Frailty is associated with adverse outcomes among patients with head and neck cancers. We evaluated the awareness of frailty among Irish head and neck healthcare professionals.

A cross-sectional survey was distributed to Irish multidisciplinary head and neck healthcare professionals.

Eighty responses were received with varying clinical experience. Seventy-nine (99 per cent) participants believed frailty could influence: post-treatment functional outcomes (77 [96 per cent]), overall survival (72 [90 per cent]) and treatment related toxicity among head and neck cancer patients. Eighteen (23 per cent) participants had used frailty in practice. A lack of awareness / training (68 [85 per cent]) and time / practical constraints (62 [78 per cent]) were the main barriers identified to the utilisation of frailty in practice.

Irish head and neck healthcare professionals are aware of frailty and believe it may be of benefit in clinical practice. Barriers to incorporation of frailty in head and neck care included a lack of training, time or resources.

Transoral robotic surgery (TORS) has emerged as a promising alternative to conventional open approaches for parapharyngeal space malignancies. This review aimed to evaluate the surgical indications, oncologic efficacy and functional outcomes of robotic-assisted procedures.

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. PubMed, Scopus and Cochrane databases were searched for studies published between 2007 and 2025. Eligible studies included patients with parapharyngeal space malignancies managed by transoral robotic surgery or combined transoral robotic surgery–open approaches.

Eleven studies, comprising 20 patients, met the inclusion criteria. Ten patients underwent transoral robotic surgery-only resection, with no intra-operative or post-operative complications and no evidence of recurrence during follow-up. Eight patients were treated with combined transoral robotic surgery–open approaches, achieving comparable oncologic control, albeit with a higher rate of tracheostomy and feeding tube placement.

Transoral robotic surgery-only represents a valid strategy for selected small and well-localised parapharyngeal space malignancies, ensuring favourable oncologic and functional outcomes. Combined transoral robotic surgery–open approaches expand surgical indications to larger and anatomically complex tumours, while maintaining acceptable morbidity and oncologic results.

This study aimed to determine the incidence, location and outcome of incidental avid lesions on positron emission tomography-computed tomography scans for head and neck cancer.

A retrospective study reviewing digital case notes, performed from a single centre. Clinicopathological information was collected and incidental avid lesions on positron emission tomography-computed tomography reports were recorded. Further investigations were followed up to determine the outcome of the lesions.

A total of 281 patients undergoing staging positron emission tomography-computed tomography (stages T4, N3 or unknown primary) and/or treatment response positron emission tomography-computed tomography scans for head and neck cancer were identified, with 363 incidental avid lesions reported in 369 scans. The most common location was the abdomen (30.0 per cent), followed by thorax (28.9 per cent). A total of 33.1 per cent of lesions had further investigation. The rate of incidental synchronous primary was 3.6 per cent.

The benefit of investigating carefully selected incidental avid lesions outweighs the harm of investigation, as it may alter management. There is a need for a standardised pathway for investigating these lesions in head and neck cancer services.

To evaluate clinical characteristics, complications and survival outcomes in patients undergoing lateral temporal bone resection for malignancy at a tertiary skull base centre.

This retrospective cohort study analysed patients treated between 2004 and 2023 at a UK tertiary referral centre. Data collected included demographics, histological diagnosis, stage, surgical approach, reconstruction and adjuvant therapy. Complications and survival were examined using descriptive statistics, Kaplan–Meier survival curves and Cox proportional hazards modelling.

Eighty-nine patients were included (mean age, 67.2 years; 69.7 per cent male). Squamous cell carcinoma (SCC) was the most frequent diagnosis (58.4 per cent) and lateral temporal bone resection was the predominant procedure (73.0 per cent). Post-operative complications occurred in 25.8 per cent of patients, with haematoma the most common complication. Median follow up was 19 months. The 5-year overall survival rate was 50 per cent, with significant differences by cancer stage and patient age.

