24th Czech-German ENT Days

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Background/Introduction: Obstructive sleep apnea (OSA) affects nearly 1 billion people worldwide. Surgery is variably effective and patients should be indicated very selectively. This study summarizes and presents our personal experience with TORS (not only) for OSA treatment, with the aim to provide information regarding its safety, efficacy, postoperative complications and its role in the Health system in Czech Republic. Methods: Our experiences with TORS surgery started in 2023 obtaining DaVinci Xi system. TORS is nowadays considered a common surgical minimally approach for Base of Tongue (BOT) reduction in cases of OSA due to a lingual tonsil obstruction. Furthermore, this procedure can be combined with other techniques, such as tonsillectomy, pharyngoplasty and many others in cases of a multilevel obstruction. Our patients have followed the standart indication protocol in OSA treatment (Endoscopy, PG, DISE). Pediatric patients were excluded from TORS program. Results: From 9/2023, 85 patients underwent transoral robotic surgery at our departement, 61 (72%) patients underwent surgery for oropharyngeal carcinoma, 8 (10%) for benign lesions of oropharynx, 14 (16%) for OSA. 7 patients underwent BOT reduction, 4 patients BOTr together with epiglotopalsty, in 3 cases the multilevel surgery was performed (BOTr, UPPP). There was 68% decrease of AHI in average in the patients after TORS. No patient with OSA had postoperative bleeding. No readmission was experienced. Conclusion(s): TORS for OSA treatment is an effective and safe procedure for adequately selected patients. Considering other effective ways of surgery (upper airway stimulation), in the Czech Republic, TORS is still being in its golden era regarding the surgical treatment of retrolingual space.

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Transoral robotic surgery (TORS) has been established as a standard surgical approach in head and neck oncology for nearly 15 years. It has demonstrated clear superiority primarily in T1–T2 oropharyngeal carcinomas and carcinomas of unknown primary (CUP). In highly selected patients, its application extends to T3 oropharyngeal, as well as T1–T2 hypopharyngeal and supraglottic cancers. However, patients may also benefit from the advantages of this modality in several less conventional indications. First, parapharyngeal space tumors and the resection of an elongated styloid process represent ideal indications for TORS. Nonetheless, their low incidence and anatomical proximity to critical vascular structures—such as the internal carotid artery and branches of the external carotid artery—limit the widespread adoption of TORS for these pathologies in many centers. Furthermore, the inherent advantages of the robotic system, including enhanced 3D visualization and tremor reduction, can be successfully utilized in open neck indications. Due to the angled robotic arms, neck surgeries can be performed through distant incisions concealed in the hairline or the axilla. While robotic transaxillary or bilateral axillo-breast approach thyroidectomy is a standard procedure in the Far East, its adoption remains limited in European centers. Additionally, various neck procedures, including submandibulectomy, and elective neck dissection, can be safely executed through retroauricular or facelift incisions. In experienced hands, salvage surgery for persistent or recurrent oropharyngeal cancer represents another promising indication. In conclusion, advanced robotic surgery is driving a critical paradigm shift in head and neck oncology, expanding its scope from early-stage cancers to a significantly wider variety of complex indications.

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Comparative Evaluation of RobOtol, Otoarm, and Manual Electrode Insertion.

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Background Transoral robotic surgery (TORS) provides minimally invasive access to anatomically complex regions of the upper aerodigestive tract. Its principal indications include selected tumors of the palatine tonsil and base of tongue, as well as lesions of the parapharyngeal and retropharyngeal spaces. TORS may also be used in selected patients with obstructive sleep apnea. Objectives To present our institutional experience with TORS, describe the perioperative management of patients undergoing robotic surgery, and evaluate the clinical characteristics of patients treated between 2023 and 2026. Methods A retrospective descriptive analysis was performed of 85 patients who underwent TORS at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, between 2023 and 2026. The evaluation included indications for surgery, diagnosis distribution, and clinical stage. The perioperative protocol comprised appropriate imaging and tumor staging, pre-anesthetic assessment, dental clearance and enteral access when indicated, antibiotic and venous thromboembolism prophylaxis, and postoperative intensive care monitoring. In oncological procedures, particular attention was paid to the prevention of oropharyngeal bleeding through external carotid artery ligation and intraoperative clipping of relevant vessels. Results TORS was used predominantly in patients with lesions involving the palatine tonsil and base of tongue, including selected T1 and T2 carcinomas. Additional indications included parapharyngeal and retropharyngeal tumors and procedures for obstructive sleep apnea. Robotic surgery enabled transoral access to anatomically challenging sites within a standardized multidisciplinary diagnostic and perioperative pathway. Specific attention to vascular control and postoperative monitoring formed an essential component of patient safety. Conclusions TORS represents an established minimally invasive option for selected oncological and non-oncological diseases in otorhinolaryngology. Appropriate patient selection, comprehensive staging, multidisciplinary management, meticulous intraoperative hemostasis, and structured postoperative monitoring are essential for its safe implementation. Further expansion of robotic surgery may include supraglottic laryngeal procedures, salvage surgery, and the use of single-port robotic systems.

