Several emerging sinonasal malignancies have recently been described in the pathology literature. Although not all distinctly classified by the World Health Organization, these rare tumors present a management challenge to surgeons and oncologists. While prior studies have summarized histologic details, a clinically focused review is currently lacking in the literature. This review describes the presentation, histopathology, imaging, treatment, and prognosis of newly described or recently evolving sinonasal malignancies while highlighting the distinguishing features of these entities. It includes teratocarcinosarcoma, human papillomavirus‐related multiphenotypic carcinoma, biphenotypic sinonasal sarcoma, sinonasal renal cell‐like adenocarcinoma, NUT‐midline carcinoma, squamous cell carcinoma associated with inverted papilloma, sinonasal undifferentiated carcinoma, and INI‐1‐deficient sinonasal carcinoma. By describing the diagnosis, treatment, and prognosis of these recently defined entities, this clinical review aims to help guide oncologists in the clinical management of these patients.

Background There are conflicting recommendations and possibly overuse of imaging for surveillance of second primary tumors for patients with a history of head and neck paraganglioma. Methods Retrospective cohort study of 234 adults with head and neck paragangliomas (1990‐2010) followed for a mean of 7.5 ± 8.4 years. Results The rate of second paraganglioma was 1.7% after 5 years and 5.1% after 10 years, yielding an incidence of 6.65 per 1000 person‐years. Only 1.3% of patients (2.59 per 1000 person‐years) ever had a second paraganglioma in the chest, abdomen, or pelvis. Patients with a hereditary paraganglioma (hazard ratio [HR] = 4.84, 95% confidence interval [CI]: 1.52‐15.43) or carotid body tumor (HR = 3.55, 95% CI: 1.15‐10.99) were at greater risk. Conclusions The incidence rate of a second primary paragangliomas is low but increases with hereditary disease. These results question the utility of repeated imaging outside of the neck to screen for second paragangliomas.

Objectives: Understand the utility and technique of injection pharyngoplasty with autologous fat for the treatment of mild to moderate velopharyngeal insufficiency in adults without a history of cleft palate. Methods: Consecutive case series of 11 patients (mean [SD] 41 ± 21 years of age) who underwent injection pharyngoplasty with autologous fat from 2012 to 2018 at a tertiary care center. Patients were followed for a mean of 8.6 ± 8 months with pre versus postoperative evaluations of improvement in rhinophonia, dysphagia, and velopharyngeal closure by nasopharyngoscopy (scored: 0, none; 1, mild; 2, moderate; 3, near-complete; 4, complete). Results: Patient selection and surgical techniques are described. Mean improvements were 2.3 ± 0.86 for rhinophonia, 2.0 ± 0.89 for dysphagia, and 3.0 ± 0.95 for velopharyngeal closure by nasopharyngoscopy. Five (45%) patients underwent subsequent intervention, including four repeat fat injections and three sphincter pharyngoplasties. There were two transient complications–donor site hematoma and subjective nasal obstruction. Conclusions: Although objective assessments are lacking to date, this is among the first reports to demonstrate the effectiveness and safety of injection pharyngoplasty with autologous fat for velopharyngeal insufficiency in a population of adults without a history of cleft. We found, on average, moderate improvement in rhinophonia and dysphagia, and near-complete improvement in velopharyngeal closure by nasopharyngoscopy; however, a portion of patients required subsequent intervention.

Objectives To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). Materials and Methods Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. Results Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01–19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19–30.29) and smoking (OR 5.91, 95% CI 1.69–20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16–12.17) and preoperative swallow (OR 3.42, 95% CI 1.23–9.51). Five‐year ORN‐recurrence‐free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43–8.94). Conclusions Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.

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