BACKGROUND:Salivary gland tumors are rare and heterogeneous head and neck neoplasms. Preoperative distinction between benign and malignant lesions is challenging because imaging is often insufficient. Fine-needle aspiration cytology (FNAC) combined with the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides standardized risk stratification and diagnostic guidance; however, its influence on surgical frequency remains insufficiently characterized. METHODS:This retrospective single-center study included patients with histologically confirmed malignant tumors within the major salivary glands with preoperative FNAC and surgery. The association between MSRSGC category and number of surgeries was evaluated using χ2 tests and multivariate Poisson regression. RESULTS:Overall, 157 patients were included. Those with high-to-intermediate-risk MSRSGC categories (two surgeries: 22.3% vs. one surgery: 77.7%) required significantly fewer surgeries than those with low-risk/nondiagnostic FNAC (two surgeries: 54.2%/53.3% vs. one surgery: 45.8%/46.7%, p < .001). A high-to-intermediate risk compared to a nondiagnostic FNAC results was an independent predictor for fewer surgeries in multivariate analysis (incidence rate ratio, 0.875; 95% confidence interval, 0.773-0.990; p = .034). True-positive results were most frequent in squamous cell carcinoma, whereas acinic cell and mucoepidermoid carcinomas were often misclassified. CONCLUSIONS:The use of the MSRSGC enables reliable preoperative risk stratification of malignant salivary gland tumors. High-to-intermediate-risk categories (Milan III/IVb/V/VI) were associated with a lower likelihood of multiple surgeries. True-positive FNAC results were most frequent in squamous cell carcinoma and metastatic melanoma, whereas acinic cell, mucoepidermoid, and salivary duct carcinomas were prone to misclassification. Structured FNAC reporting improves diagnostic accuracy and informs personalized surgical planning, reducing interventions and optimizing management.

ABSTRACT Introduction Salivary gland lesions (SGL) are a rare and heterogeneous group of benign and malignant masses. Fine‐needle aspiration cytology (FNAC), guided by the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), offers a minimally invasive method for early differentiation of SGL. The purpose of this study was to evaluate the cost‐effectiveness of FNAC in diagnosing major SGL within the MSRSGC framework. Methods Three decision tree models were created based on probabilities from real‐world and literature data. Real‐world data was derived from the previously published largest single‐center study evaluating FNAC performance of SGL to date. Costs were determined from German and American fee catalogs. Multiple Monte Carlo simulations were run to assess the cost‐effectiveness of performing FNAC within the MSRSGC framework under different conditions for both health care systems. Results Using decision analysis, FNAC followed by surgery, if indicated, was less costly than upfront surgery. The cost reduction through FNAC was over 30% for all models. Cost reduction per case through FNAC followed by surgery, if indicated, compared to upfront surgery ranged between $5606 and $13,096 in the US model (average costs for upfront surgery: $17,472) and between 2465€ and 5337€ in the German model (average costs for upfront surgery: 8018€). When enhancing the German model with real world data, the cost reduction ranged between 2478€ and 5954€ (average costs for upfront surgery: 7988€). Conclusion In this model based on MSRSGC estimates and real‐world data, FNAC followed by surgery, if indicated, proved to be a more cost‐efficient approach to diagnosing SGL than upfront surgery. Thus, patients and healthcare systems benefit from high‐output centers that guarantee expert cytopathological diagnosis.