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Despite the very good prognosis for HPV-positive oropharyngeal cancer treated with chemoradiation, approximately 10% of patients experience locoregional recurrence, which can be managed surgically. Salvage surgery presents a number of challenges. Recently, transoral treatment has been preferred whenever possible; however, more extensive surgical procedures are also performed, often requiring reconstruction. The prognosis for patients treated surgically for locoregional recurrence remains poor, and the 5-year survival rate is generally reported to be between 20 and 40%.

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Cancer of unknown primary (CUP) in the head and neck accounts for 1–5% of malignancies, and roughly half of primary tumors remain undetected despite standard workup (endoscopy, imaging, PET/CT). Transoral robotic surgery (TORS) base-of-tongue mucosectomy has been proposed since 2013 to improve detection by resecting the lingual tonsil lymphoid tissue. In a single-center series of 30 CUP patients (Oct 2021–Apr 2024) treated with TORS tonsillectomy and bilateral base-of-tongue mucosectomy, the primary tumor was identified in 19 cases (63.3%) — 6 tonsillar and 13 base-of-tongue carcinomas — with a low complication rate (3 postoperative bleeds, no permanent swallowing disorders) and no cases requiring treatment de-escalation compromise. These results support TORS mucosectomy as an effective, safe addition to the diagnostic algorithm for head and neck CUP.

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Reirradiation offers a potentially curative treatment option for selected patients with recurrent head and neck squamous cell carcinoma (HNSCC) after previous radiotherapy. Salvage surgery remains the preferred curative approach when feasible, while reirradiation may be considered for unresectable or medically inoperable disease. Careful patient selection based on tumour extent, disease-free interval, resectability, performance status and organ function is essential. Modern techniques including IMRT, SBRT and proton therapy allow more precise treatment and improved organ-at-risk sparing, but severe acute and late toxicity remains a major concern. Optimal outcomes therefore depend on careful patient selection, individualized treatment planning and a multidisciplinary approach.

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Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly prevalent disease that results in significant healthcare costs as well as societal costs in the form of lost productivity and time. Unfortunately, a significant proportion of patients suffering from this disease find no relief from either current standard medications or surgical intervention. Biological therapy can offer a more targeted approach by blocking specific cytokines and immune signaling pathways involved in type 2 inflammation. These therapies have fundamentally changed treatment options for patients with severe CRSwNP who do not respond to conventional treatment. Biological therapy represents a new therapeutic class in the treatment of CRSwNP that has the potential to be a “game changer” for patients. At the same time, however, it poses a major challenge for us as physicians, especially for surgeons. Biological agents have demonstrated efficacy in treating CRSwNP, but they are also very expensive and may require long-term use. In our department, we began treating patients with dupilumab in 2024. Today, we see many satisfied patients who are quickly benefiting from the treatment with minimal side effects. On the other hand, however, there is a clear increase in healthcare costs associated with this therapy. The question for the future is what impact the long-term use of biologic medications will have, compared to the current standard of care for CRSwNP - not only on patients, but also on the healthcare system and on us as physicians.

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Malignant tumors of the nasal cavity are rare, representing only less than 1% of all malignancies. In spite of this fact, it is crucial not to leave them out in the differential diagnosis of the nasal obstruction, even more importantly in one-sided nasal obstruction and epistaxis. The main topic of this presentation is to sum up the history of a 50 year old patient, who initially presented with one-sided nasal obstruction with occasional nosebleeds. Even though surgical intervention was initially recommended, the symptoms resolved spontaneously, and no surgery took place. After a short asymptomatic period, the issues along with worsened nasal breathing started occurring again. The biopsy of the mass found on the rhinoendoscopic inspection was performed and thus the diagnosis of non-keratinizing squamous cell carcinoma was made. Afterwards the patient was referred to our department, where a primary surgical removal was indicated and performed and adjuvant chemoradiotherapy in the Proton Centre was considered. The principal aim is to emphasize the importance not only of a thorough history taking when approaching a patient presenting with unilateral nasal obstruction, but also the risks associated with omiting a histopathological examination of one-sided nasal masses.

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Surgery of the external nose is among the most technically demanding procedures in otorhinolaryngology and plastic surgery. It encompasses a wide range of surgical approaches and techniques and continues to undergo dynamic development. This presentation provides a comprehensive overview of the philosophy of modern rhinoplasty, with particular emphasis on the preservation of tissues and anatomical structures. Using a series of the authors’ own patients, it demonstrates the practical application of preservation rhinoplasty principles and provides practical explanations of surgical techniques and tips that can be directly applied in the operating room.

