Rey M, Adelou S, Pham Dang N
… +4 more, Biau J, Bernadach M, Puechmaille M, Saroul N
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42373367
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INTRODUCTION: Progression of advanced-stage head-and-neck cancer (HNC) can lead to respiratory distress requiring emergency tracheotomy. In the context of palliative care, this raises major prognostic and ethical issues....INTRODUCTION: Progression of advanced-stage head-and-neck cancer (HNC) can lead to respiratory distress requiring emergency tracheotomy. In the context of palliative care, this raises major prognostic and ethical issues. The present study sought to assess survival and morbidity after emergency tracheotomy in HNC patients under palliative care. MATERIAL AND METHODS: A 2-center retrospective study included all HNC patients in palliative care who underwent emergency tracheotomy between 2000 and 2023 in our institution. Demographic, clinical/pathologic and survival data were analyzed. RESULTS: Thirty-eight of the 1243 tracheotomies performed during the study period were for patients in palliative care. Mean age was 64.5±11.9years. Ninety-five percent of cancers were stage IV and 40% were metastatic. Forty-two percent of patients experienced postoperative complications. No deaths directly implicated surgery. Median overall post-tracheotomy survival was 2months (IQR: 1-4months), for a mean 4.3±6.6months. Discharge home was the only significant protective factor (HR: 0.27; P=0.006). CONCLUSION: Emergency tracheotomy is rare in the context of palliative care, with fewer than 2 cases per year in our center. It prolongs survival by a few weeks, but at the cost of elevated morbidity. Indications should be anticipated and discussed in a tumor board including palliative care professionals.
Asimakopoulos AD, Dulguerov N, Ciucchi L
… +1 more, Avagnina A
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42350255
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INTRODUCTION: Thermal injury of the upper aerodigestive tract related to inhalational drug abuse is uncommon but increasingly recognized. While airway injury associated with crack cocaine inhalation has been reported, th...INTRODUCTION: Thermal injury of the upper aerodigestive tract related to inhalational drug abuse is uncommon but increasingly recognized. While airway injury associated with crack cocaine inhalation has been reported, the otolaryngologic manifestations of inhaled heroin vapor ("chasing the dragon") remain poorly described. CASE SUMMARY: We report the case of a 39-year-old woman presenting with progressive dysphonia and dyspnea. She had a history of polysubstance smoking including tobacco, cannabis, crack cocaine, and heroin vapor inhalation. Flexible fiber-optic nasopharyngolaryngoscopy demonstrated extensive bilateral necrosis of the vocal fold mucosa with preserved vocal fold mobility and abundant carbonaceous debris within the laryngeal lumen. Histopathological analysis of expectorated fragments confirmed ischemic necrosis of squamous mucosa. The patient was managed conservatively with corticosteroids, antibiotics, and close outpatient follow-up, with partial clinical improvement. DISCUSSION: Thermal injury from crack cocaine inhalation has been associated with supraglottic and laryngeal mucosal damage. In contrast, the effects of inhaled heroin vapor on the upper airway remain poorly documented. Combined inhalation of multiple substances may result in additive thermal and chemical mucosal injury, potentially explaining the extensive laryngeal necrosis observed in this case. This report highlights the need to consider polysubstance inhalational abuse in patients presenting with unexplained necrotizing laryngeal lesions.