Abstract A peritonsillar abscess (PTA) displays a purulent infection arising from acute tonsillitis, involving a variety of aerobic and anaerobic bacteria. Fusobacterium necrophorum , a gram-negative anaerobe, is considered a significant risk factor for complications like Lemierre’s syndrome. This study aimed to analyze the microbiological spectrum of PTA and its impact on the clinical course and outcomes. This retrospective study included all patients diagnosed with PTA at a tertiary care center between January 2018 and June 2023. Data on patient demographics, inflammatory markers, microbiological aspects (including species identification and antibiotic therapy), and clinical management were collected. Overall, 321 patients with a mean age of 34.1 years were included. Most patients (80.1%) underwent tonsillectomy, while others received surgical incision and drainage (18.1%) or no surgical treatment (1.9%). Patients with tonsillectomy had a significantly longer hospital stay compared to those with incision and drainage (5.4 ± 2.5 days vs. 4.4 ± 1.3 days; adjusted p = 0.004). Surgical complications were more frequent in patients with tonsillectomy (13.6% vs. 1.7%; adjusted p = 0.048), whereas ipsilateral recurrence was more common in patients with incision and drainage (8.6% vs. 0.0%; adjusted p = 0.004). Higher CRP levels at admission ( p = 0.002) were predictive for a higher risk of infection-related complications. Streptococcus pyogenes was the most frequently identified pathogen (25.9%), followed by Streptococci of the anginosus group (15.3%), and Fusobacterium necrophorum (FN; 11.5%), which was significantly more common in adolescents (age < 18 years; 25.3%) than in adult patients (9.5%; adjusted p = 0.020) and had high antibiotic susceptibility rates with 100% to clindamycin and 96.6% to penicillin or aminopenicillin with beta-lactamase inhibitor, the latter being administered to the majority (87.2%) of patients as empiric antibiotic treatment. This study provides insights into the demographic, clinical, and microbiological characteristics of PTAs. Consistent with previous literature, this study shows a higher frequency of FN in PTAs in adolescents and young adults. However, unlike previous reports, this was not associated with increased complication rates.

OBJECTIVE:The current study aims to analyze the educational quality of septoplasty videos on YouTube and to investigate the Instructional Videos in Otorhinolaryngology by YO-IFOS grading system (IVORY-GS), the first otorhinolaryngologic video evaluation system based on the IVORY guidelines. METHODS:In March 2023, a YouTube search for the terms "septoplasty," "closed septoplasty," and "deviated nasal septum surgery" was performed. Videos of operations on patients and cadaver dissections were included. The IVORY-GS was adapted for septoplasty and used to evaluate the quality of videos in terms of ethical considerations, technical aspects, case presentation, surgical procedure, and organ-specific elements. Descriptive data on the videos were collected, including views, likes, video duration, and time since publication. Statistical tests were applied to identify correlations between the characteristics of the videos and the overall IVORY-GS score. RESULTS:A total of 105 septoplasty videos were included. While 40% showed a Cottle technique, 53% observed the Killian technique. The average overall IVORY-GS score for septoplasty videos was 25.3 (maximally 48.0). In only 10% of the videos was the training quality evaluated as moderate/high. In comparison to macroscopic videos and videos published within the past 50 months, endoscopic videos received significantly higher overall scores (both p < 0.01). There was a significant correlation between the overall IVORY-GS score and the number of likes (p = 0.02). A higher overall score was a significant predictor of the number of likes (p = 0.02). CONCLUSION:The analysis shows that only a small proportion of the septoplasty videos available on YouTube are suitable for surgical education. The IVORY-GS is useful for evaluating the training quality of videos in otorhinolaryngology and could be helpful for creation of a dedicated online platform for high-quality ENT surgical videos.

