Objective: Survival differences in oral cancer between black and white patients have been reported, but the contributing factors, especially the role of stage, are incompletely understood. Furthermore, the outcomes for Hispanic and Asian patients have been scarcely examined.Study Design: Retrospective, population‐based national study.Setting: Surveillance, Epidemiology, and End Results 18 Custom database (January 1, 2010, to December 31, 2014).Subjects and Methods: In total, 7630 patients with primary squamous cell carcinoma in the oral cavity were classified as non‐Hispanic white (white), non‐Hispanic black (black), Hispanic, or Asian. Cox regression was used to obtain unadjusted and adjusted hazard ratios (HRs) of 5‐year mortality for race/ethnicity with sequential adjustments for stage and other covariates. Logistic regression was used to examine the relationship between race/ethnicity and stage with adjusted odds ratios (aORs).Results: The cohort consisted of 75.0% whites, 7.6% blacks, 9.1% Hispanics, and 8.3% Asians. Compared to whites, the unadjusted HR for all‐cause mortality for blacks was 1.68 (P <. 001), which attenuated to 1.15 (P =. 039) after adjusting for stage and became insignificant after including insurance. The unadjusted HRs for all‐cause mortality were not significant for Hispanics and Asians vs whites. Compared to whites, blacks and Hispanics were more likely to present at later stages (aORs of 2.63 and 1.42, P <. 001, respectively).Conclusion: The greater mortality for blacks vs whites was largely attributable to the higher prevalence of later stages at presentation and being uninsured among blacks. There was no statistically significant difference in mortality for Hispanics vs whites or Asians vs whites.

Chyle leak, although rare, is a well-documented complication following surgical dissection of the neck. To date, reports of the rate of this complication have ranged between 1% and 2.5% of cases,^1,2 with a higher rate for radical neck dissections than selective neck dissections.³ Patients who received radiation therapy prior to neck dissection had a higher incidence of chyle fistula, but the difference was not statistically significant. Because of the location of the thoracic duct in the left side of the neck, there is a risk of chyle leak in lateral and central neck procedures,⁴ but injury can also occur in penetrating trauma. The duct terminates at the junction of the left internal jugular and subclavian veins and typically has a complex branching pattern into multiple smaller channels. Although the left side of the neck is the most common site, chyle fistulas have been reported in the right side of the neck as well because of the variability in the lymphatic system, with the possibility of a thoracic duct outlet on the right side.⁵ Although it occurs infrequently, it is a serious complication with substantial risk that can ultimately be life threatening. Left untreated, patients can experience hypovolemia; metabolic imbalances such as hyponatremia, hypochloremia, and nutritional deficiencies; and immunological complications. Patients may require total parenteral nutrition (TPN), with associated risks of liver failure and thrombosis and sepsis associated with central venous access. In addition, prolongation of a chyle leak can lead to longer hospital stays, delayed healing, and necrosis of skin flaps. In refractory cases, a return to the operating room may be required, causing a substantial increase in cost for the hospitalization.

OBJECTIVE: The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base neurosurgery remain limited. Therefore, the authors performed a systematic review of the literature to identify all articles that used robotic systems to access the sella or anterior, middle, or posterior cranial fossae. METHODS: A systematic review of MEDLINE and PubMed in accordance with PRISMA guidelines performed for articles published between January 1, 1990, and August 1, 2021, was conducted to identify all robotic systems (autonomous, semiautonomous, or surgeon-controlled) used for skull base neurosurgical procedures. Cadaveric and human clinical studies were included. Studies with exclusively otorhinolaryngological applications or using robotic microscopes were excluded. RESULTS: A total of 561 studies were identified from the initial search, of which 22 were included following full-text review. Transoral robotic surgery (TORS) using the da Vinci Surgical System was the most widely reported system (4 studies) utilized for skull base and pituitary fossa procedures; additionally, it has been reported for resection of sellar masses in 4 patients. Seven cadaveric studies used the da Vinci Surgical System to access the skull base using alternative, non–TORS approaches (e.g., transnasal, transmaxillary, and supraorbital). Five cadaveric studies investigated alternative systems to access the skull base. Six studies investigated the use of robotic endoscope holders. Advantages to robotic applications in skull base neurosurgery included improved lighting and 3D visualization, replication of more traditional gesture-based movements, and the ability for dexterous movements ordinarily constrained by small operative corridors. Limitations included the size and angulation capacity of the robot, lack of drilling components preventing fully robotic procedures, and cost. Robotic endoscope holders may have been particularly advantageous when the use of a surgical assistant or second surgeon was limited. CONCLUSIONS: Robotic skull base neurosurgery has been growing in popularity and feasibility, but significant limitations remain. While robotic systems seem to have allowed for greater maneuverability and 3D visualization, their size and lack of neurosurgery-specific tools have continued to prevent widespread adoption into current practice. The next generation of robotic technologies should prioritize overcoming these limitations.

Objective: With burgeoning popularity of artificial intelligence‐based chatbots, oropharyngeal cancer patients now have access to a novel source of medical information. Because chatbot information is not reviewed by experts, we sought to evaluate an artificial intelligence‐based chatbot's oropharyngeal cancer‐related information for accuracy.Methods: Fifteen oropharyngeal cancer‐related questions were developed and input into ChatGPT version 3.5. Four physician‐graders independently assessed accuracy, comprehensiveness, and similarity to a physician response using 5‐point Likert scales. Responses graded lower than three were then critiqued by physician‐graders. Critiques were analyzed using inductive thematic analysis. Readability of responses was assessed using Flesch Reading Ease (FRE) and Flesch–Kincaid Reading Grade Level (FKRGL) scales.Results: Average accuracy, comprehensiveness, and similarity to a physician response scores were 3.88 (SD = 0.99), 3.80 (SD = 1.14), and 3.67 (SD = 1.08), respectively. Posttreatment‐related questions were most accurate, comprehensive, and similar to a physician response, followed by treatment‐related, then diagnosis‐related questions. Posttreatment‐related questions scored significantly higher than diagnosis‐related questions in all three domains (p < 0.01). Two themes of the physician critiques were identified: suboptimal education value and potential to misinform patients. The mean FRE and FKRGL scores both indicated greater than an 11th grade readability level—higher than the 6th grade level recommended for patients.Conclusion: ChatGPT responses may not educate patients to an appropriate degree, could outright misinform them, and read at a more difficult grade level than is recommended for patient material. As oropharyngeal cancer patients represent a vulnerable population facing complex, life‐altering diagnoses, and treatments, they should be cautious when consuming chatbot‐generated medical information.Level of Evidence: NA Laryngoscope, 134:2252–2257, 2024