OBJECTIVE: Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. METHODS: We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. RESULTS: We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. CONCLUCION: Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. LEVEL OF EVIDENCE: How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series).

• Klíčová slova
• Cutaneous squamous cell carcinoma, Elective neck dissection, Elective parotidectomy, Occult metastasis, Skin cancer,
• MeSH
• krční disekce metody   MeSH
• lidé MeSH
• nádory hlavy a krku * chirurgie   patologie   MeSH
• nádory kůže * chirurgie   patologie   MeSH
• nádory příušní žlázy * chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• spinocelulární karcinom * patologie   MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Risk factors for developing osteoradionecrosis (ORN) are well known, but less is known about factors influencing the interval between radiotherapy and the onset of ORN. Also, it is unknown whether there is any specific period post-radiotherapy with a reduced probability of ORN when irradiated teeth require extraction. PURPOSE: The primary aim of this study was to identify factors influencing the interval in developing ORN in the following subgroups of patients: (1) patients who spontaneously developed ORN, (2) surgical-intervention-related ORN with a particular focus on patients after mandibulectomy. The secondary aim was to attempt to identify a possible time for safer dental intervention after primary treatment. MATERIALS AND METHODS: The authors retrospectively analysed 1608 head and neck cancer (HNC) patients treated in a single centre. Time intervals were measured from the end of radiotherapy to the development of ORN and further analysed in the subgroups listed above. RESULTS: In all, 141 patients (8.8%) developed intra-oral ORN. Median time from radiotherapy to ORN development in the whole cohort was 9 months. Median interval for spontaneous ORN was 8 months, 6.5 months for intervention-related ORN, and 15 months for patients post-mandibulectomy. In patients who required dental extraction preradiotherapy, median interval of ORN onset was 5 months. CONCLUSION: In our study, a slightly higher proportion of patients with intervention developed ORN earlier in comparison with spontaneous ORN. The period from 12-18 months after radiotherapy was identified as having the highest probability of developing ORN in patients after mandibulectomy. A time for safer dental intervention after primary treatment was not identified.

• Klíčová slova
• Dental intervention, Head and neck cancer, Osteoradionecrosis, Radiotherapy, Time factors,
• MeSH
• dospělí MeSH
• extrakce zubů * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mandibulotomie MeSH
• nádory hlavy a krku radioterapie   chirurgie   MeSH
• osteoradionekróza * etiologie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The radial forearm free flap (RFFF) is one of the cornerstone of reconstructive microvascular surgery in the head and the neck. It is a fasciocutaneous flap, which is mainly used for free flap reconstructions not only in the head and neck region - for its pliability, long vascular pedicle, predictability and possibility for two teams working synchronously. MATERIAL AND METHODS: In our group analysis, we decided to include and evaluate the data of all patients who were treated at our department between March 2018 to April 2024 with diagnoses that resulted in a soft tissue defect in the head and neck area, which was closed using a microvascular radial forearm flap. RESULTS: In total, in our group of 75 patients in a 6-year period, we used the RFFF for tongue reconstruction, reconstruction of the defects of the floor of the mouth, defects after orbital exenteration, defects in the retromolar area, oropharynx, and midsize cheek defects, temporal, frontal or parotidomasseteric defects. We also use the RFFF as a workhorse to reconstruct midsize defects of the infraorbital region, the lip, the area of the alveolar process of the lower or upper jaws, and the palate. DISCUSSION AND CONCLUSION: From the perspective of overall complications in our group, we performed 75 radial forearm free flaps reconstructions in head and neck region with no flap loss. The RFFF is very reliable free flap, with a very low risk of complications. It should be emphasized that thanks to sufficient venous drainage, supported by including of the cephalic vein into the flap during its harvesting, and by performing at least two venous anastomoses, we did not lose a single radial free flap in our group of patients.