BACKGROUND:Primary salivary gland carcinomas (SGC) are rare tumors comprising 5 % of head and neck cancers. While most published studies on SGC in Germany focus on state-level data, nationwide population-based data on incidence, demographics, and outcomes have not been reported. OBJECTIVES:This study aimed to provide a nationwide overview of the incidence, clinicopathologic characteristics, and survival of patients with primary SGC of the major salivary glands in Germany. DESIGN AND METHODS:Data were extracted from the German Centre for Cancer Registry Data (ZfKD), covering all 16 federal states, for the period 2009-2022. Patients with primary malignant neoplasms of the major salivary glands were included. Crude and age standardized incidence rates were calculated. Relative survival was estimated using the period approach, stratified by demographic and tumor characteristics. RESULTS:We identified 10,808 SGC cases. The most frequent subtypes were adenocarcinoma not otherwise specified (ANOS) (18.4 %), mucoepidermoid (MEC, 13.5 %), adenoid cystic (ACC, 13.3 %), acinic cell (Acin, 10.4 %), and salivary duct carcinoma (SDC, 5.7 %). The mean age-standardized incidence rate was 5.2/1000,000 person-years, 5.8 for men and 4.8 for women, and increased slightly over observation period. A decline in ANOS and increase in SDC incidence were observed, primarily among men. The five-year relative survival was 70 %, with a pronounced disparity observed between male (62 %) and female (80 %) patients. Survival declined with advanced tumor status, nodal involvement, and distant metastasis. CONCLUSION:To date, this represents the largest epidemiological investigation of major SGC worldwide. Over the observation period, the incidence of major SGC has slightly increased in Germany. Men showed a distinctly more unfavorable prognosis than women and were more likely to be diagnosed with aggressive entities like ANOS and SDC.

Background: Salivary gland carcinomas (SGC) are rare head and neck malignancies with diverse molecular profiles and treatment challenges. Tissue factor (TF), a transmembrane glycoprotein involved in cancer pathophysiology, has emerged as a potential therapeutic target. Objectives: The objective of this study was to investigate TF expression in SGC and its correlation with clinicopathological data. Design: A cohort of 109 SGC patients who underwent curative surgery between 1990 and 2023 was analyzed. Methods: TF expression in primaries and lymph node (LN) metastases was assessed using immunohistochemistry on tissue microarrays. Histo-scores were calculated for cytoplasmic and membranous staining and correlated with clinicopathological data. Results: TF was expressed in 80.7% of samples with a mean combined H -score of 29.6. Moderate and high expression was found in 22.9% of all cases. Mucoepidermoid carcinoma (MEC), secretory carcinoma, and salivary duct carcinoma (SDC) showed the highest expression. A significantly higher membranous TF expression was observed in SDC LN metastases compared to primaries (71.1 vs 31.7, p = 0.012). Survival analysis revealed a trend toward worse outcomes for tumors with higher TF expression. Conclusion: This study provides the first analysis of TF expression in SGC revealing its presence across various subtypes. The findings suggest potential for TF-targeted therapies in SGC treatment, particularly for metastatic SDC and MEC. The trend toward worse survival outcomes in high TF-expressing tumors warrants further investigation.

To spatially characterize the single-cell tumor microenvironment (TME) of salivary gland carcinomas (SGC) and identify prognostic biomarkers. SGC, including salivary duct carcinomas (SDC), acinic cell, mucoepidermoid, and secretory carcinomas, were analyzed using a 13-marker imaging mass cytometry panel. Multichannel image data from 54 primary cases and nodal metastases were processed to generate single-cell datasets. Cell phenotypes (tumor cells, cancer-associated fibroblasts (CAFs), endothelia, immune cells) were classified using a validated CAF algorithm, followed by spatial analysis and clinicopathological correlation. Clinicopathological results were validated using a previously published independent bulk RNA-sequencing (RNA-seq) cohort of n = 67 SDC cases. Spatial transcriptomics data of three SDC cases was leveraged to understand the molecular mechanisms of spatial interactions. Among 509,364 cells, SDC exhibited the highest fractions of Collagen- and matrix-CAFs (mCAFs). Acinic cell carcinomas (ACC) showed enriched CD4+/CD8+ T cells and antigen-presenting CAFs (apCAFs), indicating strong immune infiltration. A spatially defined cellular neighborhood (CN8) of mCAFs and endothelia was elevated in SDC, with higher CAF infiltration in androgen receptor (AR)high versus ARlow SDC. Elevated mCAF frequency and CN8 were significantly associated with reduced recurrence-free probability (RFP) and distant control rates (DCR) in SDC. Additionally, higher mCAF frequencies were an independent prognostic factor for decreased RFP and DCR in Cox regression analysis. The association between mCAFs and a decreased RFP as well as recurrence-free survival was confirmed with previously published RNA-seq data using an mCAF signature. Spatial transcriptomics confirmed enrichment of metastasis-associated gene signatures as well as platelet-derived growth factor and insulin-like growth factor pathways within mCAFhighendotheliahigh tumor niches indicating that the latter may be involved in mCAF-endothelia crosstalk. SDC are characterized by Collagen-/mCAF-rich microenvironments and mCAF-endothelial spatial interactions that are linked to metastasis. ACC display pronounced immune infiltration, suggesting its potential for immunotherapy. mCAFs in SDC emerge as prognostic biomarkers and therapeutic targets, highlighting the importance of targeting CAF-driven metastasis in future treatments. This study provides insights into the biology of SGC and identifies novel prognostic markers.