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Keratoacanthoma is a distinctive skin tumor with a variable clinical course that often closely mimics malignant lesions, particularly squamous cell carcinoma. Its characteristic rapid growth, followed by the potential for spontaneous regression, makes accurate diagnosis and treatment selection challenging. This may lead to unnecessary radical surgical procedures, especially in functionally and aesthetically sensitive areas such as the nose. Careful clinical evaluation and close interdisciplinary collaboration are therefore essential for appropriate management. We present two case reports of patients with keratoacanthoma located in the nasal region, demonstrating different clinical courses and therapeutic approaches. Clinical presentation, disease progression, histological findings, treatment strategy, and final outcomes were assessed. In the first case, the lesion was initially suspected to be squamous cell carcinoma, and surgical excision was considered. However, due to spontaneous regression observed during follow-up, a watchful waiting strategy was chosen, resulting in complete regression without the need for surgery and leaving only minimal scarring. In the second case, a patient presented with a large keratoacanthoma of the nasal apex with rapid progression and central necrosis. Based on the clinical appearance and disease course, conservative treatment with intralesional methotrexate was initiated. Gradual tumor regression was achieved; however, residual nasal deformity remained and required subsequent reconstructive plastic surgery. Keratoacanthoma represents a significant diagnostic challenge because of its clinical and histological similarity to squamous cell carcinoma. An individualized interdisciplinary approach can enable more conservative management in selected patients, helping to avoid unnecessarily mutilating surgery while preserving both functional and aesthetic outcomes.

Poster ke stažení

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Background: Retrograde cricopharyngeal dysfunction (RCPD) is an underrecognized disorder of upper esophageal sphincter (UES) relaxation. Clinical features include an inability to belch or vomit, chest gurgling, bloating, and abdominal pain. Botulinum toxin injection into the UES is the current gold standard treatment. The aim of this work is to present the first experience with treatment of RCPD at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava. Methods: Since the beginning of 2026, we have treated three consecutive patients. One patient had UES spasm demonstrated on high-resolution manometry, and two patients were diagnosed clinically. All patients received transoral Dysport injections (150 SU) into the cricopharyngeus muscle under general anesthesia. Clinical severity and treatment effect were assessed using the BURP questionnaire pre- and post-operatively. Results: All patients reported marked clinical improvement and better psychosocial functioning. The mean BURP score decreased from 90.3 preoperatively to 16.0 postoperatively, a mean reduction of 82.3%. Reported adverse effects included transient dysphagia, reflux symptoms, and reduced voluntary control of belching. These effects were transient and resolved spontaneously. Conclusion: RCPD is a somatic condition with a major impact on quality of life. Botulinum toxin injection into the cricopharyngeus muscle is a simple, safe and effective treatment that provides substantial benefit for patients.

Poster ke stažení

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Introduction: Cervical lymphadenopathy represents a common and relatively nonspecific clinical manifestation of a broad spectrum of pathological conditions. In this context, malignancies of the head and neck region are of major consideration, though systemic malignancies, most notably lymphomas, should also be considered. Case report: In this retrospective study, we describe a rare presentation of a female patient with bilateral multilevel cervical lymphadenopathy with no other clinical symptoms, who was referred to our department with an initial clinical suspicion of lymphoma. However, subsequent biopsy and colonoscopy revealed the underlying etiology to be metastatic colorectal carcinoma. Discussion and conclusion: While otherwise asymptomatic colonic cancer presenting with cervical lymphadenopathy is almost unheard of, tumours especially from the upper GI tract are known to metastasize into cervical nodes via the well described pathway of the thoracic duct and presenting as Virchow’s node. While these are a small minority of cases, they always have to be considered. A proper diagnostic algorithm for cervical lymphadenopathy should lead to correct and timely diagnosis even in such rare cases.

Poster ke stažení

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Introduction: Laryngomalacia is the most common congenital anomaly of the larynx and also the most common cause of inspiratory stridor in children. The condition usually requires only observation and resolves spontaneously within 1–2 years. Severe cases are indicated for endoscopy under general anaesthesia to rule out any associated pathology. Direct laryngoscopy also allows a surgical treatment depending on the type of obstruction. Methods: A retrospective study of 50 paediatric patients who underwent dissection of aryepiglottic folds between the 1st of January 2013 and the 30th of June 2024 at the Department of ENT, 2nd Faculty of Medicine Charles University and Motol and Homolka University Hospital, Prague based on information from surgical records, medical records, outpatient records and the UNIS hospital information system. Results: In the patient cohort studied, a high success rate of surgical treatment (94%) was recorded, with a low incidence of post-operative complications (6%). Conclusions: The results of surgical treatment of laryngomalacia at our department are consistent with those of leading paediatric endoscopic centres worldwide. Associated comorbidities have been shown to be a potentially significant factor that negatively affects not only the course of the disease itself, but also leads to a higher incidence of complications and treatment failure. The post-operative course was uncomplicated in the majority of patients, particularly those who were otherwise healthy, allowing discharge by the second post-operative day (70%) with subsequent rapid regression of symptoms.

