BACKGROUND:Disparities in thyroid cancer care are driven by demographic and socioeconomic factors such as insurance status, income, and access to specialized care. METHODS:Retrospective chart review. Demographic and clinical data from 281 adult patients who underwent thyroidectomy or hemithyroidectomy for papillary or follicular thyroid cancer at a single institution from 2015 to 2023. We evaluated the effect of demographic variables with stage at diagnosis, tumor size, and time to surgery. We assessed predictors of tumor size > 2 cm, advanced cancer stage (stage III+), and surgical delay > 90 days using multivariable logistic regression. RESULTS:Male patients were at increased risk for tumors > 2 cm, while female patients experienced more surgical delays. Advanced-stage disease was associated with older age and Medicare coverage. CONCLUSIONS:Disparities by age, sex, and insurance remain, highlighting the need for targeted, equity-focused interventions. The cohort was not reflective of local demographics, limiting assessment of racial disparities.

Salivary gland tumors primarily arise in the parotid gland with surgery representing the cornerstone of treatment. Parotidectomies often lead to a soft tissue deficit that may benefit from reconstruction to reduce incidence of Frey’s syndrome, improve aesthetic outcomes, and allow for appropriate postoperative therapies. Several options exist including avascular tissue transfer, locoregional tissue flaps, and microvascular free flaps. This paper is a literature review exploring the efficacy of the various reconstructive options, and includes randomized control trials, prospective studies, and retrospective studies from 1999 to 2024. The literature demonstrates that any reconstructive option is superior to no reconstruction in reducing the risk of FS and in improving cosmetic outcomes without increasing the risk of postoperative complications including hematomas and sialoceles. While literature demonstrates that reconstruction is beneficial in parotidectomies, the existing literature does not provide an adequate comparison of options to guide surgeons in making an informed choice.

BACKGROUND: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. METHODS AND RESULTS: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. 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. CONCLUSION: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.

Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. In rare instances, PTC has metastasized to the retropharyngeal and parapharyngeal nodes. This is hypothesized to occur due to an aberrant lymphatic channel or via retrograde lymphatic flow following previous neck dissection. Methods: A literature search was conducted with keywords "parapharyngeal," "retropharyngeal," and "papillary thyroid carcinoma." Results: 46 articles were identified for a total of 135 cases. The most common presenting symptom was lymphadenopathy followed by pharyngeal mass and dyspnea. 38.03 % of patients were asymptomatic. Of cases including initial treatment history, 94.44 % had a history of neck dissection. The transcervical approach was the most utilized to resect the tumors, although in recent years trans-oral robotic surgery (TORS) has also been used. Conclusion: PTC metastatic to the retropharyngeal and parapharyngeal nodes is a rare occurrence that can be difficult to diagnose due its indolent nature.

Oral squamous cell carcinoma (OSCC) with metastasis to the thyroid gland is exceedingly rare, with limited documentation within the literature. Between 1984 and 2023, only 40 cases of head and neck squamous cell carcinoma (SCC) with thyroid gland metastasis were described in published literature. Herein, we present a distinctive case of second primary oropharyngeal SCC with metastasis to the thyroid, detected during surveillance positron emission tomography (PET) scanning subsequent to negative margin resection and radiation therapy for SCC originating from the hard palate. The underlying mechanisms overseeing metastasis remain elusive, with hypotheses ranging from lymphatic drainage routes connecting the thyroid gland and retropharyngeal lymph nodes to hematologic dissemination. The management of metastases to the thyroid gland is multifaceted, encompassing approaches ranging from lobectomy and total thyroidectomy to palliative interventions. We present this atypical case alongside supportive pathological and radiological findings and a comprehensive review of this rare clinical entity to offer insight into its diagnosis and management.

Oral squamous cell carcinoma (OSCC) is the most common malignancy affecting the oral cavity and commonly presents as an exophytic lesion with red or white granular ulcerations. Most diagnoses are confirmed by biopsy and clinical features; however, early SCC has been shown to hide within benign appearing lesions, such as vascular tumors, resulting in missed diagnoses and delay in treatment. The following case report will discuss a patient who presented with a mass in the floor of the mouth which appeared as a vascular tumor on exam and imaging. This was originally thought to be benign based on FNA findings however was found to harbor invasive squamous cell carcinoma on final pathology. The goal of this case report is to provide a background on the variable presentations of OSCC, vascular tumors, and uncommon presentations for which specialists should be aware of in their practice.