Ultrasound-guided fine-needle aspiration cytology (FNAC) is a widely used diagnostic procedure which facilitates the differentiation of salivary gland lesions. Although the performance of salivary gland FNAC (SG-FNAC) has improved since the introduction of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), the range of the reported performance is still wide. Therefore, the aim of this study was to determine lesion- and sampling-related factors that influence the success of SG-FNAC. All SG-FNAC cases performed in a tertiary referral hospital between September 1st, 2011, and August 31st, 2022, were retrospectively identified. Demographic, histopathological, lesion-specific, and sampling-related data were retrieved from the clinical charts. Cytopathological reports were categorized according to the MSRSGC. The risk of malignancy (ROM), the performance measures, and factors influencing the success of SG-FNAC were calculated. Overall, 1289 cases with histopathological follow-up diagnosis (out of 1952 SG-FNACs) were included. The ROM was: non-diagnostic = 23.9

Purpose. Ultrasound-guided fine-needle aspiration cytology (FNAC) is a widely used diagnostic procedure which facilitates the differentiation of salivary gland lesions. Although the performance of salivary gland FNAC (SG-FNAC) has improved since the introduction of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), the range of the reported performance is still wide. Therefore, the aim of this study was to determine lesion- and sampling-related factors that influence the success of SG-FNAC. Methods. All SG-FNAC cases performed in a tertiary referral hospital between September 1st, 2011, and August 31st, 2022, were retrospectively identified. Demographic, histopathological, lesion-specific, and sampling-related data were retrieved from the clinical charts. Cytopathological reports were categorized according to the MSRSGC. The risk of malignancy (ROM), the performance measures, and factors influencing the success of SG‑FNAC were calculated. Results. Overall, 1,289 cases with histopathological follow-up diagnosis (out of 1,952 SG-FNACs) were included. The ROM was: non-diagnostic = 23.9%, non-neoplastic = 4.4%, atypia of undetermined significance (AUS) = 34.5%, neoplasm-benign = 1.0%, neoplasm‑salivary gland neoplasm of uncertain malignant potential (SUMP) = 15.3%, suspicious for malignancy = 74.1%, malignant = 96.2%. The sensitivity, specificity, accuracy, positive, and negative predictive value for differentiating benign from malignant lesions (excluding lesions categorized as AUS and SUMP) were 87.5%, 97.7%, 96.3%, 85.0%, and 98.1%, respectively. A larger lesion size (OR (95% CI) =1.21 (1.06-1.39), p = 0.004), a higher number of obtained slides (OR (95% CI) = 1.31 (1.17-1.46), p < 0.001), and the physician performing the FNAC (p = 0.047) were independent predictors for a higher success, while localization of the lesion within the submandibular compared to the parotid gland (OR (95% CI) = 0.38 (0.19-0.77), p = 0.008) was an independent predictor for lower success of SG-FNAC. Conclusion. This is the largest single-center study evaluating SG-FNAC performance to date. It identified independent lesion- and sampling-related factors influencing the success of SG‑FNAC. Knowledge of those can improve performance of the procedure.

Als Komplikation einer akuten bakteriellen Parotitis hat der Parotisabszess (PA) einen potenziell lebensbedrohlichen Verlauf. Abgesehen von Fallserien ist die Datenlage knapp. Ziel dieser Studie war die umfassende Analyse des mikrobiologischen Spektrums und des therapeutischen Managements bei PA.. In zwei Zentren der tertiären Versorgungsstufe in Deutschland wurden retrospektiv alle Patienten mit PA identifiziert. Klinische, demographische und mikrobiologische Daten wurden extrahiert und mit der Rate an Komplikationen und Rezidiven korreliert. 85 Patienten mit PA wurden eingeschlossen. Die meisten PA (92,9%) wurden chirurgisch eröffnet und etwa die Hälfte (45,9%) in Lokalanästhesie (LA) behandelt. Die am häufigsten nachgewiesenen Erreger waren Streptokokken (n=23). Die Mehrheit (68,2%) erhielt eine empirische Antibiotikatherapie mit Aminopenicillin+/- Betalaktamase-Inhibitor. In 7 Fällen wurde die antibiotische Therapie nach Erhalt des Antibiogramms umgestellt. Die Ätiologie war entweder idiopathisch (42,4%) oder obstruktiv, immunsuppressiv oder tumorös (jeweils 11,8%). Patienten mit einem dentalen Fokus (p=0,007) und Patienten mit eingelegter Wunddrainage (p=0,005) hatten eine signifikant längere Krankenhausverweildauer. Patienten ohne Drainageinsertion zeigten keine höhere Rate an Komplikationen (p=0,379) oder Rezidiven (p=0,605). Eine chronische Parotitis war signifikant mit dem Risiko eines PA-Rezidivs assoziiert (p<0,001). Die chirurgische Therapie von PA in LA ist sicher und effektiv. Es konnte kein klarer Nutzen einer Drainageneinlage nachgewiesen werden. Eine zahnärztliche Untersuchung sollte bei PA durchgeführt werden, um einen dentalen Fokus auszuschließen. Die Entnahme mikrobiologischer und histopathologischer Proben ist für Therapie und Prognose obligat.

Background Therapeutic options in recurrent/metastatic salivary gland carcinoma (SGC) are scarce. Enfortumab vedotin, a nectin-4-binding antibody-drug conjugate, was recently approved by the FDA and EMA for third-line treatment of urothelial carcinoma.

ZusammenfassungSpeicheldrüsenkarzinome sind eine seltene und heterogene Gruppe von bösartigen Tumoren, die 3–6% aller bösartigen Tumoren im Kopf-Hals-Bereich ausmachen. Die 1-, 3- und 5-Jahres-Überlebensraten liegen bei 83%, 69% bzw. 63%. Aufgrund immer neuer molekularpathologischer und genetischer Erkenntnisse werden im Rahmen der wiederkehrenden WHO-Klassifikation der Speicheldrüsenkarzinome stetig neue Entitäten definiert, sodass die Inzidenzraten der Entitäten einem ständigen Wandel unterliegen. Der einzige gesicherte Risikofaktor für die Entstehung von Speicheldrüsenkarzinomen ist ionisierende Strahlung. Darüber hinaus verschlechtern große Tumoren, zervikaler Lymphknotenbefall und Perineuralscheidenbefall die Prognose signifikant. Heute rückt die Molekularpathologie in den Vordergrund, mit der potenzielle Targets identifiziert werden konnten, die insbesondere in rezidivierten oder fernmetastasierten Stadien prognoseverbessernde Therapieoptionen bieten können. So können entitätsspezifische Tyrosinkinase-Inhibitoren wie Axitinib beim Adenoidzystischen Karzinom oder Larotrectinib beim sekretorischen Karzinom und entitätsübergreifende Therapien wie HER2-Inhibition und Androgendeprivation bei günstigem Nebenwirkungsprofil das mediane und progressionsfreie Überleben verlängern.

