The rabbit costal cartilage reconstructive surgical model.

Rib grafts in facial plastic surgery are becoming more frequently used. Small animal models, although not ideal may be used to emulate costal cartilage-based procedures. A surgical characterization of this tissue will assist future research in the selection of appropriate costal segments, based on quantitative and qualitative properties. The objective of this study is to assess the surgical anatomy of the rabbit costal margin and evaluate costal cartilage for use in either in vivo or ex vivo studies and to examine reconstructive procedures. Detailed thoracic dissections of 21 New Zealand white rabbits were performed post-mortem. Costal cartilage of true, false, and floating ribs were harvested. The length, thickness, and width at proximal, medial, and distal locations of the cartilage, with perichondrium intact were measured. Further qualitative observation and digital images of curvature, flexibility, and segmental cross-sectional shape were recorded. The main outcome measure(s) is to characterize, describe, and assess the consistency of dimensions, location, and shape of costal cartilage. In this study, 12 to 13 ribs encase the thoracic cavity. Cartilage from true ribs has an average length, width, and depth of 23.75 ± 0.662, 3.02 ± 0.025, and 2.18 ± 0.018 mm, respectively. The cartilage from false ribs has an average length, width, and depth of 41.97 ± 1.48, 2.00 ± 0.07, 1.19 ± 0.03 mm, and that of floating ribs are 7.66 ± 0.29, 1.98 ± 0.04, and 0.96 ± 0.03 mm. Rib 8 is found to be the longest costal cartilage (49.10 ± 0.64 mm), with the widest and thickest at ribs 1 (3.91 ± 0.08 mm) and 6 (2.41 ± 0.11 mm), respectively. Cross-sectional segments reveal the distal cartilage to maintain an hourglass shape that broadens to become circular and eventually ovoid at the costochondral junction. The New Zealand white rabbit is a practical source of costal cartilage that is of sufficient size and reproducibility to use in surgical research where the long-term effects of operations, therapies, devices, and pharmacologic on cartilage can be studied in vivo.

Mycobacterium tuberculosis spoligotypes circulating in the Lebanese population: a retrospective study.

Genotyping Mycobacterium tuberculosis in Lebanon on the national level may be beneficial for assessing patients and monitoring the therapeutic response to DOTS. This study aimed to characterize the spoligotypes of clinical isolates of M. tuberculosis patients collected between April 2004 and October 2005 from all Lebanese provinces. Isolates (n = 60) were cultured and identified by their biochemical characteristics. DNA extracts of these samples were amplified by PCR and genotyped by spoligotyping. Thirteen (13) patterns of M. tuberculosis complex family strains were identified: 41.6% of the strains belonged to the T 1 family, 25.0% to LAM 9, 10.0% to Haarlem 3, 3.3% to each of CAS, LAM 8, BCG and Family 36 and 1.7% to each of Haarlem 1, LAM 10, S, M. africanum, X 1 and T 3 families. The noticeable absence of Beijing and East African Indian families was not consistent with the patterns reported in neighbouring countries. A more inclusive study of the Lebanese population is necessary to accurately identify most of the prevailing families in the country.

Prevalence of IL-1ß +3954 and IL-1α-889 polymorphisms in the Lebanese population and its association with the severity of adult chronic periodontitis.

Pro-inflammatory cytokines, i.e., IL-1 mediate the inflammatory response and are genetically regulated in periodontal diseases. Strong association was found between the composite genotype allele 2 of IL-1ß+3954 and IL-1α-889 and severe chronic periodontitis. The aim of this study is to determine the prevalence of IL-1ß+3954 and IL-1α-889 polymorphism in a group of Lebanese individuals of homogeneous ethnicity and the possible association between genotype positive individuals and the severity of periodontal disease. One hundred and fifty-seven patients aged 53.29±13.13 years participated in the study. Subjects were classified as follows: 1) healthy subjects with no attachment loss >1mm and no clinical signs of gingival or periodontal inflammation; 2) diseased subjects with mild periodontitis (less than 15‰ of global periodontal bone loss); 3) subjects with moderate periodontitis (less than 4 interproximal sites with bone loss = or >50 percent and mean bone loss between 15 and 30%); 4) subjects with severe periodontitis (more than 7 interproximal sites with >50% bone loss and mean bone loss >35‰). Blood samples were taken and analyzed for polymorphism in the IL-1α gene at position +4845 and in the IL-1beta gene at position +3953. Statistical analysis was performed using chi-square test, Fisher Exact test, and ANOVA followed by Bonferroni multiple comparisons. The prevalence of genotype-positive subjects was 52.3‰ in the healthy control group and 42 ‰ in the diseased group. Positive genotype heterozygous of allele 1 and 2 for IL-1ß+3954 and IL-1α-889 did not represent in this study a major risk for chronic periodontitis (p=0.590). Only subjects homozygous for allele2 of the IL-1ß+3954 and IL-1α-889 were significantly more at risk for severe periodontitis with OR of 51.42.