Surgical management of lateral temporal bone malignancies, predominantly SCC, carries significant morbidity, while survival and complication rates mirror published literature, with outcomes chiefly influenced by age and cancer stage rather than nodal status.

To show our experience in performing endoscopic-assisted maxillectomy (EAM), with the aim of facilitating delineation of tumour resection and improve the achievement of free tumour resection margins.

Patients undergoing EAM between 2021 and 2024 were reviewed. During the endoscopic approach, the medial and lateral plates of the pterygoid were drilled, taking as reference the superior margin of the inferior turbinate.

Six patients underwent an EAM surgery. The maxillectomy was completed with an external transfacial approach in four patients and with a transoral approach in two. No intraoperative complications were observed. Five patients had postoperative flap dehiscence; two cases healed spontaneously and three cases required surgery.

EAM allows delimitation of the posterior limit of tumour resection in total or subtotal maxillectomies. This endoscopic approach facilitates the drilling of the pterygoid process to complete the posterior osteotomy, which is a complex manoeuvre during the exclusive external approach.

To investigate socio-economic and clinical disparities in the utilisation of robotic surgery for head and neck cancer.

Using the National Cancer Database (2010–2020), 212 449 surgically treated patients were analysed. Multivariate logistic regression identified predictors of robotic versus non-robotic surgery (p < 0.05).

Robotic surgery utilisation increased over time during the study period. The following characteristics positively correlated with the use of robotic surgery: male, aged 41–80 years, White race, insured (with private insurance, Medicaid and Medicare) and treatment at an Academic/Research centre. Metropolitan residency, higher income/education levels, lower comorbidity (Charlson–Deyo score of 0) and Stage I disease were also associated with increased robotic surgery utilisation.

Significant socio-economic disparities exist in robotic surgery access, potentially exacerbating outcome inequities. Targeted interventions are needed to improve equity in treatment access and standardise care protocols. Further research should validate trends and address systemic barriers.

This is a radiobiological modelling study aimed at comparing stereotactic ablative body radiotherapy (SABR) with conventional palliative radiotherapy (CPRT) and curative-dose volumetric-modulated arc therapy (CD-VMAT) in the palliation of patients with previously untreated head and neck cancer.

Three radiotherapy plans were generated for 8 patients with head and neck cancer: SABR, prescribed to 45 Gy in 5 fractions; CPRT, prescribed to 30 Gy in 5 fractions and CD-VMAT, prescribed to 70 Gy in 35 fractions. The tumour control probability (TCP) and normal tissue complication probability for salivary and swallowing function (NTCPsaliva and NTCPswallow, respectively) were determined. From those values, the therapeutic ratio, as measured by the uncomplicated tumour control probability (UTCP), was determined.

Dosimetric objectives were achieved in all treatment plans. SABR had a higher mean TCP compared to CPRT and CD-VMAT (100% vs 81% vs 93%, p = 0·003). There were no statistically significant differences in the mean NTCPs for salivary or swallowing function (mean NTCPsaliva 27% vs 41% vs 36%, p = 0·093 and mean NTCPswallow 9% vs 12% vs 23%, p = 0·093). This resulted in the mean UTCP being statistically significantly higher for SABR plans compared to CPRT and CD-VMAT (66% vs 42% vs 49%, p = 0·004).

It is feasible to create SABR plans that satisfy the dosimetric objectives in this study. Based on radiobiological modelling, SABR has superior TCP and similar NTCP, leading to a better therapeutic ratio than CPRT and CD-VMAT.

Smoking is a risk factor for head and neck cancer. Referral for suspected head and neck cancer can be an opportunity for reassessing smoking behaviour. This study examined attitudes towards smoking in patients referred urgently with suspected head and neck cancer.

A total of 98 smokers were referred urgently for suspected head and neck cancer. Patients completed the Fagerstrom Test for Nicotine Dependence and the Perceived Risk and Benefits Questionnaire.

