Nilda Süslü

Large language models (LLMs) are increasingly used in clinical decision-making and patient education, including in complex specialties such as head and neck cancer (HNC). To evaluate the performance of ChatGPT-4o and DeepSeek-V3 in answering HNC-related clinical questions. A set of 154 questions across six clinical categories was submitted twice to both models. Responses were independently graded by head and neck surgeons using a four-point accuracy scale. Accuracy, reproducibility, and inter-model agreement were assessed. ChatGPT-4o and DeepSeek-V3 provided ''comprehensive/correct'' answers in 92.2% and 89.6% of cases, respectively (p = .42). The accuracy ratings of both models' responses overlapped in 85.1% of cases; however, the statistical agreement between them remained low (Cohen's κ = 0.12; ICC = 0.21, p = .006). DeepSeek-V3 outperformed ChatGPT in Treatment category (96.3% vs. 81.5%, p = .08), while ChatGPT excelled in Recovery, Complications, and Follow-up (95.0% vs. 82.5%, p = .08); however, these differences did not reach statistical significance. Reproducibility was high for both models (ChatGPT-4o: 96.1%; DeepSeek-V3: 96.8%). Both models demonstrated strong accuracy and consistency in HNC-related queries. LLMs hold promise as reliable tools in clinical decision-making and patient education within HNCs when used with careful consideration of their inherent limitations.

To investigate whether there is a difference in olfactory functions among individuals who use different voice restoration methods after total laryngectomy. The study group for this research comprised individuals who had undergone total laryngectomy and aged 44 to 75 years; 10 participants using oesophageal speech, 10 participants using tracheoesophageal speech, and 10 participants using electrolarynx were included. The control group comprised 10 individuals with normal olfactory function of similar age and gender to the individuals in the study group. The participants' olfactory functions were evaluated using the Sniffin Sticks Extended Test. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - H&N-35 was used as a subjective scale. All laryngectomised patients exhibited olfactory impairment, with 73.3% diagnosed with anosmia and 26.7% with hyposmia. Regarding Sniffin Sticks Test combined scores; the mean values of voice prosthesis users, electrolarynx and oesophageal speech group were 8.4, 10.1 and 21.6 respectively, while in the control group it was 38.2. In terms of Sniffin Sticks Test composite scores, the oesophageal speech group had significantly higher scores than the voice prosthesis and electrolarynx groups (p < 0.001). While all laryngectomised patients showed olfactory dysfunction, those using oesophageal speech - a somewhat overlooked rehabilitation method - exhibited statistically significant preservation of olfactory function compared to other voice restoration techniques. These findings suggest that oesophageal speech may offer distinct advantages for maintaining post-laryngectomy olfactory capacity, warranting further consideration in clinical practise.

Sentinel lymph node biopsy (SLNB) is increasingly used in oral cavity squamous cell carcinoma (OCSCC) as a minimally invasive approach that may reduce overtreatment and morbidity compared to elective neck dissection (END). This study evaluated the diagnostic performance of SLNB in clinically node-negative (cN0) OCSCC and its utility in mapping lymphatic drainage, particularly in advanced tumors. A retrospective cohort of 57 cN0 OCSCC patients undergoing SLNB followed by completion neck dissection was analysed. In early-stage tumors (T1/T2), SLNB demonstrated 100% sensitivity and negative predictive value, with an occult metastasis rate of 23.8%. No false negatives were observed, and only one patient was upstaged. In T3/T4 tumors, sensitivity and NPV decreased to 55.6% and 60%. The false-negative rate (FNR), calculated as the proportion of false negatives among patients with histopathologically confirmed nodal metastases, was 44.4%. Contralateral or bilateral drainage occurred in 40% of well-lateralized advanced tumors, reflecting altered drainage with progression. SLNB is a reliable staging tool in early OCSCC. In advanced disease, although diagnostic accuracy is reduced, it provides valuable information on atypical drainage pathways. These findings support SLNB as an effective staging and lymphatic mapping tool, reinforcing its selective integration into OCSCC management.

Objective: The present study aimed to investigate the symptomatic swallowing complaints in individuals with total laryngectomy (TL) and reveal how swallowing kinematics differs between those with and without symptomatic dysphagia complaints.Methods: A total of 34 subjects with TL were included in the study. Swallowing kinematics of those with symptomatic swallowing complaints (Group 1) were compared to those without (Group 2). Kinematic parameters including pharyngeal transit duration (PTD), maximum pharyngeal constriction ratio (MPCR), upper esophageal sphincter opening ratio (UESOR), upper esophageal sphincter opening duration (UESOD), and bolus clearance ratio (BCR) were investigated from Videofluoroscopic Swallowing Study (VFSS) records via ImageJ software.Results: Symptomatic swallowing complaints were determined in 47.1% of the subjects (n = 16). Difficulty while swallowing solid foods and pills, diminished pleasure of eating, food getting stuck in the throat, and increased level of stress during swallowing were among the major swallowing complaints in the present cohort. PTD, MPCR, and BCR parameters were significantly higher in subjects with symptomatic swallowing complaints than those without.Conclusion: These preliminary findings indicate that almost half of individuals with TL may have symptomatic swallowing complaints. The underlying pathophysiology of this phenomenon may be the devianced kinematic parameters including PTD, MPCR, and BCR in this population. Therefore, it is recommended to include the kinematic measurements in the dysphagia evaluation protocol in individuals with TL, most notably in those with symptomatic swallowing complaints.Level of Evidence: 3 Laryngoscope, 135:809–817, 2025

Background: We aimed to evaluate the effect of sarcopenia on survival in head and neck squamous cell carcinoma patients treated with chemoradiotherapy. Materials & methods: Disease-free survival an... Plain language summary Head and neck cancer is one of the main causes of cancer-related death worldwide. Most patients are diagnosed in the advanced stage. Muscle wasting with significant weight lo... Tweetable abstract Sarcopenia may be a potential prognostic biomarker for head and neck squamous cell carcinoma patients. Sarcopenic patients have significantly worse survival rates and are more su...