Radial Forearm Free Flap Reconstruction of Glossectomy Defects Without Tracheostomy.

OBJECTIVES: To assess the feasibility of radial forearm free flap (RFFF) reconstruction of glossectomy defects without tracheostomy tube (TT). METHODS: Retrospective review of patients with at least oral tongue defects who underwent RFFF reconstruction. Pre- and intra-operative factors were documented. Post-operative respiratory complications included inability to extubate, pneumonia, or need for re-intubation or TT within 30 days. RESULTS: Twenty-one patients underwent RFFF reconstruction without TT, and 36 patients with TT. The average hospital length of stay was 1.5 days shorter in those without TT (P < .01). Two patients who underwent TT placement experienced a respiratory complication (P = .27). There were no respiratory complications among those without TT. After multivariate analyses, large tongue base defect (>25% resection, P < .001) and bilateral neck dissection (P < .001) were independently associated with TT placement. CONCLUSIONS: In our experience, RFFF reconstruction of glossectomy defects is feasible without TT among selected patients with small tongue base defects (≤25% resection) and unilateral neck dissection.

Cytology and clinical spectrum of sexually transmitted infections in Lebanese women as revealed by Pap smear: a cross-sectional study from 2002-2006.

To study the cytology profile of cervical smears and the respective prevalence and incidence of certain cervico-vaginal infections detectable by routine Pap smear cytology in Lebanese women from 2002 to 2006. Pap smear cytology results were compiled from the archives of the Institut National de Pathologie for the period extending from 2002 until 2006. This study covered 118,230 cervical specimens obtained from Lebanese women attending clinics and hospitals in all the five districts of Lebanon; prevalence and incidence rates for infections detectable by routine Pap smear examination were determined. A rise in prevalence of these infections by 2.1 percent (2,555) from 2002 to 2006 was revealed. A doubling of Pap smears showing HPV-associated changes was detected (1.4 percent in 2002 to 2.9 percent in 2006), and a simultaneous almost 7-fold increase of Atypical Squamous Cells of Undetermined Significance (ASCUS) cytology was detected during this period; the rise in ASCUS cytology was age-dependent. Moreover, a 60 percent increase in prevalence of bacterial vaginosis (2.3 percent in 2002 to 3.7 percent in 2006) and a more than 3-fold decline in Trichomonas vaginalis infection (1 percent in 2002 to 0.3 percent in 2006) were also noted in this population during this period. An increase in the prevalence and incidence of cervico-vaginal infections detectable by Pap smear cytology in Lebanese women was revealed from 2002 to 2006. Such changes could point to recent modifications of sexual and health behaviours in the Lebanese community.

Appearance-Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction.

