Faculty Bibliography

PURPOSE/UNASSIGNED:To determine whether nasal intramucosal 5-fluorouracil (5-FU) injection improves outcomes after external dacryocystorhinostomy (DCR) in pediatric patients with nasolacrimal duct obstruction (NLDO). METHODS/UNASSIGNED:Multi-center retrospective non-comparative case series review of all DCR cases with intra-operative 5- FU injection performed between 2014 and 2023 on all patients age < 18 years. Each case was reviewed to determine if the patients had epiphora recurrence following surgery with 5-FU injection. RESULTS/UNASSIGNED:Sixteen pediatric patients with NLDO (19 eyes) underwent DCR and nasal intramucosal injections of 5-FU intra-operatively. One had a lost stent. Ten (53%) eyes were in patients with craniofacial syndromes. In all patients with the use of 5-FU there was no recurrence of tearing. Eight of the patients (42%) had already had at least one or two failed stents prior in which recurrence had occurred. There were no post-operative complications. CONCLUSION/UNASSIGNED:Adjuvant intramucosal 5-FU demonstrated a 100% success rate of epiphora not recurring following pediatric DCR without any complications in this small sample size, particularly in patients with increased risk of recurrence.

BACKGROUND:Robot-assisted microsurgery with the Symani surgical system has emerged as a potential adjunct in complex reconstructive procedures. Its application in head and neck reconstruction remains early and incompletely characterized. We performed a systematic review to evaluate indications, technical utilization, and reported clinical outcomes of Symani-assisted microsurgery in head and neck reconstruction. METHODS:A systematic review was conducted in accordance with PRISMA guidelines. PubMed (MEDLINE), Embase, Scopus, and the Cochrane Library were searched for studies reporting Symani-assisted microsurgery in head and neck reconstruction. Primary outcomes were flap success and anastomotic complications. Secondary outcomes included operative time, conversion to conventional technique, ischemia time, reported learning curve metrics, and risk of bias. RESULTS: = 0%). Anastomotic complication rates were reported to be low with conversion to conventional technique occurring in one case due to technical malfunction. Anastomosis times were poorly reported across studies. CONCLUSIONS:Early clinical experience suggests that robot-assisted microsurgery with the Symani surgical system in head and neck reconstruction is technically feasible with acceptable short-term outcomes in selected cases. However, evidence remains limited to small, heterogeneous series. Prospective comparative studies are required to determine whether robotic assistance confers meaningful clinical or efficiency advantages over conventional microsurgery and determine optimal operative indications.

Reconstruction in head and neck surgery requires restoration of complex functions, including speech, swallowing, and breathing, while preserving as much facial form and patient identity as possible. Over the past decade, advances in preoperative digital planning, intraoperative technologies, and robotic platforms have reshaped reconstructive strategies, giving rise to the concept of hybrid reconstruction. Hybrid approaches integrate free tissue transfer with computer-aided design and manufacturing (CAD/CAM), virtual surgical planning, intraoperative navigation, and robot-assisted microsurgery to enhance precision, reproducibility, and functional outcomes. This narrative review examines the principles and applications of hybrid reconstruction in head and neck surgery with particular emphasis on osseous reconstruction of the mandible, maxilla, and midface. The roles of intraoperative navigation and robotic assistance as enabling tools are discussed, along with their potential benefits and current limitations. Functional and morphologic outcomes, patient-reported quality of life, and challenges related to cost, access, training, and evidence heterogeneity are critically reviewed. Hybrid reconstruction represents an advancement toward outcomes-driven, patient-centered care; however, thoughtful integration of emerging technologies and continued emphasis on rigorous outcome assessment are essential to guide responsible adoption in contemporary head and neck reconstructive surgery.

PURPOSE/OBJECTIVE:This prospective, non-randomized phase II single-arm pilot trial aimed to explore favorable mid-treatment nodal response (FMNR) through CT imaging to guide de-escalated chemoradiation therapy (CRT) in patients with favorable risk, node-positive HPV-associated oropharyngeal cancer (OPC). MATERIALS AND METHODS/METHODS:. At week 4, CT imaging evaluated nodal response: ≥40% reduction warranted de-escalation to 60 Gy, while <40% reduction continued standard CRT. Primary endpoint was 2-year PFS from initiation of dose de-escalated CRT. Tissue tumor modified viral (TTMV) HPV DNA samples and DW-MRI were collected at baseline and week 4. MDADI questionnaires were collected at baseline, 1, 3, 6, 12, and 24 months. RESULTS:Of 39 patients, 26 had FMNR and underwent de-escalated treatment. 13 pts had slow mid-treatment nodal shrinkage and received standard dose. At a median follow-up of 47.4 months, the 2-year PFS was 92.1% (95% CI: 0.72-0.98) for the deescalated dose group and 92.3% for the standard dose patients (95% CI: 0.57-0.99), p=0.96. With a median survival follow up of 48.9 months (range: 16.7-77.8 months), there were no deaths or distant failures. FMNR was associated with rapid TTMV HPV DNA clearance, reduced TTMV HPV DNA flare, lower baseline and week 4 MRI diffusivity, and higher baseline and week 4 MRI diffusional kurtosis. No differences in acute or late maximum grade 3-4 toxicity by patient were noted. MDADI composite scores showed minimal clinical important difference (MCID) in the de-escalated group at 1-month post-treatment while the standard group had MCID up to 1-year post-treatment. No patients required feeding tube placement. CONCLUSIONS:De-escalated CRT using CT-based mid-treatment nodal response in favorable risk, node-positive HPV-associated OPC achieved excellent 2-year PFS and OS rates and represents a potential approach in better selecting patients for treatment de-escalation.