Poster ke stažení

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Myasthenia gravis (MG) is an autoimmune disorder that affects neuromuscular transmission. It is caused by autoantibodies directed against acetylcholine receptors, which impair the normal function of the neuromuscular junction. The initial symptoms frequently involve the head and neck muscles, and patients may present with voice, swallowing, and speech disorders. Consequently, otorhinolaryngologists (ENT specialists) are often the first physicians to evaluate these early manifestations before a formal neurological diagnosis is established. Dysphagia, dysphonia, and dysarthria may be the initial presenting symptoms. ENT specialists play an important role in the initial evaluation of patients with unexplained pharyngeal or vocal cord weakness, in the assessment and management of aspiration risk to prevent serious airway and swallowing complications, and in the timely referral of patients to a neurologist for confirmatory diagnostic testing, including antibody assays and electrophysiological studies. In this presentation, we will review the most common ENT manifestations of myasthenia gravis and present two illustrative case reports demonstrating its clinical presentation.

Poster ke stažení

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Background survival of Thyroid cancer patients is around 90% after thyroidectomy mainly in papillary thyroid carcinoma. Early diagnosis is a important factor in good outcome. Relation of Quality of life with a generic focus has been undr reported among thyroid cancer survivors. Aim Aim of my study to examine and describe factors associated with quality of life after surgery in thyroid cancer patients. Methods: Patients who underwent thyroidectomy for cancer between January 1999 and June 2001 in a Dhaka city & Feni town were included in the study. Interviews was completed with 146 (67%) of those 218 eligible, asking about sociodemographic variables, disease/treatment characteristics and social support. Quality of life was measured by the Chinese version of the Quality of Life Index. Multivariate analyses were performed using multiple linear regressions. Result: Post operation patients at 12-36 months follow up result reveals lower quality of life in comparison with those within 18 months of operation. Symptoms of fatigue and chills were negatively associated with quality of life. Patients who rated the impact of operational scar on activities as 'high' had lower quality of life scores. Support from friends, families and relatives had a high positive impact on quality of life. Conclusions: Doctors & specially nurses could improve quality of life among patients with thyroid cancer. Nurses by strengthening their social support and educating them in self-management of uncomfortable symptoms. Surgeons should consider types of operation in which the scar would be less likely to influence the patients' activities.

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Background: The Ligasure sealing system is a bipolar diathermy sealing device using high current with low voltage for creating a consistent seal to up to 7mm diameter vessels with reduced thermal spread. The electrosurgical generator is responsible for the detection of the characteristics of the tissue closed between the instrument jaws so it can deliver the exact amount of energy needed to seal it permanently. The Ligasure sealing system has been in standard use in our ENT department in Mladá Boleslav since January 2016. Methods: Reflecting on the sample of 751 standard total thyroidectomy procedures performed since January 2003 we are going to evaluate the demographic features, the effect on the surgery length, complications and patient outcome. To compare the data objectively we included solely total thyroidectomies and excluded every procedure including collar mediastinotomy, lymph node resection or any other accompanying procedure. We use the Ligasure sealing system in 218 patients and traditional hemostatic procedures in the other 573, we also tested the harmonic scalpel technology, but it will not be part of this overview. Results: In the Ligasure group the surgery length average was 89,62 minutes, the median was 88 minutes. In the traditional group the average was 98,10 minutes and the median 95 minutes. Other demographics and safety data are yet to be determined, based on the data set we have collected. Conclusion: Ligasure is an effective tool for hemostasis control and it shows reduction in the operating time. It has now become a standard tool in total thyroidectomy and other major surgeries in the ENT department Mladá Boleslav.

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Introduction: Robototic head & neck surgery offers numerous benefits & is a better option for delicate and complex head & neck surgery. Reduced blood loss, shorter hospital stays, and improved postoperative outcomes are huge advantages, but its adoption and widespread implementation in Bangladesh present a unique set of challenges. Huge financial expenses& the lack of training among surgeons are 2 major challenges. This study explores the current state, barriers, successes, and facilitators of Robotic Surgery in Bangladesh. Furthermore, it highlights strategies that will help adoption Robotic surgery and the implementation of training. Methodology: We conducted a literature search using PubMed, Google Scholar, and Google search engine. We identified, reviewed, and extracted key information from relevant articles to ensure a comprehensive understanding of the practice of Robotic surgery and identify barriers, facilitators, and strategies for training in developing countries. Results: From different relevant articles the subject matter were identified, analyzed, and reviewed. The data reveals that training programs borne from collaborations with international institutions can help capacity building to implement robotic surgery training successfully. This review also identified the current barriers to robotic surgery training & other barriers and potential strategies to help overcome them. The barriers identified were inadequate financial resources, poor support from health care stakeholders, lack of adequate training equipment, limited training curriculum, and the lack of qualified personnel & reluctant to accept new technology out of fear are important. Conclusions: Despite the financial constraint & challenges in Robotic surgery training in Bangladesh, we hope help from some authorities can bring this technology close to us. Training programs and workshops have been recorded in different Asian countries. To further advance the progress made, joint efforts from the local surgical workforce, the government, (allocation of budget to purchase robots, subsidy & discount for Poor patients), the robotic companies (request for creating cheap robots), and health care stakeholders will be required.

