Peter Giannaris

Objectives: Coblation is a plasma‐mediated ablative technology that removes tissue at low temperatures with minimal thermal injury. Although interest in its application to laryngotracheal pathologies has grown, the existing evidence remains fragmented and no consensus guidelines exist. We mapped the literature, characterized outcomes, and identified gaps for future research. Data Sources: Embase, PubMed, and Web of Science were searched using MeSH and free‐text terms for laryngotracheal pathology and coblation. The protocol was registered on PROSPERO (CRD420251167760). Review Methods: The review followed PRISMA‐ScR guidelines. Studies of any design reporting patient outcomes following coblation for laryngotracheal indications were eligible. Titles, abstracts, and full texts were independently screened by two reviewers, with discrepancies resolved by additional reviewers. Results: Thirty studies encompassing 473 patients were included, spanning congenital abnormalities, vascular malformations, and cysts ( n = 12), laryngotracheal stenosis or airway obstruction ( n = 12), malignancy or benign tumors ( n = 3), suprastomal granulation tissue ( n = 2), and recurrent respiratory papillomatosis ( n = 1). Reported outcomes were favorable and endpoints ranged from complete lesion resolution (congenital cysts) to decannulation or airway patency (stenosis) to palliative debulking (malignancy). Reintervention was low, exceeding 20% in only 6 of 20 multi‐patient studies. No intraoperative mortality, major hemorrhage, or airway compromise was reported. Outcome reporting was heterogeneous; dysphonia and dysphagia were unreported in 18 and 20 studies, respectively. Conclusion: Coblation was associated with favorable reported outcomes and a low complication profile across diverse laryngotracheal pathologies, though outcome definitions and follow‐up varied substantially. Prospective comparative studies with standardized reporting frameworks are needed to define coblation's role in laryngotracheal surgery. Level of Evidence: N/A.

Objective: Malignant seeding of the trachea after resection of head and neck cancer is a rare but clinically significant complication, most often associated with advanced‐stage disease and nodal metastasis. We aim to present a case of malignant seeding to the trachea and provide a comprehensive literature review to identify patterns in presentation, management, and outcomes. Methods: A literature search was performed to identify cases of malignant seeding to the trachea or tracheostomy site in patients with head and neck cancers. Inclusion required histological confirmation and sufficient clinical detail. Results: We report a case of an 83‐year‐old woman with a history of mandibular squamous cell carcinoma (SCC) who underwent segmental mandibulectomy with free flap reconstruction and temporary tracheostomy. She presented 19 months later with progressive shortness of breath. Biopsy confirmed SCC at the prior tracheostomy site. Including our case, 28 cases were identified from the literature. SCC accounted for 92.9% of cases, with the oral cavity as the most common primary site (67.9%). Treatment for the tracheal seeding included surgical intervention with or without RT or chosen palliative care. At last follow‐up, 60.7% of patients died from the tracheal malignancy, with 25.0% alive without disease. Conclusion: Malignant seeding to the trachea or tracheostomy site is relatively rare with a poor prognosis. Measures to prevent this occurrence include delaying tracheostomy until tumor resection, using separate sterile instruments when performing multiple surgeries, and providing prophylactic radiation to the stoma in high‐risk patients.

Background: Sinonasal inverted papilloma (SNIP) is a benign but locally aggressive tumor that has demonstrated a propensity to recur. Multiple anatomic and surgical factors have been proposed to influence recurrence; dysplasia has recently emerged as a predictor, yet its prognostic significance remains unclear. Clarifying its role may improve postoperative risk stratification. Methods: A systematic review and meta‐analysis were performed following PRISMA guidelines and registered with PROSPERO (CRD420251140223). PubMed, Embase, Scopus, and Web of Science were queried for studies reporting recurrence outcomes stratified by dysplasia status. Studies with extractable recurrence data for dysplasia and non‐dysplasia SNIP were included. Fixed‐effects meta‐analysis was performed using the inverse variance method to calculate pooled odds ratios (OR) with 95% confidence intervals (CIs). Heterogeneity was assessed using I ² and Cochran's Q statistics. Results: Thirteen studies comprising 1893 patients were included. Based on reported data, mean age ranged from 48.3 to 58.0 years. The cohort was predominantly male (1172/1720; 68.1%). Of 283 patients with dysplasia, 104 experienced recurrence (36.7%), compared with 302 of 1346 patients without dysplasia (22.4%). Dysplasia was significantly associated with increased recurrence risk (pooled OR 3.42; 95% CI, 2.45–4.78; p < 0.001) with low–moderate heterogeneity ( I ² = 20.33%). Mean follow‐up was 39.8 months. Findings were robust on leave‐one‐out sensitivity analysis and trim‐and‐fill adjustment (adjusted OR 3.05; 95% CI 2.21–4.22). Conclusion: Dysplasia is a significant independent predictor of recurrence in SNIP, conferring 3.4 times increased odds of recurrence. Standardized dysplasia reporting and risk stratification protocols are needed to optimize surveillance strategies in SNIP patients.

