Malpractice in Head and Neck Surgery

For patients with head and neck cancer, errors in diagnosis, surgical technique, and postoperative care each have a potential for high-impact negative outcomes and are targets of malpractice litigation. Guidelines in conjunction with expert testimony help a court define standard of care, and the head and neck surgeon should be familiar with guidelines related to head and neck surgery and cancer care. Prior to surgery, informed consent for these complex procedures is lengthy and leaves potential for deviation from focused discussion of risks, and patient recall of specific risks is low. As such, a careful informed consent process should be supplemented with standardized patient handouts. Additionally, current medicolegal literature suggests special attention should be paid to the facial (CN VII), vagus (CN X), and spinal accessory (CN XI) cranial nerves. The use of intraoperative nerve monitoring for CN VII and recurrent laryngeal nerves remains controversial in the setting of malpractice, as lack of use does not lead to litigation; however, routine use should be considered for other reasons. Should injury occur, otolaryngologists should be comfortable with diagnosis and management of possible nerve injuries. Airway-related cases represent another important source of malpractice litigation for the otolaryngologist, and avoiding negligence during the postoperative period warrants careful attention. Delayed, missed, or improper diagnosis in head and neck cancer contributes to poorer prognosis and outcomes and is a major risk for litigation. The head and neck surgeon should carefully review all pathology reports and ensure appropriate postoperative oncologic management, as failure to do so may result in malpractice litigation. Additionally, young patient age is routinely associated with cancer-related malpractice litigation, especially compared to the median age of laryngeal and oral cavity cancers.