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Background: Routine grading of facial palsy is largely subjective and overlooks functions that matter to patients – facial symmetry, eye protection during blinking, and emotional expression. We present four objective tools developed in Jena, covering facial asymmetry, blinking, and muscle activity. Methods: AI-based angle mapping quantified facial asymmetry automatically from clinical photographs using 478 landmarks in 405 datasets from 198 patients. Automated blinking analysis (JeFaPaTo) extracted facial features from smartphone video in patients with acute palsy, patients with synkinesis, and healthy controls. Bilateral high-resolution surface EMG (HR-sEMG; 58 electrodes, muscle-oriented Fridlund and symmetrical Kuramoto schemes) recorded muscle activity during 11 movements in 36 synkinesis patients and 36 healthy controls. A proof-of-concept model (EIFER) mapped facial geometry to muscle activity via a 3D morphable model, toward electrode-free EMG. Results: Angle-map scores correlated moderately to strongly with the clinical Stennert index score (r = 0.32–0.73, p < 0.001), were robust to head rotation, and produced reference-free maps. Blinking analysis separated acute palsy, synkinesis, and controls: in acute palsy the minimal Eye-Aspect-Ratio (incomplete closure) was higher on the affected side, while blink frequency was lower and duration longer in both patient groups; these differences were not reflected in patient-reported outcome measures. On HR-sEMG, each movement activated nearly the entire muscle network rather than isolated muscles. In synkinesis, off-target muscles were overactive on the synkinetic and often the clinically unaffected contralateral side — evidence of a bilateral disorder relevant for contralateral treatment; the Fridlund scheme gave more specific contrasts. The electrode-free model showed that muscle activity can be inferred from video alone. Conclusions: The tools quantify facial asymmetry and muscle activity objectively in both flaccid and synkinetic palsy. Within multidisciplinary ENT-led care, they complement physician-based grading and patient-reported outcome measures and help standardize recovery monitoring. * Orlando Guntinas-Lichius and Joachim Denzler acknowledge support by the Deutsche Forschungsgemeinschaft (DFG), grant GU-463/12-1 and DE-735/15-1

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Introduction: Accurate delineation of tumor margins is a persistent challenge in surgery of oropharyngeal squamous cell carcinoma (OPSCC). The rising incidence of OPSCC further highlights the need for reliable, real-time tissue characterization tools. Hyperspectral imaging (HSI) captures spatially resolved spectral information across a broad wavelength range, enabling label-free, non-contact differentiation of tissue types. This study aims to evaluate the feasibility of HSI combined with machine learning (ML) for distinguishing tumor from healthy tissue in patients with OPSCC. Methods: In the prospective feasibility study HSI-HEAD-NECK (DRKS00033009) in vivo HSI data were acquired in 35 patients with OPSCC (91% males, mean age 68 ± 11 years, 71% of stage IV) using a hyperspectral endoscopy camera system with100 spectral channels. For each patient, HSI datacubes were collected intraoperatively from tumor-bearing and adjacent healthy tissue regions. Regions of interest were annotated in cooperation with an independent surgeon. Mean spectral profiles were extracted per tissue class and used to train ML approaches, evaluation was realized using cross-validation. Results: Preliminary results demonstrate visually distinct spectral profiles between tumor and healthy tissue across all investigated anatomical sites. Classifiers achieved promising discrimination accuracy higher than 80%. Consistent spectral differences were observed over the whole measured wavelength region, suggesting tumor-associated changes in tissue oxygenation and structural composition. Analysis is ongoing with a larger patient cohort. Conclusion: HSI represents a promising non-invasive approach for intraoperative in vivo tissue characterization in OPSCC. The combination with ML classification has the potential to support surgical decision-making regarding tumor margin assessment. This feasibility study will provide a foundation for prospective clinical validation. This work was funded by BMFTR/DVI under the HyperTUM project (Grant Agreement No. 16SV9564) and by EU Horizon Programme under the CHARM project (Grant Agreement No. 101058004).

