Background Adenoidectomy is one of the most frequently performed pediatric surgical procedures worldwide. However, optimal surgical technique remains controversial particularly regarding recurrence rates. This systematic review and meta-analysis aimed to compare adenoid recurrence following conventional cold curettage and coblation techniques. Methods A systematic literature search was conducted across multiple databases from 2007 to August 2025 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCT) comparing conventional curettage with coblation adenoidectomy in pediatric patients were included. The primary outcome was adenoid recurrence, while secondary outcomes included recovery duration. Data were analyzed using random-effects model and Odds Ratios (OR) with 95% Confidence Intervals (CIs) were calculated. Results Five RCT comprising 492 participants were included. The pooled analysis demonstrated significantly higher recurrence rate in conventional curettage group compared to coblation group (OR = 5.78, 95% CI: 2.68-12.43; Z = 4.49,p<0.00001). No significant heterogeneity was observed(I2=0%). Subgroup analysis showed a significant difference in recovery duration between two techniques. Publication bias assessment revealed no significant bias. Conclusion Coblation adenoidectomy is associated with significantly lower recurrence rates and improved recovery outcomes compared to conventional curettage, supporting its use as a preferred surgical technique in pediatric patients.
Head and neck squamous cell carcinoma management remains a clinical challenge due to high recurrence rates and persistent difficulties in achieving clear surgical margins. Molecular-targeted fluorescence-guided surgery (FGS) offers a promising solution by enabling real-time visualization of tumor boundaries and critical functional structures. This review synthesizes current evidence on key molecular targets for FGS in head and neck squamous cell carcinoma, including CD44v6, αVβ6 integrin, urokinase-type plasminogen activator receptor, PARP1, and epidermal growth factor receptor, as well as emerging strategies for nerve preservation. Epidermal growth factor receptor-directed probes, such as cetuximab-IRDye800 and panitumumab-IRDye800, demonstrate strong clinical performance for margin and metastatic lymph node assessment, while alternative targets provide complementary advantages for invasive fronts and peripheral tumor regions. Advances in dye chemistry, including near-infrared II fluorophores and small-molecule tracers, address limitations in penetration depth and preoperative logistics. Additionally, nerve-specific agents like ALM-488 (bevonescein) extend FGS utility to functional preservation. Despite encouraging results, challenges remain in optimizing probe pharmacokinetics, imaging depth, and multispectral integration. Future research should prioritize pragmatic tracer design, standardized imaging protocols, and patient-centered outcomes to enable widespread clinical adoption. Molecular-targeted FGS represents a transformative approach to improving oncologic control and quality of life outcomes in head and neck cancer surgery.
Intraoperative visualization is critical to achieving safe and effective outcomes in endoscopic anterior skull base surgery, as the field has expanded its scope in the management of cerebrospinal fluid leaks and skull base tumor resection. Fluorescein and indocyanine green have transformed modern endoscopic procedures by enhancing the detection of cerebrospinal fluid leaks and aiding in the identification of critical structures, thereby reducing complications. This chapter reviews the indications, techniques, safety, and limitations of these adjunctive visualization technologies.
Indocyanine green (ICG) is a nonselective near-infrared fluorescent tracer that first received FDA approval in 1956. Subsequently, numerous applications have been developed, including uses in head and neck surgery. This paper provides succinct reviews of the current literature, techniques, and limitations of sentinel lymph node mapping and intraoperative parathyroid identification using ICG.
This chapter reviews the role of computed tomography guidance in improving outcomes for cochlear implantation. The development and core principles of computed tomography are outlined to establish the foundation for use in cochlear implants. Studies have shown that using preoperative imaging supports assessment of cochlear anatomy and improvement in electrode array placement. Intraoperative imaging has been shown to reduce complications, and postoperative imaging enhances cochlear implant programming and assists in management of revision cases. These advancements illustrate that cochlear implantation with computed tomography guidance contributes to more precise electrode array placement and has the potential to improve postoperative functional outcomes.