Einleitung Die Feinnadelpunktion (FNP) einer Raumforderung ist eine wichtige präoperative Methode, die zur zytologischen Probegewinnung in der Praxis angewandt wird. Wegen ihrer einfachen Anwendung, günstigen Kosten, entscheidenden Aussagekraft und geringen Komplikationen kann sie als ein diagnostischer Standard für Speicheldrüsentumoren an HNO Kliniken angewendet werden. Ihr größter Nutzen besteht in der Differenzierung zwischen malignen und benignen Befunden, um dabei wegweisende Therapieentscheidungen zu treffen.

Therapeutische Optionen in rezidivierten/metastasierten Speicheldrüsenkarzinomen (SGC) sind rar. Enfortumab vedotin, ein Nectin-4 bindendes Antikörper-Wirkstoff-Konjugat, wurde kürzlich durch die FDA und EMA zur Drittlinientherapie des Urothelkarzinoms zugelassen. Eine Immunhistochemie für Nectin-4 wurde für Primärtumoren und korrespondierende Lymphknotenmetastasen von Patienten mit primärem SGC der Glandula parotidea/submandibularis und suffizientem FFPE-Gewebe, die zwischen 1990 und 2019 in kurativer Absicht operiert worden waren, durchgeführt. Klinisch-pathologische Daten wurden aus der kontinuierlich aktualisierten SGC Datenbank extrahiert. Eine Analyse auf statistische Assoziation zwischen der Expression von Nectin-4 und klinisch-pathologischen Daten wurde durchgeführt. Einhundertzweiundzwanzig SGC und 20 Lymphknotenmetastasen (LKM) wurden eingeschlossen. Eine Expression von Nectin-4 wurde in 80,3% aller SGC nachgewiesen. Der mittlere Histo(H)-Score lag bei 61,2. 25,9% der Speichelgangkarzinome (SDC) und 30,7% der adenoidzystischen Karzinome (ACC) zeigten eine moderate oder hohe Expression. 90,0% der LKM waren positiv für Nectin-4. Der mittlere H-Score der LKM lag bei 75,6. SDC mit einem niedrigeren T-Stadium (p=0,04), ohne lokoregionale LKM (p=0,049), ohne Gefäßinvasion (p=0,04) und ohne perineurale Ausbreitung (p=0,03) zeigten einen signifikant höheren mittleren Nectin-4 H-Score. Es zeigte sich eine statistische Tendenz in Richtung eines günstigeren krankheitsfreien Überlebens unter SDC Patienten mit Nectin-4 Expression (p=0,09). Nectin-4 ist in der Mehrzahl der SGC exprimiert und stellt vor allem für Entitäten mit einer hohen Rate an Lokalrezidiven und Fernmetastasen wie das SDC und das ACC ein potenzielles therapeutisches Zielmolekül für Enfortumab vedotin dar.

PURPOSE:This study aims to provide a broad overview of the epidemiology of cancer of the paranasal sinuses (PSC) in Germany. The data include information on incidence, staging, clinicopathological features and survival from one of the largest cancer registries in Europe. METHODS:Population-based data on PSC diagnosed from January 1st, 2009 until December 31st, 2019 were retrieved from the German Centre for Cancer Registry Data (ZfKD). Age standardized incidence was calculated and relative survival estimates were computed by sex, histological subtype, age group and T-, N-, and M-Stage. RESULTS:In total, 3975 cases were included in this study. The age-adjusted incidence rate (ASR) for PSC was 0.3/100,000 which remained stable during the observation period. The most frequent tumor localization was the maxillary sinus (41.9 %) and the most common histological subtype was keratinizing squamous cell carcinoma (kSCC) (44.3 %). All subtypes were predominantly found in the maxillary sinus except for adenocarcinoma and neuroendocrine carcinomas (SNEC), which were most frequently located in the ethmoidal sinus. The majority of the patients with a known T stage was diagnosed in tumor stage T4 (60.8 %). The overall 5-year relative survival (RS) for all patients with PSC was 52 %. RS dropped from 93 % for T1 stage tumors to 39 % for T4 tumors. RS was 58 % for N0 and 31 % for N+ cases, 54 % for M0 and 27 % for M1 cases. CONCLUSION:Age-adjusted incidence for PSC is low and has been stable for the observed 11-year period. RS decreases continuously with increasing T-, N- and M-stage.

