Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer.

Objective: Recent literature studying the impact of blood transfusion on outcomes in patients with head and neck cancer (HNC) have shown that blood transfusions are associated with increased risk of death and higher wound infection rates. The purpose of this study was to implement a lower transfusion threshold while comparing outcomes of free flap patients following initiation of a new transfusion guideline.

Methods: A retrospective study of all patients at a tertiary care academic center who underwent free tissue transfer after HNC resection between July 17, 2007 and June 7, 2021.

Oncocytic carcinoma of the thyroid: Conclusions from a 20-year patient cohort.

Background: Oncocytic carcinoma (OCA) was recently reclassified as a distinct differentiated thyroid carcinoma (DTC). Given its rarity, OCA studies are limited. This study describes the characteristics of OCA in a 20-year cohort.

Thyroid cancer necrosis not evident on imaging: A cautionary case series on poorly differentiated thyroid carcinoma diagnosed only on final pathology.

Objective: Poorly-differentiated thyroid cancer (PDTC) is a highly aggressive malignancy which is recently defined and understudied in the radiologic literature. Necrosis is a key histopathologic criterion for the diagnosis of PDTC. We illustrate the current difficulty in accurate identification of histopathologic necrosis on preoperative imaging.

A staged approach to oromandibular reconstruction using the iliac crest free flap in the setting of bilateral failed fibula free flaps.

Background: While a single-stage free-flap reconstruction is the preferred approach for oromandibular defects, a multistaged approach may be necessary in rare cases. These patients can still be effectively restored with functional and aesthetic improvements.

Methods: We report two cases with a history of bilateral failed fibula free flaps.

Synchronous thyroid cancer and malignant struma ovarii: concordant mutations and microRNA profile, discordant loss of heterozygosity loci.

Background: Struma ovarii is an unusual ovarian teratoma containing predominantly thyroid tissue. Less than 10% of cases undergo malignant transformation in the thyroid tissue and are considered malignant struma ovarii (MSO). MSO have been reported with concurrent thyroid lesions, but molecular data is lacking.

How I Do It: Sternocleidomastoid Flap Augmentation of Tracheal Repair After Resection for Invasive Thyroid Cancer.

Surgical treatment for thyroid carcinoma invading the trachea often involves circumferential tracheal resection and primary tracheal repair. This procedure involves a significant risk of anastomotic breakdown. We present a novel approach to cricotracheal repair using an SCM flap bolster designed to reduce the risk of anastomotic complications.

WPOI-5: Accurately Identified at Intraoperative Consultation and Predictive of Occult Cervical Metastases.

Background: Frozen section analysis of oral cancer specimens is ideal for assessing margin distances and depth of invasion (DOI); the latter impacts intraoperative decisions regarding elective neck dissection (END). Here, we show that intraoperative determination of worst pattern of invasion (WPOI), specifically WPOI-5, has a high level of accuracy. This relates to our demonstration herein that WPOI-5 predicts occult cervical metastases (OCM) for pT1 oral squamous carcinoma (OSC).

Extratumoral invasion: A unique phenomenon of aggressive recurrent oropharyngeal squamous cell carcinoma.

Background: Oropharyngeal squamous carcinomas cause significant morbidity and mortality. Poor prognosticators include lymphovascular and perineural invasion. Extratumoral phenotypes of these histologic findings confer worse prognoses.

Psychological adjustment to initial treatment for low-risk thyroid cancer: Preliminary study.

Background: Low-risk papillary thyroid carcinoma (LR-PTC) can be managed by immediate surgery (IS) or active surveillance (AS). We compare the psychological impact of these treatments on patients with LR-PTC.

Methods: Psychological data were collected over 1 year, with assessments at the time of treatment decision (T1), at 6 months (T2) and 12 months (T3) follow-up.

Utilizing 3D head and neck specimen scanning for intraoperative margin discussions: Proof of concept of our novel approach.

Background: The current standard of documenting and communicating frozen section margin results is inefficient. We present a novel method of generating 3D digital models of gross tumor specimens to more clearly visualize histopathological margin results.

Methods: Fifty-five head and neck specimens were scanned and virtually "inked" using 3D software.

Novel technique to prevent or correct open-mouth deformity after bilateral mandibular resection: Use of tensor fascia lata slings.

Open-mouth deformity after mandibular resection presents a challenge for surgeons and patients, contributing to significant functional and cosmetic morbidity. We present an innovative surgical technique to prevent or correct open-mouth deformity. Tensor fascia lata slings were utilized in combination with maxillomandibular fixation to surgically correct or prevent open-mouth deformity in four patients who had previously undergone mandibulectomy or at the time of a contralateral mandibulectomy following prior hemimandibulectomy and reconstruction.