Key points: High‐risk dysplasia and multifocal attachment independently predict inverted papilloma recurrence. Novel nomogram generates individualized 3‐, 6‐, and 9‐year recurrence risk estimates. Risk‐stratified surveillance may optimize postoperative monitoring intensity and intervals

Key points: Most physicians hold antithrombotic medication prior to surgery, regardless of drug class Physicians rely on the cardiologist or their own experience for perioperative decision making There was no consensus on antithrombotic perioperative medication timing across drug classes

Background: Myopericytoma (MPC) is a rare perivascular tumor with myoid differentiation that poses diagnostic and therapeutic challenges in the head and neck. Methods: We present four cases of oral and sinonasal MPC and conducted a literature review to analyze clinical characteristics, diagnostic approaches, and management. Results: Sixty‐five published cases were identified, yielding a cohort of 69 patients. The oral cavity was the most common site (44.9%) followed by parotid (15.9%), sinonasal (10.1%), neck (10.1%), and other head regions (18.8%). Complete excision was achieved in 95.7% of cases with a 7.2% recurrence rate. Histopathology confirmed MPC in all cases with characteristic perivascular spindle cell proliferation, 95.6% showing positive smooth muscle actin immunostaining. Conclusion: MPC must be considered in the differential diagnosis of vascular head and neck lesions. Complete surgical excision with negative margins remains the treatment of choice, with immunohistochemistry essential for accurate diagnosis.

Objectives: Sinonasal inverted papilloma (SNIP) is a benign sinonasal tumor with a tendency to recur and potential for malignant transformation. Dysplasia may be present, ranging from mild to severe. We aim to evaluate the effect of dysplasia on tumor behavior and patient outcomes. Methods: Retrospective chart review of SNIP cases from 2002 to 2023 treated by fellowship‐trained Rhinologists at seven institutions. Clinical data were extracted, and tumors were histologically confirmed. Results: Four hundred and forty‐eight patients were eligible for analysis. The mean age was 58 years with an average postoperative surveillance of 27 months. Most patients had tumors without dysplasia (74.3%), followed by severe (10.5%), mild (10.0%), and moderate (5.1%) dysplasia. The overall recurrence rate was 11.6%. Unifocal attachment was most prevalent in tumors without dysplasia. Among patients with multifocal attachment, recurrence was highest in those with severe dysplasia (38.1%) compared to no dysplasia (17.2%). Unifocal attachment was associated with improved recurrence‐free survival in all three histology types (without, mild, and moderate dysplasia). Conclusion: In the largest study to date examining the effect of dysplasia on patient outcomes, we found that SNIP that has severe dysplasia to be high risk for recurrence while the other three types of dysplasia to be of lower risk. We therefore propose a two‐tiered grading system to improve consensus among pathologists and to guide patient counseling. In the treatment of SNIP, high‐risk dysplasia is more often associated with multifocal attachment pattern and remains the most challenging to treat. Level of Evidence: 3.

Objectives: Inverted papilloma (IP) is typically a benign sinonasal tumor with a propensity to recur. The surgical treatment of IP arising from the frontal sinus is complicated by proximity to the orbit and skull base. The objective of this study is to describe the surgical challenges when managing this disease and report treatment outcomes in a multicenter cohort. Methods: A retrospective review was performed on frontal sinus IP resected from 1993 to 2023. Demographic and clinicopathologic data, complications, surgical approach, and outcomes were analyzed. Results: Ninety‐eight patients (60 males, 38 females) were identified. Mean age was 59 years, with a median follow‐up of 44 months. Histopathologic evaluation identified 13 lesions with carcinoma in situ or invasive carcinoma (13.3%). Bilateral involvement was found in 28 patients (28.6%). Overall, 17 patients (17.3%) had recurrent disease with a median recurrence time of 29.2 months. Fourteen patients (14.3%) underwent staged procedures, with a median time to the second procedure of 7.7 months. Twenty‐three patients (23.5%) presented with skull base dehiscence on perioperative imaging. Skull base dehiscence had a significant effect on intraoperative cerebrospinal fluid leak (OR 9.1, 95% CI 3.0–27.4 p < 0.001). Conclusion: Frontal sinus IP is commonly attached at the skull base and associated with skull base dehiscence, CSF leak, and often requires operative repair and staged procedures. Complete tumor removal can be challenging and may necessitate a combined open and endoscopic approach. Careful surgical planning and close follow‐up in the postoperative period are essential for disease control. Level of Evidence: Level 4.