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Introduction Artificial intelligence (AI) is becoming an increasingly important tool in healthcare, supporting diagnosis, prognosis, treatment planning, and patient monitoring. In rehabilitation medicine, AI offers opportunities to transform subjective clinical assessments into objective, data-driven evaluations. However, successful implementation of AI requires access to high-quality clinical data and digital tools capable of collecting standardized patient information. Methods As a case study of AI integration into rehabilitation practice, we present Rehapple, a digital platform developed for patients with facial palsy. The platform supports rehabilitation exercises while collecting facial movement data during routine use. These data are subsequently analyzed using machine learning and deep learning approaches. Current research focuses on automated classification of facial nerve impairment according to the House–Brackmann (HB) grading system using convolutional neural networks, as well as detection of synkineses through machine learning models based on extracted movement features. Results The platform has enabled systematic collection of facial movement recordings from patients undergoing rehabilitation. Preliminary analyses indicate that AI models can identify clinically relevant patterns within the collected data and provide automated assessments of facial function. The continuously growing dataset supports further model development and validation. Conclusion AI has the potential to enhance rehabilitation by providing objective, reproducible, and scalable assessment methods. The Rehapple platform demonstrates how digital data collection and AI-based analysis can be combined in clinical practice to support evaluation of facial palsy. Such approaches may contribute to improved monitoring of patient progress, more standardized assessments, and future development of personalized rehabilitation strategies.

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Background: Human listener-based assessment of alaryngeal speech is clinically established but time-consuming and influenced by listener experience. We investigated whether automatic speech recognition (ASR) can provide a standardized adjunct for assessing speech intelligibility. Methods: Speech samples from 17 alaryngeal speakers (10 tracheoesophageal, 7 electrolaryngeal) were evaluated using 21 complete PLTT datasets. ENT physicians, speech professionals, and speech science students transcribed the recordings. The same samples were processed independently with the locally installed Whisper large-v3 model without fine-tuning and evaluated using identical reference texts and scoring rules. Analyses compared absolute PLTT scores, speaker-level correlations, rehabilitation methods, and exploratory classification of clearly well versus poorly intelligible speakers. Results: ASR produced substantially lower PLTT scores than human listeners (25.36% vs. 55.21–72.03%; all p < 0.001). Nevertheless, ASR scores strongly correlated with pooled human ratings at speaker level (Pearson r = 0.858; Spearman ρ= 0.898; both p < 0.001). Tracheoesophageal speakers achieved higher ASR scores than electrolaryngeal speakers (33.88% vs. 14.46%; p = 0.035). After excluding moderately intelligible speakers, ASR completely separated six well-intelligible from four poorly intelligible speakers in an exploratory analysis (AUC = 1.000; cutoff ≥ 37.5%). Conclusions: The evaluated ASR system underestimated speech intelligibility after laryngectomy and cannot yet replace human assessment. However, its ability to distinguish clearly well from poorly intelligible speakers suggests clinical relevance. External validation in larger cohorts and across languages is required.

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Introduction: Broadband stimulated Raman scattering (bSRS) microscopy provides label-free, chemically specific contrast reflecting intrinsic molecular composition of cells and tissues. Its capability to resolve biochemical heterogeneity in head and neck cancer specimens makes it a promising ex vivo biosensing approach for diagnostic tissue characterization. We present a clinically deployable multimodal bSRS imaging device, COherent Raman PLatform (CORAL), integrating 38 Raman channels with simultaneous second harmonic generation (SHG) and two-photon excited fluorescence (TPEF) acquisition in a single platform. Methods: The system architecture was specifically engineered for operation under routine clinical laboratory conditions. To ensure compatibility with standard histopathological workflows, a robust and reproducible dewaxing protocol was established. Measurement parameters and calibration routines were optimized to balance data quality, acquisition time, and operational stability. Head and neck cancer specimens were analyzed using whole-section scans. A dedicated processing pipeline was developed for visualization and analysis of multimodal bSRS data and integrated into a user-friendly graphical user interface, enabling rapid quality control. Following bSRS imaging, all samples underwent conventional hematoxylin and eosin (H&E) staining. Digitized H&E sections were annotated by expert pathologists, providing systematic correlation of Raman-derived biochemical information with established histopathological features, including tumor cell density, stromal composition, and tissue architecture. Results: Measurement protocols were successfully optimized to achieve reproducible molecular contrast and stable multimodal image acquisition under routine laboratory conditions. Whole-section imaging of clinical tumor specimens generated consistent bSRS, SHG, and TPEF datasets across samples. Comparison with pathologist-annotated H&E sections revealed that the multimodal measurements captured tissue-specific biochemical and structural features corresponding to histopathological tissue organization. Conclusion Multimodal bSRS enables reproducible, label-free biochemical tissue characterization in head and neck cancer specimens and provides diagnostically interpretable contrast at the cell and tissue level. These findings support its potential as an ex vivo biosensing modality complementing conventional histopathology. Acknowledgements: This work was funded by the EU Horizon Programme under the CHARM project (Grant Agreement No. 101058004). Furthermore, we acknowledge funding from the German Cancer Aid (Deutsche Krebshilfe) under the ARBOR- Automated RoBOt Tumor Resection project (grant number: 70116061), TROPHY- ulTRafast holograPHic FTIR microscopY funded by the European and Innovation Council under the Horizon Europe program in the PATHFINDEROPEN-01 call. (HORIZON-EIC-2021 PATHFINDER-OPEN-01, grant number: 101047137), QUANCER- Quantum microscopy with non-detected light for chemical-selective imaging of tumor tissue in a clinical setting (BMFTR, grant number: 13N16444), and TOOLS- Tailored Optics fOr Life Sciences Engineering funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, grant number: 528591139– FIP 31).