Does surgical management still play a role in the management of ectopic lingual thyroid: Institutional experience and systematic review of the literature.

Objective: Management of ectopic lingual thyroid (ELT) must balance the morbidity of disease with the morbidity of treatment. We investigate clinical outcomes associated with modern treatment options and analyze the role of transoral surgery in the treatment algorithm for ELT.

Methods: This was a retrospective chart review of ELT patients treated at a tertiary care center from 1/1/1979 to 12/31/2019.

A novel technique for management of stenosis of the postlaryngectomy stoma with preservation of a functional tracheoesophageal puncture following tracheal resection.

Tracheostomal stenosis following total laryngectomy presents a serious concern for surgeons and patients. Although various techniques correct tracheostomal stenosis, none address an existing tracheoesophageal puncture (TEP). We present an approach to repair tracheostomal stenosis, requiring tracheal resection, and preserve the TEP in a functional position needed for speech rehabilitation.

Development and Validation of Instrument for Operative Competency Assessment in Selective Neck Dissection.

Background: Instruments to assess surgical skills have been validated for several key indicator procedures in otolaryngology. Selective neck dissection is a core procedure for which trainees must integrate knowledge of complex head and neck anatomy with technical surgical skills. An instrument for assessment of surgical performance in selective neck dissection has not been previously developed.

Cuneiform (cuniculatum) variant of oral squamous cell carcinoma revisited: Presentation of two cases and literature review of a rare entity.

Background: Oral carcinoma cuniculatum (OCC) is a rare, locally aggressive tumor, which tends to invade underlying bone. We present two cases of OCC, one demonstrating invasion of the mandible and the other limited to the tongue.

Methods: An 87-year-old male presented with a right-sided buccogingival lesion.

Assessing Operative Competency in Cochlear Implantation Across the Residency Training Continuum.

Objective: To derive normative data based on postgraduate year (PGY) and number of completed otology rotations using a validated tool for cochlear implant surgical competency assessment.

Study Design: Prospective, blinded validation study.

Setting: Otolaryngology-Head and Neck Surgery residency training program at a tertiary academic medical center.

Contextualizing the Modern Epidemiology of Neurofibromatosis Type 2 in an Era of Heightened Detection of Sporadic Vestibular Schwannoma.

Objective: Closely paralleling previous radiologic studies, recent population-based prevalence data suggest sporadic vestibular schwannoma (VS) affects over one in 2,000 adults and up to one in 500 in those aged 70 years or older. Attributable to increased utilization of magnetic resonance imaging and screening protocols for asymmetrical sensorineural hearing loss, the increasing detection rate of sporadic VS fundamentally changes the perception of VS as a whole. The primary objective of the current study was to contextualize modern epidemiological trends in neurofibromatosis type 2 (NF2) in light of these recent advancements in the understanding of sporadic VS.

The Influence of Vestibular Schwannoma Tumor Volume and Growth on Hearing Loss.

Objective: To ascertain the relationship among vestibular schwannoma (VS) tumor volume, growth, and hearing loss.

Study Design: Retrospective cohort study.

Setting: Single tertiary center.

Manifestations of Skull Base IgG4-Related Disease: A Multi-Institutional Study.

Objective: IgG4-related disease (IgG4-RD) is a recently recognized disease characterized by fibroinflammatory infiltrates rich in IgG4+ plasma cells that can present as isolated tumor-like lesions of the head and neck. The objective of the current study was to describe the cranial base manifestations of IgG4-RD.

Methods: Review of all cases at three tertiary-referral centers since disease description in 2003.

Acute airway compromise after recombinant human TSH administration: A case report and review of the literature.

Radioiodine ablation is a commonly utilized treatment for differentiated thyroid carcinoma. Uptake of radioiodine can be enhanced by pretreatment with thyroid hormone withdrawal or administration of recombinant human thyroid-stimulating hormone (rhTSH). rhTSH is generally well-tolerated with minimal adverse effects.

Durability of Hearing Preservation Following Microsurgical Resection of Vestibular Schwannoma.

Objective: To ascertain long-term hearing outcomes in patients with serviceable hearing following microsurgical resection of sporadic vestibular schwannoma (VS).

Study Design: Retrospective cohort.

Setting: Tertiary academic referral center.

Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma.

Objective: To date, prediction models for estimating risk of acquiring non-serviceable hearing in subjects with observed vestibular schwannoma (VS) have evaluated outcomes primarily based on features at initial diagnosis. Herein, we evaluate the association of rate of hearing decline during the initial period of observation with time to non-serviceable hearing. If significant, rate of hearing decline may inform decision making after an introductory period of observation.