In this article, the indications for performing the supraomohyoid, lateral, and anterolateral selective neck dissections will be discussed. Super selective neck dissections, though not included with a specific technique section, will also be briefly examined. An emphasis of the authors’ techniques will be illustrated with pertinent anatomy as well as post-operative care and complications to consider. Photographs will accompany the write-up in order to provide the reader with an anatomic operative reference.

Background:Social media (SoMe) has become a powerful platform for distributing health information. Facial palsy (FP) results in functional and social impairment and lowers quality of life. Social media may help to raise awareness of FP sequalae. This study aims to determine the FP information growth on SoMe platforms and parameters that influence user engagement on FP content. Methods:Five commonly used SoMe platforms (Facebook, Instagram, TikTok, Twitter, and Reddit) were analyzed. Data on 18 FP hashtags and their social interaction parameters (posts, likes, reaches, comments, shares, language, and country of origin) over the past 5 years (July 31, 2016, to July 31, 2021) were collected. In-depth account analysis was performed on the 5 most popular Instagram profiles associated with FP. Results:The annual growth curve was positive on each platform. Facial Palsy Awareness Week 2021 trended best on TikTok. Facebook accumulated 315,411 likes and 1,922,678 reaches on 8356 posts. On Instagram, 24,968 posts gathered 4,904,124 likes and 9,215,852 reaches. TikTok users interacted on 3565 posts, accumulating 4,304,155 likes and 4,200,368 reaches. The implementation of reels (P<0.001) and the profile host interacting with their followers by liking (P<0.001) and replying (P<0.001) to users' comments significantly increased the engagement rate. Conclusions:Facial palsy is of increasing interest on SoMe. Facial palsy surgeons may post reels, interact with their community, and engage into FPAW to promote user engagement.

Reconstructive head and neck surgery requires the amalgamation of core surgical skills spanning several surgical disciplines. The intersection of otolaryngology, plastic surgery, orthopaedic surgery, oral surgery, neurosurgery, and vascular surgery has given rise to the principles that underscore this unique surgical subspecialty. The proficiency and broad training of these reconstructive surgeons have led to a plethora of reparative techniques leveraged and applied in this unique anatomic region. Delicately addressing components that define, if not personify, the human experience, reconstructive surgeons seek to restore form and function.

This study reviews the operative technique of external jugular vein to the internal jugular vein (IJV) bypass and discusses its advantages of decreasing postoperative complications in bilateral neck dissection patients. A retrospective chart review was performed on 2 patients at a single institution with prior bilateral neck dissection and jugular vein bypass. The tumor resection, reconstruction, bypass, and postoperative management were led by the listed senior author (S.P.K). An 80-year-old (case 1) and a 69-year-old (case 2) underwent bilateral neck dissection with the creation of a micro-venous anastomosis. This bypass allowed for improved venous drainage without adding significant time or difficulty to the procedure. Both patients recovered well in the initial postoperative period with maintained venous drainage. This study describes an additional technique that the trained microsurgeon can consider during the index procedure and reconstruction that can benefit the patient without adding significant time or technical challenges to the remaining portion of the procedure.

The clinical use of Integra™ has expanded to include scalp reconstruction since its FDA approval in 1996. Integra™, or dermal regeneration template, can be utilized in patients who are elderly with multiple medical comorbidities. Well-established Integra™ techniques utilize skin grafting 1-2 weeks following evidence of template vascularity. Most studies show the time to graft placement as <30 days, with almost all <52 days. No single article proposes a time frame for applying STSG after neodermis regeneration. Therefore, we aimed to describe our protocol to define a time frame for delaying scalp reconstruction with STSG following dermal regeneration. Over the last several years, the senior author has utilized a delayed reconstruction with skin grafting method where-in Integra™ is applied to either debrided bone or exposed pericranium in selected patients, and allowed to mature for ~6 weeks before performing skin grafting. The results have been predictable, reproducible, and have yielded high levels of patient and provider satisfaction due to the improved contour cosmesis. In this pictorial essay, the authors' novel protocol is detailed.

The utilization of an arteriovenous loop is an underreported technique that affords the creation of reliable vascular options. Understanding the efficacy and impacting variables of microvascular reconstruction with an arteriovenous loop can be critical to its use.