In the Fagerstrom Test for Nicotine Dependence, higher education background (education beyond secondary or high school level) had a lower dependence score (p = 0.02) and men were more likely to have higher dependence scores (p = 0.02). In the Perceived Risk and Benefits Questionnaire, women scored higher for concerns regarding the negative effects of smoking cessation (p = 0.01) and the perceived health benefits of smoking cessation were greater in those with higher education (p = 0.03).

Men are more nicotine dependent. Women are concerned about perceived side effects of smoking cessation. Patients with a higher education background are more receptive to cessation interventions and should be identified early.

The presence of nodal disease at presentation of a head and neck mucosal-based squamous cell carcinoma has a significant impact upon outcomes.

This is a retrospective, ethics-approved study in which patients with squamous cell carcinoma of the larynx, oropharynx, hypopharynx and oral cavity were reviewed and compared with respect to nodal disease (N0 vs N1–N2 vs N3). Patient, disease and treatment parameters were evaluated with ultimate local control, regional control, cancer-specific survival and overall survival investigated.

In the cohort of 1265 patients, 764 presented with nodal disease (N3 = 60). The majority of the N3 group had oropharynx squamous cell carcinoma (52%) and experienced worse ultimate local control (63%; p < 0.001), regional control (67%; p < 0.001) and both squamous cell carcinoma and overall survival (log rank p < 0.001).

Patients presenting with N3 nodal disease had poor regional control, a lower cancer-specific survival and a worse overall survival compared to patients with lesser to no nodal disease.

Radiomics refers to converting medical images into high-quality quantitative data. This review examines applications of radiomics in vestibular schwannomas and future considerations for translation into clinical practice.

The review was pre-registered on Prospero (ID: CRD42024579319). A comprehensive systematic review-informed search of the Ovid Medline, Embase and Global Health online databases was undertaken using the keywords ‘acoustic neuroma’ or ‘vestibular schwannoma’ or ‘cerebellopontine angle tumour’ or ‘cerebellopontine tumour’ or ‘head and neck cancer’ were combined with ‘radiomic’ or ‘signature’ or ‘machine learning’ or ‘artificial intelligence’.

The studies (n = 6) were categorised into two groups: radiomics for pre-operative decision-making (n = 1) and radiomics for treatment outcomes (n = 5). Radiomic features were significantly associated with clinical outcomes. Radiomics-based predictive models were superior to expert vision.

Radiomics has potential for improving multiple aspects of vestibular schwannoma care, but lack of studies inhibited firm conclusions. Prospective studies are required to progress this field.

Ultrasound-guided wire localisation may improve intra-operative identification and outcomes of non-palpable cervical lymphadenopathy in a previously treated neck. We undertook a literature search and present our case series to determine the safety and efficacy of ultrasound-guided wire localisation.

A search of databases up to 29 April 2024 was performed. At our tertiary centre, ultrasound-guided wire localisation was utilised for 20 patients with cervical lymphadenopathy between February 2021 and April 2024.

Seventeen studies with a combined total of 92 patients were identified, with one complication reported. Within our case series, all 20 patients had accurate lesion localisation using ultrasound-guided wire localisation and none required repeat operations.

Ultrasound-guided wire localisation is a safe and cost-effective technique for lesions in an otherwise difficult area to operate, providing confidence to the multidisciplinary team, particularly where histopathology indicates benignity. Surgical outcomes do not appear worse than outcomes without ultrasound-guided wire localisation. We advocate its use provided appropriate patient selection is considered.

A systematic review of case reports in spontaneous regression of head and neck squamous cell carcinoma (SCC) was carried out to investigate the pattern and characteristics of this phenomenon.

A systematic search of case studies of spontaneously regressed head and neck SCC was carried out in Ovid Embase, Ovid Medline and Pubmed. Methodological quality was assessed by ascertainment of diagnosis and overall details of reports. Outcomes included patient demographics, head and neck SCC characteristics and clinical course of disease.

A total of 8 cases were included and 50 per cent (n = 4) of the reported cases were SCC of the vocal folds. All cases received a surgical biopsy and three cases had possible febrile episodes preceding regression. The mean length of time to regression was 4.3 months.