Mhatli M, Ebode D, Haddad R
… +3 more, Michel J, Vandersteen C, Gargula S
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42342527
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BACKGROUND: Eustachian tube dysfunction (patulous Eustachian tube or obstructive impermeability) can significantly impair quality of life, but no French-language questionnaire was previously available. The present study...BACKGROUND: Eustachian tube dysfunction (patulous Eustachian tube or obstructive impermeability) can significantly impair quality of life, but no French-language questionnaire was previously available. The present study sought to adapt and validate a French version of the ETDQ-7 questionnaire. MATERIALS AND METHODS: A prospective controlled study was conducted between February 2024 and March 2025. Translation used the forward-backward technique and statistical validation was performed in adult patients treated for Eustachian tube dysfunction and a control group. OBJECTIVES: Internal consistency, discriminant validity and test-retest reliability were assessed for global score, subtotals and items. RESULTS: In all, 32 patients (cases) and 32 controls filled out the questionnaire. Twenty-three of the 32 cases also filled out the retest. Internal consistency on Cronbach alpha was 0.84 for cases. Mean total ETDQ-7 score was 27±10.2 for cases versus 8.9±2.6 for controls (P<0.0001). Test-retest reliability on Pearson correlation coefficient was satisfactory, at r=0.77. All items showed satisfactory individual performance. CONCLUSION: The French-language ETDQ-7 is a short, simple and reliable instrument for assessing quality of life in patients with Eustachian tube dysfunction.
Lien CF, Yeh SA, Hwang TZ
… +7 more, Chiang FY, Wang CC, Cai BH, Yang CC, Chen CC, Cheng CS, Hsieh MC
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42342526
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OBJECTIVE: Prognostic influence of invasion pattern and circumferential spread of internal carotid artery (ICA) on survival in patients with nasopharyngeal cancer (NPC) was not well established. Thus, we conducted a retr...OBJECTIVE: Prognostic influence of invasion pattern and circumferential spread of internal carotid artery (ICA) on survival in patients with nasopharyngeal cancer (NPC) was not well established. Thus, we conducted a retrospective study to investigate the association with survival. MATERIAL AND METHODS: This was a retrospective study and included pathologically proved NPC patients from November 2015 to Dec 2022 at our Hospital. The invasion pattern and circumferential spread of ICA were carefully reviewed from computed tomogram or magnetic resonance image. Survival were estimated by the Kaplan-Meier method with five-year overall survival (OS) rate and five-year disease specific survival (DSS) rate. RESULTS: A total of 200 NPC patients were included in this study for outcome analysis. Of the included patients, ICAI by NPC was observed in 55 (27.5%) patients. After stratifying by ICA invasion (ICAI) or not, the OS and DSS were 41% and 44% in patients with ICAI, while 81% and 85% in those without ICA invasion, respectively (P<0.001 in both OS and DSS). Subgroup analysis found that patients with C4 segment invasion had worst outcomes. The OS and DSS were 14% and 14% in patients with C4 segment invasion of ICA, while 72% and 77% in those without C4 segment invasion of ICA, respectively. As for extent of circumferential spread, the 5-year survival rate and 5-year disease specific survival rate were 80% versus 40% and 85% versus 45% for patients with spread less than 180 degree and more than 180 degree, respectively. CONCLUSIONS: Locally advanced NPC patients with ICAI has miserable outcomes, especially those with ICAI more than 180 degree and C4 segment involvement. More aggressive interventions were needed to extend their survival.
Davila M, Barba N, Guerrero ME
… +1 more, Villarroel PP
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42342525
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INTRODUCTION: Palatine tonsil metastasis is an uncommon manifestation of disseminated malignancy and is exceptionally rare in small-cell lung cancer (SCLC). Because it may mimic benign tonsillar disease or a primary orop...INTRODUCTION: Palatine tonsil metastasis is an uncommon manifestation of disseminated malignancy and is exceptionally rare in small-cell lung cancer (SCLC). Because it may mimic benign tonsillar disease or a primary oropharyngeal tumor, diagnosis can be delayed. CASE SUMMARY: A 71-year-old man was admitted after pertrochanteric hip fracture. Preoperative evaluation revealed a left tonsillar mass and a left hilar pulmonary lesion. Computed tomography showed a 3-4cm lesion involving the left palatine tonsil, a 7.5cm left hilar mass with mediastinal lymphadenopathy and multiple brain metastases. Bronchial biopsy confirmed SCLC. Tonsillar biopsy showed metastatic SCLC with a matching neuroendocrine immunophenotype, including TTF-1, chromogranin, synaptophysin, and CD56 positivity and a high Ki-67 index. Palliative carboplatin-etoposide was started, but the patient died after two cycles. DISCUSSION: This case highlights that unilateral tonsillar enlargement may rarely represent metastatic lung cancer, particularly in the appropriate clinical context and advanced disease. Histopathology with immunohistochemistry is essential to distinguish metastatic SCLC from primary tonsillar malignancy. Early otolaryngologic assessment and biopsy remain the key diagnostic steps in this rare presentation.