OBJECTIVES/HYPOTHESIS: To better understand aesthetic patient-reported outcomes and psychosocial quality of life (QOL) after head and neck microvascular reconstruction for benign or malignant tumors. STUDY DESIGN: Single-center prospectively obtained in-office validated questionnaire-based study. METHODS: Analysis of prospectively collected surveys at a tertiary care academic center from June 2018 to February 2021. Patients completed two FACE-Q scales: Appearance-Related Psychosocial Distress (ARPD) and Social Function (SF). Survey scores, demographics, operative course, and adjuvant therapy data underwent univariate and multivariable analyses. RESULTS: One hundred and three patients completed surveys at a median of 13.5 months postoperatively (interquartile range: 5.2-30.8). Mean ARPD from 0 (no distress) to 100 (maximum distress) was 32.4 (standard error of the mean [SEM]: 2.7). Mean SF from 0 (worst functioning) to 100 (best functioning) was 55.5 (SEM: 2.7). Postoperative adjuvant radiation was associated with 13.9% higher ARPD (95% CI: 3.4-24.4, P = .019) and 10.4% lower SF (95% CI: -20.7 to -0.1, P = .047). Each appearance-related question on the ARPD scale independently predicted impaired SF (P < .001 for all questions). Upon multivariable logistic regression, osteocutaneous reconstruction, compared to soft tissue alone (P = .043), and postoperative adjuvant radiation (P = .014) were associated with higher levels of ARPD. Age, sex, relationship status, anxiety or depression history, defect location, and hospital stay were not significantly associated with ARPD or SF scores. CONCLUSIONS: Aesthetic outcomes are important determinants of psychosocial QOL following head and neck microvascular reconstruction: an effect that is worsened by adjuvant radiation. Reconstructive surgeons should prioritize aesthetic outcomes, in addition to functional restoration, to optimize social functioning in patients with head and neck tumors. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2204-E2211, 2021.

Vasodilation by Verapamil-Nitroglycerin Solution in Microvascular Surgery.

OBJECTIVE: Papaverine is a topical vasodilator commonly used during microvascular surgery to inhibit undesired vasoconstriction. A previous national shortage of papaverine prompted evaluation of an alternative, effective vasodilator. This study aims to assess the experience of a solution of verapamil and nitroglycerin (VG) as a potential alternative pharmacologic vasodilator. STUDY DESIGN: Retrospective case series. SETTING: Two tertiary academic medical centers. SUBJECTS AND METHODS: Among 298 patients, 306 consecutive free tissue transfers performed between 2014 and 2017 for head and neck defect reconstruction utilized a VG solution. Patient and flap characteristics, intraoperative patient and flap complications, and postoperative complications were reviewed. Diameter of the cervical recipient artery was measured intraoperatively before and after topical application of the VG solution in a subset of 43 patients (44 flaps). RESULTS: Flaps included fibula, radial forearm, subscapular system, and anterolateral thigh. In total, 3 (0.98%) flaps failed with varied etiology unrelated to the VG solution (venous thrombosis, arterial anastomosis thrombosis, physical damage to the perforator). Specific to topical application of the VG solution, the mean recipient artery diameter increased from 2.1 to 3.1 mm, a 48% increase (P < .01). There were no intraoperative cardiac events or complications attributable to the VG solution. CONCLUSION: We describe the use of a VG solution for pharmacologic vasodilation during microvascular free tissue transfer. Its use was associated with an acceptable incidence of adverse events, none of which were directly attributable to the VG solution. Apparent and sustained vasodilation was demonstrated. The VG solution represents a safe and efficacious alternative to papaverine in microvascular surgery.

Bioabsorbable Steroid Eluting Stents in the Treatment of Recurrent Rathke's Cleft Cyst.

Objectives Bioabsorbable steroid eluting stents may prevent the stenosis of ostia after sinus surgery. We describe a technique utilizing this technology to prevent the reformation of Rathke's cleft cysts (RCC) after transnasal transsphenoidal surgical drainage. Design This study is based on retrospective review. Setting The research took place at Tertiary academic medical center. Participants Patients who underwent endoscopic marsupialization of RCC with stent placement were participated in this study. Main Outcome Measures Demographics, surgical history, outcomes, and complications were primary measures of this study. Results Four patients underwent drainage of a recurrent RCC with subsequent stent placement. All patients consented to off-label use of the stent. The mean age of patients was 42 years old and the number of prior drainage procedures ranged from 1 to 3. The stent was placed directly into the opening of the cyst after drainage with no other tissue placed into the cyst cavity or opening. The stents are bioabsorbable and were not removed after surgery but were evaluated endoscopically at 2 and 6 weeks after surgery. The patients have been followed for a mean of 14 months after surgery with no evidence of recurrence on endoscopic exam or imaging. No patient had cerebrospinal fluid leak during or after the operation or permanent endocrinopathy. Conclusion The use of a bioabsorbable steroid eluting stent had no unanticipated consequences and all drainage pathways of all the RCCs remain patent. The use of this technology may decrease recurrence rates in revision or complex cases where patients have extensive scarring of the operative field from prior drainage procedures. Further follow-up of the current cases and study in a larger cohort are warranted.