INTRODUCTION/BACKGROUND:Tracheostomy is a commonly performed procedure in Otolaryngology and can be performed in different settings. We evaluate patient characteristics and cost efficacy of tracheostomy at the bedside versus operating room (OR). MATERIALS AND METHODS/METHODS:Retrospective chart review was performed for adult intensive care unit (ICU) patients who underwent tracheostomy from 2020 to 2023. Data and cost of procedures were analyzed using descriptive statistics. RESULTS:One hundred and sixty-five patients were included. One hundred and thirty-four (81.2%) patients underwent bedside tracheostomy. Age, sex, and BMI were not significantly different. Average time from consult to procedure and operative time was significantly shorter (p = 0.03; 0.008). There were no differences in postoperative complications, 30-day mortality, ICU length of stay (LOS), or overall LOS. Tracheostomy at the bedside offered a 73.1% cost reduction compared with performed in the OR. CONCLUSION/CONCLUSIONS:Advantages of bedside tracheostomy include decreased operative time, time from consult to procedure, and cost reduction for the hospital system. We advocate for consideration of bedside tracheostomy when appropriate.

OBJECTIVE:To investigate whether a new preoperative education and discharge planning protocol reduced unexpected discharge delays for patients undergoing reconstructive surgery for head and neck cancer. METHODS:A quality improvement (QI) intervention was implemented in January 2021 with several components to address historically prolonged observed lengths of stay (LOS) with head and neck cancer patients. The intervention added a preoperative educational visit with a head and neck cancer advanced practice provider, a standardized preoperative speech and swallow assessment, a personalized patient care plan document, discussion of inpatient hospital stay expectations, and early discharge planning. The intervention group included patients who underwent the preoperative education protocol from February to December 2021. For comparison, an age and sex-matched control group was constructed from inpatients who had been admitted for similar procedures in the 2 years prior to the QI intervention (2019-2020) and received standard of care counseling. RESULTS:Our study demonstrated a significant reduction in observed to expected LOS ratio after implementation of the intervention (1.24 ± 0.74 control, 0.95 ± 0.52 intervention; P = .012). DISCUSSION/CONCLUSIONS:We discuss a preoperative education QI intervention at our institution. Our findings demonstrate that our intervention was associated with decreased LOS for patients undergoing head and neck reconstructive surgeries. IMPLICATIONS FOR PRACTICE/CONCLUSIONS:This QI study shows the benefit of a new standardized preoperative education and discharge planning protocol for patients undergoing head and neck reconstructive surgeries.

BACKGROUND/UNASSIGNED:Patients with head and neck cancer (HNC) often experience high symptom burden leading to lower quality of life (QoL). OBJECTIVE/UNASSIGNED:This study aims to conceptually model optimal cutpoint by examining where total number of patient-reported symptoms exceeds patients' coping capacity, leading to a decline in QoL in patients with HNC. METHODS/UNASSIGNED:Secondary data analysis of 105 individuals with HNC enrolled in a clinical usefulness study of the NYU Electronic Patient Visit Assessment (ePVA)©, a digital patient-reported symptom measure. Patients completed ePVA and European Organization for Research and Treatment of Cancer (EORTC©) QLQ-C30 v3.0. The total number of patient-reported symptoms was the sum of symptoms as identified by the ePVA questionnaire. Analysis of variance (ANOVA) was used to define optimal cutpoint. RESULTS/UNASSIGNED:<.0001). CONCLUSIONS/UNASSIGNED:In HNC, defining optimal cutpoints in the total number of patient-reported symptoms is feasible. IMPLICATIONS FOR PRACTICE/UNASSIGNED:Cutpoints in the total number of patient-reported symptoms may identify patients experiencing a high symptom burden from HNC. FOUNDATIONAL/UNASSIGNED:Using optimal cutpoints of the total number of patient-reported symptoms may help effectively align clinical resources with patients' symptom burden.