FELLOWSHIP IN HEAD AND NECK SURGICAL ONCOLOGY

• Introduction to the head and neck oncology team and interdisciplinary approach.
• Discussion of pathophysiology, staging, and clinical presentation of head and neck cancers.
• Presentation of the diagnostic and imaging modalities (CT, MRI, PET-CT, biopsy techniques).
• General principles of surgery, such as margins, lymphatic drainage, and tumor biology.
• General anatomy of head and neck.
• Summary of TNM staging system.
• Multidisciplinary team tasks (surgeons, radiologists, pathologists, oncologists).
• Simple surgical skills: Incision, flap, and tissue manipulation.

• Knowledge of oncological resection of oral cavity, oropharynx, hypopharynx, larynx, nasopharynx and paranasal sinuses cancers.
• Use of wide local excision principles and functional preservation.
• Methods of dealing with problematic resections (e.g., involvement of the base of the skull, cervical spine involvement).
• Removal of mouth and oropharyngeal tumors.
• Surgery of the larynx and hypopharynx.
• Malignancies of the nose, sinus and nasopharynx.
• Multifocal skull base and infratemporal fossa resections.
• Treatment of perineural invasion, vascularity, and bone resections.
• Surgical procedures with complex tumor resections.
• Use of surgical navigation and intraoperative imaging.

• Thorough learning and performance of detailed neck dissections (levels I-V).
• Selective neck dissection using tumor site and lymphatic drainage.
• Location and protection of the essential structures (e.g., nerves, blood vessels).
• Knowledge about recurrence patterns of the neck, and the effect of neck dissection on prognosis.
• Signs of radical vs. selective neck resection.
• Techniques in lymphatic mapping and sentinel node biopsy.
• Neck recurrent disease.
• The value of frozen section and intraoperative pathology in neck surgery.
• Neck dissection courses, cadavers dissections and live operations.

• Art in the reconstruction procedures after oncological resections.
• Knowledge of soft tissue and bony reconstruction.
• Use of free tissue transfer, flap (microvascular, regional, local) and grafts.
• Maximization of functional and aesthetics in head and neck reconstructions.
• Flap design and choice principles.
• Microvascular surgery and blood vessels transfer (free fibula, radial forearm flaps).
• Mandibular defects bone grafting and reconstruction.
• Functional outcomes: Pre- and post-reconstruction functional restoration of swallowing, speech, and breathing.
• Aesthetic reconstructions of the faces.
• Live case and cadaveric simulated surgery.
• Practice of microvascular suturing and free flap anastomosis.

• Introduction to head and neck oncology, minimally invasive techniques.
• Expertise in endoscopic methods of resection of tumours in hard to reach locations.
• Practical exposure to head and neck cancer resections using robots.
• Naresopharyngeal and laryngeal tumors, endoscopic resection.
• Surgery Robotic-assisted procedures in head and neck surgery.
• Advantages and disadvantages of less invasive methods.
• Aftercare and possible complications of minimally invasive procedures.
• Simulation models of robotic surgery.
• Endoscopic techniques of dissection and resection of the nasopharynx and larynx.

• Combination of surgery, radiation therapy and chemotherapy to treat head and neck cancer.
• Recognizing those patients who would need adjuvant therapy (radiotherapy/chemotherapy).
• Treating radiation therapy complications, which include xerostomia and osteoradionecrosis.
• Postoperative adjuvant therapy and preoperative optimization.
• Neoadjuvant therapy and induction chemotherapy.
• Treatment of radiation induced toxicities and follow-up.
• Nutrition and speech/swallowing therapy after treatment.
• Involvement in tumor boards, conversations about complex cases with the multidisciplinary team.
• Practical training on dealing with complications and side effects of adjuvant therapy.

• Exposure to latest technologies in head and neck cancer.
• Artificial intelligence (AI) applications in surgery and diagnosis.
• Knowledge of the potential of personalized medicine and molecular targeted therapies.
• Artificial intelligence and machine learning in tumor imaging and surgery.
• Intraoperative imaging, augmented reality, and robotic assistance innovations.
• The importance of next-generation sequencing and targeted therapies in head and neck cancer.
• Immunotherapy and the changing roles of immuno-oncology in head and neck cancers.
• Case studies Precision medicine and molecular tumor profiling.
• Practical experience with AI-driven diagnostic systems and robots.

• Training to become a self-sufficient clinician and academic leader.
• Practice in how to do high-impact research, writing scientific articles, and speaking at international conferences.
• Acquisition of leadership and teaching skills in academics.
• Head and neck oncology Research methodology and biostatistics.
• Composing and publication of papers in academia; speaking at conferences.
• Surgical team leadership, junior resident mentoring, and fellows.
• Head and neck oncology surgery: Innovations in surgery: Trends and future directions.
• Presentation and peer review of research projects.
• Mentorship and leadership training.

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• Knowledge of the concepts of palliative care with advanced head and neck cancers.
• Symptom management skills such as pain management, dysphagia management and airway obstruction management.
• Ethics in end of life care, such as interaction with patients and families.
• Palliative care principles: The management of pain, dysphagia management. Tracheostomy management.
• Treatment of complications of the advanced disease: Hemorrhage, airway obstruction.
• Importance of hospice care and multidisciplinary palliative teams.
• The ethical decision-making in terminally ill head and neck cancer.
• Patient/family psychological support.
• Palliative care interventions case studies.
• Role-playing activities on how to convey bad news and end-of-life conversations.

• Detailed knowledge of the genetic and molecular mechanisms of head and neck tumours.
• Molecular profiling and genetic testing in treatment decisions.
• Role of genetic counseling and precision medicine in head and neck oncology.
• Pathways and genetic mutations in head and neck cancer (e.g., EGFR, HPV-related cancers).
• Biomarkers and their use in prognosis and treatment planning.
• The future of personalized treatment and molecular targeted therapies.
• Genomic sequencing and its translation to clinical practice.
• Ethical factors and genetic counseling.
• Genetic test and molecular profile interpretation workshops.
• Oncologists and genetic counselor panel discussion on precision medicine.

• Knowledge of the special features of head and neck cancers in children.
• Knowledge of pediatric-related surgical techniques and factors.
• Cooperative care by pediatric oncologists, radiologists, and speech pathologists.
• Epidemiology and biology of tumors of the head and neck in children.
• Surgical plans of children with malignant or congenital tumors.
• Reconstructive surgery in children.
• Childhood cancer treatment such as rhabdomyosarcoma, neuroblastoma and thyroid cancer in children.
• Radiotherapy and chemotherapy problems, specific to the pediatric population.
• Discussions of pediatric head and neck tumors based on a case.
• Practical simulation of pediatric surgery.

• Emphasize functional rehabilitation after head and neck surgery, speech and swallowing.
• Cooperation with speech-language pathologists to maximize functional results.
• Post-cancer rehabilitation of long-term disabilities.
• Rehabilitation of speech, swallowing and voice after surgery.
• Methods of rehabilitation of speech following laryngectomy (e.g., voice prostheses, esophageal speech).
• Swallowing rehabilitation therapy, such as feeding tubes and other techniques.
• Use of prosthetics for oral cavity defects and restoration of facial aesthetics.
• Management of trismus, xerostomia, and other functional impairments.
• Workshops with speech therapists for voice restoration techniques.
• Simulated swallowing exercises and rehabilitation protocols.