Oral tongue squamous cell carcinoma survival as stratified by age and sex: A surveillance, epidemiology, and end results analysis.

OBJECTIVES/HYPOTHESIS: To utilize the Surveillance, Epidemiology, and End Results (SEER) database to elucidate differences in predictors of survival in oral tongue squamous cell carcinoma (OTSCC) as stratified by age and sex. STUDY DESIGN: Retrospective, population-based database analysis. METHODS: The SEER registry was utilized to calculate survival trends for patients with OTSCC between 1973 and 2012. Patient data were then stratified by age (≤40 years vs. >40 years) and sex, then analyzed with respect to race, stage, grade, and treatment modalities. Overall survival (OS) and disease-specific survival (DSS) were calculated and compared. RESULTS: There were 16,423 cases of OTSCC identified, with 526 and 706 young female and male patients, respectively. Young female patients had improved OS and DSS as compared to young male patients (75% vs. 67% at 5 years), which is better than older patients (P < .001). Younger patients were more likely to receive surgery (P < .001) and combination surgery and radiation (P < .001) as compared to older patients. On multivariate analysis, tumor stage was uniformly associated with worse OS and DSS (P < .05), with surgery predicting improved OS and DSS in all groups except young females (P < .05). Higher tumor grade predicted worse OS and DSS in older patients, but not younger patients (P < .05). CONCLUSIONS: OTSCC appears to present with relatively heterogeneous characteristics across different age groups and sexes. Despite the rising incidence of OTSCC in young individuals, our study demonstrates that young patients have improved survival rates compared to older patients. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2076-2081, 2019.

Readmission after surgery for oropharyngeal cancer: An analysis of rates, causes, and risk factors.

OBJECTIVES/HYPOTHESIS: Determine the rate, diagnoses, and risk factors associated with 30-day nonelective readmissions for patients undergoing surgery for oropharyngeal cancer. STUDY DESIGN: Retrospective cohort study. METHODS: We analyzed the Nationwide Readmissions Database for patients who underwent oropharyngeal cancer surgery between 2010 and 2014. Rates and causes of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission. RESULTS: Among 16,902 identified cases, the 30-day, nonelective readmission rate was 10.2%, with an average cost per readmission of $14,170. The most common readmission diagnoses were postoperative bleeding (14.1%) and wound complications (12.6%) (surgical site infection [8.6%], dehiscence [2.3%], and fistula [1.7%]). On multivariate regression, significant risk factors for readmission were major ablative surgery (which included total glossectomy, pharyngectomy, and mandibulectomy) (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.06-1.60), advanced Charlson/Deyo comorbidity (OR: 2.00, 95% CI: 1.43-2.79), history of radiation (OR: 1.58, 95% CI: 1.15-2.17), Medicare (OR: 1.34, 95% CI: 1.06-1.69) or Medicaid (OR: 1.82, 95% CI: 1.32-2.50) payer status, index admission from the emergency department (OR: 1.19, 95% CI: 1.02-1.40), and length of stay ≥6 days (OR: 1.57, 95% CI: 1.19-2.08). CONCLUSIONS: In this large database analysis, we found that approximately one in 10 patients undergoing surgery for oropharyngeal cancer is readmitted within 30 days. Procedural complexity, insurance status, and advanced comorbidity are independent risk factors, whereas postoperative bleeding and wound complications are the most common reasons for readmission. LEVEL OF EVIDENCE: 4. Laryngoscope, 129:910-918, 2019.

Total Glossectomy With Free Flap Reconstruction: Twenty-Year Experience at a Tertiary Medical Center.

