of the vertical segment is common and may impede round window exposure via the facial recess. Preoperative HRCT should systematically assess nerve courses to reduce intra- and postoperative facial nerve complications.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroendocrine Carcinoma of the Head and Neck: A Two-Decade Institutional Experience.","authors":"Micah K Harris, Katie M Carlson, Nathan Lu, Anthony Tang, Matthew E Spector, Joshua D Smith, Jessica H Maxwell, Kevin J Contrera, Seungwon Kim, Steven B Chinn, Angela Mazul, Shaum S Sridharan","doi":"10.1002/wjo2.70129","DOIUrl":"10.1002/wjo2.70129","url":null,"abstract":"<p><strong>Objectives: </strong>Primary neuroendocrine carcinoma (NEC) of the head and neck is rare (< 1% of cases) and aggressive, with poorly defined management strategies. This study evaluated clinical characteristics, treatment patterns, and survival outcomes in a single-institution cohort, identifying factors associated with improved survival.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients with head and neck NEC treated at a tertiary center. Variables associated with 3-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed using Cox regression and Kaplan-Meier curve analyses.</p><p><strong>Results: </strong>Sixty-nine patients (59.4% male, 95.7% White) were included. The most common subsites were sinonasal (36.2%) and laryngeal (30.4%). Most tumors were poorly differentiated (73.9%), and 50.7% were T category 3-4. Surgical resection was performed in 68.1% and primary radiotherapy or chemoradiotherapy in 20.3% of patients. Overall 3-year OS and RFS were 55.5% and 56.1%, respectively. On multivariable analysis, surgery remained associated with improved 3-year OS (adjusted hazard ratio [aHR]: 0.21, 95% CI: 0.06-0.66, <i>p</i> = 0.007) and DSS (aHR: 0.33, 95% CI: 0.11-0.99, <i>p</i> = 0.050) when controlling for tumor stage, histologic differentiation, tumor site, and age at diagnosis. Chemotherapy and radiotherapy were not associated with survival.</p><p><strong>Conclusions: </strong>Head and neck NEC carries a poor prognosis. Undergoing surgical resection was strongly associated with improved 3-year OS and DSS in our cohort, highlighting its importance when feasible. Multicenter collaboration and prospective studies are warranted to refine optimal treatment strategies for this rare and challenging malignancy.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality and Readability of Websites on Tongue Base Procedures for Pediatric Obstructive Sleep Apnea.","authors":"Nathan G Rasmussen, Jeffrey C Mecham, Patrick Scheffler","doi":"10.1002/wjo2.70120","DOIUrl":"10.1002/wjo2.70120","url":null,"abstract":"<p><strong>Objectives: </strong>Tongue base obstruction is a cause of persistent sleep apnea after adenotonsillectomy in pediatric patients. The internet is the most used tool by patients for gathering healthcare information. This study aims to assess the quality and readability of websites directed to patients regarding tongue base procedures for pediatric obstructive sleep apnea.</p><p><strong>Methods: </strong>Queries for the terms \"lingual tonsillectomy,\" \"posterior midline glossectomy,\" \"tongue reduction,\" \"tongue base suspension,\" and \"hypoglossal nerve stimulator\" were entered into Google on September 11, 2023. Thirty sites were pulled for each, and up to 10 sites per query meeting inclusion criteria were included for analysis. The DISCERN tool was used to evaluate quality. Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) were used to measure readability. Sites were analyzed for mention of pediatrics.</p><p><strong>Results: </strong>Thirty-five unique sites were analyzed. The mean DISCERN score was 44.7 (range 28.5-64.0) or \"fair.\" The mean FRES was 46.3 (range 9.6-66.6) and FKGL 11.5 (range 7.4-19.2), indicating college and 12th-grade reading levels. Only 8/35 sites mentioned pediatrics. The average number per query of relevant sites directed towards patients on the first search engine page was 3.6. Despite tongue base procedures being relevant to pediatrics, only one in five sites mentioned children.</p><p><strong>Conclusion: </strong>Websites directed at patients regarding tongue base procedures are of \"fair\" quality and at readability grade levels far above what is recommended. The majority of sites available for tongue base procedures are geared to professionals rather than patients. This study demonstrates a need for high-quality information for patients about these procedures.