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

{"title":"Adjuvant Radiotherapy for Early-Stage Oral Tongue Cancer: Insights From the NCDB Based on Grade.","authors":"Bryan Nolasco, N Patrik Brodin, Nina Samuel, Bradley Schiff, Vikas Mehta, Madhur Garg, Rafi Kabarriti","doi":"10.1002/hed.28243","DOIUrl":"https://doi.org/10.1002/hed.28243","url":null,"abstract":"<p><strong>Background: </strong>Oral tongue squamous cell carcinoma (OTSCC) incidence is rising in the United States. While early-stage (pT1-2N0M0) OTSCC is primarily managed with surgery, the role of postoperative radiotherapy (PORT) remains debated, particularly in moderate-to-poor differentiation. Current guidelines do not recommend PORT based on histologic grade alone, yet a retrospective study by Tian et al. found PORT improved survival in moderately-to-poorly differentiated OTSCC in a Chinese cohort. We aimed to validate these findings in a US population.</p><p><strong>Methods: </strong>A retrospective cohort study using the National Cancer Database (2004-2022) identified patients with pT1-2N0M0 OTSCC treated with surgery or surgery plus PORT. After stringent inclusion criteria, 3562 patients remained, including 456 (12.8%) who received PORT. Propensity score matching (PSM) balanced key prognostic factors, and survival was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>PORT did not improve OS in well- or moderately differentiated tumors. However, in poorly differentiated tumors, PORT was associated with a significant survival benefit (HR: 0.53, 95% CI: 0.30-0.92, p = 0.025) before and after PSM. This effect persisted in multivariable analysis (HR: 0.56, 95% CI: 0.31-0.99, p = 0.047) and after excluding patients with lymphovascular invasion (HR: 0.48, 95% CI: 0.27-0.87, p = 0.016).</p><p><strong>Conclusions: </strong>These findings validate and extend prior international data, demonstrating a PORT-associated survival benefit in poorly differentiated early-stage OTSCC. The lack of benefit in well- and moderately differentiated tumors underscores the need for individualized treatment approaches. Prospective studies are warranted to refine risk stratification and optimize clinical guidelines.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627796","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":"Traumatic Intrathyroidal Hematoma: Case Report and Review of Literature.","authors":"Morgan Terry, Ana Araujo, Skylar Trott, Mark K Wax","doi":"10.1002/hed.28248","DOIUrl":"https://doi.org/10.1002/hed.28248","url":null,"abstract":"<p><strong>Background: </strong>Traumatic expanding intrathyroidal hematoma is rare and can be clinically obscured, leading to delayed diagnosis and potential airway compromise. Identification and prompt intervention are paramount to survival.</p><p><strong>Methods: </strong>Patient presented to the emergency department as a modified trauma without signs of respiratory distress or enlarging neck circumference. Comprehensive trauma imaging identified the thyroid pathology prompting otolaryngology involvement.</p><p><strong>Results: </strong>Rapid operating room arrangement allowed for prevention of airway compromise, straight forward intubation, and resolution of thyroid pathology prior to clinical decompensation.</p><p><strong>Conclusions: </strong>We present an unusual case of traumatic thyroid hematoma in which the bleeding source was contained within the thyroid capsule; intubation and surgical intervention resolved the airway and thyroid pathology. Trauma-indicated imaging allowed for identification in a clinically obscured pathology.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627718","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":"Impact of Extranodal Extension in Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Systematic Review and Meta-Analysis.","authors":"Andrea Costantino, Gian Marco Pace, Camilla Zimello, Elena Russo, Antonio Greco, Antonella Polimeni, J Scott Magnuson, Armando De Virgilio","doi":"10.1002/hed.28251","DOIUrl":"https://doi.org/10.1002/hed.28251","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to analyze the impact of extranodal extension (ENE) on survival outcomes for patients with metastatic cutaneous head and neck squamous cell carcinoma (cHNSCC).</p><p><strong>Methods: </strong>The pooled hazard ratios (HRs) and the 95% confidence interval (CI) were calculated to define the impact of ENE on overall survival (OS) and disease-free survival (DFS).</p><p><strong>Results: </strong>A total of 2076 patients (males: 84.4%) with a median age of 73.3 years were included. The incidence of ENE was 65.6% (N = 1299/1979). The median follow-up time was 38.4 months (95% CI: 21-38.4). The estimated pooled HRs were 1.31 (95% CI: 0.72-2.39; p = 0.28) and 1.80 (95% CI: 0.53-6.10; p = 0.22) for OS and DFS, respectively.</p><p><strong>Conclusions: </strong>ENE may not be a reliable prognostic factor in metastatic cHNSCC. Further prospective studies are needed to refine risk stratification and improve the current nodal classification system.