Faculty Bibliography

LEARNING OBJECTIVES/OBJECTIVE:After studying this article, the participant should be able to (1) understand the incidence and trends of pediatric head and neck cancer; (2) identify the common tumors that present in the head and neck region; (3) describe the risk factors and pathogenesis associated with these malignancies, to identify children at risk; and (4) describe and understand the common presentations of these tumors to gain confidence in diagnosing these patients early in practice. SUMMARY/CONCLUSIONS:Pediatric head and neck malignancies are rare; however, their incidence is rising rapidly, with an incidence of 3.29 diagnoses per 100,000 person-years. These malignancies often present with nonspecific symptoms distinct from adults, making early diagnosis more challenging. Recognizing early symptoms in children is essential to improve treatment and long-term outcomes. This review discusses the incidence, pathogenesis, classification, and presentation of the common pediatric head and neck malignancies, including lymphoma, soft tissue sarcoma, thyroid carcinoma, salivary gland malignancies, bone malignancies, nasopharyngeal carcinoma, and melanoma.

LEARNING OBJECTIVES/OBJECTIVE:After studying this article, the participant should be able to (1) gather appropriate history and perform relevant physical exam maneuvers for head and neck complaints, (2) relate presenting complaints to differential diagnoses, (3) describe the appropriate workup for various head and neck complaints and presentations, and (4) perform clinical staging of head and neck tumors according to current guidelines. SUMMARY/CONCLUSIONS:Pediatric head and neck cancers are rare and complex, but plastic surgeons may play a crucial role in the multidisciplinary and multifaceted workup of a suspected malignancy. These cancers present unique diagnostic and therapeutic challenges given the unique anatomy, physiology, and developmental considerations in children compared to their adult counterparts. A comprehensive workup for pediatric head and neck malignancies is essential, starting with taking a thorough history and physical exam, followed by a well-considered and wide differential diagnosis. Appropriate imaging modalities and biopsy techniques are pivotal in obtaining an accurate diagnosis. Tumor and site-specific staging seek to provide essential information for guiding treatment planning. Plastic surgeons, therefore, must be informed and well versed in their evaluation and workup to best optimize patient outcomes.

INTRODUCTION/BACKGROUND:Nasoalveolar molding (NAM) is a presurgical technique used to improve nasolabial cleft severity prior to repair. This study ascertains the rates of revision surgery in a large cohort of patients with a cleft who underwent NAM and were followed to facial maturity. METHODS:A single-institution retrospective review of all patients with a cleft who underwent NAM from 1995 to 2005 was performed. Operative reports were queried to record intervnetions to the lip and nose performed through facial maturity. Patients with incomplete medical records prior to reaching skeletal maturity were excluded. Pearson correlation coefficient and two-paired student t-tests were employed for data analysis. RESULTS:A total of 81 patients were studied, 46 male and 35 female, with 52(64%) unilateral and 29(36%) bilateral clefts. Average age at last follow-up was 18.8 years. Revision to the lip was carried out in 36(44%) of patients, and only 3(3.7%) prior to reaching facial maturity. Re-repair was performed in 10(12%) patients. No significant difference of lip revisions rates were seen among patients with a bilateral and unilateral cleft (48% v. 37.9%, p=0.38).Immature cleft rhinoplasty was performed in 3(4%) patients, and more commonly among patients with a unilateral (23%) than bilateral cleft (10%), p=0.18. Mature rhinoplasty was performed in 46(57%) patients, similarly between unilateral (58%) and bilateral clefts (55%). Nasal revision following mature rhinoplasty was performed in 8(10%) patients. CONCLUSIONS:Nasoalveolar molding is an effective adjunct to surgical management in reducing the burden of operative revisions as patients reach facial maturity, namely for bilateral clefts.