OBJECTIVES/HYPOTHESIS: To characterize the demographics, clinicopathologic characteristics, and treatment and reconstructive outcomes of patients who underwent total glossectomy STUDY DESIGN: Retrospective chart review at an academic tertiary-care medical center. METHODS: All patients who had undergone total glossectomy (as an individual procedure or as part of a more extensive resection) between January 1, 1995 and December 31, 2014 were included in the analysis. Patient characteristics and clinical outcomes were reviewed. RESULTS: Forty-eight patients underwent total glossectomy for oral tongue and base of tongue cancer. The mean age of the patients was 56 (range, 29-92 years). History of tobacco and heavy alcohol use was found in 76% and 11% of patients, respectively. The majority of patients had advanced cancer (91.7% at stage IV), and 60.4% had salvage therapy for recurrent disease. T4 disease comprised 81% of patients. Sixty percent had clinical or radiographic evidence of nodal metastasis. Reconstruction of the defect was performed with free flaps from the rectus abdominus (40%), fibula (25%), anterolateral thigh (23%), and other donor tissues. One- and 5-year survival rates were 42% and 26%, with locoregional and distant recurrence reported at 36% and 25%, respectively. CONCLUSIONS: Total glossectomy for oncologic control is most commonly performed in patients who have stage IV cancers. Despite high reconstructive success rates, the likelihood of locoregional and distance recurrence was high. Most patients can communicate intelligibly and achieve decannulation, but swallowing outcomes remain guarded, especially considering previous irradiation and resection of the base of tongue. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1087-1092, 2019.

Predictors of Short-term Morbidity and Mortality in Open Anterior Skull Base Surgery.

OBJECTIVES/HYPOTHESIS: To describe rates of complications and mortality within 30 days of open anterior skull base surgery using a large, multi-institutional outcomes database. STUDY DESIGN: Retrospective cohort study. METHODS: The study included patients who underwent open anterior skull base surgery as listed in the American College of Surgeons National Surgical Quality Improvement Project database from 2007 through 2014. RESULTS: A total of 336 open anterior skull base surgeries were identified. One hundred nine (32.4%) patients experienced a complication, reoperation, or mortality. The most common events were postoperative transfusion (15.8%), reoperation (10.1%), and readmission (8.0%). Significant independent predictors of any adverse event included higher American Society of Anesthesiologists (ASA) score and increased total operative time (both P < .05). The only predictor of mortality was higher ASA score (P = .02). Predictors of increased hospital stay included impaired sensorium (P = .04), coma >24 hours (P < .001), lower preoperative hematocrit (P = .02), higher ASA score (P = .04), and increased total operative time (P < .001). CONCLUSIONS: Open anterior skull base surgery is understandably complex, and is thus associated with a relatively high adverse event rate. Knowledge of factors associated with adverse events has the potential to improve preoperative optimization of controllable variables and translate into improved surgical outcomes for patients. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1407-1412, 2019.

Lasers, Microneedling, and Platelet-Rich Plasma for Skin Rejuvenation and Repair.

Skin resurfacing for the purpose of rejuvenation and repair continues to evolve with the development of noninvasive or minimally invasive surgical substitutes. Advances in laser therapy, microneedling, and platelet-rich plasma have reinvigorated research in wound repair and regenerative science. An overall positive clinical response toward the use of platelet-rich plasma as an adjuvant to fractional photothermolysis and percutaneous collagen induction is observed. Its effect on post-treatment adverse symptoms, erythema, edema, crusting, and clinical outcomes in rejuvenation are summarized in this article. The lack of identifiable complications and convenience of treatment provides a positive outlook for future use and investigations.

Platelet-Rich Plasma for Hair Loss: Review of Methods and Results.

Given substantial advances in hair regrowth research and platelet-rich plasma (PRP) science, a review of currently used systems and results is informative for physicians using a biologics approach to hair restoration. Overall positive clinical response to the use of PRP in androgenetic and alopecia areata patients is observed. The effects on hair density, count, and thickness were demonstrated through multiple clinical trials. Use as an adjunct to hair transplantation and with other technologies is also described. When compared with traditional oral/topical treatments, the lack of identifiable complications and convenience of treatment provide a positive outlook for future use and investigation.

Pediatric Benign Paranasal Sinus Osteoneogenic Tumors: A Case Series and Systematic Review of Outcomes, Techniques, and a Multiportal Approach.