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42342524
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AIMS: Parotidectomy is a common surgery to treat parotid neoplasms. While much discussion has been invested in complications such as facial nerve injury and Frey syndrome, outcomes arising from great auricular nerve (GAN...AIMS: Parotidectomy is a common surgery to treat parotid neoplasms. While much discussion has been invested in complications such as facial nerve injury and Frey syndrome, outcomes arising from great auricular nerve (GAN) sacrifice are not well studied. The present study aims to investigate quality of life outcomes post-parotidectomy according to GAN preservation status. MATERIALS AND METHODS: A cross-sectional study of parotidectomy patients between 2011-2020 for benign tumours was performed. Data on quality of life (QoL) was collected through a composite questionnaire (Douleur Neuropathique 4 [DN4] and Leeds Assessment of Neuropathic Symptoms and Signs [LANSS]). OBJECTIVES: To assess patient quality of life post-parotidectomy according to GAN preservation status. RESULTS: Among the contacted patients, 76/205 (37.1%) responded. Of these, 38/76 were categorised as GAN-preserved, 34/76 as GAN-sacrificed and 4/76 were excluded as GAN status could not be ascertained. All patients were >6months post-operation. On a scale of 0-10, for pain, the mean values were 2.21/10 (GAN-sacrificed) and 1.32/10 (GAN-preserved) (P=0.645), and for numbness 4.47/10 (GAN-sacrificed), and 4.34/10 (GAN-preserved) (P=0.645). The angle of mandible was the most reported area for neuropathic sensations (42.1% (16/38) of GAN-preserved; 50.0% (17/34) of GAN-sacrificed). Tingling sensation was the most frequent sensation described. On a scale of 0-10 for effect on general QoL, the mean was 1.08/10 for GAN-preserved, and 1.62/10 GAN-sacrificed cohort (P=0.29). No statistical differences for specific QoL measures were found. CONCLUSION: Our results suggest that GAN sacrifice is not associated with increased sensory defects and does not negatively impact on quality of life. LEVEL OF EVIDENCE: III.
Khidichian H, Simon F, Leboulanger N
… +3 more, Couloigner V, Denoyelle F, Loundon N
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42297641
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OBJECTIVE: To report anatomical and functional results and predictive factors for failure of myringoplasty in children under 6 years of age. MATERIAL AND METHODS: Retrospective study of myringoplasty for tympanic membran...OBJECTIVE: To report anatomical and functional results and predictive factors for failure of myringoplasty in children under 6 years of age. MATERIAL AND METHODS: Retrospective study of myringoplasty for tympanic membrane perforation in children under 6 years of age with at least 2 years' follow-up. Anatomic and audiological results were evaluated before surgery, at 6 weeks (short-term), 12 months (medium-term) and 24 months (long-term). Predictive factors for failure were analyzed. RESULTS: Forty-seven myringoplasties were included, with a mean patient age of 4.7±0.4 years. Thirty-nine received underlay grafts and 8 received inlay grafts. The rate of success (tympanic closure, and no otitis media with effusion, myringitis of tympanic retraction) at 6 weeks was 77%, and 70% at 24 months: 79% for underlay and 25% for inlay techniques (P=0.005). Audiometric thresholds improved significantly, with 96% of patients with air-bone gap≤20dB at 12 months after surgery, compared to 57% before (P=0.002). No risk factors for failure were identified, except use of inlay. CONCLUSION: Myringoplasty performed before the age of 6 yielded satisfactory anatomic and functional results, comparable to other pediatric series across all age groups. The underlay cartilage graft technique provided the best long-term outcomes.