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transoral Robotic Resection of Glossopharyngeal Neurofibroma: A Case Report.","authors":"Cody L Messick, Austin R Swisher, Hannah M Gibbs, Michael T Sramek, Laura Klusovsky, Payam Entezami, James S Lewis, Brent A Chang","doi":"10.1002/wjo2.70123","DOIUrl":"10.1002/wjo2.70123","url":null,"abstract":"<p><p>This case highlights the diagnostic challenges posed by rare oropharyngeal neurofibromas, their potential to mimic other conditions, and the novel application of transoral robotic surgery (TORS) for the management of an oropharyngeal neurofibroma. A 47-year-old female presented with a 1-year history of a left tonsillar mass. Clinical evaluation, imaging, and biopsy results were inconclusive but raised suspicion for a neoplasm. The patient underwent robotic-assisted tonsillectomy and mass resection. Subsequent histopathological evaluation confirmed a benign spindle cell tumor consistent with neurofibroma. Oropharyngeal neurofibromas may present diagnostic challenges due to their resemblance to common tonsillar pathologies. Imaging and biopsies may not always provide definitive diagnoses, necessitating surgical excision for accurate characterization. This case demonstrates the utility of TORS, offering improved visualization and access while minimizing patient morbidity.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers Predictive of Immunotherapy Efficacy in Head and Neck Squamous Cell Carcinoma: Current Insights and Future Perspectives.","authors":"Xiao-Tong Yan, Zhao-Hong An, Chang-Ming An","doi":"10.1002/wjo2.70105","DOIUrl":"10.1002/wjo2.70105","url":null,"abstract":"<p><p>With the approval of immunotherapies by regulatory bodies, head and neck squamous cell carcinoma (HNSCC) treatment has been revolutionized, and anti-programmed cell death-1 (anti-PD-1) agents are now the standard for platinum-resistant recurrent/metastatic HNSCC. However, programmed death ligand 1 (PD-L1) expression does not always align with treatment efficacy, and given the risk of immune-related toxicities and high costs, identifying predictive biomarkers is crucial. This review comprehensively examines the current evidence for diverse biomarkers predictive of HNSCC response to anti-PD-1/PD-L1 therapy, including but not limited to PD-L1 expression, tumor mutational burden (TMB), features of the tumor microenvironment (TME), and circulating biomarkers. This integrative approach aims to overcome current limitations, comprehensively evaluate immunotherapy response potential, enhance prognostic assessment, and ultimately guide personalized treatment strategies in clinical practice for HNSCC patients.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blinded by the Bot: Benchmarking GPT and Gemini Against Human Authors in Otolaryngology Reviews.","authors":"Sholem Hack, Rebecca Attal, Letizia Nitro, Cecilia Rosso, Anastasia Urbanelli, Antonio Mario Bulfamante, Luigi Angelo Vaira, Omar G Ahmed, Masayoshi Takashima","doi":"10.1002/wjo2.70131","DOIUrl":"10.1002/wjo2.70131","url":null,"abstract":"<p><strong>Objective: </strong>To compare the quality of scientific review articles generated by two artificial intelligence systems, ChatGPT and Gemini, with those written by human authors in the field of otolaryngology.</p><p><strong>Methods: </strong>Two otolaryngology topics, chronic rhinosinusitis and infantile subglottic hemangioma, were selected. For each topic, four AI-generated reviews (GPT-4.0 and Gemini 2.0; narrative and PRISMA-style) and one human-authored peer-reviewed review were included, yielding a total of 10 manuscripts (8 AI-generated, 2 human-authored). A blinded panel of seven board-certified otolaryngologists evaluated all manuscripts using a 5-point Likert scale across seven domains: scientific accuracy, depth of content, citation quality, structure and organization, readability and tone, critical insight, and overall scientific quality. Group comparisons were performed using linear mixed-effects models with random intercepts for reviewer and manuscript. Interrater reliability was assessed using Shrout-Fleiss intraclass correlation coefficients (ICC). Manual verification of AI-generated references was conducted to assess citation accuracy and fabrication.</p><p><strong>Results: </strong>Human-authored manuscripts received the highest ratings across all domains (overall quality 4.50 ± 0.76). GPT-4.0 demonstrated moderate performance (2.71 ± 1.46 overall), while Gemini 2.0 scored lowest (2.14 ± 1.01). Mixed-effects modeling demonstrated significant group differences across all domains (<i>p</i> ≤ 0.008). Citation quality showed one of the largest between-group differences and strong reliability [ICC(2,1) = 0.68; ICC(2,7) = 0.94]. Manual verification of 123 AI-generated references revealed high citation accuracy for GPT-4.0 (89.6% fully accurate; 0% fabricated) compared with Gemini 2.0 (71.7% fully accurate; 23.9% fabricated). Reviewers misclassified 50% of GPT-4.0 manuscripts as human-authored, correctly identified 93% of human-authored manuscripts, and classified 86% of Gemini manuscripts as AI-generated.</p><p><strong>Conclusion: </strong>GPT generated fluent, stylistically strong reviews but remained significantly inferior to human-authored manuscripts in analytical depth and citation integrity. Gemini 2.0 underperformed across all domains and demonstrated a substantial rate of fabricated citations. As large language models become integrated into academic workflows, transparent disclosure, structured fact-checking, and human oversight remain essential to safeguard scientific reliability.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in AI-Based Prior Authorization for Head and Neck Reconstruction: A Large Language Model Analysis.","authors":"Shannon S Wu, Mugil V Shanmugam, Yu-Jin Lee, Noel F Ayoub","doi":"10.1002/wjo2.70130","DOIUrl":"10.1002/wjo2.70130","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLM) are being rapidly integrated into healthcare, particularly to streamline time- and labor-intensive administrative processes. However, the potential for artificial intelligence (AI) systems to demonstrate bias when employed for insurance authorization remains poorly understood. As insurers increasingly adopt AI to make coverage decisions, this study examined bias in LLM-driven prior authorization in otolaryngology, using oral cavity squamous cell carcinoma (SCC) as a case study.</p><p><strong>Methods: </strong>Using OpenAI's generative transformer GPT-4o, this study assessed for LLM bias when simulating insurance coverage decisions for head and neck cancer reconstruction. A standardized clinical scenario was constructed involving patients with T2N2 oral cavity SCC, all requiring surgical resection and reconstruction. The LLM was prompted to choose between a radial forearm free flap (RFFF) and split-thickness skin graft (STSG) for reconstruction, across 19,900 simulations. Patient profiles were systematically varied by age, sex, race/ethnicity, zip code-based income level, socioeconomic status (SES), and substance use history.</p><p><strong>Results: </strong>The LLM output showed significant disparities in approval decisions. RFFF was more frequently approved for younger, Asian, or white patients from high-income zip codes or high SES backgrounds (<i>p</i> < 0.0001). Older, Black, and Hispanic patients, and those from lower-income areas or with substance use histories, were less likely to receive RFFF authorization (<i>p</i> < 0.0001). On sensitivity analysis, inclusion of tumor-specific information markedly skewed recommendations towards RFFF across sociodemographic backgrounds.</p><p><strong>Conclusion: </strong>In this experimental study, the LLM's outputs exhibited significant disparities for oral cavity cancer reconstruction based on patient demographic variables in the setting of limited clinical information. Inputs to LLMs for clinical decision-making should include pertinent and detailed information to reduce the risk of bias. As insurers increasingly integrate AI for prior authorization, recognition of its biases, rigorous safeguards, and increased regulatory governance are needed to promote equitable health care.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Papillary Thyroid Cancer With Cutaneous Metastasis: A Case Report and Literature Review.","authors":"Yi-Qing Gao, Xin-Lu Yin, Lu-Ying Zheng, Jia-Dong Wang","doi":"10.1002/wjo2.70128","DOIUrl":"10.1002/wjo2.70128","url":null,"abstract":"<p><strong>Background: </strong>Cutaneous metastasis of papillary thyroid carcinoma is rare, which may present as slowly growing nodules, erythematous papules, or ulcerative nodules. The pathophysiological mechanisms of skin metastasis in thyroid cancer remain unclear. Skin metastasis of thyroid papillary carcinoma represents a poor prognostic factor in previous studies, and whether there exist relative genes still needs to be further investigated.</p><p><strong>Summary: </strong>Eight years after a radical surgery for left-sided thyroid cancer, a 29-year-old female presented to our dermatology department after discovering a patch of hyperpigmentation on the right side of her neck for 2 years. The dermatologist performed a biopsy of the neck skin mass under local anesthesia, and the gross specimen consisted of a piece of skin tissue measuring 0.4 cm × 0.3 cm × 0.3 cm, with a gray-black area of 0.4 cm on the surface. Microscopic examination, along with the clinical history, suggested metastasis of papillary thyroid carcinoma. Further immunohistochemical analysis showed results consistent with metastasis of papillary thyroid carcinoma, with tumor cells expressing TTF-1 (positive), TG (-), Ki67 (-), PAX-8 (+), GCDFP (-), ER (-), PR (20%), and GATA-3 (-).</p><p><strong>Conclusion: </strong>Skin metastases account for a relatively small proportion of metastatic thyroid cancer and can be easily misdiagnosed. Patients with skin lesions, especially in the head and neck area, that appear during the follow-up of thyroid cancer should be carefully selected and diagnosed.</p>","PeriodicalId":32097,"journal":{"name":"World Journal of OtorhinolaryngologyHead and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}