Free Flap Donor Sites in Head and Neck Reconstruction
Microvascular free tissue transfer, also referred to as free flaps surgery, is a reconstructive technique that has become a foundational component of complex head and neck reconstruction. There have been considerable advancements in the field over the last 30  years including the number and variety of free flaps. Each of these free flaps has unique characteristics that must be considered for the defect when selecting a donor site. Here, the authors focus on the most common free flaps used in head and neck reconstruction. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 10, 2023 Category: ENT & OMF Authors: Akina Tamaki, Chad A. Zender Source Type: research

Oral Cavity Reconstruction
This summary provides a concise overview of oral cavity reconstruction to optimize functional outcomes in the modern era. Soft tissue and osseous reconstruction options for a wide range of oral cavity sites including lip, oral tongue, floor of mouth, buccal, hard palate, and composite oromandibular resections are reviewed. The appropriate applications of primary closure, secondary intention, skin grafts, and dermal substitute grafts are included. Anatomic considerations, indications, contraindications, and complications of local, regional, and free flaps in oral cavity reconstruction are discussed. Specific defects and the...
Source: Otolaryngologic clinics of North America - May 8, 2023 Category: ENT & OMF Authors: Pablo Quadri, Caitlin McMullen Source Type: research

Updates on Tumor Biology in Vestibular Schwannoma
Vestibular schwannomas (VSs) are benign tumors that develop after biallelic inactivation of the neurofibromatosis type 2 (NF2) gene that encodes the tumor suppressor merlin. Merlin inactivation leads to cell proliferation by dysregulation of receptor tyrosine kinase signaling and other intracellular pathways. In VS without NF2 mutations, dysregulation of non-NF2 genes can promote pathways favoring cell proliferation and tumorigenesis. The tumor microenvironment of VS consists of multiple cell types that influence VS tumor biology through complex intercellular networking and communications. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Authors: Aida Nourbakhsh, Christine T. Dinh Source Type: research

Welcome to the Otolaryngologic Clinics of North America, Vestibular Schwannoma Issue
Despite vestibular schwannoma being relatively uncommon, otolaryngologists and neurosurgeons have maintained an enduring fascination with the management of sporadic and NF2-associated vestibular schwannoma. Within the last 100 years, vestibular schwannomas characteristically defined the subspecialties of neurotology and neurologic skull base surgery —supporting refinements in middle and posterior fossa skull base approaches, driving innovation, such as intraoperative cranial nerve monitoring and early adoption of the operating microscope, and fostering the multidisciplinary collaboration that exists today. (Source: Otola...
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Authors: Erika Woodson, Matthew L. Carlson Tags: Preface Source Type: research

Vestibular Schwannoma
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Authors: Erika Woodson, Matthew L. Carlson Source Type: research

Copyright
Elsevier (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Source Type: research

Contributors
SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Source Type: research

Contents
Sujana S. Chandrasekhar (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Source Type: research

Forthcoming Issues
Reconstruction Options in Otolaryngology (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Source Type: research

The Innovative Art of Reconstruction in Otolaryngology
Reconstruction in otolaryngology is an incredibly diverse and complex topic. From tumors, both benign and malignant, to trauma from mechanisms as varied as from motor vehicle crashes to self-inflicted gunshot wounds, the surgical defects necessitating reconstruction are vast. Reconstruction of these defects requires both intimate knowledge of anatomy and thorough understanding of normal physiologic function in order to best achieve rehabilitation of form and function. The techniques used in reconstructive surgery of the head and neck require technical knowledge as well as an ability to adapt, as each reconstruction is uniq...
Source: Otolaryngologic clinics of North America - April 29, 2023 Category: ENT & OMF Authors: Jayne R. Stevens, Kiran Kakarala Tags: Preface Source Type: research

Retrosigmoid Approach for Sporadic Vestibular Schwannoma
The retrosigmoid corridor provides the most broadly applied approach for resection of sporadic vestibular schwannoma. It may be utilized for any size tumor and for patients with intact hearing with the intention of hearing preservation. For larger tumors, the skull base surgeon must weigh the benefits the retrosigmoid approach against those of the translabyrinthine route. For smaller tumors where hearing preservation is a goal, the retrosigmoid approach is contrasted to the middle fossa route. Hearing preservation is most likely for patients with small and medially located intracanalicular tumors with minimal extension int...
Source: Otolaryngologic clinics of North America - April 10, 2023 Category: ENT & OMF Authors: Jacob C. Lucas, Caleb J. Fan, Jeffrey T. Jacob, Seilesh C. Babu Source Type: research

Vestibular Schwannoma: The Current Knowledge
Vestibular schwannoma (VS) is a rare tumor. The incidence of VS in the United States is somewhere between 1.2 and 2.6 cases per 100,000 per year, with a median age at diagnosis of 55 years. Eighty-nine percent of all nerve sheath tumors are schwannomas, and 60% of benign schwannomas are VSs. The incidence of VS diagnosis is increasing as brain MRI scans are done for various reasons, with VS often being found incidentally. When they are symptomatic, they often present with asymmetric or sudden hearing loss, often with tinnitus, due to pressure on the adjacent cochlear nerve in the internal auditory canal. (Source: Otolaryng...
Source: Otolaryngologic clinics of North America - April 5, 2023 Category: ENT & OMF Authors: Sujana S. Chandrasekhar Tags: Foreword Source Type: research

Natural History of Hearing Loss in Sporadic Vestibular Schwannoma
Hearing loss is the most common and earliest symptom of sporadic vestibular schwannoma (VS). The most common pattern of hearing loss is asymmetric sensorineural hearing loss. Throughout its natural history, patients with serviceable hearing (SH) maintain SH at 94% to 95% after 1 year, 73% to 77% after 2 years, 56% to 66% after 5 years, and 32% to 44% after 10 years. For patients newly diagnosed with VS, it is likely their hearing will worsen despite small initial tumor size or lack of tumor growth. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 4, 2023 Category: ENT & OMF Authors: Kaitlyn A. Brooks, Esther X. Vivas Source Type: research

Targeted Therapies in the Treatment of Vestibular Schwannomas: Current State and New Horizons
Vestibular schwannomas continue to cause hearing loss, facial nerve paralysis, imbalance, and tinnitus. These symptoms are compounded by germline neurofibromatosis type 2 (NF2) gene loss and multiple intracranial and spinal cord tumors associated with NF2-related schwannomatosis. The current treatments of observation, microsurgical resection, or stereotactic radiation may prevent catastrophic brainstem compression but are all associated with the loss of cranial nerve function, particularly hearing loss. Novel targeted treatment options to stop tumor progression include small molecule inhibitors, immunotherapy, anti-inflamm...
Source: Otolaryngologic clinics of North America - April 4, 2023 Category: ENT & OMF Authors: D. Bradley Welling Source Type: research

Guiding Patients Through Decision-Making in Management of Sporadic Vestibular Schwannoma
Decision-making in management of sporadic vestibular schwannoma aims to identify the most appropriate options based on tumor characteristics, symptoms, health, and goals for each patient. Advances in knowledge of tumor natural history, improvements in radiation techniques, and achievements in neurologic preservation with microsurgery have shifted emphasis toward maximizing quality of life using a personalized approach. To empower patients to make informed decisions, we present a framework to help match patient values and priorities with reasonable expectations from modern management options. Introduced herein are practical...
Source: Otolaryngologic clinics of North America - April 4, 2023 Category: ENT & OMF Authors: Janet S. Choi, Andrew S. Venteicher, Meredith E. Adams Source Type: research