Presurgical lip, alveolus, and nose approximation (PLANA) is a novel form of presurgical infant orthopedics (PSIO) involving a prefabricated silicone intranasal device combined with hydrocolloid adhesive lip taping. Early studies have demonstrated favorable nasolabial morphologic outcomes using PLANA and a reduction in the burden of care on infants and their caregivers relative to nasoalveolar molding (NAM). However, the efficacy of PLANA in reducing cleft severity to facilitate surgical repair has not been comprehensively assessed from the perspective of the cleft surgeon. This study, therefore, compared surgeon ratings of PSIO outcomes in infants with unilateral cleft lip treated with PLANA and NAM. Two expert surgeons blindly evaluated PSIO outcomes in 10 patients treated with PLANA and 10 patients treated with NAM using standardized pre- and post-PSIO photographs. Surgeons used a 4-point Likert scale to assess improvement in lip approximation, lateral displacement of the subnasale from the midsagittal plane, nasal deviation, alar base width symmetry, alar base height symmetry, columellar angle, columellar length, nostril width symmetry, nostril height symmetry, and nasal tip projection, as well as overall morphologic improvement. The PLANA cohort received statistically significantly greater scores for alar base width symmetry (3.45 versus 2.35, P<0.001), alar base height symmetry (3.40 versus 2.55, P=0.02), columellar angle (3.70 versus 3.10, P=0.05), nostril width symmetry (3.65 versus 2.20, P<0.001), and overall outcome (3.65 versus 2.90, P=0.02). The 2 cohorts received similar ratings across all other parameters. Surgeons consistently rated PSIO outcomes as equivalent or superior with PLANA relative to NAM.

Despite the increasing prevalence of micromobility vehicles, including bicycles, e-bikes, and e-scooters, the burden of neurocranial trauma sustained by pedestrians struck remains understudied. This retrospective observational cohort study compared injury patterns, management, and outcomes between vehicle riders and pedestrians admitted to a level 1 trauma center from 2020 to 2024 for neurocranial trauma. Presence of traumatic brain injury, intracranial hemorrhage, neurocranial fracture, surgical intervention, intensive care unit admission, intensive care unit length of stay, hospital length of stay, 30-day readmission, mortality, and focal neurological deficits on discharge were assessed. χ2 tests and independent-samples t tests were used for comparison between vehicle riders and pedestrians struck. Of the 250 total patients, 70 were pedestrians struck. Pedestrians exhibited significantly greater rates of moderate or severe traumatic brain injury (71.4% versus 56.7%, P=0.032), subdural hematoma (58.6% versus 37.8%, P=0.003), and frontal bone fracture (24.3% versus 13.9%, P=0.048), and were more likely to undergo burr hole evacuation (4.3% versus 0.6%, P=0.035), intracranial pressure monitor placement (5.7% versus 0.6%, P=0.009), and intensive care unit admission (82.9% versus 59.4%, P<0.001). The overall incidence of micromobility-related neurocranial trauma more than doubled (25 in 2020 and 59 in 2024), whereas pedestrian admissions tripled (6 in 2020 and 18 in 2024) during the study period. Pedestrians struck by micromobility vehicles exhibit a growing, underappreciated, and more severe burden of neurocranial trauma than vehicle riders, underscoring the need for targeted prevention strategies.

BACKGROUND:This study evaluates the Presurgical Lip, Alveolus, and Nose Approximation (PLANA) technique as a novel alternative to NasoAlveolar molding (NAM). The study hypothesizes that PLANA can achieve comparable Nasolabial outcomes to NAM while addressing its limitations, particularly by reducing the burden of care. METHODS:A retrospective review was conducted on 50 patients with non-syndromic unilateral or bilateral cleft lip and palate (CLP) treated with either NAM (n=28, including 2 treatment discontinuations) or PLANA (n=22). The overall physical burden of care was assessed in the full cohort. A subset of 25 patients with complete unilateral CLP (PLANA n=12; NAM n=13) was further analyzed to assess changes in nasolabial anthropometric ratios between cleft and non-cleft side using standardized 2D photographs taken pre-treatment (T1) and post-treatment (T2). RESULTS:The physical burden of care was significantly lower in the PLANA group, with 61.2 % fewer total office visits (5.2 vs. 13.4; p<0.001). The PLANA group also showed 72.19 % reduction in transient reversible side effects, such as oral, nasal, and cheek irritations (18.18% [n=4] vs. 65.38% [n=17]; p<0.001). PLANA achieved a significantly greater improvement in the columellar length ratio (0.53 vs. 0.37; p = 0.026), while NAM demonstrated a greater increase in the nostril height ratio (0.29 vs. 0.39; p = 0.04). No significant differences were observed in nostril width and alar base width ratios, or columellar deviation angle between the groups. CONCLUSION/CONCLUSIONS:These findings suggest that PLANA significantly reduces the burden of care for patients with cleft lip and palate and may offer comparable nasolabial outcomes to NAM.