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627797","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":"Quantitative Analysis of Videofluoroscopy Following Total Laryngectomy Using the ASPEKT Method.","authors":"Sana Smaoui, Sean M Lee, Sandhya Ganesan, Emily Ankeney, Tatiana Ferraro, Rebecca Dorward, Erin-Anne Cardman, Arjun Joshi","doi":"10.1002/hed.28240","DOIUrl":"https://doi.org/10.1002/hed.28240","url":null,"abstract":"<p><strong>Introduction: </strong>Swallowing dysfunction is a common postoperative challenge for patients following total laryngectomy. Videofluoroscopic swallow study (VFSS) can be used to assess the mechanism of swallowing dysfunction in patients; however, many standardized protocols do not account for the anatomical changes in patients who have undergone total laryngectomy. In this study, we aim to utilize the ASPEKT (Analysis of Swallowing Physiology: Events, Kinematics & Timing) Method to quantify swallowing mechanics in a cohort of post-laryngectomy patients.</p><p><strong>Methods: </strong>A retrospective study of swallowing post total laryngectomy was performed. All participants received a VFSS as part of standard care up to 10 months following their surgery between 2011-2021. Blinded raters trained in the ASPEKT method scored the VFSS for: number of swallows, UES opening duration, pharyngeal area at maximum pharyngeal constriction (PhAMPC), and total pharyngeal residue. A mixed-effects beta regression model was fitted to the data, with total pharyngeal residue as the dependent variable and number of swallows, UES duration, and pharyngeal area at maximum constriction as independent variables.</p><p><strong>Results: </strong>The average number of swallows per bolus was greater than 2. For patients who required more than 1 swallow to clear the bolus, the average UES opening duration increased with each swallow, from 567 ms during the first swallow to 633 ms during the third swallow. Additionally, the average PhAMPC for patients who required more than one swallow was 40.4% C2-C4² compared with 22.2% C2-C4² in patients who cleared the bolus with one swallow. Results from the mixed-effects beta regression model showed that PhAMPC (OR = 22.58; p < 0.001; [95% CI 7.39, 64.28]) was a significant predictor of residue. UES opening duration and number of swallows were not significantly predictive of total pharyngeal residue.</p><p><strong>Conclusions: </strong>This study represents the application of the ASPEKT Method to more precisely analyze VFSS in patients following total laryngectomy. Changes in swallowing function and efficiency post-laryngectomy may largely be attributed to ineffective maximal pharyngeal constriction. Future work further characterizing this change in swallowing dynamics is crucial in developing treatment options to address swallowing dysfunction following total laryngectomy.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621153","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":"Predictive Modeling of Hyperparathyroidism in Patients With Benign Thyroid Nodules: A Cohort Study Using the Vizient Database.","authors":"Christopher S Hollenbeak, Qiang Hao, Melody Greer, Totton A Hollenbeak, Brendan C Stack","doi":"10.1002/hed.28247","DOIUrl":"https://doi.org/10.1002/hed.28247","url":null,"abstract":"<p><strong>Importance: </strong>Predicting primary hyperparathyroidism in data may facilitate earlier diagnosis and treatment.</p><p><strong>Objective: </strong>Primary Hyperparathyroidism (pHPT) is the leading cause of hypercalcemia and up to 75% of hypercalcemic patients go undiagnosed. The purpose of this study was to examine the use of predictive modeling using a large clinical database to predict pHPT in patients with benign thyroid nodules.</p><p><strong>Design: </strong>Retrospective analysis and predictive modeling of pHPT using a large discharge database. A predictive model of pHPT was created using logistic regression and compared to three machine learning algorithms: a Gaussian naive Bayes classifier, a stochastic gradient descent classifier, and a histogram-based gradient boosting classifier.</p><p><strong>Setting: </strong>Vizient hospital discharge database from over 1000 hospitals including academic health centers.</p><p><strong>Participants: </strong>Data from the Vizient Clinical Database (CDB), 2 541 901 patients with benign thyroid nodules were identified between 2020 and 2023, of whom 83 555 (3.29%) had pHPT. INTERVENTION(S) (FOR CLINICAL TRIALS) OR EXPOSURE(S) (FOR OBSERVATIONAL STUDIES): Analyses controlled for demographics (age, sex, race), comorbidities (body mass index (BMI), diabetes, hypertension, smoking status, renal disease) and use of proton pump inhibitors and bisphosphonates.</p><p><strong>Main outcome(s) and measure(s): </strong>The primary outcome measure was the presence of pHPT, which was identified using ICD-10 codes. Model performance was compared using the area under the receiver operating characteristics (ROC) curve.</p><p><strong>Results: </strong>In the baseline predictive model, several demographic characteristics were significant predictors of pHPT. The logistic regression model had an area under the ROC curve of 68.1%, which was lower than that of the histogram gradient boosting model (68.7%) but equivalent to the gradient descent classifier (68.1%). Furthermore, the logistic regression model correctly classified 80.4% of pHPT cases, compared to 80.5% for both the histogram gradient boosting classifier and the gradient descent classifier. A threshold of 5% yielded a sensitivity of 38.5% and specificity of 81.8% for logistic regression.