• Klíčová slova
• microvascular free flap, radial forearm free flap, reconstruction, soft tissue head and neck defects,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory hlavy a krku chirurgie   MeSH
• obličej * chirurgie   MeSH
• předloktí MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ústa * chirurgie   MeSH
• volné tkáňové laloky * MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Pedicled flaps are prioritized in the free flap era for reconstruction only in institutions without sufficient microsurgical support. They are reliable for reconstruction, but with a lot of advantage, including cost, operating and hospitalization time, easy learning curve and better management of older and polymorbid patients, not suitable for the free flap reconstruction. The experience from two institutions with various types of pedicled flaps are presented in this retrospective study. MATERIAL AND METHODS: A total of 62 patients were enrolled in this study. With 63 flaps harvested, 1 patient underwent two reconstructions. Operations were performed in two centers. Evaluation of parameters, like age and gender of patients, indication for reconstruction, type and extent of the primary surgery, type of the pedicled flap, the primary or salvage reconstruction, complications of reconstruction and survival of flaps, was included. RESULTS: The median age of this cohort was 64 years (range 30-82 years) with male predominance (53 male to 9 female patients). Five groups of flaps were designed: myocutaneous, myofascial, myomucosal, fasciocutaneous and muscular flaps. Thirteen types of pedicled flaps were utilized. The most frequent flap was the infrahyoid myocutaneous flap (IHMF) in 26 patients, followed by the pectoralis major myocutaneous flap (PMMC) in 14 patients, including 15 flaps. In 1 patient, the second reconstruction was required with harvesting PMMC from the other side. Indications for reconstruction were defects after either primary or salvage surgery in 30 and 32 patients respectively. Reconstructions of the mobile tongue (13 patients) and floor of the mouth (13 patients) with IHMF predominated after primary resection in this area, followed by PMMC (three patients). In a group of defects after salvage surgery, the most frequent reconstructed area was the neck, where PMMC was preferred in 5 patients. PMMC was otherwise the most frequent type of flap utilized in salvage reconstruction (14 flaps in 13 patients). The overall cumulative flap survival was 96.8% with total flap loss in 2 patients. CONCLUSION: Various flaps are favored according to institutions, however, the alternative flaps should be considered, if necessary. Pedicled flaps are still valuable options in the most of minor reconstructive centers even in well developed countries and should be reserved for reconstruction in major centers, primarily utilizing free flaps, for indicated patients, not suitable for a microsurgical reconstruction.

• Klíčová slova
• head and neck reconstruction, infrahyoid myocutaneous flap, pectoralis major myocutaneous flap, pedicled flap,
• MeSH
• chirurgické laloky * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory hlavy a krku chirurgie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Nano-sized carriers are widely studied as suitable candidates for the advanced delivery of various bioactive molecules such as drugs and diagnostics. Herein, the development of long-circulating stimuli-responsive polymer nanoprobes tailored for the fluorescently-guided surgery of solid tumors is reported. Nanoprobes are designed as long-circulating nanosystems preferably accumulated in solid tumors due to the Enhanced permeability and retention effect, so they act as a tumor microenvironment-sensitive activatable diagnostic. This study designs polymer probes differing in the structure of the spacer between the polymer carrier and Cy7 by employing pH-sensitive spacers, oligopeptide spacers susceptible to cathepsin B-catalyzed enzymatic hydrolysis, and non-degradable control spacer. Increased accumulation of the nanoprobes in the tumor tissue coupled with stimuli-sensitive release behavior and subsequent activation of the fluorescent signal upon dye release facilitated favorable tumor-to-background ratio, a key feature for fluorescence-guided surgery. The probes show excellent diagnostic potential for the surgical removal of intraperitoneal metastasis and orthotopic head and neck tumors with very high efficacy and accuracy. In addition, the combination of macroscopic resection followed by fluorescence-guided surgery using developed probes enable the identification and resection of most of the CAL33 intraperitoneal metastases with total tumor burden reduced to 97.2%.

• Klíčová slova
• HPMA copolymers, fluorescence, guided surgery, polymer probes, stimuli-sensitiveness,
• MeSH
• chytré polymery * MeSH
• fluorescence MeSH
• fluorescenční barviva chemie   MeSH
• lidé MeSH
• nádorové buněčné linie MeSH
• nádorové mikroprostředí MeSH
• nádory hlavy a krku * diagnostické zobrazování   chirurgie   MeSH
• polymery MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• chytré polymery * MeSH
• fluorescenční barviva MeSH
• polymery MeSH

