This Week in Otolaryngology — Jul 2, 2026

Welcome to This Week in Otolaryngology. This week we are covering ten notable papers spanning three broad themes: advances in head and neck oncology and reconstruction, airway reconstruction and safety protocols, and key clinical updates in general otolaryngology, rhinology, and pediatric practice. Let us dive in.

We begin with a series of crucial studies in head and neck oncology that focus on optimizing surgical margins, wound healing, and reconstructive success. Achieving clear surgical margins is one of the most critical prognostic factors in oral cavity squamous cell carcinoma, yet the rate of close or compromised margins remains a persistent challenge. Writing in the journal Head and Neck, Kohler and colleagues conducted a large-scale retrospective review of over nineteen hundred treatment-naive patients to identify what clinical and surgical factors predict these compromised margins, defined as five millimeters or less [5]. Out of nineteen hundred thirteen patients, ten and a half percent had close or compromised margins. The researchers identified several key preoperative predictors that significantly increased this risk, including relying on physical examination alone for clinical staging, having clinical T3 or T4 disease, and utilizing a single-team approach for both the tumor resection and the subsequent reconstruction. In the postoperative setting, pathological features such as bone invasion and the worst pattern of invasion were also strongly associated with compromised margins. These findings deliver a powerful clinical message: to maximize the likelihood of clear margins, we must avoid relying solely on physical exams for staging and instead employ comprehensive imaging, while also prioritizing a two-team surgical approach where one team focuses on clearance and another on reconstruction.

Once a resection is complete, the focus shifts to wound healing and reconstructive outcomes, particularly when patients have undergone neoadjuvant therapies. Also in Head and Neck, Wang and colleagues evaluated the safety and impact of neoadjuvant immunochemotherapy on postoperative wound healing in patients with locally advanced oral squamous cell carcinoma [3]. In a retrospective cohort of four hundred sixty-six patients, they compared two hundred seventy-eight who received neoadjuvant immunochemotherapy to one hundred eighty-eight who underwent upfront surgery. To ensure a rigorous comparison, they performed a propensity score matching analysis, yielding one hundred forty-five balanced patient pairs. Surprisingly, the incidence of major wound complications, defined as Clavien-Dindo grade three or higher within ninety days postoperatively, was significantly lower in the neoadjuvant group at fifteen percent, compared to nearly twenty-five percent in the upfront surgery group. Furthermore, upfront surgery was found to be an independent predictor of major wound complications, more than doubling the risk. Patients in the neoadjuvant group also experienced a shorter time to complete wound healing, a shorter median hospital stay of ten days compared to twelve, and a lower rate of delays in starting adjuvant therapy. This suggests that neoadjuvant immunochemotherapy is not only oncologically viable but may actually improve the local tissue microenvironment or tumor burden in a way that facilitates safer, faster postoperative healing.

To further optimize reconstructive success, we must also examine our postoperative medical protocols, particularly regarding deep vein thrombosis prophylaxis. A multicenter retrospective study published in the American Journal of Otolaryngology analyzed the impact of pharmacologic deep vein thrombosis prophylaxis on free flap outcomes across sixty-eight healthcare organizations in the United States [2]. The study included patients undergoing either non-bony or bony free flap reconstructions for head and neck cancer. When looking at chemoprophylaxis administered on the same day of surgery, there was no significant difference in flap failure, the need for blood vessel repair, or flap revision. However, when looking at the postoperative period, patients who did not receive pharmacologic prophylaxis had a significantly higher risk of flap failure and flap revision. Specifically, for non-bony reconstructions, patients without postoperative prophylaxis experienced a significantly higher rate of flap failure and revision, and a matching significant increase in risk was seen for bony reconstructions. These findings strongly suggest that postoperative pharmacologic deep vein thrombosis prophylaxis should be routinely implemented, as it not only protects against systemic thromboembolism but is also associated with a significant reduction in microvascular flap complications and flap failure.