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Introduction : Surgical resection is the primary treatment for head and neck squamous cell carcinoma (HNSCC), where complete tumor removal is critical for prognosis. However, current intraoperative margin assessment using frozen section analysis is time-consuming and subjective. Raman spectroscopy is a label-free biophotonic technique that provides a molecular fingerprint of tissue based on inelastic light scattering. It has shown potential for distinguishing tumors for discriminating between tumors and precancerous lesions or benign changes and inflammations. Methods: This prospective, monocentric feasibility trial (DRKS00028114) evaluated the applicability of in vivo Raman spectroscopy for the detection of tumours during surgery in patients with primary head and neck squamous cell carcinoma (HNSCC). The workflow was fully established by the time the 30th patient had been examined. Using a clinical Raman system (InvaScope), spectra were acquired intraoperatively from tumour and healthy tissue sites. Subsequent histopathological analysis served as the diagnostic gold standard. The protocol was designed to integrate seamlessly into the standard surgical workflow. The probe measures in the wavenumber range of 500 cm⁻¹ to 3300 cm⁻¹ (numerical aperture of individual fibres (NA) = 0.22; spectral resolution ≈ 20 cm⁻¹). Results: Following the establishment of the clinical protocol, measurement time was significantly reduced, decreasing from over 30 minutes initially to approximately two minutes. High-quality, interpretable data was obtained from 90% of patients, revealing consistent and clear spectral differences between malignant and healthy tissues in both the fingerprint and high-wavenumber spectral regions. Recruitment of the planned 100 HNSCC patients (intention-to-treat) was completed in May 2025. The final analysis is ongoing. Conclusions: This study demonstrates that Raman spectroscopy, performed in compliance with clinical regulatory standards, is a feasible and rapid technique for the in vivo discrimination of HNSCC. The results support its potential role as a real-time, adjunctive optical biopsy tool for real-time margin assessment during surgery.

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Introduction: Secondary malignancies occur in 10–25 % of patients with head and neck (HN) cancers. The most common locations include the lungs, other HN regions, and the esophagus. Methods: We retrospectively analyzed patients treated for laryngeal or hypopharyngeal carcinoma, focusing on synchronous and metachronous second primary tumors, their association with clinicopathological characteristics, and prognostic relevance. Patients and Results: The cohort included 225 patients (197 men, 28 women; mean age 65 years), including 171 with stage III–IV disease and 162 with T3–T4 tumors. Regional metastases were present in 93 patients and distant metastases in 7; 102 tumors were poorly differentiated. Treatment was surgical in 122 patients, non-surgical in 103. Synchronous or metachronous second primary tumors, or multiple malignancies, were identified in 31 patients, with 34 tumors- 7 synchronous and 27 metachronous. The most frequent secondary malignancies were bronchogenic (n= 11), skin (n= 4) and thyroid (n= 3) carcinomas. Tumors were diagnosed 0–262 months after completion of treatment (mean 52, median 34). Seven patients were symptomatic at diagnosis, while 27 tumors were detected incidentally during follow-up, predominantly by PET/CT (n = 20), CT (n = 2), ENT examination (n = 1), colonoscopy (n = 1), and histopathology after thyroidectomy (n = 3). Median overall survival (OS) was 63 months. Median disease-free interval (DFI) was 129 months. Second primary tumors had no significant impact on OS or DFI. None of the analyzed parameters (smoking, age, sex, tumor size, grade, stage, metastases, treatment modality) influenced their development. Conclusion: Second primary tumors did not affect prognosis in patients treated for laryngeal carcinoma. As no predictors for risk stratification were identified, uniform follow-up is recommended, including head and neck examination and whole-body PET/CT, or chest CT, as one-third originated in the lungs. Follow-up is essential for at least 3 years, when half were diagnosed. Supported by MH CZ – DRO (FNOl, 00098892) and internal research IGA_LF_2026_018.