BACKGROUND: The ablative surgical resection has a critical importance for achieving better oncological outcomes for patients with head and neck cancer. However, radical surgical resections reveal the reconstruction requirement of complex anatomical structures. Microvascular free flaps have been recommended as a gold standard treatment choice for head and neck reconstruction following definitive oncological surgery. The supraclavicular artery island flap (SCAIF) is a thin and reliable fasciocutaneous pedicled flap that is simple and quick to harvest. MATERIAL AND METHODS: A total of 19 patients who underwent head and neck reconstruction with SCAIF were included in this study. The SCAIF was used for the reconstruction of oncological defects in 17 patients while it was used for the reconstruction of a skin defect on the lower face following radiotherapy in 1 patient and for cervical open wound (blast injury) closure in 1 patient. RESULTS: There were neither intraoperative nor postoperative major complications in any patient. The SCAIF has been used successfully in 18 of 19 patients for head and neck reconstructive surgery. Partial necrosis of the skin was detected in 1 patient (5.3%) only, while a total flap failure has not occurred in any patient. The partial skin necrosis was seen in an area of 1.5 cm of the distal end of the flap and was managed conservatively with local wound care. Wound dehiscence has not appeared in the flap donor area in any patient. CONCLUSION: The SCAIF constitutes a good alternative to free flaps, providing almost equivalent functional results and requiring less operative time and surgical effort.

• Klíčová slova
• fasciocutaneous flap, head and neck cancer, head and neck reconstruction, pedicled flap, supraclavicular artery island flap,
• MeSH
• arterie MeSH
• krk chirurgie   MeSH
• lidé MeSH
• nádory hlavy a krku * chirurgie   MeSH
• retrospektivní studie MeSH
• volné tkáňové laloky * MeSH
• zákroky plastické chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The Czech Head and Neck Cancer Cooperative Group (CHNCCG) held a meeting in Tabor on 11-12 October 2019 with the aim of reaching an interdisciplinary consensus on some controversial points where international unity is absent. The meeting resulted in recommendations on resection margin size terminology (definition of terms: negative margin, close margin and positive margin) and on the adoption of terminology for neck dissections reporting according to the International Recommendation of the International Head and Neck Scientific Group and on assessment of HPV/p16 status in head and neck tumors.

• Klíčová slova
• HPV, guidelines, head and neck cancer, neck dissection, p16, recommendation, resection margin,
• MeSH
• infekce papilomavirem * MeSH
• inhibitor p16 cyklin-dependentní kinasy MeSH
• konsensus MeSH
• krční disekce MeSH
• lidé MeSH
• nádory hlavy a krku * chirurgie   MeSH
• resekční okraje MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• inhibitor p16 cyklin-dependentní kinasy MeSH

A solitary fibrous tumor (SFT) is a rare, NAB2-STAT6 fusion gene-associated mesenchymal neoplasm. It most commonly arises in the pleural site, but it can occur at many other sites, and rarely also in the head and neck (H&N) region. STFs may show many growth patterns and therefore can be easily mistaken for other more common H&N spindle cell or epithelial lesions. In this study, we present our experience in the diagnosis of 20 cases of SFT in the H&N region and discuss their most notable mimickers. In all cases, STAT6 expression was found positive by immunohistochemistry, and the NAB2-STAT6 fusion was confirmed by next-generation sequencing. Three major fusion variants were detected: NAB2ex2-STAT6int1 (5/20, 25%), NAB2ex6-STAT6ex16 (4/20, 20%), and NAB2ex4-STAT6ex2 (3/20, 15%). Clinical follow-up was available for 16 patients (median follow-up time: 84 months). One patient with a morphologically malignant SFT experienced multiple local recurrences, followed by dissemination into the lungs and meninges. This malignant SFT also displayed an aberrant FLI1 expression, which was not previously reported in SFT cases. We also summarize findings from 200 cases of SFT of the H&N region, which included cases from our study, and from previous studies that reported on the fusion status of the STAT6 gene. The results suggest that metastatic disease developed only in cases with STAT6 variants that included the DNA-binding domain (STAT6-full variants), which contradicts expectations from previous reports and deserves further investigation.