Purpose Neck dissection (ND), whether therapeutic or elective, is an essential component of the treatment of head and neck squamous cell carcinoma (HNSCC). Due to altered anatomy and fibrosis caused by initial treatments, surgeons face challenges during salvage ND. A combination of Technetium-99 m and indocyanine green (ICG) previously used in the sentinel lymph node (SLN) biopsy for oral cavity cancers, may be useful in different types of neck surgeries. We aimed to show the additional advantage of this combination in detecting HNSCC and thyroid cancer recurrences, as well as individual lymphatic drainage in elective ND. Methods We retrospectively reviewed medical records of patients, underwent neck surgery guided with ICG and Tc-99 m, in Hacettepe University Hospital between June 2018 and December 2020. In a total of 28 patients, intraoperative gamma probes were paired with near infrared (NIR) cameras. Patients are divided into two groups: neck surgery with recurrent occult lesion localization (NS- ROLL) (n: 14) and ND with SLN screening (ND-SLNS) (n: 14). Results Among all 14 patients in NS-ROLL group, recurrent diseases, hidden behind tissues were 100% successfully localized. In ND-SLNS group, 238 lymph nodes were harvested, metastasis rate was 31.3% (10/32) in sentinel nodes. SLNS revealed 100% accuracy in detecting metastasis in clinically N0 neck (10/238). Contralateral lymphatic drainage was observed in three patients (lateral-sided oral cavity SCC). In two patients (floor of mouth), three sentinel nodes were detected by NIR only. Conclusion The use of ICG-radiotracer provides additional value in disease removal for both primary and recurrent tumors of the head and neck.

The level of the major endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) are altered in several types of carcinomas, and are known to regulate tumor growth. Thusly, this study hypothesized that the HEp-2 human laryngeal squamous cell carcinoma (LSCC) cell line releases AEA and 2-AG, and aimed to determine if their exogenous supplementation has an anti-proliferative effect in vitro. In this in vitro observational study a commercial human LSCC cell line (HEp-2) was used to test for endogenous AEA and 2-AG release via liquid chromatography-tandem mass spectrometry (LC–MS/MS). The anti-proliferative effect of AEA and 2-AG supplementation was evaluated via WST-1 proliferation assay. It was observed that the HEp-2 LSCC cell line released AEA and 2-AG; the median quantity of AEA released was 15.69 ng mL^–1 (range: 14.55–15.95 ng mL^–1) and the median quantity of 2-AG released was 2.72 ng ^–1 (range: 2.67–2.74 ng mL^–1). Additionally, both AEA and 2-AG exhibited an anti-proliferative effect. The anti-proliferative effect of 2-AG was stronger than that of AEA. These findings suggest that AEA might function via a CB1 receptor-independent pathway and that 2-AG might function via a CB2-dependent pathway. The present findings show that the HEp-2 LSCC cell line releases the major endocannabinoids AEA and 2-AG, and that their supplementation inhibits tumor cell proliferation in vitro. Thus, cannabinoid ligands might represent novel drug candidates for laryngeal cancers, although functional in vivo studies are required in order to validate their potency.

Purpose Reconstruction of parotidectomy involves the correction of facial contour abnormalities and prevention from Frey Syndrome. Reconstruction of parotidectomy field with autologous fat has not been popular among head and neck surgeons due to unclear predictability of fat resorption rates. The aim of this paper is to compare the fat resorption rates between different fat transfer techniques using radiologic measurements and reviewing the aesthetic and functional outcomes. Methods We retrospectively reviewed medical records of patients, who underwent parotidectomy in Hacettepe University Hospital between 2015 and 2018. The aesthetic and functional outcomes of en-bloc fat graft and lipofilling techniques were compared among themselves, as well as with patients who had no reconstruction, using objective parameters. Fat resorption rates were compared using calculation of fat volumes obtained by MRI scans, 1 year after surgery. Results Among 77 patients, 26 underwent reconstruction with en-bloc fat graft (P-EBFG); 21 patients reconstruction with lipofilling technique (P-LFT), whereas 30 patients had no reconstruction of parotidectomy field (P-NR). In three groups, there was no statistically significant difference in mean resected parotid tissue volumes (mean 18 ± 10.8 cm³, p = 0.754). We found a significant difference in decreased presence of Frey Syndrome and increased satisfation rates of cosmetic appearance in P-EBFG and P-LFT, in comparison to P-NR (p < 0.001). There was no significant difference in fat resorption rates between P-EBFG (50.75 + 21.20%) and P-LFT (48.59 + 17.93%) (p = 0.771). Conclusion Both en-bloc fat graft and lipofilling techniques have been found to be safe and to have similar fat resorption rates for reconstruction after parotidectomy.