</p><p><strong>Conclusions and relevance: </strong>Predictive modeling of pHPT among patients with benign thyroid nodules is possible using a large clinical database. The predictive equation could be built into decision support systems to alert clinicians to potentially undiagnosed pHPT and aid in timely diagnosis and treatment of pHPT.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621152","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":"Transoral Submandibular Gland Excisions: Avoiding the Unsightly Neck Scar in Select Patient Populations.","authors":"Amelia Curtis, Christina M Palomo, Cristina Benites, Jimmy Brown","doi":"10.1002/hed.28242","DOIUrl":"https://doi.org/10.1002/hed.28242","url":null,"abstract":"<p><strong>Background: </strong>Submandibular gland (SMG) excision is traditionally performed using a transcervical approach, which, although effective, carries risks such as visible neck scarring and nerve complications. The transoral approach presents a cosmetically favorable alternative, yet its adoption remains limited. This case series was done to evaluate the safety, efficacy, and complication profile of the transoral approach for SMG excision in patients with benign pathologies.</p><p><strong>Methods: </strong>This retrospective case series was conducted at a single tertiary-care institution and included 30 patients who underwent transoral SMG excision between the ages of 7 and 80 years, performed by a single surgeon. Patients included in the case series had benign conditions such as chronic sialadenitis, ranulas, and a pleomorphic adenoma. Outcomes of interest included conversion to open surgery, avoidance of cervical scarring, intraoperative duration, and postoperative complications.</p><p><strong>Results: </strong>All 30 patients avoided a transcervical incision and no conversions to an open approach occurred. The average operative time was 95 min, transient tongue paresthesias occurred in three patients, resolving within 6 weeks. No cases of hypoglossal or marginal mandibular nerve injury were observed. Two postoperative infections were recorded, one of which required hospitalization and intravenous antibiotics. No hematomas or seromas were identified.</p><p><strong>Conclusion: </strong>The transoral approach for SMG excision is a viable, cosmetically favorable alternative for select patients with benign glandular disease.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592904","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":"Autologous Arteriovenous Loop Graft Creation for Head and Neck Microsurgical Reconstruction: A Pictorial Essay","authors":"Shelby Kitchin,&nbsp;Jake Whiteside,&nbsp;Sabrina Mahanpour,&nbsp;Justin Robbins,&nbsp;Mohamedkazim Alwani,&nbsp;Sunishka Wimalawansa,&nbsp;Mark K. Wax,&nbsp;Glen Schwartzberg,&nbsp;Sameep Kadakia","doi":"10.1002/hed.28237","DOIUrl":"10.1002/hed.28237","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The arteriovenous (AV) loop is a versatile and reliable technique for establishing vascular access in head and neck free tissue reconstruction. This method is particularly advantageous in complex cases where conventional vascular access may be challenging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>In this pictorial essay, we present the pre-operative planning and patient selection factors for creating AV loops, and artist-illustrated drawings detailing our intraoperative technique.</p>\u0000 \u0000 <p>This work provides the surgeon a guide to perform and understand the procedure of harvesting a vein graft, creating a loop, and appropriately positioning it in preparation for microsurgical repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The AV loop technique yields a reliable conduit, and its flexibility allows for complex free-flap reconstructions in challenging scenarios where vessels are not locally available or in situations where vessel length is inadequate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"47 9","pages":"2627-2633"},"PeriodicalIF":2.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585710","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":"Magnifying Glass on Sinonasal NUT Carcinoma Heterogeneity via Spatial Transcriptomics.","authors":"Diana Bell, Garret Choby, Michelle Afkhami, Ellie Maghami, Renata Ferrarotto, Carl Snyderman, Eric Wang, Ehab Hanna, Raja Seethala","doi":"10.1002/hed.28231","DOIUrl":"https://doi.org/10.1002/hed.28231","url":null,"abstract":"<p><strong>Background: </strong>Nuclear protein in testis (NUT) carcinomas (NCs) are rare, clinically aggressive tumors with characteristic translocation involving NUTM1 and BRD4 genes. While NCs are generally characterized by undifferentiated basaloid cells with focal/abrupt squamous differentiation, tumoral heterogeneity remains unexplored. This may have therapeutic implications as NC frequently develops drug resistance and metastasis. Spatial transcriptomics (ST) sequencing technology emerged as an approach to elucidate tumoral heterogeneity by integrating cellular transcriptome and spatial distributions within tissues, providing insights into the interactions among different cell types and overall tissue genomic architecture.