Spontaneous regression in head and neck SCC is likely to be under-reported. A better understanding of how the host immune system can instigate an antitumour response will shed light on the development of novel treatments.

Temporal bone osteoradionecrosis is a rare but significant complication of radiation for head and neck malignancies. Various management techniques have been described, but no clear protocol exists.

A retrospective case review of patients with temporal bone osteoradionecrosis managed over 15 years was carried out to highlight multidisciplinary team (MDT) management. The review findings were compared with the published literature and a protocol was derived for the management of future cases.

A total of 20 patients were included. The sites of osteoradionecrosis included the external auditory canal, the middle ear and the lateral skull base, presenting with features including recalcitrant pain, infection, neuropathies and intracranial sepsis. Treatments included hyperbaric oxygen, antibiotics, debridement and, in advanced cases, lateral temporal bone resection with vascularised tissue transfer. Post-operative and long-term outcomes were discussed.

Early temporal bone osteoradionecrosis may be managed conservatively. Refractory osteoradionecrosis can be life-threatening because of intracranial complications and sepsis. Such cases need an MDT approach with radical skull-base surgery for removal of necrotic foci and reconstruction using vascularised tissue transfer.

In this study, we reviewed the post-operative complications in parotidectomy and its association with various patient, tumour and surgical factors.

All parotidectomies performed in our regional unit between 2013 to 2020 were identified. Electronic medical record and clinic letters were reviewed for any post-operative complications. A logistical regression model was applied on data collected on twelve patient factors, three tumour factors and four surgical factors.

379 cases of parotidectomy were identified in the eight-year study period. 55% (n = 210) were documented with nine types of post-operative complications. This study identified age >80 (odds ratio = 1.89, p = 0.018), active smoker (odds ratio = 0.94, p = 0.018), total parotidectomy approach (odds ratio = 1.77, p = 0.012), longer operation time (odds ratio = 0.006, p = 0.015) and hypertension (odds ratio = 1.23, p = 0.019) were associated with a higher risk of facial nerve palsy. Predictive factors were also identified for auricular nerve numbness and Frey syndrome.

This study revealed the incidences and potential predictors of post-operative complications in parotidectomy. Notably, the grade of operator (consultants/ registrars) had no effect on the possibility of adverse outcome, reflecting patient safety was not compromised for training. These findings can be used in patient counselling and guide treatment options to minimise post-operative complications.

The larynx is the second most prevalent subsite for head and neck cancer. Over half of head and neck cancer patients present with advanced disease. We report our regional practices for palliative intent laryngeal squamous cell cancer (SCC).

Retrospective analysis of patients with laryngeal SCC treated with palliative intent, discussed at the regional head and neck multidisciplinary team meeting from July 2010 to June 2016.

A total of 65 patients were included, of whom 45 per cent had potentially curable disease but were not fit for curative treatment. Nine patients (14 per cent) underwent tracheostomy, with mean survival and hospital stay of 278 and 48 days, respectively. Four patients (6 per cent) underwent debulking surgery with mean survival and hospital stay of 214 and 1 days, respectively.

All palliative treatment measures offered to patients can have an impact on survival and quality of life. Patients should be at the centre of the decision-making process and counselled on the potential impact of interventions.

Out-patient channelled endoscopic local anaesthetic biopsy reduces the time to diagnosis and wider use may improve cancer pathway times. This study aimed to assess the practice of ENT surgeons using channelled local anaesthetic biopsy.

A survey was distributed nationally, containing questions about out-patient local anaesthetic biopsy.

In total, 58 responses were returned; only 12 per cent of respondents (n = 7) used general anaesthetic biopsy. The advantages of local anaesthetic biopsy were: the avoidance of general anaesthetic for patients with poor performance scores (95 per cent, n = 55) and faster cancer pathway times (91 per cent, n = 53). Disadvantages were: clinics running late (29 per cent, n = 17) and complications (24 per cent, n = 14). The main barrier to using local anaesthetic was access to channelled flexible endoscopy (38 per cent, n = 22), with 43 per cent (n = 25) reporting they were not using out-patient channelled endoscopes but would be interested in using them.

