Myocardial Injury After Non-Cardiac Surgery in Otolaryngology: Evidence Gaps and a Systematic Review.

Background/Objectives: Myocardial injury after non-cardiac surgery (MINS) is a common and serious postoperative complication. Its largely asymptomatic course hampers early recognition, highlighting the importance of systematic biomarker monitoring. The aim of this review is to summarize current evidence on the diagnosis, risk factors, and management of MINS, with a focus on otolaryngology, where intraoperative hypotensive techniques may increase risk. Methods: A basic science review was conducted using PubMed, Embase, and the Cochrane Library (2005-2025). From 2712 records, 30 studies met the inclusion criteria after removing duplicates, screening titles/abstracts, and full-text assessment. These studies formed the basis for the final analysis. Results: Observational studies and reviews identify perioperative troponin monitoring as the diagnostic gold standard. However, no evidence-based management guidelines exist, and otorhinolaryngology-specific data remain rare but not entirely absent. Troponin elevation in the early postoperative period reliably predicts adverse outcomes. While MINS is well documented in vascular and orthopedic surgery, evidence in otolaryngology is limited. Controlled hypotension in procedures such as functional endoscopic sinus surgery or head and neck tumor resection may further elevate risk. Conclusions: MINS is an underrecognized complication with major prognostic significance. The lack of standardized management and the absence of large otolaryngology cohorts underscore an urgent need for targeted research and specialty-specific guidelines and support the justification for integrating existing evidence into otolaryngologic practice.