Finally, in the oncology domain, we must consider the prognostic implications of surgical margins when treating metastatic cutaneous squamous cell carcinoma to the parotid gland. In a study published in Head and Neck, Mendis and colleagues analyzed a large cohort of two hundred ninety-one patients to evaluate the impact of margin status [10]. While previous literature suggested that microscopically involved margins on the facial nerve might not compromise survival if managed with a nerve-sparing approach and adjuvant radiotherapy, this expanded analysis revealed a more sobering reality. An involved parotid nodal margin was associated with significantly worse regional control, worse distant control, and worse disease-specific survival. After adjusting for confounding factors, patients with an involved margin had a one hundred fourteen percent higher risk of disease-specific death, representing a more than doubled hazard ratio. This highlights that achieving a microscopically clear margin remains paramount in parotid metastatic disease, and clinicians must carefully weigh the decision to spare critical anatomic structures when it comes at the cost of leaving microscopically positive margins.

Moving on to our second theme, we address patient selection and operating room safety in airway surgery. Open airway reconstruction, such as cricotracheal or tracheal resection, is a highly effective but morbid procedure, and surgeons often worry about how patient comorbidities, particularly obesity, affect recovery. In a retrospective study published in The Laryngoscope, Bertoni and colleagues evaluated the association between body mass index and postoperative outcomes in ninety-three adults undergoing tracheal or cricotracheal resection [9]. Within this cohort, seventy percent of patients were overweight or obese, including over twelve percent with class two or class three obesity. Despite these high rates, the researchers found no significant association between body mass index and overall complications, which stood at roughly thirty-nine percent across the entire cohort. There were also no significant differences in intensive care unit length of stay, total hospital stay, or specific complications such as hematoma, dehiscence, restenosis, or death. The only variable significantly associated with postoperative complications was the length of the airway segment resected. This provides strong reassurance that an elevated body mass index alone is not associated with adverse outcomes and should not be considered a contraindication to open airway reconstruction.

While patient selection is reassuringly broad, the intraoperative environment during airway surgery requires strict vigilance, particularly when using lasers. A Best Practice review in The Laryngoscope by Lahiff and colleagues synthesizes evidence-based strategies to mitigate the uniquely high risk of operating room fires during airway laser surgery [4]. Because these procedures bring together endotracheal tubes, surgical materials, oxygen-enriched environments, and laser ignition sources in the upper aerodigestive tract, the risk of fire is elevated. The authors emphasize several critical safety precautions, including optimizing the selection and preparation of the endotracheal tube, strictly controlling and minimizing the concentration of oxidizers like oxygen and nitrous oxide, delivering laser energy with meticulous care, and establishing clear, team-based protocols for immediate fire prevention and emergency response. Adhering to these structured safety guidelines is essential for every airway surgeon to prevent catastrophic intraoperative events.

Our final theme covers diverse but highly practical updates across rhinology, laryngology, and pediatric otolaryngology. We begin with a potentially practice-changing study in JAMA Otolaryngology-Head and Neck Surgery by Lechien and colleagues, which compared a strict diet and lifestyle program against three conventional medical therapies for the management of laryngopharyngeal reflux disease [1]. In a retrospective analysis of one hundred forty-five patients with an objective diagnosis confirmed by twenty-four-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing, patients were treated with either a strict antireflux diet combined with stress reduction, alginates, antacids, or proton pump inhibitors. At three months, all groups showed significant improvements in reflux symptom and sign scores. However, the diet and lifestyle group achieved significantly lower symptom scores than the antacid group and boasted the highest proportion of clinical responders at over eighty-one percent. In comparison, the response rate was fifty-six percent for proton pump inhibitors, fifty-eight percent for alginates, and seventy-four percent for antacids. This represents a substantial clinical benefit for a non-pharmacologic approach, suggesting that a structured diet and lifestyle intervention can be as effective, if not more effective, than traditional medications, and should be strongly advocated as a first-line therapy.