LEARNING OBJECTIVES/OBJECTIVE:After studying this article, the participant should be able to (1) understand the nonsurgical and surgical techniques and advancements in the management of pediatric head and neck cancers, (2) describe the common management strategies used in pediatric head and neck cancers, and (3) Understand therapies to target head and neck cancers within pediatric patient populations. SUMMARY/CONCLUSIONS:Pediatric head and neck cancer management is complex and often requires a multidisciplinary approach. Management goals aim to deliver a multimodal treatment approach that integrates surgery with concurrent medical management through adjuvant and/or neoadjuvant chemotherapy and/or radiation therapy. Patients in remission should be monitored closely for recurrence or long-term treatment complications. Harmonizing a multidisciplinary approach between pediatric oncologists, hematologists, radiologists, pathologists, and surgeons is a priority. This review discusses advances in management strategies used for common pediatric head and neck malignancies, with a focus on surgical and medical techniques as well as treatment complications that can arise.

BACKGROUND:The severity of unilateral cleft lip significantly influences surgical outcomes, yet no standardized system exists to classify cleft severity or assess the impact of presurgical infant orthopedics (PSIO). This study proposes an objective classification system integrating anthropometric measurements with expert evaluations. METHODS:Deidentified pre- and post-PSIO photographs of 50 infants with unilateral cleft lip from the Smile Train Express database were analyzed. Three anthropometric parameters-nostril width ratio (NWR), columellar angle (CA), and subnasale lateral displacement (SN)-were measured. An expert panel of orthodontists and surgeons independently rated cleft severity and PSIO outcomes in a structured three-stage process. Severity thresholds were established through consensus, and interrater agreement was analyzed using weighted kappa. RESULTS:Consensus-derived thresholds categorized NWR, CA, and SN into four severity levels. Interrater agreement for cleft severity improved across stages, reaching near-perfect levels in Stage 3 (weighted kappa = 0.91 pre-PSIO, 0.93 post-PSIO). While pre-PSIO agreement was similar between surgeons and orthodontists, post-PSIO assessments showed greater variability. PSIO had a disproportionate effect on nasal morphology (CA) compared to maxillary segments (NWR, SN), with severe NWR and SN frequently coexisting with mild CA. The proposed classification system demonstrated substantial reliability, aligning at least two parameters within the same severity subclassification. CONCLUSIONS:This study introduces a standardized classification system for cleft severity and PSIO outcomes, demonstrating strong interrater reliability. By integrating anthropometric data with expert assessments, it provides a reproducible framework for clinical and research applications. Further refinements, including intraoral measurements and 3D imaging, may enhance its precision and applicability.

LEARNING OBJECTIVES/OBJECTIVE:After studying this article, the participant should be able to (1) understand how unique biological and developmental characteristics of children influence pediatric cancer treatment and how advancements in diagnostics and adjuvant therapy help tailor care, (2) describe treatment approaches to pediatric head and neck malignancies, and (3) understand how surgical resection integrates with multimodal systemic therapies. SUMMARY/CONCLUSIONS:Pediatric head and neck malignancies require a tailored, multidisciplinary management approach that considers the unique biological, developmental, and long-term implications in this vulnerable population. This comprehensive review provides a disease-specific overview of the most common pediatric head and neck cancers. Current evidence-based surgical and nonsurgical treatment strategies are summarized, and recent advancements in diagnostic imaging, minimally invasive techniques, and adjuvant therapies are discussed for each cancer type commonly incurred within the pediatric population. The integration of multi-agent chemotherapy, radiation therapy, and targeted therapeutic modalities with precise surgical intervention has reshaped treatment paradigms and led to improved survival outcomes while minimizing long-term patient morbidity. Emphasis is placed on the importance of early diagnosis, prompt initiation of treatment, and vigilant long-term follow-up to monitor patients for both recurrence and treatment-related complications. Ultimately, this review serves as a practical guide to clinicians, reinforcing the critical role of a coordinated, interdisciplinary team-including pediatric oncologists, surgeons, radiologists, pathologists, and allied specialists-in optimizing care and enhancing quality of life for children with head and neck malignancies.