Einleitung Diese Studie zielte darauf ab, die didaktische Qualität und den Inhalt von Septumplastik-Videos auf YouTube zu analysieren und das "Instructional Videos in Otorhinolaryngology by YO-IFOS-Grading-System" (IVORY-GS) zu validieren.

A parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. Data on the diagnosis and therapy of PA is sparse. We aimed at comprehensively analyzing the microbiological spectrum and therapeutic management. We retrospectively identified all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiology were analyzed for their statistical association with complications and recurrence. Overall, 85 patients with PA were included. Most patients (92.9%) underwent surgical incision and drainage. Approximately half of the patients (45.9%) were treated under local anesthesia (LA). The most frequently detected pathogens were Streptococci (n=23). Most patients (68.2%) received an aminopenicillin+/- beta-lactamase inhibitor as empiric antibiotic therapy. In 7 cases the antibiotic therapy was modified after receiving the antibiogram. Etiology was either idiopathic (42.4%) or obstructive, immunosuppressive, tumorous (each 11.8%). Patients with a dental focus (p=0.007) and patients with an inserted wound drain had a longer duration of hospital stay (p=0.005). Patients without drain insertion did not show a higher rate of complications (p=0.379) or recurrences (p=0.605). Chronic parotitis was significantly associated with the risk of recurrence of the PA (p<0.001). The results show that the surgical therapy of PA under LA seems to be safe. A benefit of drain insertion cannot be proven. A dental examination should routinely be performed in case of PA to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and obtaining a histopathological specimen to rule out a tumorous etiology is obligate.

Introduction Primary squamous cell carcinoma of the salivary glands (pSCC) has been described, but it must be distinguished from secondary squamous cell carcinoma (sSCC). In a previous study, we found an unusually high proportion of pSCC in the North Rhine-Westphalian (NRW) Cancer Registry. We investigated whether this finding can be observed throughout Germany and whether these tumors could be misclassified sSCC.

Salivary gland carcinomas are a rare and heterogeneous group of malignant tumors, accounting for 3-6% of all malignant tumors in the head and neck region. The 1-, 3- and 5-year survival rates are 83%, 69% and 63% respectively. Due to new molecular pathological and genetic findings, new entities are constantly being defined as part of the recurring WHO classification of salivary gland carcinomas, so that the incidence rates of the entities are subject to constant change. The only certain risk factor for the development of salivary gland carcinomas is ionizing radiation. In addition, large tumors, cervical lymph node involvement and perineural sheath involvement significantly worsen the prognosis. Today, molecular pathology is coming to the fore, with which potential targets have been identified that can offer prognosis-improving treatment options, particularly in recurrent or distant metastatic stages. Entity-specific tyrosine kinase inhibitors such as axitinib in adenoid cystic carcinoma or larotrectinib in secretory carcinoma and cross-entity therapies such as HER2 inhibition and androgen deprivation can prolong median and progression-free survival with a favorable side effect profile.

Introduction Fine needle aspiration (FNA) of a tumor is an important preoperative method used for cytological sampling in practice. Due to its easy application, cost-effectiveness, crucial diagnostic value, and minimal complications, it can be applied as a diagnostic standard for salivary gland tumors in ENT clinics. Its greatest benefit lies in differentiating between malignant and benign findings to guide treatment decisions.