Background: Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early‐stage T1–T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN‐technique in advanced OSCC (T3–T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC.Materials and Methods: In total, 85 patients with T1–T4 OSCC diagnosed 2019–2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT–CT to include all SNs.Results: Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early‐stage disease. T3–T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1–T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3–T4 versus T1–T2 (p = 0.0398).Conclusion: SN‐assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.

Background: Optimum management of the N0 neck is unresolved in parotid salivary gland cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis and its´ clinical use is increasing for head and neck tumors. The object of this study was to establish whether the technique is applicable to detect distribution of sentinel nodes for parotid tumors.Materials and Methods: Prosepective observational study in 30 patients with benign or low‐grade T1‐T2N0 malignant tumors in the parotid gland planned for surgical treatment. Distribution of SN was detected with a preoperative ultrasound‐guided peritumoral injection with a technetium‐99 (Tc‐99 m) laballed tracer followed by a SPECT–CT and intraoperative measurement in the neck and parotidal tissue. In patients with cytologically suspected malignant tumor or highly unclerar cytology, SNB was also performed.Results: Sentinel nodes (SNs) were detected in 26/30 cases. Out of these, 7 presented with only one SN, whereas multiple sentinel nodes where detected in 19 cases. No SNs were found in neck level 1. SN was detected in level 5 independent of tumor location within the parotid gland. An intraparotidal distribution of SNs was more frequent in larger tumors.Conclusions: The use of SN‐technique in the planning of surgical treatment of parotid tumors seems feasible. It may be of clinical value for patients with parotid cancer to enable a more accurate staging and to detect occult metastasis in the SNs within the parotid as well as in the neck, enabaling the possibility to surgically remove all positive SNs at primary surgery and with reduced surgical morbidity.

The incidence of human papillomavirus positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC) has increased the past decades. Initial reports disclosed that HPV type 16 (HPV16) was predominant and that patients with HPV+ OPSCC were generally younger and had a better prognosis than those with HPV negative (HPV−) OPSCC. However, recent reports suggest that age differences between patients with HPV+ and HPV−OPSCC are less pronounced and that other high‐risk HPV types (HR‐HPV) are becoming more common. Here, we therefore investigated whether there were age differences between patients with HPV16‐positive and other HR‐HPV type positive OPSCC. During 2000–2022, in the Stockholm–Gotland‐Region, Sweden, 1681 patients with OPSCC tested for the presence of common mucosal HPV types were included. Among these, 1180 cases had a HR‐HPV type infection, with 1032 identified as HPV16 and 148 as other HR‐HPV types; one with a low‐risk HPV type infection; and 500 classified as HPV−. Patients with HPV+ OPSCC were significantly younger than those with HPV− OPSCC (mean 63 vs. 66.5, p <.001). Among patients with HPV+ OPSCC, those diagnosed with HPV16 were significantly younger than those with other HR‐HPV types (mean 61.1 vs. 64.5, p < 0.001). These age differences were present irrespective of sex, but patients with HPV16‐positive OPSCC were significantly more likely to present with smaller tumours upon diagnosis ( p = 0.002). Moreover, notably, statistically significant age differences between HPV16 and other HR‐HPV types were mainly observed in the more recent years (2010–2022). To conclude, the increasing influence of HR‐HPV types other than HPV16 in OPSCC warrants further investigation.

Objective: To determine the prevalence and identify associated risk factors of pharyngocutaneous fistula following total laryngectomy. Methods: Medical records of 160 patients diagnosed with laryngeal cancer between 2000–2021, subsequently undergoing total laryngectomy at Karolinska University Hospital, were analyzed for demographics, comorbidities, tumor characteristics, treatments and postoperative outcomes. Uni- and multivariate analyses were used to identify risk factors for pharyngocutaneous fistula. Results: Pharyngocutaneous fistula developed in 28 patients (17.5%). Univariate analysis identified cardiovascular disease (OR 2.50; 95% CI 1.00–6.28), preoperative hemoglobin <110 g/L (OR 5.34; 95% CI 1.74–16.45), prior radiotherapy (OR 3.78; 95% CI 1.24–11.52), preoperative tracheostomy (OR 2.44; 95% CI 1.05–5.72), pharyngectomy (OR 8.47; 95% CI 2.46–29.17), neck dissection (OR 2.52; 95% CI 1.06–6.00), pectoral flap reconstruction (OR 10.83; 95% CI 1.88–62.49) and postoperative infection (OR 28.44; 95% CI 9.00–89.81) as significant risk factors. In multivariate analysis only pharyngectomy (OR 7.18; 95% CI 1.08–47.63; p = 0.041) and postoperative infection (OR 24.94; 95% CI 6.66–93.46; p < 0.001) remained independent. Conclusions: Pharyngocutaneous fistula is a common complication occurring in 17.5% of patients following total laryngectomy. Pharyngectomy and postoperative infection are independent risk factors for fistula formation.