To describe a standardized office-based technique for tympanostomy tube placement using topical lidocaine-based anesthesia in adults and selected pediatric patients. Tympanostomy tube placement is commonly performed under general anesthesia in children and under injected local anesthesia or phenol-based anesthesia in adults. A reproducible topical-only method may reduce procedural invasiveness and avoid systemic anesthesia exposure. After canal cleaning and drying, a thin, uniform layer of 5% lidocaine cream or compounded 6% lidocaine/6% tetracaine cream is applied to the entire tympanic membrane under microscopic visualization. Adults typically require 5 to 8 minutes of dwell time with the lidocaine/tetracaine preparation. In cooperative children (≥4 years), 5% lidocaine cream is applied and allowed to dwell for 15 to 20 minutes before incision. Excess cream is gently suctioned when needed. Standard radial myringotomy, aspiration, and tube placement are then performed using standard alligator forceps. Over a 10-year period, more than 500 adult procedures and approximately 10 pediatric cases were successfully completed in the office setting. No procedures required abandonment or conversion to the operating room. No tympanic membrane necrosis, canal chemical injury, observable nystagmus, syncope, or local anesthetic systemic toxicity were observed. A minority of patients reported transient subjective dizziness without objective vestibular findings. Topical lidocaine-based anesthesia provides a safe and reproducible method for office-based tympanostomy tube placement in adults and selected cooperative children.
Augmented reality (AR) and virtual reality (VR) are technologies rapidly expanding across the medical landscape. Within head and neck surgery, both AR and VR have been studied in a wide variety of applications. VR appears positioned to provide significant improvements in preoperative visualization, while AR is targeted toward intraoperative guidance. This is due in large part to AR’s ability to preserve the real-world environment. Applications of AR include intraoperative guidance for bony reconstruction and tumor ablation, anatomic visualization during transoral robotic surgery, and localization of lymph nodes during sentinel lymph node biopsy. Registration of superimposed AR overlays to native patient anatomy remains a point of constant iteration as researchers seek to improve accuracy and advance toward markerless registration. This review serves to highlight the current state of AR and VR applications within head and neck surgery, notable studies, and their relevance for the future of the field.
Microvascular free tissue transfer and locoregional flap reconstruction in the head and neck are mainstays given the often-extensive defects encountered after cancer extirpation. While success rates are reported above 93 percent, the ability to assess tissue viability and perfusion is paramount to reducing postoperative complications given the environment in which this tissue is often transplanted. The proximity of the upper aerodigestive structures, the large vessels, and in some cases dural coverage and separation of the sinonasal structures from the brain present a unique reconstructive challenge, and even partial failure can lead to catastrophic consequences including salivary fistula, carotid blow-out, chronic draining wounds, inability to eat, aspiration, cerebrospinal fluid leak, intracranial infection or hemorrhage, hardware exposure, and death. Once elevated, flap tissue is wholly dependent on its pedicle until surrounding tissue can begin to vascularize—often taking weeks to months. Thus, timely assessment of adequate vascularity is vital to success. Historically, imaging technology for vascularity has been limited to standard angiography requiring ionizing radiation and cannulation of the vessels, but modern technology allows for less invasive and in some cases, noninvasive, reliable options.