Saroul N, Petersen JE, Lambert C
… +7 more, Massoubre J, Marianowski R, Puechmaille M, Mondain M, Gilain L, Mom T, Akkari M
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42288468
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OBJECTIVE: A video score applied to polysomnography recordings for diagnosing pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) was previously described. Given the accessibility of smartphone home sleep video r...OBJECTIVE: A video score applied to polysomnography recordings for diagnosing pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) was previously described. Given the accessibility of smartphone home sleep video recordings (HSVR), this study aimed to assess the reliability of an HSVR-based scoring system for pediatric OSAHS diagnosis. METHODS: We conducted a prospective multicenter clinical trial. Children suspected of OSAHS without comorbidities underwent respiratory polygraphy (RP). Within four days before or after RP, parents recorded a 10-minute HSVR, marking the minute they perceived as worst for obstructive sleep-disordered breathing symptoms. A 10-minute (VS10) and 1-minute (VS1) video score were established using seven parameters and compared to clinical examination, a sleep questionnaire, and the obstructive-apnea-hypopnea index (OAHI) from RP. The STROBE guidelines were followed. RESULTS: Fifty-six children (mean age: 5.1±1.6 years) were included. The VS10 (n=53) diagnosed OSAHS with an Area Under the Curve (AUC) of 0.76 (95% CI: 0.61-0.90) and moderate-to-severe OSAHS with an AUC of 0.85 (95% CI: 0.74-0.97). The VS1 (n=26) diagnosed OSAHS with an AUC of 0.71 (95% CI: 0.46-0.96) and moderate-to-severe OSAHS with an AUC of 0.81 (95% CI: 0.64-0.99). CONCLUSION: A smartphone HSVR-based video score shows promise for detecting OSAHS in children. Further studies with pre- and post-intervention comparisons could enhance its clinical utility.
Tuset MP, Daval M, Levy D
… +3 more, Nekrouf C, Ayache D, Gargula S
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 Jun · PMID 42251020
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OBJECTIVE: Linguistic and psychometric validation of the French version of the COSI questionnaire (Client-Oriented Scale of Improvement) assessing perceived improvement with hearing aids. METHODS: A single-center prospec...OBJECTIVE: Linguistic and psychometric validation of the French version of the COSI questionnaire (Client-Oriented Scale of Improvement) assessing perceived improvement with hearing aids. METHODS: A single-center prospective study was conducted in 100 patients with hearing aids (NCT06108609). They filled out the COSI and IOI-HA questionnaires (International Outcome Inventory for Hearing Aids). COSI is a free-choice questionnaire in which the respondent chooses 5 out of 16 items corresponding to the main auditory problems. Psychometric analysis followed the COSMIN guidelines. Test-retest reliability was assessed on intra-class correlation coefficient (ICC) in 36 patients. Correlations between COSI subscores and between COSI and global IOI-HA score were assessed. RESULTS: Median COSI subscores were 3.8 [IQR: 3.2-4.2] for "degree of change" and 3.6 [IQR: 3.0-4.2] for "final ability". Internal consistency was good, with Cronbach alpha 0.76 and 0.79 respectively. ICC was 0.68 (95% CI: 0.45-0.82) for "degree of change" and 0.81 (95% CI: 0.66-0.90) for "final ability". There was a strong correlation between the 2 subscores: r=0.73 (95% CI: 0.62-0.81); P<0.001 There were moderate positive correlations between COSI and IOI-HA scores: r=0.59 and r=0.63; P<0.001. CONCLUSION: The French version of the COSI questionnaire showed satisfactory psychometric properties. Its reliability, internal consistency and clinical relevance are sufficient for inclusion in everyday practice for personalized evaluation of hearing aids.
Gatignol P, Fauvet C, Baverel L
… +2 more, Lannadere E, Picard D
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 May · PMID 42209391
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This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to explore diagnostic errors in peripheral facial palsy in adults and their impact on medical and paramedical care. Four databas...This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to explore diagnostic errors in peripheral facial palsy in adults and their impact on medical and paramedical care. Four databases were used to collect 303 articles, 23 of which, published between 2015 and 2024, were analyzed using the CARE grid for case studies and the JBI grid for case series. Fifty cases of diagnostic error were identified. A tumor was found to be the cause in 56% of cases that were initially identified as Bell's palsy. The results of this meta-analysis show that symptoms that come on gradually are linked to longer time to diagnosis (P=0.04). Furthermore, time to diagnosis was significantly longer (P=0.04) when the final diagnosis was a tumor. The results also highlight the importance of detailed clinical and medical assessment, particularly for women, who are consistently diagnosed later than men despite presenting the same symptoms. The challenge of diagnosis by exclusion is highlighted by the diversity of etiologies, but is essential before a diagnosis of Bell's palsy can be established. Healthcare professionals must be vigilant in case of atypical developments in peripheral facial palsy, as such cases can be complex and require careful monitoring. Paramedical professionals also play a key role in alerting the medical profession when the progression of the disorder does not correspond to the typical clinical picture.
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 May · PMID 42173711
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The term "Jael syndrome" is a symbolic analogy referring to penetrating craniofacial trauma caused, intentionally or accidentally, by blade or similar weapon in which the foreign body is kept in-situ during initial manag...The term "Jael syndrome" is a symbolic analogy referring to penetrating craniofacial trauma caused, intentionally or accidentally, by blade or similar weapon in which the foreign body is kept in-situ during initial management. It is rare in clinical and medicolegal practice, but is potentially life-threatening or with neurologic and functional impact. Its name comes from an episode in the Book of Judges in the Hebrew Bible (Old Testament) in which Jael, a woman, kills the Canaanite general Sisera by hammering a tent peg through his temple while he is asleep, thus ensuring the liberation of the people of Israel. Over the centuries, the story had an enduring influence on the European artistic and cultural imagination, with numerous paintings, sculptures, musical and literary compositions memorializing the symbolic power of a unique act of violence. Artists such as Abraham Godyn and Artemisia Gentileschi, baroque sculptors, composers such as Georg Friedrich Haendel and French writers such as Victor Hugo gave the figure of Jael a lasting place in our cultural heritage. In medicine, the first description of a penetrating craniofacial injury with the foreign body in-situ was by Geoffrey Jefferson, a British neurosurgeon, in the mid-20th century, who reported a case of orbitocranial impalement. Subsequently, a few rare cases mainly involved isolated case reports or retrospective series, with consequently low levels of evidence for optimal management. Via a present-day case of penetrating facial trauma involving an arrow, this article reviews diagnostic and therapeutic issues in Jael syndrome. The case illustrates the importance of management in a well-equipped tertiary referral center with specialized medical-surgical multidisciplinary teamwork. Management is based on fundamental principles: systematized initial clinical assessment using the ABCDE (ATLS®) algorithm; not moving or removing the foreign body during the initial stage; early protection of the airway and vascular system; and adapted imaging, ideally by head-and-neck CT angiography. Current strategies favor personalized, selective management based on clinical examination, lesion topography and hemodynamic stability, rather than systematic surgical exploration. However, multicenter prospective studies are needed to refine guidelines, notably by integrating advanced imaging and minimally invasive techniques in order to improve functional prognosis in these rare but high-risk trauma.
Marécaux C, Poncelet M, Bonhomme O
… +1 more, Lagier A
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 May · PMID 42173710
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OBJECTIVES: The course of chronic obstructive pulmonary disease (COPD) features episodic exacerbation, contributing to severity. The present study assessed associations between COPD, dysphonia and dysphagia. Laryngeal as...OBJECTIVES: The course of chronic obstructive pulmonary disease (COPD) features episodic exacerbation, contributing to severity. The present study assessed associations between COPD, dysphonia and dysphagia. Laryngeal aspiration is a risk factor for repeated exacerbation of COPD. Certain risk factors are common to COPD and laryngeal pathology; dyspnea impairs phonation and swallowing. MATERIAL AND METHODS: This prospective study included 29 patients with group E COPD outside of exacerbation episodes, and free of neurodegenerative disease and history of head and neck cancer. Phonation and swallowing were assessed concomitantly. ENDPOINTS: The main study endpoint was the prevalence of phonation and swallowing disorders in severe COPD. The secondary objective was to determine whether vocal disorder is a marker of dysphagia in patients at risk of respiratory infection. RESULTS: Prevalence of dysphonia and dysphagia was high on objective assessment but underestimated in self-reports. More than 50% of patients showed deficits in at least 1 mechanism of swallowing, and notably delayed triggering of the pharyngeal reflex. Only the s/z ratio was significantly associated with dysphagia. CONCLUSION: Dysphagia and dysphonia are frequent and underestimated in severe COPD. The present study argues for systematic objective screening of swallowing disorder, even in the absence of complaint or dysphonia.
Celik B, Gul F, Serifler S
… +6 more, Bulut KS, Locatello LG, Gorphe P, Kerawala C, Leemans CR, Babademez MA
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 May · PMID 42161673
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OBJECTIVE: To investigate current surgical margin assessment strategies, intraoperative frozen section (FS) use, and the interpretation of dysplasia and carcinoma in situ (CIS) among European academic head and neck surge...OBJECTIVE: To investigate current surgical margin assessment strategies, intraoperative frozen section (FS) use, and the interpretation of dysplasia and carcinoma in situ (CIS) among European academic head and neck surgeons. METHODS: A cross-sectional, web-based survey was distributed to head and neck surgeons in 17 European countries between June 5 and July 10, 2025. The 20-item questionnaire, structured into four domains, examined FS use, margin definitions, pathology access, and intraoperative imaging. Descriptive analysis was applied. RESULTS: Most respondents (92.3%) routinely used FS during oral cavity resections. Tumor bed sampling was preferred over main specimen sampling (64.1% vs. 35.8%), mainly to reduce sampling error (40.1%) and based on clinical experience (36.7%). A ≥5mm cutoff was the most accepted threshold for negativity (77.7%). CIS was considered a positive margin by 88% of participants, while interpretation of dysplasia varied. Only 42.7% reported access to a dedicated head and neck pathologist. Despite this, 94.8% expressed willingness to adopt intraoperative imaging modalities if proven effective. CONCLUSION: This multi-country European survey among predominantly academic head and neck surgeons highlights both consensus and variability in surgical margin assessment. While FS remains widely practiced, significant differences persist in interpreting dysplasia and FS-guided margin conversion. These findings stress the need for standardized guidelines. Future prospective studies should validate margin thresholds and investigate the value of emerging intraoperative imaging technologies to improve oncologic outcomes.
Geoffroy M, Alibert F, Fadel M
… +2 more, Samimi M, Boucher S
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 May · PMID 42128698
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INTRODUCTION: Standard treatment for locoregional (stages I-III) Merkel cell carcinoma (MCC) includes wide local excision (WLE) with lymph node management. However, the optimal surgical approach remains debated, especial...INTRODUCTION: Standard treatment for locoregional (stages I-III) Merkel cell carcinoma (MCC) includes wide local excision (WLE) with lymph node management. However, the optimal surgical approach remains debated, especially in the head and neck, where extensive excision may impair function and aesthetics, affecting patients' health-related quality of life (HR-QoL), and delay postoperative radiotherapy (RT). OBJECTIVE: This systematic review aimed to evaluate the impact of surgical excision modalities - including surgical margins, Mohs micrographic surgery (MMS), and histological resection status - on recurrence and survival outcomes in head and neck MCC (HN-MCC). Secondary objectives included assessing morbidity and HR-QoL. MATERIALS AND METHODS: A systematic search of Medline, Embase, and Web of Science identified studies on HN-MCC surgical treatments. Studies were categorized into a narrative review and an individual descriptive analysis of cases. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment. RESULTS: A total of 43 studies were included: 9 cohort studies, 10 case series, and 24 case reports. No randomized clinical trials were found. No superior technique was identified between MMS and WLE. No studies showed a statistical link between surgical margin categories or histological resection status and local control or survival outcomes. None of the cohort and case series studies reported data on HR-QoL in patients with HN-MCC. CONCLUSION: Significant heterogeneity in available data limits definitive recommendations on surgical approaches for HN-MCC.
Moya-Plana A, Khalaf M, Casiraghi O
… +16 more, Baujat B, Costes-Martineau V, de Gabory L, Digue L, Even C, Dupin C, Righini C, Rumeau C, Michel J, Radulesco T, Thariat J, Vergez S, Vérillaud B, NGuyen F, de Kermadec H, Robert C
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 May · PMID 42106208
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AIMS: The authors present the guidelines of the REFCOR (French Rare Head-and-Neck Cancer Expert Network) for sinonasal mucosal melanoma. METHODS: A multidisciplinary working group made a systematic review of the literatu...AIMS: The authors present the guidelines of the REFCOR (French Rare Head-and-Neck Cancer Expert Network) for sinonasal mucosal melanoma. METHODS: A multidisciplinary working group made a systematic review of the literature. The formalized expert consensus methodology was followed in drawing up recommendations, which were presented according to the degree of agreement between members of the review group. RESULTS: Strong agreement: it is recommended to perform systematic regional and remote extension assessment at diagnosis; PET-CT is the gold standard for remote assessment; isolated radiotherapy is not recommended for curative treatment; given the major risk of metastasis and the poor prognosis, alternatives to heavy destructive surgery should be considered in the rare cancer multidisciplinary tumor board; it is recommended to screen for NRAS, BRAF and KIT mutations, to identify possible treatment targets; reference imaging should be performed 3 months after end of treatment, using sinonasal and brain MRI and PET-CT; due to the risk of early recurrence, close follow-up is recommended during the first 2 years, then at least every 6 months up to 5 years postoperatively. Relative agreement: operable sinonasal mucosal melanoma should be treated by total macroscopic resection with negative margins followed by radiotherapy on the tumor bed; postoperative radiotherapy is recommended, to improve local control; neoadjuvant or adjuvant chemotherapy, other than immunotherapy or targeted therapy, is not recommended; for non-resectable and/or metastatic sinonasal mucosal melanoma, immunotherapy is the systematic first-line treatment; prophylactic lymph-node treatment is not recommended in N0 sinonasal mucosal melanoma; lymph-node surgery is recommended in N+ cases without remote metastasis, including cases of regional recurrence.
de Gabory L, Monnot C, Baglin AC
… +15 more, Baujat B, Coste-Martineau V, de Bonnecaze G, Digue L, Dupin C, Even C, Ferrand FR, Michel J, Moya-Plana A, Radulesco T, Thariat J, Vergez S, Vérillaud B, Kérimian M, Rumeau C
Eur Ann Otorhinolaryngol Head Neck Dis
· 2026 May · PMID 42106207
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INTRODUCTION: Since 2009, management of sinonasal adenocarcinoma (ADK) was governed by general guidelines. The present paper presents an update. METHOD: The formalized expert consensus methodology was applied. A literatu...INTRODUCTION: Since 2009, management of sinonasal adenocarcinoma (ADK) was governed by general guidelines. The present paper presents an update. METHOD: The formalized expert consensus methodology was applied. A literature analysis for the period 2009-2020 in the PubMed and Cochrane Library databases selected 60 studies meeting the PRISMA criteria. Eighteen recommendations were drawn up and validated. RESULTS: For T1 and T2N0M0 intestinal ADK and low-grade non-intestinal ADK, isolated surgery with negative margins is recommended (Relative agreement). For pT2 and pT3N0M0 intestinal ADK with negative resection margins, tumor-board discussion of adjuvant radiotherapy is recommended (Relative agreement). Complete resection with negative margins followed by radiotherapy to the tumor bed is the curative treatment for T4N0M0 intestinal ADK (Strong agreement) and N0M0 high-grade non-intestinal ADK of whatever stage (Relative agreement). Prophylactic cervical lymph-node treatment is not recommended in N0 sinonasal ADK (Relative agreement). CONCLUSION: The present update defines specific recommendations for this histologic family.