In rhinology, repairing nasal septal perforations is notoriously difficult, but endoscopic techniques continue to evolve. A systematic review in The Laryngoscope by Shah and colleagues evaluated the efficacy of the anterior ethmoidal artery flap for nasal septal perforation repair [7]. Analyzing sixteen studies that included two hundred forty-nine pediatric and adult patients, they found that the original anterior ethmoidal artery flap achieved an overall successful closure rate of eighty-four and a half percent for perforations smaller than two and a half centimeters. Interestingly, there was no statistically significant difference in closure rates between patients who received an interposition graft, such as cartilage or dermal matrices, and those who did not, with success rates remaining high at roughly eighty-four percent and eighty-five percent respectively. This demonstrates that the anterior ethmoidal artery flap is a highly reliable, robust endoscopic reconstructive option that does not strictly require an additional interposition graft to achieve excellent results.

In pediatric otolaryngology, the management of infected preauricular sinuses has long been subject to debate. The traditional clinical paradigm recommends treating active infections with antibiotics and delaying surgical excision until the inflammation has completely resolved, under the assumption that hot excisions carry a higher risk of recurrence. However, a ten-year retrospective cohort study in the International Journal of Pediatric Otorhinolaryngology by Nicholson and Levi challenged this dogma [8]. Reviewing seventy-six sinus excisions, they found no significant difference in recurrence rates between patients undergoing elective delayed surgery and those undergoing single-stage emergency excision during an active infection. Furthermore, microbiological analysis revealed that over three-quarters of cases involved multiple organisms, with anaerobes, Staphylococcus aureus, and upper respiratory tract flora being the most common. These findings suggest that single-stage excision of actively infected preauricular sinuses is a safe and viable option that does not compromise long-term outcomes, and the authors advise incorporating anti-anaerobic antimicrobials into the treatment regimen when managing these infections.

Finally, we highlight a State of the Art Review in Otolaryngology-Head and Neck Surgery by Alter and colleagues, which compiled evidence on gender-affirming care within our specialty [6]. Reviewing eighty-three clinical studies, the authors found that both surgical and non-surgical interventions for the face and voice yield high patient satisfaction, objective improvements in vocal frequency, and enhanced quality of life for transgender and gender nonconforming individuals. However, the review also highlights that patient access to these life-changing services remains severely limited by high costs, lack of insurance coverage, and a shortage of qualified providers, underscoring a critical area where otolaryngologists can lead in advocacy, education, and clinical service expansion.

If you only have time for one paper this week, make it the study by Lechien and colleagues in JAMA Otolaryngology-Head and Neck Surgery comparing diet and lifestyle modifications to medical therapies for laryngopharyngeal reflux disease [1]. This study provides compelling, objective evidence that a structured antireflux diet and stress reduction can achieve an eighty-one percent clinical response rate, outperforming standard medications like proton pump inhibitors and alginates, and offering us a highly effective, non-pharmacologic primary treatment strategy for our patients.

Here are the key takeaways from this week in Otolaryngology. First, for patients with laryngopharyngeal reflux, a structured diet and stress-reduction program should be prioritized as a first-line therapy, as it can achieve clinical response rates exceeding eighty percent, outperforming proton pump inhibitors and alginates. Second, when planning oral cavity cancer resections, utilizing a two-team surgical approach and comprehensive preoperative staging significantly reduces the risk of close or compromised margins. Third, postoperative pharmacologic deep vein thrombosis prophylaxis in head and neck free flap patients is associated with a lower rate of flap failure and revision, whereas administration on the day of surgery does not affect these outcomes. Fourth, single-stage emergency excision of actively infected preauricular sinuses is safe and does not increase recurrence rates compared to delayed elective surgery, and empiric antibiotics should cover anaerobic organisms. Finally, elevated body mass index is not associated with increased complications or longer hospital stays after open tracheal or cricotracheal resection, meaning obesity should not be a contraindication to these procedures.

That's your roundup for This Week in Otolaryngology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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