Objectives: The rectus abdominis myocutaneous free flap has been widely used as a reconstructive option in head and neck reconstruction with great success. Challenging the popular assumption, this study sought to examine the effects of smoking on donor site complications in this population.Methods: Multi-institution retrospective study of 103 patients (50 active smokers, 28 former and 25 never smoked).Results: Overall complication rate was 14.5 %. Hernia rate 4.8 %, evisceration 0 %, dehiscence 2.9 %, infection 6.7 %. Smoking history did not significantlly influence complication rates (chi square test, p = 0.33). Abdominal wall closure technique also did not influence the complication rate (chi square test, p = 0.58).Conclusions: The rectus abdomonis myocutaneous free flap has an acceptable complication rate that does not appear to be influenced by smoking history. While patients should be counseled regarding smoking cessation, smoking habits should not delay treatment nor obviate consideration of rectus flap utilization.

BACKGROUND:There are variations in implantable arterial Doppler usage for microvascular free tissue monitoring among North American surgeons. Identifying utilization trends among the microvascular community may elucidate practice patterns that may be useful in determining protocols. Furthermore, study of this information may yield novel and unique applications in other disciplines such as vascular surgery.METHODS:Electronically disseminated survey study shared with a large database of North American head and neck microsurgeons.RESULTS:Seventy four percent of respondents use the implantable arterial Doppler; 69% report use in all cases. Ninety five percent remove the Doppler by the seventh postoperative day. All respondents felt that the Doppler did not impede care progression. Any implication of flap compromise was followed with a clinical assessment in 100% of respondents. If viable, 89% would continue monitoring after clinical examination, while 11% would take the patient for exploration regardless of clinical examination.CONCLUSIONS:The efficacy of the implantable arterial Doppler has been established in the literature and is supported by the results of this study. Further investigation is required to establish a consensus on use guidelines. The implantable Doppler is more often used in conjunction with rather than substitution for clinical examination.

The implantable arterial doppler (IAD) is frequently used to postoperatively monitor free flaps with high accuracy, but there are no guidelines for its use. Bedside exam is used adjunctively to determine necessary intervention. This systematic review seeks to discover why the doppler is used adjunctively despite its established record of accuracy. Criteria for inclusion and exclusion were established. In total, 280 articles were found on PubMed and Web of Science, then screened accordingly. Data from 22 articles were analyzed using a bivariate hierarchical random effects model. Twenty-two studies yielded 2996 total patients undergoing 3127 free flap procedures. The meta-analysis found a high sensitivity of 0.809 (95% CI = 0.709, 0.880) and specificity of 0.966 (95% CI = 0.947, 0.979). False-positive rate was found to be 0.034 (95% CI = 0.021, 0.053). Positive and negative predictive values were 0.711 (95% CI = 0.581, 0.817) and 0.979 (95% CI = 0.966, 0.988). Positive and negative likelihood ratios were 24.7 (95% CI = 14.5, 39.5) and 0.20 (95% CI = 0.12, 0.30). The established efficacy of the IAD is supported by this study. Clinical exams may remain as the final adjunct due to the risks of inaccurate IAD signals. Further studies are warranted to optimize its use for future practice guidelines.

Total rhinectomy is ontologically necessary for large and locally invasive carcinomas of the nasal cavity owing to the complex three-dimensional structure of the nose. Reconstruction options include singular or combined options of local tissue rearrangement, free flap reconstruction, and prosthetic reconstruction which may be delayed in the setting of post-ablative radiation therapy. If significant bony exposure is present prior to radiation, there is a substantial risk of osteoradionecrosis and the ensuing sequalae. In these cases, coverage of the bony defect may be advantageous prior to radiation and final reconstructive treatment. We present a case of a total rhinectomy defect for squamous cell carcinoma in a patient who had significant bony exposure prior to radiation which was resurfaced with a combined forked paramedian flap and nasolabial flap. The patient went on to be treated with a full course of radiation and had planned for a post-treatment nasal prosthesis.

The nasolabial flap (NLF) has been reported extensively for reconstruction of various intraoral and extraoral defects resulting from trauma or ablative surgery. However, it has not been described for post-radiation lip augmentation. Herein, we present the case of a 74-year-old female who previously underwent a subtotal glossectomy and free flap reconstruction followed by radiotherapy. While oncologically the patient did well, she developed a significant lower lip contracture which compromised oral intake, denture placement, lip excursion, and psychosocial well-being. The patient underwent release of the scar contracture and a NLF was utilized intraorally to act as a spacer between the gingiva and inner lip mucosa to augment the soft tissue deficit. The patient went on to regain oral intake and placement of her dentures, while reporting significant satisfaction with the post-procedural benefits.