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The latest medical research on Mouth, Head and Neck Cancer

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Perspectives on the state of cleft lip and cleft palate patient care in Africa.

Mouth, Head and Neck

As the most common congenital craniofacial defect, patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa.

To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources.

The replacement of CLP 'missions' with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.

Ergonomics in facial plastic and reconstructive surgery.

Mouth, Head and Neck

Understanding effective ergonomic interventions is crucial for enhancing occupational health and career longevity. There is a paucity of clear ergonomics guidelines in facial plastic and reconstructive surgery (FPRS), placing practitioners at high risk of work-related musculoskeletal disorders (WMSDs) and their consequences.

There is mounting evidence that FPRS specialists are at increased risk of WMSDs as compared with the public and other surgical specialties. Numerous studies have demonstrated that implementation of ergonomics principles in surgery decreases WMSDs. Furthermore, WMSDs are reported as early as the first year of surgical residency, marking the importance of early intervention.

Fatigue and physical injuries among surgeons occur more often than expected, particularly during complex, extended procedures that necessitate maintaining a constant posture. FPRS procedure often place surgeons into procrustean positions. Thus, integrating ergonomic practices into the practice of FPRS is essential for reducing WMSDs.

Management of facial nerve trauma.

Mouth, Head and Neck

To present the current literature on management of facial nerve disorder secondary to trauma, with a focus on the utility of electrodiagnostic testing in this setting.

Patients with facial palsy related to temporal bone fractures should be started on high-dose corticosteroids as early as possible. Recent literature on the benefit of surgical intervention in the setting of temporal bone fracture is mixed. Some studies support early surgical decompression whereas others have found no benefit compared with conservative treatment.

The management of facial nerve trauma is based on location and extent of injury. Extratemporal trauma and transected nerve should be treated with surgical exploration and tension-free coaptation ideally within 72 h. There are no guidelines for intratemporal facial nerve trauma. Surgical decompression compared with medical management is debated in the literature without consensus and more large studies are needed.

Applications of artificial intelligence in facial plastic and reconstructive surgery: a systematic review.

Mouth, Head and Neck

Arguably one of the most disruptive innovations in medicine of the past decade, artificial intelligence is dramatically changing how healthcare is practiced today. A systematic review of the most recent artificial intelligence advances in facial plastic surgery is presented for surgeons to stay abreast of the latest in our field.

Artificial intelligence applications developed for use in perioperative patient evaluation and management, education, and research in facial plastic surgery are highlighted. Selected themes include automated facial analysis with landmark detection, automated facial palsy grading and emotional assessment, generation of artificial facial profiles for testing and model training, automated postoperative patient communications, and improving ethnicity-sensitive facial morphometry norms. Inherent bias can exist in artificial intelligence models, and care must be taken to utilize algorithms trained with diverse datasets.

Artificial intelligence tools are helping clinicians provide more standardized, objective, and efficient care to their patients. Increasing surgeon awareness of available tools, and their widespread implementation into clinical workflows are the next frontier. Ethical considerations must also shape the adoption of any artificial intelligence functionality. As artificial intelligence applications become a fixture in medicine, surgeons must employ them effectively to stay at the vanguard of modern medicine.

Paediatric voice disorder: who to refer and how to assess? A summary of recent literature.

Mouth, Head and Neck

The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders.

Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance.

We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child.

Sustainable equipment donation in otolaryngology in low-resource settings.

Mouth, Head and Neck

The purpose of this review is to examine current practices in surgical equipment donation to lower- and middle-income countries (LMICs) with a particular focus on otolaryngology-head and neck surgery (OHNS). This is designed as a pragmatic review to guide potential donor communities to implement sustainable OHNS equipment donation in LMICs.

LMICs are increasingly reliant on international equipment donation. In terms of OHNS services, global OHNS have compiled a list of essential equipment for baseline care in LMICs. Especially in terms of audiology, OHNS equipment donation has the potential to have a significant impact on populational health. However, there is a scarcity of research on donated equipment in OHNS. A suggested blueprint for sustainable equipment donation follows these steps: establish partnerships, assess needs, source equipment, and follow-up and evaluate the intervention. Key further considerations for sustainability include remanufacturing and repurposing methods, maintenance, and contextual understanding.

Sustainable equipment donation in otolaryngology is an important part of global health equity and healthcare delivery in low-resource settings. Despite the good intentions behind medical equipment donations, there are many challenges; donors and recipients should engage in collaborative, needs-based planning processes that result in long-term sustainability, local capacity building, and community participation.

The mechanism of action for laryngeal manual therapies: the need for an update.

Mouth, Head and Neck

To propose a pathway for expanding the understanding of potential mechanisms of action with laryngeal-based manual therapy (LMT) for muscle tension dysphonia (MTD). This review may help determine if current LMT literature has kept up with advances in the more general manual therapy (MT) findings.

Studies over the past thirty years, including recently published articles, have confirmed the efficacy of various manual therapy interventions in treating MTD. However, gaps exist between current LMT literature and that being presented in the more general MT field. Instead of viewing peripheral manipulation's influences as a local cause/effect process, the MT literature paints a richer tapestry of centrally mediated impacts.

Evidence from outside the LMT field has introduced a broad tapestry of factors that may contribute to the efficacy of MT, extending beyond the local effects reported in LMT literature. To better understand the effect and mechanism of action touch-based interventions have on a patient's voice and to potentially improve outcomes, it is necessary to broaden investigations to include a broader range of perspectives.