Surgeons are interested in using channelled endoscopic local anaesthetic biopsy, but they are limited by access to equipment. Increased use of channelled endoscopes may improve national cancer pathway times and avoid challenging general anaesthetics.

During the coronavirus disease 2019 pandemic, ENT-UK recommended a move from face-to-face clinics to telephone appointments. This study reviewed the safety of telephone clinics for urgent two-week-wait cancer referrals.

Patients consulted in telephone clinics between April and November 2020 were identified from an electronic database. Study patients included those diagnosed with malignant disease at six months. The Head and Neck Cancer Risk Calculator version 2 score, outcome of the initial clinic and final diagnoses were reviewed.

A total of 1062 patients were triaged in clinic; 9.2 per cent (n = 98) were diagnosed with cancer at 6 months. Of these 98 patients, 69 received an urgent face-to-face appointment, 26 underwent urgent scans and 3 had a delayed telephone review. Twenty patients (20.4 per cent) diagnosed with cancer had a low-risk Head and Neck Cancer Risk Calculator score.

The late diagnosis rate of 0.28 per cent suggests a small proportion of cancer could have been missed. Telephone clinics, whilst a pragmatic means to maintain patient flow during the pandemic, could result in late diagnoses.

Image enhancement systems are important diagnostic tools in the detection of laryngeal pathologies. This study aimed to compare three different image enhancement systems: professional image enhancement technology, Image1 S and narrow-band imaging.

Using the three systems, 100 patients with laryngeal lesions were investigated using a flexible and a 30° rigid endoscope. The lesions were diagnosed by three experts and classified using the Ni classification. The findings were compared.

Lesions classified as ‘benign’ were histopathologically confirmed in 50 per cent of patients, malignant lesions were confirmed in 41 per cent and recurrent respiratory papillomatosis were confirmed in 9 per cent. There was no significant difference between the experts’ assessments of each image enhancement system.

The three systems give comparable results in the detection of laryngeal lesions. With two additional systems, more users can perform image-enhanced endoscopy, resulting in a broadly available tool that can help to improve oncological assessment.

Digital health tools are increasingly being recognised as effective interventions in monitoring chronic health conditions. This systematic review addressed how digital health is currently utilised in patients with head and neck cancer as an adjunct to care.

Studies of the development or evaluation of an eHealth, telemedicine or telemonitoring tool were eligible. A narrative synthesis was performed as per Preferred Reporting Items for Systematic Review and Meta-Analyses reporting guidelines.

Twenty-nine studies of digital health tools in head and neck cancer were identified. Nine were randomised, controlled trials but most had concern of bias. Fourteen (48 per cent) of the interventions used multiple modes of delivery. The primary digital tool functions are symptom tracking and self-care, prehabilitation and rehabilitation, psychological support, and education, including decision aids. Most tools aimed to support patients during active cancer treatment.

There are a small number of digital health tools for head and neck cancer patients; however, there is a lack of well-designed randomised, controlled trials to demonstrate effectiveness.

The coronavirus disease 2019 pandemic led to increased pressure on health services, which, combined with variable social restrictions, led to decreased referrals for head and neck cancer. This study assessed whether there were lasting changes to head and neck cancer referrals during different stages of the pandemic response in 2020 and 2021.

A retrospective review was conducted of all cases referred for suspected head and neck cancer to our institution in January 2020, April 2020, April 2021 and June 2021.

There was a rebound 91 per cent increase in referrals between April 2020 and April 2021 following the 59 per cent decrease in referrals between January 2020 and April 2020. Males made up 47.1 per cent of referrals in January 2020, 40 per cent in April 2020 and 37.82 per cent in April 2021.

Further research is recommended to investigate the reasons why there is a continued decline in male referrals and the effect this has on their outcomes.