Total and subtotal nasal defects present a formidable reconstructive challenge, requiring the restoration of structural integrity, functional nasal airway, and aesthetic form. Previously described methods of reconstruction are subject to postoperative deformation, often require multiple revisions for debulking to restore patency and form, and can create an intranasal environment prone to crusting. We describe a comprehensive single-stage reconstructive approach using an anterolateral thigh fascia lata (ALTFL) free flap for nasal lining, osseocartilaginous rib grafts for structural framework, and a paramedian forehead flap (PMFF) for external coverage. All aspects of the reconstruction are described and depicted. We describe an example case detailing its use in a 66-year-old male with a subtotal nasal defect following oncologic resection and adjuvant radiation therapy. The final outcome of the three-layer single stage reconstruction demonstrated favorable aesthetic contour and durable nasal function despite a complex postoperative course. Small revisions were required for forehead flap inset, infectious debridement, and minimal contour adjustment. The combination of ALTFL for lining, osseocartilaginous rib graft for framework, and PMFF for skin coverage offers a reliable and anatomically sound option for total nasal reconstruction. This method addresses common pitfalls associated with conventional lining techniques, providing a thin, vascularized internal lining which mucosalizes and supports long-term structural integrity and functional outcome.
Over the past several decades, extensive clinical and investigative efforts have been directed toward the development of hypoglossal nerve stimulation (HNS) as an alternative treatment option for patients with obstructive sleep apnea (OSA) who are intolerant to positive airway pressure. Nevertheless, HNS is ultimately effective only for a subpopulation of individuals with OSA and a need exists for additional neuromodulation strategies to better replicate the complex interactions that exist between upper airway muscles in the awake, patent state. Two additional neuromodulation strategies have recently emerged from a reappraisal of pharyngeal mechanics: ansa cervicalis stimulation (ACS) and glossopharyngeal nerve stimulation (GNS). ACS is designed to generate active caudal traction through infrahyoid strap muscle contraction, and GNS is intended to impose a lateral stabilizing vector on the oropharyngeal wall through activation of the stylopharyngeus muscle and potentially related pharyngeal plexus motor components. This chapter reviews the mechanistic basis for these approaches and outlines key priorities for future translational and clinical research.
Obstructive sleep apnea has shown increased prevalence and global disease burden in recent decades. In addition to obesity, craniofacial maldevelopment, like transverse maxillary deficiency, are thought to play a role in the pathophysiology of obstructive sleep apnea. Surgically-assisted maxillary expansion procedures have been developed to correct transverse maxillary deficiency with the aim of improving occlusion, nasal breathing and obstructive sleep apnea. This chapter serves to elucidate surgical techniques for maxillary expansion, including Distraction Osteogenesis Maxillary Expansion and Posterior Palatal Expansion via Subnasal Endoscopy. The surgical steps of these procedures are outlined as well as necessary pre- and post-operative planning.
Bilateral hypoglossal nerve stimulation (HNS) represents a novel approach for the treatment of obstructive sleep apnea (OSA), offering an alternative to existing unilateral systems. This article reviews the indications and contraindications for implantation of the Genio® system (Nyxoah S.A.), currently the only available bilateral HNS device, and provides a detailed description of the surgical technique for placement. A single submental incision allows for bilateral hypoglossal nerve access and implantation of a passive externally powered stimulator that eliminates the need for intrathoracic components or sensing leads. The operative steps, including patient preparation, exposure, identification of the hypoglossal branches, device fixation, and intraoperative functional verification, are outlined in a reproducible fashion. This approach expands the therapeutic armamentarium for patients with moderate to severe OSA who are unable to tolerate positive airway pressure (PAP) therapy.
Barbed suture pharyngoplasty is an innovative technique for the surgical management of obstructive sleep apnea (OSA) and primary snoring. Unlike traditional excisional palatal procedures, this method aims to reposition and stabilize the lateral pharyngeal walls and the soft palate using self-anchoring, knotless barbed sutures. The technique offers the advantages of reduced operative time, even distribution of tension, and secure tissue suspension without knot-related complications. This manuscript describes the relevant anatomy, indications, surgical steps, postoperative care, complications, and outcomes of barbed suture pharyngoplasty.