• Klíčová slova
• Head and neck, Hemangiopericytoma, NAB2-STAT6, Solitary fibrous tumor,
• MeSH
• dospělí MeSH
• fenotyp MeSH
• fúze genů * MeSH
• genetická predispozice k nemoci MeSH
• imunohistochemie MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• mikrofilamentové proteiny genetika   MeSH
• mladiství MeSH
• nádorové biomarkery analýza   genetika   MeSH
• nádory hlavy a krku chemie   genetika   patologie   chirurgie   MeSH
• represorové proteiny genetika   MeSH
• senioři MeSH
• solitární fibrózní tumory chemie   genetika   sekundární   chirurgie   MeSH
• trans-aktivátory genetika   MeSH
• transkripční faktor STAT6 analýza   genetika   MeSH
• výsledek terapie MeSH
• vysoce účinné nukleotidové sekvenování MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• FLII protein, human MeSH Prohlížeč
• mikrofilamentové proteiny MeSH
• NAB2 protein, human MeSH Prohlížeč
• nádorové biomarkery MeSH
• represorové proteiny MeSH
• STAT6 protein, human MeSH Prohlížeč
• trans-aktivátory MeSH
• transkripční faktor STAT6 MeSH

INTRODUCTION: The pedicled pectoralis major flaps are still harvested and mainly indicated for reconstruction in the polymorbid patient. Other indications are combinations of pedicled pectoralis major flaps with free microvascular flap, salvage reconstruction following complications, free flap failure and recurrent or extended primary disease. MATERIALS AND METHODS: We describe the pedicled pectoralis major flap in 18 patients operated on at the Department of Oral and Maxillofacial Surgery, Olomouc from 1st January 2014 to 1st December 2016. RESULTS: Fifteen oropharyngeal defect reconstructions were performed using pedicled pectoralis major flap (including 1 submandibular defect of the neck). Indications were primary resection in polymorbid patients in 10 cases and recurrent diseases after previous neck dissection and radiotherapy in 5 cases. Pedicled pectoralis major flap was used for secondary reconstruction in 3 cases. Complications occurred in 50 % of patients, 28 % were major and 22 % minor. Major complications included a total flap failure (defect was successfully treated with free tissue transfer of latissimus dorsi myocutaneous flap) in 1 case, plate exposure in 2 cases, large dehiscence and large hemorrhage 1 case each. Minor complications included only small dehiscences (22 %). One was associated with fluidothorax after rib harvesting (6%). There were no cases of neck contracture or supraclavicular bulge. CONCLUSION: Even today, usage the pedicled pectoralis major flap in head and neck reconstruction surgery cannot be considered as an obsolete reconstructive procedure that has been completely replaced by a free microvascular flap. Innovations of flap harvesting techniques and high rate of flap survival are the main reasons why pedicled pectoralis major flap can still be primarily indicated for high-risk patients, non-cooperative patients and also for patients with extensive neck dissection. The pedicled pectoralis major flap has been the first choice in salvage surgery, in cases of a complication or free flap failure or a recurrence of a primary disease.

• Klíčová slova
• Oral cancer, pedicled pectoralis major flap, pectoralis muscle flap, head and neck reconstruction,
• MeSH
• chirurgická rána etiologie   chirurgie   MeSH
• chirurgické laloky krevní zásobení   transplantace   MeSH
• lidé MeSH
• nádory hlavy a krku chirurgie   MeSH
• prsní svaly krevní zásobení   transplantace   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The pedicled pectoralis major flap was the original workhorse flap for head and neck reconstruction. Over time, it became the secondary choice for oropharyngeal reconstruction with the implementation of free-soft tissue transfers. Nowadays, a polymorbid patient is primarily indicated for pedicled pectoralis major flap reconstruction, other indications include combinations of pedicled pectoralis major flap with free microvascular flap, salvage reconstruction due to complications, salvage reconstruction due to free flap failure and salvage reconstruction due to recurrent or extended primary disease. Pedicled pectoralis major flap can be successfully used for specific oropharyngeal defects, even primary resections, especially for less cooperative patients and patients after extensive neck dissection. Improving the flap harvesting techniques can reduce undesired complications in specific cases of oropharyngeal reconstruction. Flap morbidity in these cases remains comparable to morbidity of patients who had undergone free flap reconstruction. Pedicled pectoralis major flap remains valid reconstruction tool that should be included in the armamentarium of each surgeon dealing with reconstruction of the head and neck.

• Klíčová slova
• Oral cancer, pedicled pectoralis major flap, pectoralis muscle flap, head and neck reconstruction,
• MeSH
• chirurgické laloky krevní zásobení   transplantace   MeSH
• lidé MeSH
• nádory hlavy a krku chirurgie   MeSH
• odběr tkání a orgánů MeSH
• prsní svaly krevní zásobení   transplantace   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH