Head and Neck-Journal for the Sciences and Specialties of the Head and Neck最新文献

{"title":"Cold Exposure to the Recurrent Laryngeal Nerve: A Porcine Continuous Intraoperative Neuromonitoring Model Study.","authors":"Tzu-Yen Huang, Hsin-Yi Tseng, Yi-Chu Lin, Gregory W Randolph, Marika Russell, Amr H Abdelhamid Ahmed, I-Cheng Lu, Chih-Hung Lin, Cheng-Hsun Chuang, Jia Joanna Wang, Leong-Perng Chan, Feng-Yu Chiang, Li-Ren Yeh, Che-Wei Wu","doi":"10.1002/hed.70489","DOIUrl":"https://doi.org/10.1002/hed.70489","url":null,"abstract":"<p><strong>Background: </strong>Tissue exposure to cold temperatures is common in clinical practice, yet the safety of exposing the recurrent laryngeal nerve (RLN) to cold remains unclear. This study evaluated temperature-dependent effects of cold exposure on RLN function.</p><p><strong>Methods: </strong>A porcine continuous intraoperative neuromonitoring (C-IONM) model was used to assess electromyographic (EMG) changes in 16 RLNs exposed to four temperature conditions: room temperature water, cold water, ice water, and ice block. Each exposure lasted 1 min, followed by 20 min of EMG monitoring.</p><p><strong>Results: </strong>Room temperature and cold water caused no or only mild EMG changes with complete recovery. Ice water induced moderate to severe disturbances with partial reversibility. Ice block exposure produced the most severe effects, including transient loss of signal and incomplete recovery in some nerves.</p><p><strong>Conclusions: </strong>Cold exposure below 3°C can induce significant RLN dysfunction. These findings provide evidence that near-freezing temperatures, presumed to be neuroprotective, instead carry a distinct risk of iatrogenic neural injury, underscoring the need for caution in clinical applications.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Oral Cancer From Precursor Lesions: The Case for a Standardized Framework of Analysis to Improve Prediction Modeling.","authors":"Michael E Troka, James C Gates","doi":"10.1002/hed.70465","DOIUrl":"https://doi.org/10.1002/hed.70465","url":null,"abstract":"<p><p>Oral Cancer often occurs from the transformation of precursor lesions, and this offers an opportunity for early detection. Current methods to assess risk of precursor lesion progression to oral cancer incompletely predict risk. A multimodal framework that leverages machine learning is needed to improve prediction. In this manuscript, we propose more standardization in the study of OPMD across sites and propose a framework aligned to the principles of the NCI's Human Tissue Atlas Network (HTAN). We explore whole exome sequencing for genomic risk, methylation array for environmental genetic regulation, RNA sequencing for transcriptional control of cellular programs with spatial transcriptomics to fulfill the spatial requirements of HTAN. Moreover, we propose a machine learning (ML) analysis whereby a learned image-molecular association is created by integrating H&E histology and sequencing results. Once these associations are learned, a \"Teacher-Student\" model can be created whereby the Student model can be deployed to infer the \"molecular associations\" from H&E and patient covariates alone. Such a framework integrating multiomic data across multiple different biologic processes and time points can help to better understand and potentially even predict the biologic events that underlie oral cancer initiation.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of the Association Between ILIB and Photobiomodulation in Oral Mucositis Among Oncology Patients: A Prospective Study","authors":"Clébia Roberta Eufrazio do Nascimento,&nbsp;Fernanda Suely Barros Dantas,&nbsp;Tácio Fragoso Pereira,&nbsp;Myllenne dos Santos Abreu,&nbsp;Katarina Haluli Jano da Veiga Pessoa,&nbsp;Jair Carneiro Leão,&nbsp;Alessandra de Albuquerque Tavares Carvalho","doi":"10.1002/hed.70285","DOIUrl":"10.1002/hed.70285","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Purpose</h3>\u0000 \u0000 <p>Oral mucositis is one of the most frequent and debilitating adverse effects of antineoplastic therapy, significantly impairing treatment adherence and patients' quality of life. This study aimed to evaluate the effectiveness of Intravenous Laser Irradiation of Blood (ILIB), applied alone or combined with low-level laser therapy, in reducing oral mucositis and improving the quality of life of oncology patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This quasi-experimental prospective study with parallel groups was conducted between 2023 and 2024 at the Memorial Hospital of Arcoverde (PE), involving 76 patients equally allocated into four groups (<i>n</i> = 19): ILIB alone (A and C) and ILIB combined with laser therapy (B and D), applied therapeutically or preventively over weeks. Oral mucositis grade (WHO scale) and quality of life (OHIP-14) were assessed before and after the interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No baseline differences were observed between groups (<i>p</i> &gt; 0.05). After the intervention, the combined therapy groups showed greater reductions in mucositis (B: −1.60; −55.2% and D: −1.70; −60.7%) compared with ILIB alone (A: −0.70; −25.0% and C: −0.70; −25.9%) (<i>p</i> &lt; 0.05). Improvements in quality of life were also more pronounced in the combined groups (B: −9.00; −31.0% and D: −10.40; −36.0%) compared with ILIB alone (A: −4.50; −15.8% and C: −4.30; −15.5%) (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The ILIB + laser therapy association was more effective than ILIB alone in reducing oral mucositis and improving quality of life, both in prevention and treatment contexts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2685-2692"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swab-Derived Viral Load as a Biomarker of Tumor Biology in HPV-Associated Oropharyngeal Squamous Cell Carcinoma","authors":"Ella P. Jackert,&nbsp;Michelle Koh,&nbsp;Swar Vimawala,&nbsp;Liyang Tang,&nbsp;Daniel Kwon,&nbsp;Niels Kokot,&nbsp;Maie St. John,&nbsp;Yang Chai,&nbsp;Uttam Sinha,&nbsp;Albert Y. Han","doi":"10.1002/hed.70296","DOIUrl":"10.1002/hed.70296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Site-specific identification of human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (HPV+ OPSCC) remains a major diagnostic challenge. We developed a site-directed mucosal swab assay designed to detect and quantify tumor-derived HPV DNA shed into the oropharyngeal surface overlying HPV-associated tumors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with biopsy-proven HPV+ OPSCC or oral cavity SCC as controls were enrolled after providing informed consent. Swabs of the tumor site as well as the contralateral normal mucosa were collected. Swab-derived DNA was extracted and analyzed by quantitative PCR targeting HPV16 and HPV genotyping with Sanger sequencing. Multivariable linear regression models were used to evaluate associations between swab-based viral load and clinicopathologic features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a prospective cohort of 30 patients with HPV+ OPSCC, tumor-side swabs detected HPV DNA in 30 of 30 cases. Swabs obtained from the contralateral mucosa showed substantially lower HPV DNA levels, demonstrating strong spatial specificity for the tumor-bearing region. The assay limit of detection was determined to be ~10 HPV16 copies per reaction (1 viral genome per 500 diploid cells). All negative control patients with oral cavity SCC had negative results. Regression models revealed node-positive status to be independently associated with low quantitative HPV16 viral load (fold change = 0.013, 95% CI: 0.001–0.178).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By enabling minimally invasive, anatomically targeted detection of HPV-driven cancer at the primary site, this swab-based assay has the potential to shorten the diagnostic pathway for HPV+ OPSCC while providing quantitative viral load measurements that may serve as a surrogate biomarker for intratumoral biology in HPV+ OPSCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2782-2791"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the Clinically Node-Negative Neck in Intermediate-Grade Mucoepidermoid Carcinoma of the Head and Neck: A Single-Institution Retrospective Study","authors":"Min-Chuan Lin,&nbsp;Xu Jiang,&nbsp;Zi-Chen Qiu,&nbsp;Xiong Zhou,&nbsp;Ya-Lan Tao","doi":"10.1002/hed.70304","DOIUrl":"10.1002/hed.70304","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Management of the clinically node-negative (cN0) neck in intermediate-grade mucoepidermoid carcinoma (MEC) of the head and neck remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed patients with cN0 intermediate-grade MEC treated between 2008 and 2025. Patients underwent observation or elective neck treatment, including elective neck dissection and/or radiotherapy. Survival outcomes were analyzed using Kaplan–Meier methods and Cox proportional hazards models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty patients were included (27 observation, 33 elective treatment). After a median follow-up of 53 months, regional recurrence occurred in three patients in the observation group and in none receiving elective treatment. Five-year regional recurrence-free survival, disease-free survival, and disease-specific survival were high in both groups, without significant differences. Perineural invasion was associated with worse disease-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In cN0 intermediate-grade MEC, regional control outcomes were favorable, and a statistically significant benefit of elective neck treatment was not demonstrated in this cohort. For carefully selected patients without adverse clinicopathologic features, close observation of the neck may be a reasonable strategy. These findings should be interpreted cautiously given the limited sample size and low event rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2773-2781"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predominance of In-Field Recurrence After Radiotherapy for Sinonasal Cancer: A Single-Center Retrospective Study","authors":"M. de Ridder,&nbsp;L. J. van de Velde,&nbsp;T. de Bie,&nbsp;R. van Noortwijk,&nbsp;C. P. J. Raaijmakers,&nbsp;E. H. Voormolen,&nbsp;W. W. Braunius,&nbsp;R. de Bree,&nbsp;G. E. Breimer,&nbsp;L. A. Devriese,&nbsp;E. J. Smid,&nbsp;J. A. Rijken","doi":"10.1002/hed.70287","DOIUrl":"10.1002/hed.70287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sinonasal malignancies (SNM) are rare, heterogeneous tumors with poor prognosis. There is an unmet need to improve treatment outcomes. Despite advances in imaging and molecular classification, optimal curative radiotherapy (RT) strategies remain undefined. We analyzed the pattern of failure after RT, focusing in depth on local recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included 104 SNM patients treated with curative-intent RT (either primary or after endoscopic surgery) at a tertiary center between 2010 and 2022. Local recurrences were delineated on follow-up imaging and registered to pretreatment plans. Recurrence location was classified as in-field, marginal, or out-of-field based on dose at the center of mass.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Local recurrence rate was 25%. Most local recurrences (81%) occurred in-field in the high-dose region (&gt; 95% of prescribed dose), with a median dose of 65 Gy. Perineural spread accounted for most out-of-field failures. Local recurrence significantly impaired disease-specific survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Local failures after RT for SNM predominantly arise in-field within adequately irradiated volumes, suggesting biological radioresistance. These findings support the need for histology-driven, biologically tailored treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2704-2712"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hed.70287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy","authors":"Daqi Zhang,&nbsp;Francesco Brucchi,&nbsp;Carla Colombo,&nbsp;Gianlorenzo Dionigi,&nbsp;Hui Sun","doi":"10.1002/hed.70276","DOIUrl":"10.1002/hed.70276","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To characterize the patterns, mechanisms, and outcomes of vagus nerve (VN) injury associated with continuous intraoperative neuromonitoring (CIONM) during total thyroidectomy and to outline prevention strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>A prospectively maintained thyroidectomy database (2014–2024), operative records, anesthesia charts, intraoperative electromyography (EMG) data, and standardized postoperative laryngoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Review Methods</h3>\u0000 \u0000 <p>Retrospective identification of all postoperative VN injuries following total thyroidectomy with CIONM. VN injury was defined as new ipsilateral vocal fold palsy with abrupt or marked VN EMG loss not attributable to recurrent laryngeal nerve (RLN) trauma, confirmed by absent proximal and preserved distal stimulation. Variables included demographics, surgical approach, device type, VN topography, timing and mechanism of injury, EMG pattern, and recovery to 180 days. Incidence was calculated per nerve at risk. Analyses were descriptive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1060 thyroidectomies (2120 nerves at risk), nine VN injuries occurred (0.42%). Eight were transient and one permanent. Most injuries (89%) arose during initial carotid sheath dissection or probe application, particularly in posterior VN positions or short, thick necks. Older circumferential probes were more often involved. All lesions were segmental with preserved RLN EMG. No global VN damage, macroscopic disruption, thermal injury, or intraoperative hemodynamic instability was observed. Complete EMG loss predicted the only permanent palsy; partial amplitude/latency changes resolved. Early recognition, stopping manipulation, and timely voice therapy supported recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CIONM-related VN injury rate is low (0.4%), and most cases recovered in approximately 4 months. CIONM-related VN injury is usually related to nerve exposure rather than probe handling.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2627-2637"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive Swallowing Rehabilitation for Head and Neck Cancer Survivors With Chronic Dysphagia: Outcomes From a Prospective Multicentre Cohort Study With 6-Month Follow-Up","authors":"J. I. Oldenbeuving,&nbsp;L. van der Molen,&nbsp;J. T. Groothuis,&nbsp;J. G. Kalf","doi":"10.1002/hed.70271","DOIUrl":"10.1002/hed.70271","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic dysphagia persists in some head and neck cancer (HNC) survivors despite preventive exercises, negatively impacting quality of life. Evidence for effective rehabilitation strategies remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cohort study included 34 HNC survivors (≥ 1 year post-treatment) who completed a 3-week intensive swallowing rehabilitation (ISR) program (15 sessions, 60 min/day). Outcomes were measured at baseline (T0), post-treatment (T1), and 6-month follow-up (T2) using patient-rated (VAS, MDADI, PSS-HN), clinician-rated (food level, AUS-TOM), and objective swallowing outcomes (MSS, MSV, TOMASS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ISR was feasible and safe (92% completion, no adverse events). Patient-rated and most clinician-rated outcomes improved significantly post-ISR and remained stable at 6 months (VAS: <i>p</i> &lt; 0.001; PSS-HN: <i>p</i> &lt; 0.001; food level: <i>p</i> = 0.002). MDADI and AUS-TOM for solids further improved at follow-up. Objective swallowing tests showed no clinically relevant change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ISR effectively improves normalcy of diet and quality of life in HNC survivors with chronic dysphagia, with benefits sustained at 6 months.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2617-2626"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hed.70271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Identification of Gastrostomy Tube Placement in the Surgical Treatment of Head and Neck Cancer","authors":"Makayla R. Matthews,&nbsp;Victoria I. Fonseca,&nbsp;Jason Tasoulas,&nbsp;Trevor G. Hackman","doi":"10.1002/hed.70282","DOIUrl":"10.1002/hed.70282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is no consensus on optimal timing or indications for gastrostomy tube (G-tube) placement for Head and Neck Cancer (HNC) patients. While avoiding procedural risks for many, a reactive-only approach has been linked to longer hospital stays, higher costs, and complications related to prolonged hospitalization for some patients. The aim of this study was to identify patients at risk of gastrostomy during the primary hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective review of patients who underwent HNC resection and reconstruction at a single academic institution (2017–2022) was completed. Statistical analysis was performed with Stata.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 145 patients, tumor site [55% oral, 6% oropharynx, 7% hypopharynx, 31% larynx] significantly influenced G-tube placement (<i>p</i> &lt; 0.0005). The following were independently associated with reactive G-tube placement: sex (females, HR 1.81, 95% CI 1.01–3.23), tumor site (oropharynx 2.42, 95% 1.29–4.54; larynx 0.16, 95% 0.07–0.36), and prior systemic therapy (0.22, 95% 0.05–0.96); which were used to create a nomogram for patient counseling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Presurgical risk stratification offers a value-based approach for identifying HNC patients most likely to require G-tube placement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2650-2659"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Clinical Impact of the Direct-To-Test Neck Lump Referral Pathway. A Retrospective Review at a District General Hospital","authors":"Celine Iswarya Partha Sarathi,&nbsp;Sahar Alghnaimawi,&nbsp;Sehar Naseem,&nbsp;Ayeshea Shenton,&nbsp;Ali Wadood,&nbsp;Adrian Hall,&nbsp;Woo-Young Yang,&nbsp;Max Sallis Osborne","doi":"10.1002/hed.70283","DOIUrl":"10.1002/hed.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate a precision-triage, direct-to-test (DTT) neck-lump referral pathway under the National Health Service (NHS) Faster-Diagnosis-Standard (FDS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A district-general hospital in England.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective review of FDS referrals for “neck lump” or “unexplained thyroid lump” from November 1, 2023 to December 31, 2024. After triage, patients proceeded directly to ultrasound (DTT-USS) with further tests as needed. Minimum follow-up: 6-months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>417/440 referrals were included; 55.6% lacked clinical details. USS was normal in 110 (26.4%). Suspicious lesions requiring biopsy were found in 130, with malignancy in 12.7%, consistent with national data. Following benign/normal USS, 348 (83.5%) were removed from the cancer pathway; 71 (20%) requested review and 21 (6%) chose routine surgery. Straight-to-biopsy reduced diagnostic intervals (15 vs. 24 days, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The DTT-USS pathway streamlines referrals, ensures diagnostic accuracy, and improves efficiency. Standardized referral data, radiologist-led biopsy, and structured benign follow-up could further enhance sustainability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"48 10","pages":"2677-2684"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}