</p><p><strong>Methods: </strong>Three cases of sinonasal NC with formalin-fixed paraffin embedded tissue formed the study material. A representative region of each NC was subjected to 10X Genomics Visium Spatial Gene Expression analysis. Resulting data were analyzed in 10X Genomics Loupe Browser.</p><p><strong>Results: </strong>All cases demonstrated statistically distinct (graph-neural network based) transcriptomic clusters. These clusters were correlated with histologic characteristics by parsing all spots by region types based on tissue distribution including tumor, limited stroma, and normal epithelium. Cluster constitution and transcriptomic pattern were consistent with the morphologic features of each tissue region. NC#3 had a relatively low number of tumor clusters in comparison to NC#1 and NC#2.</p><p><strong>Conclusions: </strong>Spatial transcriptomic profiling corresponds to histopathologic features in NC and yet highlights cell type diversity across tumors and in the case of NC#2, within a given tumor. Behavioral correlates are speculative, but NC#3 for which the patient had a rapidly lethal outcome showed a preponderance of neural gene expression which may be of interest in tumor cell progression/evolution.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577008","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":"Comparing Outcomes of Pedicled Submandibular Gland Flap and Submental Artery Perforator Flap in Oral Cavity Reconstruction.","authors":"Maged Ali Al-Aroomi, Yiheng Feng, Jie Chen, Ning Li, Canhua Jiang, Jie Wang","doi":"10.1002/hed.28229","DOIUrl":"https://doi.org/10.1002/hed.28229","url":null,"abstract":"<p><strong>Objective: </strong>Submandibular gland flap (SMGF) has demonstrated reliability in repairing small- to medium-sized defects, yet it has not gained widespread international adoption. This study aimed to evaluate the efficacy and outcomes of SMGF for oral cancer reconstruction and compare its application with submental artery perforator flap (SMAPF).</p><p><strong>Methods: </strong>All patients with primary oral cancer requiring reconstruction using either SMGF or SMAPF were included. Demographic and surgical outcome measures (such as harvesting time, use of lip splinting, and marginal mandibulectomy), short-term outcomes (including flap partial loss, intraoral wound dehiscence, fistula, oral bleeding, and wound infection), and long-term morbidity (including cancer recurrence, neck motion restriction, hair growth, and overall aesthetic outcomes) were assessed.</p><p><strong>Results: </strong>Thirty-seven patients were enrolled (SMGF, n = 16; SMAPF, n = 21). The SMGF group was older than the SMAPF group and had a shorter harvesting time (p < 0.05). Flap partial loss and neck motion restriction occurred in 3 patients in the SMAPF group. Nine patients experienced locoregional recurrence (SMGF, n = 3; SMAPF, n = 6). A significantly higher incidence of hair growth was observed in the SMAPF group (47.6%, p = 0.002). No significant difference was found in satisfaction with appearance between the two groups. There were no flap losses in the study.</p><p><strong>Conclusion: </strong>SMGF reconstruction is a valuable technique, comparable to SMAPF, for repairing appropriately selected intraoral defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue, but it is not large enough to necessitate free flap reconstruction.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577006","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":"The Impact of Postoperative Antibiotics on Outcomes Following Segmental Resection and Microvascular Reconstruction for Mandibular Osteoradionecrosis.","authors":"Marta M Williams, Francis X Creighton, Miriam B Barshak, Jeremy D Richmon, Derrick T Lin, Daniel G Deschler, Kevin S Emerick, Mark A Varvares, Marlene L Durand","doi":"10.1002/hed.28235","DOIUrl":"https://doi.org/10.1002/hed.28235","url":null,"abstract":"<p><strong>Background: </strong>The optimal intravenous (IV) antibiotic regimen following definitive surgical treatment for mandibular osteoradionecrosis (ORN) is unknown. This study evaluated the effect of culture-directed IV antibiotics (based on intraoperative cultures) on early wound complications, including surgical site infections (SSIs) and antibiotic duration on long-term wound healing (healing ≤ 2 months without subsequent complications).</p><p><strong>Methods: </strong>Retrospective review of flap reconstruction for ORN (2009-2022, N = 44, 70% free flaps, 30% pedicled).</p><p><strong>Results: </strong>Postoperative antibiotics were culture-directed (25 patients) or empiric (19); the SSI rate was lower in the culture-directed group (0% vs. 26.3%, p = 0.01). Twenty-two patients received short-course (mean 9 days) and 22 long-course (mean 43 days) IV antibiotics postoperatively. During follow-up (mean 5.7 years), these groups had similar rates of long-term wound healing (50% vs. 36%, p = 0.54).</p><p><strong>Conclusion: </strong>In this series, patients who received culture-directed IV antibiotics postoperatively had zero SSIs. The rate of long-term wound healing was not affected by the antibiotic duration.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577010","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}