Obstructive sleep apnea is caused by dynamic collapse of upper airway structures, with the velum and lateral oropharyngeal walls being common locations of collapse. Targeted surgical techniques to this area have evolved over decades, from traditional uvulopalatopharyngoplasty to modified tissue-sparing techniques including expansion sphincter pharyngoplasty (ESP). ESP’s goal is to obtain superolateral rotation of the palatopharyngeus muscle while preserving partial attachment to the superior pharyngeal constrictor, thereby creating lateral wall tension and reducing airway obstruction. A partial inferior uvulectomy may be performed to optimize the airway aperture as needed based on anatomy. ESP outcomes are mostly reported in patients with small tonsils and lateral wall collapse on pre-operative evaluation. It is likely also beneficial for those with large tonsils who have redundant or bulky oropharyngeal lateral wall tissue making them less likely to respond to tonsillectomy alone. Post-operatively, patients achieve durable reductions in objective and subjective measures without long-term morbidity.
Obstructive sleep apnea and sleep disordered breathing are common conditions in the pediatric and adult populations that impact quality of life, daytime sleepiness, cardiovascular risk, and psychosocial function. Symptoms often result from multilevel airway obstruction and can require multiple treatment modalities, particularly in adult patients unable to adhere to positive airway pressure therapy and pediatric patients unresponsive to adenotonsillectomy. Lingual tonsil hypertrophy is commonly found in treatment refractory OSA, and lingual tonsillectomy has become an important adjunct in addressing complex cases of OSA/SDB. Multiple techniques exist for lingual tonsillectomy, and the Coblation technique has emerged as a safe and effective surgical approach for addressing lingual tonsil hypertrophy. This article reviews the indications, risks/benefits, procedure technique, and post-operative care for Coblation lingual tonsillectomy.
Hyoid suspension is a potential adjunct in the multilevel surgical management of obstructive sleep apnea (OSA), particularly in patients with hypopharyngeal collapse. Updated operative techniques, as outlined in this article, allow for a less invasive approach to advancing and suspending the hyoid bone to the mandible to improve airway patency while minimizing morbidity. The objective of this article is to describe the relevant anatomy and pathophysiology of the hyoid complex in OSA, address appropriate patient selection criteria (with an emphasis on drug-induced sleep endoscopy findings), outline pre-operative planning, and describe step-by-step surgical technique and post-operative care. Subjective and objective outcomes, potential complications, and the role of hyoid suspension within a multi-level surgical strategy will also be reviewed.
Maxillomandibular advancement (MMA) is a definitive method of enlarging the upper airway for the treatment of obstructive sleep apnea (OSA). This chapter outlines a contemporary, step-by-step approach to MMA, with precise execution pearls, and strategies to optimize functional and aesthetic outcomes. Key elements include coordinated maxillary and mandibular osteotomies and controlled skeletal repositioning to achieve targeted airway expansion. Technical nuances such as condylar seating, management of the pterygomaxillary junction, and rigid fixation methods are detailed. The chapter also reviews perioperative considerations for avoidance of complications. Through a practical, technique-focused framework, this work aims to support surgeons in delivering safe, reproducible, and outcome-driven MMA procedures for appropriately selected OSA patients.
Systemic therapies have transformed melanoma care, delivering durable responses and survival benefits in metastatic and resected high-risk disease. Immune checkpoint inhibitors—particularly anti–programmed death 1 agents—have replaced interferon-based regimens as the foundation of adjuvant therapy. Here, we summarize the evolution of systemic and adjuvant therapies for melanoma, with an emphasis on immune checkpoint inhibition, BRAF/MEK-targeted therapy, and emerging treatment strategies. Targeted therapies, especially BRAF/MEK inhibitors, provide rapid tumor regression and now play a defined role in metastatic and adjuvant settings for BRAF-mutant melanoma. The most exciting recent development is the discovery of neoadjuvant immunotherapy as superior to adjuvant alone in clinically detectable stage III disease, reshaping treatment algorithms and standard of care. The adjuvant landscape in melanoma has transformed care and outcomes dramatically in the last two decades and continues to evolve. Overcoming resistance and refining treatment sequencing remain key to expanding durable benefit and improving long-term outcomes.
