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To maintain the nasal dorsal sidewall unit, superior, central dorsal, and nasal sidewall defects have traditionally been reconstructed using a variety of techniques, including skin grafts and regional flaps, such as glabellar flaps and frontal flaps. We demonstrate that creation of the nasal dorsal sidewall unit is often not necessary, and excellent results can be achieved through the expanded use of cheek advancement flaps.

Background In this paper, we present three cases where a novel transoral robotic surgery (TORS) approach was used to resect clival chordomas extending into the nasopharynx to demonstrate progress in the evolution of robotic surgery of the head and neck. Methods The first patient had a history of metastatic chordoma resection and presented with trismus and dysphagia; the second and third patients had first presentation with nasal congestion and facial numbness, respectively. All patients underwent a novel transpalatal‐TORS resection. Results Total resection was achieved in the first patient and near‐total resections were achieved in the second and third patients. All patients had minimal postoperative morbidity and no patients experienced significant adverse events. Conclusion Clival chordomas are rare, potentially dangerous lesions with a high rate of recurrence. The novel transpalatal‐TORS approach to these tumors presented in this series represents advancement in the realm of minimally invasive surgery of the head and neck. This approach offers patients total or near‐total control of these lesions with minimal intraoperative and postoperative side effects.

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Objective In this article, we present a series of 28 patients who underwent thyroid surgery using local anesthesia. We describe our technique, report outcomes, and assess how well the procedure was tolerated from a patient perspective. Methods Three surgeons performed awake thyroidectomies and recorded data, including the patient's age and gender, surgery being performed, operative time, weight of the surgical specimen, quantity and type of local anesthetic used, additional medications, patient‐reported pain assessment, and any complications. Results Twenty‐seven of 28 patients (96%) successfully underwent awake thyroidectomy. One patient had to be converted to general anesthesia due to airway concerns. There were no complications; however, one patient had a panic attack. Based on a 0 to 10 scaled pain score, the average amount of pain reported was 3.4. The amount of pain the patient reported was significantly dependent on the amount of experience the operating surgeon had with this technique. Seventy‐one percent of patients tolerated surgery with local anesthesia only and did not require additional medications. Conclusion Awake thyroidectomy is a well‐tolerated and safe procedure in appropriately selected patients, with many potential benefits over general anesthesia. In most cases, only local anesthesia is required. Increased experience with this technique may be associated with increased patient comfort. Level of Evidence 4 Laryngoscope, 130:685–690, 2020

Introduction: It is well known that malignant cells can be implanted at distant donor sites due to iatrogenic surgical contamination. Only a small number of reports, however, have been published describing this. Case Presentation: We present a case of oral cavity Squamous Cell Carcinoma (SCC) reconstructed with a radial forearm free flap in which SCC developed in the subcutaneous tissues beneath the donor incision site 6 months after surgery. Management: The implanted tumor was excised and the field was subsequently treated with radiation. The patient remains disease-free on follow-up. Discussion: We present the second report of tumor implanted in a free flap donor site. Additionally, we discuss the risks of tumor implantation, review the literature, and make recommendations to avoid this complication.

We describe a 27-year-old female with a giant cell tumor of her sphenoid sinus, presenting with nasal obstruction and cranial neuropathies. Both the surgical and subsequent medical management are reviewed. Additionally, we review the overall presentation, pathophysiology, and management of giant cell tumors of the skull base. Current treatment recommendations are presented.A 27-year-old female presented to our institution with a 1-month history of retro-orbital headache, neck pain, nasal obstruction, and blurred vision. CT head identified a sphenoid mass with extension into the sella, clivus, and ethmoid sinuses ( Fig. 1). MRI outlined a clival mass extending into the sphenoid sinus and cavernous sinus with a mass effect on the contents of the sella turcica (Fig. 2). An endoscopic endonasal biopsy was performed with pathology consistent with GCTb (Fig. 3).The patient then presented to the emergency department 5 days later with new-onset diplopia of the right eye, nasal drainage, and worsening headache. She was found to have a right-sided cranial nerve VI palsy. MRI showed invasion into the cavernous sinus with encroachment on the optic chiasm and internal carotid arteries bilaterally. ConclusionGiant cell tumors of the skull base are rare, benign, and locally aggressive, with high recurrence rates. The age of presentation is usually between 20 and 40 years with a predominance in females. The presenting clinical symptoms vary widely depending on tumor location. Hearing loss, headache, tinnitus, and dysfunction of the cranial nerves are the usual modes of presentation in skull base involvement. Surgical excision remains the treatment of choice, yet due to the possibility of incomplete resection and high recurrence rates, adjuvant therapy with denosumab may be necessary to improve local control. Our report, in combination with previous reports, provides evidence to support this as a potential new standard of care.

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