Head and neck squamous cell carcinomas (HNSCCs) are highly aggressive, multi-factorial tumors in the upper aerodigestive tract affecting more than half a million patients worldwide each year. Alcohol, tobacco, and human papillomavirus (HPV) infection are well known causative factors for HNSCCs. Current treatment options for HNSCCs are surgery, radiotherapy, chemotherapy, or combinatorial remedies. Over the past decade, despite the marked improvement in clinical outcome of many tumor types, the overall 5-year survival rate of HNSCCs remained ∼40–50% largely due to poor availability of effective therapeutic options for HNSCC patients with recurrent disease. Therefore, there is an urgent and unmet need for the identification of specific molecular signatures that better predict the clinical outcomes and markers that serve as better therapeutic targets. With recent technological advances in genomic and epigenetic analyses, our knowledge of HNSCC molecular characteristics and classification has been greatly enriched. Clinical and genomic meta-analysis of multicohort HNSCC gene expression profile has clearly demonstrated that HPV + and HPV - HNSCCs are not only derived from tissues of different anatomical regions, but also present with different mutation profiles, molecular characteristics, immune landscapes, and clinical prognosis. Here, we briefly review our current understanding of the biology, molecular profile, and immunological landscape of the HPV + and HPV - HNSCCs with an emphasis on the diversity and heterogeneity of HNSCC clinicopathology and therapeutic responses. After a review of recent advances and specific challenges for effective immunotherapy of HNSCCs, we then conclude with a discussion on the need to further enhance our understanding of the unique characteristics of HNSCC heterogeneity and the plasticity of immune landscape. Increased knowledge regarding the immunological characteristics of HPV + and HPV - HNSCCs would improve therapeutic targeting and immunotherapy strategies for different subtypes of HNSCCs.

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Fiddler's neck is a common dermatologic condition associated with instrument use in violin and viola players. It typically manifests as a submandibular and/or supraclavicular lesion. It is a benign condition, but it may be mistaken for lymph-edema or a salivary gland malignancy. Otolaryngologists who treat patients with fiddler's neck should be aware of appropriate management protocols and the need to avoid surgical excision. We obtained informed consent from 3 violinists to present their cases as specific examples of fiddler's neck. In addition, we present a literature review based on our PubMed search for articles about this instrument-induced dermatitis. The literature suggests that submandibular fiddler's neck is caused by mechanical pressure and shear stress on the skin and that it can present as erythema, scarring, edema, and lichenification. Supraclavicular fiddler's neck, on the other hand, is caused by allergic contact dermatitis, and it can present as an eczematous, scaly, and/or vesicular lesion. In most cases, a good history (especially of string instrument use), physical examination, and a patch test are sufficient to diagnose this condition. Management of fiddler's neck includes a topical steroid, proper instrument handling, neck padding, changing the instrument's materials, and/or reducing the amount of playing time. Surgical excision is usually not advisable.

Although the image quality from modern distal chip endoscopes is superior, limited mobility of the endoscopic tower prevents this technology from being used in inpatient and emergency departments. In these settings, otolaryngologists commonly use older flexible laryngoscopes with portable light sources. However, these light sources could malfunction. Smartphones are ubiquitous nowadays, and the smartphone’s flashlight may be used alternatively to provide illumination when primary light malfunctions. This study compares the ability of flashlights from various smartphone models in providing adequate illumination for flexible laryngoscopy when compared to a commercially available portable light source. White wall and mucosal images were captured using Olympus P4 flexible scope and lights from the Stryker X8000 endoscopy tower light source, Storz 11301D3 portable light source (control), iPhone 4, iPhone 6, iPhone 8, iPhone X, Galaxy S6, and Galaxy S7. ImageJ was used to quantify pixel intensities with white and black standardized as 250 and 0, respectively. Student 2-tailed t test was used for analysis. The endoscopic tower outperformed all other light sources in all categories. The iPhone 4 and iPhone 6 consistently underperformed in comparison to the Storz 11301D3 portable light source ( P < .05). Galaxy S6, Galaxy S7, and newer generation iPhone 8 and iPhone X provide comparable pixel intensities to Storz 11301D3 portable light. Smartphones incorporate different types of light-emitting diodes. Newer Galaxy and iPhone provide adequate illumination for the endoscopic assessment of the airway when compared to commercially available portable light source. However, one should always utilize the best commercially available light source in nonemergent cases.

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