Highlights d A systematic inventory of HNSCC-associated proteins, phosphosites, and pathways d Three multi-omic subtypes linked to targeted treatment approaches and immunotherapy d Widespread deletion of immune modulatory genes accounts for loss of immunogenicity d Two modes of EGFR activation inform response to anti-EGFR monoclonal antibodies

We present a case of an 83-year-old male without previous history who presented with a cervical hematoma, initially misdiagnosed as a neck phlegmona. In the course of the diagnostic workup, the hematoma enlarged, thereby causing respiratory distress because of upper airway compromise. The endotracheal intubation was lifesaving. Later, contrast enhanced computed tomography revealed hematoma in the region of the left common carotid artery. Emergency surgery evacuated the hematoma and repaired a slit-like defect of the left common carotid 2 cm before bifurcation. The patient was discharged on the seventh postoperative day in good condition. We discuss four aspects of the case, namely, the rarity of the condition and the variety of causes, the diagnostic and treatment strategy, the uncertain reasons for spontaneous ruptures of the carotid, and the operative techniques for hematoma evacuation and definitive hemostasis. The optimal strategy for cases of cervical hematoma is the following: intubation, diagnosis, and surgery.

Adequate reconstruction of defects that are consequences of glossectomy is of primary importance for achieving satisfactory functional results and improving the quality of life. AIM: The aim of this study was to report a case of free fl ap reconstruction of a subtotal glossectomy defect and discuss it in relation to other available methods. CASE REPORT: A 48-year-old woman was operated on for a T4N0M0 squamous cell carcinoma of the tongue. A subtotal glossectomy via mandibular swing procedure with bilateral supraomohyoid neck dissection and reconstruction with a radial forearm free fl ap (RFFF) was performed. Surgery was followed by adjuvant radiotherapy. RESULTS: The post-operative period was uneventful. The patient resumed intelligible speech evaluated as "excellent" and oral feeding. The donor site morbidity was acceptable. Present reconstructive options of the tongue include two categories: to maintain mobility or to provide bulk. In glossectomy with 30 to 50 percent preservation of the original musculature, maintaining the mobility of the remaining tongue by a thin, pliable fl ap is preferred. This can be achieved by infrahyoid myofascial, medial sural artery perforator fl ap, RFFF, anterolateral thigh and ulnar forearm fl ap. When the post-resectional volume is less than 30 percent of the original tongue, the reconstruction shifts to restoration of bulk to facilitate swallowing by providing contact of the neotongue with the palate. Flaps providing bulk include the free TRAM fl ap, latissimus dorsi myocutaneous free fl ap, pectoralis major musculocutaneous fl ap and trape ius island fl ap. CONCLUSION: Surgical treatment of advanced tongue cancer requires adequate reconstruction with restoration of speech, swallowing and oral feeding. Free tissue transfer seems to achieve superior functional results with acceptable donor site morbidity when indicated.

No abstract

No abstract