Managing lymphoedema following treatment for head and neck cancer: is complete decongestive therapy an effective intervention to improve dysphagia outcomes?

Mouth, Head and Neck

The purpose of this review is to summarize current evidence regarding management of head and neck lymphoedema (HNL) to improve dysphagia outcomes following head and neck cancer (HNC) treatment. This review aims to support complete decongestive therapy (CDT) comprising compression, manual lymphatic drainage (MLD), exercises and skincare as an adjunct of dysphagia rehabilitation.

Research in the limbs supports the use of CDT to improve lymphoedema outcomes. Emerging evidence supports the use of CDT for the head and neck, though, there is no consensus on optimal treatment required to improve dysphagia outcomes. Current evidence is limited due to a paucity of randomized controlled trials, case series or cohort studies with small participant numbers, and a lack of functional and instrumental dysphagia outcome measures. This provides a foundation to design and test an individually tailored programme of HNL intervention to evaluate swallowing outcomes post CDT.

As the incidence of HNC is increasing with HPV, with patients living for longer with late effects of HNC treatment, it is vital to understand how the presence of HNL impacts on the swallow, and if functional dysphagia outcomes improve following treatment of HNL. Prospective, longitudinal research with objective and functional outcome measures are required to help determine optimal management of HNL and its impact on the swallow.

Current approaches to gender-affirming vocal care.

Mouth, Head and Neck

This review addresses the challenges faced by transgender women in achieving congruence between gender identity and voice characteristics and emphasises the importance of a multidisciplinary approach involving therapeutic and surgical interventions.

Recent literature on gender-affirming vocal care emphasises key themes such as assessment, voice feminisation therapy, and various surgical techniques, including glottoplasty and its modifications. Recent publications focused on outcomes, duration, and impact on vocal quality and scrutinised complications associated with surgical interventions.

Prospective multicentre studies with standardised protocols are needed to establish best evidence-based practices.

Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis.

Mouth, Head and Neck

Massive palatal defects resulting from palatoplasty failures arising from cleft palate repair complications present ongoing challenges in clinical practice. The purpose of this review is to provide up-to-date insights into aetiology, risk factors, surgical techniques, and adjunctive therapies, aiming to enhance the understanding of such complex cases, and optimize patient outcomes.

Primary palatoplasty has fistula recurrence rates ranging from 2.4% to 55%. Factors such as cleft width, surgical repair method, and patient characteristics, influence the likelihood of failure. Classifications such as the Pakistan Comprehensive Classification and Richardson's criteria aid in assessing defects. Surgical options range from local flaps and revision palatoplasty to regional flaps (e.g., buccinator myomucosal, facial artery-based flaps, tongue flaps, nasal septal flaps) to free microvascular flaps. Alternative approaches include obturator prostheses, and acellular dermal matrix has been used as an adjuvant to multiple repair techniques. Hyperbaric oxygen therapy has emerged as an adjunctive therapy to enhance tissue healing.

This comprehensive review underscores the intricate challenges associated with massive palatal defects resulting from palatoplasty failures. The diverse range of surgical and nonsurgical options emphasizes the importance of patient-centric, individualized approaches. Practitioners, armed with evidence-based insights, can navigate these complexities, offering tailored interventions for improved patient outcomes.

'Seeing is believing' - gender disparities in otolaryngology-head and neck surgery in Africa: a narrative review.

Mouth, Head and Neck

Various factors affect otolaryngology - head and neck surgery (OHNS) services in low- and middle-income countries (LMICs); including inadequate infrastructure, limited academic positions, unfavorable hospital research policies, and traditional misconceptions about gender and surgery, among others. Although gender inequalities exist globally, they are particularly pronounced in LMICs, especially in Africa.

A comparative narrative literature review for relevant manuscripts from January 1, 2017 to through January 10th, 2024, using PubMed, Embase and Google Scholar for articles from the United States/Canada and Africa was done. 195 relevant articles were from the United States/Canada, while only 5 were from Africa and only 1 manuscript was relevant to OHNS. The reviewed articles reported that gender disparities exist in medical training, authorship, and career advancement. We highlight possible solutions to some of these disparities to promote a more gender-diversified workforce in OHNS in Africa as well as all over the world.

Additional studies on gender disparities in Africa, are needed. These studies will highlight need for inclusive policies, structured and accessible mentorship programs; through which these disparities can be highlighted and addressed. This will in the long run ensure sustainability of OHNS care in LMICs.

The added value of radiomics in determining patient responsiveness to laryngeal preservation strategies.

Mouth, Head and Neck

Laryngeal cancer (LC) is a highly aggressive malignancy of the head and neck and represents about 1-2% of cancer worldwide.Treatment strategies for LC aim both to complete cancer removal and to preserve laryngeal function or maximize larynx retention.Predicting with high precision response to induction chemotherapy (IC) is one of the main fields of research when considering LC, since this could guide treatment strategies in locally advanced LC.

Radiomics is a noninvasive method to extract quantitative data from the whole tumor using medical imaging. This signature could represent the underlying tumor heterogeneity and phenotype.During the last five years, some studies have highlighted the potential of radiomics in the pretreatment assessment of LC, in the prediction of response to IC, and in the early assessment of response to radiation therapy. Although these represent promising results, larger multicentric studies are demanded to validate the value of radiomics in this field.

The role of radiomics in laryngeal preservation strategies is still to be defined. There are some early promising studies, but the lack of validation and larger multicentric studies limit the value of the papers published in the literature and its application in clinical practice.