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Introduction Transoral surgery is a primary treatment option for selected patients with early to moderately advanced oropharyngeal squamous cell carcinoma (OPSCC). Transoral robotic surgery (TORS) was introduced to potentially improve tumor resection precision and reduce treatment-related morbidity compared to conventional transoral surgery (CTS). This study compared oncologic outcomes, treatment burden, and functional surrogates between TORS and CTS. Material & Methods This retrospective cohort study included 74 TORS patients (Sept 2021–Oct 2023) and 48 CTS patients (Oct 2015–Oct 2023) with T1–T3, N0–N2 OPSCC. Variables analyzed included margin status, operative time, hospital stay, functional surrogates (tracheostomy, nasogastric tube dependence), need for adjuvant therapy, and recurrence. Results Mean operative time was significantly shorter for TORS (150,405 min) versus CTS (191,104 min). TORS demonstrated improved perioperative metrics: shorter median hospital stay (7,732 days vs 9,468 days), lower temporary tracheostomy rate (12,162 % vs 14,583 %), and faster nasogastric tube removal (4,142 days vs 6,137 days). The recurrence rate was lower in the TORS cohort (1,351 %) compared to the CTS cohort (10,417 %). However, TORS had a higher rate of positive surgical margins (16,216 % vs 12.5%). The need for adjuvant oncologic therapy was comparable between TORS (82,432 %) and CTS (81,250 %). Conclusions In this cohort, TORS was associated with superior perioperative and functional recovery metrics, including shorter operative time, faster return to oral intake, and lower recurrence, despite a higher rate of positive margins. These findings suggest TORS offers reduced treatment burden and may be beneficial for carefully selected OPSCC patients.

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Purpose: Differentiating benign branchial cleft cysts from cystic metastatic squamous cell carcinoma (SCC) remains challenging in adults, particularly because fine-needle aspiration biopsy (FNAB) may yield false-negative results in cystic lesions. This study aimed to evaluate diagnostic misclassification in adult lateral cystic neck masses operated on under a benign diagnosis and to assess its oncologic consequences. Methods: A retrospective cohort study (2016–2024) included adults undergoing surgery for a presumed branchial cleft cyst with unequivocally benign FNAB findings. Patients with equivocal cytology or any clinical, endoscopic, or radiologic suspicion of malignancy were excluded. Demographic, clinical, radiologic, pathologic, and survival data were analyzed. Outcomes were additionally compared with a cohort of surgically treated thyroglossal duct cysts managed at the same institution. Results: Among 72 patients operated on for a presumed branchial cleft cyst, definitive histology confirmed a benign cyst in 64 cases (88.9%) and metastatic SCC in 8 cases (11.1%). Advanced nodal disease (N1–N2b) was identified only after surgery, despite the absence of suspicious clinical or radiologic findings. Diagnostic misclassification delayed definitive oncologic treatment by a mean of 5.1 months. Two tumor-related deaths occurred, resulting in 2- and 5-year disease-specific survival rates of 75%. In contrast, all 49 patients with thyroglossal duct cysts had concordant preoperative and histopathologic diagnoses, and no malignancy was identified during follow-up. Conclusion: Even with benign FNAB findings and no clinical or radiologic suspicion, metastatic SCC may be present in adult lateral cystic neck masses. Early surgical intervention and routine frozen section analysis should therefore be considered in adult patients.

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Background Incidence of thyroid cancer is increasing worldwide specially for small size papillary thyroid carcinoma, while the mortality remains low. Thyroid cancers are the most common endocrine disorders. Bangladesh is one of the countries with the high prevalence of thyroid cancer. The actual burden of thyroid dysfunction in Bangladesh is unknown. Surgery is the mainstay of treatment for thyroid cancer. In addition, active surveillance is proven as a valid option in patients with low-risk papillary thyroid cancer. The aim of this study is to assess the possibility of implementation of active surveillance in Bangladesh by physicians and to identify potential barriers to its widespread adoption. Methods Me & my group surveyed participants, Endocrinologists, ENT & Head-Neck surgeons of Bangladesh by distributing questionnaires & talking to them over telephone. The questionnaire included dichotomous, multiple choice questions, and multiple answer questions. Results We got responses from 50 surgeons. Most of the respondents agreed that AS is a valid modality for low-risk papillary thyroid cancer but no one has patients on active surveillance. ENT surgeons, Endocrinologists with >15 years of experience, and & practicing in clinics, private hospitals & university hospitals were involved. We have started an active surveillance program with a very small group of patients & awareness activities among different groups of doctors. Conclusion Obstacles to implementing active surveillance were, patient noncompliance and lack of national awareness as well as acceptance among the Bangladeshi doctors. Still active surveillance is possible in Bangladesh with differences in health care system & health care organization and even outside academic centers. Efforts to decentralize knowledge and expertise to health-care practitioners and community hospitals would encourage its implementation.