BACKGROUND: Pediatric benign paranasal sinus osteoneogenic tumors have previously been difficult to treat due to the surgical constraints of the developing skull. Progression may lead to intracranial complications or orbital and optic nerve compression. OBJECTIVE: To assess the presentation and management of benign paranasal sinus osteoneogenic tumors. METHODS: Systematic review of the symptoms and surgical treatment of these lesions, and a case series of 2 adolescents with osteomas impinging on the orbit treated with a multiportal approach. RESULTS: Forty-eight cases of osteomas, osteoblastoma, or osteoid osteomas were reviewed from 43 articles. The average age was 14 years, 67% of tumors were osteomas, and 48% were greater than 3 cm in longest dimension. Compared to osteoblastomas, osteomas had a greater male to female ratio (4.3:1; P = .02), presented at older age ( P = .03) with a smaller tumor burden ( P = .003), and had prior trauma or surgery ( P < .001). The ethmoid, frontal, maxillary, and sphenoid sinuses were affected in decreasing order of frequency. A purely endoscopic sinus surgery approach was taken in 31% of cases, open approach in 62% of cases, and combined approach in 7% of cases. Osteoblastoma patients had a 32% rate of recurrence, compared to only 3% among osteoma patients. On univariate logistics regression of patient demographics, tumor characteristics, and surgical approaches predictive of surgical outcomes, only tumor type was predictive of postoperative recurrence (odds ratio: 0.07; 95% confidence interval, 0.007-0.77; P = .029). CONCLUSION: There was no association between surgical approach and postoperative complications or rate of recurrence. However, a transnasal and transorbital multiportal approach avoids facial incisions.

Detection of surgical margins in oral cavity cancer: the role of dynamic optical contrast imaging.

PURPOSE OF REVIEW: The quantity of tissue removed during an oncologic surgical procedure is not standardized and there are numerous reports of local recurrence despite histologically adequate resection margins. The oral cavity is one of the sites in the head and neck with high chances of recurrence following negative margins. To address this need, this article reviews the recent applications of Dynamic Optical Contrast Imaging (DOCI) towards both oral screening and the intraoperative evaluation of tumor margins in head and neck surgery. RECENT FINDINGS: Human ex-vivo and in-vivo trials suggest DOCI is well tolerated, low-cost, and sensitive for differentiating cancerous from normal tissues throughout the head and neck, in addition to the oral cavity. Ex-vivo imaging of OSCC specimens generated histologically verified image contrast. Furthermore, in-vivo intraoperative results demonstrate significant potential for image-guided detection and resection of oral cavity squamous cell carcinoma (OSCC). SUMMARY: DOCI augments tissue contrast and may enable surgeons to clinically screen patients for oral cancer, make histologic evaluations in vivo with fewer unnecessary biopsies, delineate clinical margins for tumor resection, provide guidance in the choice of biopsy sites, and preserve healthy tissue to increase the postoperative functionality and quality of life of the patient.

Minor Salivary Gland Carcinoma of the Oropharynx: A Population-Based Analysis of 1426 Patients.

Objective We sought to describe the patient, tumor, and survival characteristics of minor salivary gland carcinoma (MSGC) of the oropharynx using a large, population-based database. Study Design Cross-sectional analysis of the National Cancer Institute's SEER database (Surveillance, Epidemiology. and End Results). Subjects and Methods We reviewed the SEER database for all cases of MSGC of the oropharynx from 1988 to 2013. Relevant demographic, clinicopathologic, and survival variables were extracted and analyzed. Cox multivariate regression was performed to identify prognostic factors. Results We identified 1426 cases of MSGC of the oropharynx (mean age, 58 years; 51% female). The soft palate (39.2%) and base of tongue (38.6%) were the most commonly involved sites. The most common histologic subtypes were mucoepidermoid carcinoma (32.1%), adenocarcinoma (25.9%), and adenoid cystic carcinoma (23.3%). Five- and 10-year rates of disease-specific survival were 75.1% and 61.6%, respectively. Independent prognostic factors included tumor grade, T stage, N stage, and age >70 years. Conclusions This study represents the largest multivariate survival analysis of MSGC of the oropharynx to date. Independent prognosticators include tumor grade, T stage, N stage, and age.

Clinicopathologic Characteristics and Survival Outcomes in Floor of Mouth Squamous Cell Carcinoma: A Population-Based Study.

Objective To describe the determinants of survival for patients with floor of mouth (FOM) squamous cell carcinoma (SCC) from 1973 to 2013 with the SEER database (Surveillance, Epidemiology, and End Results). Study Design and Setting Retrospective cohort study with a national database. Subjects and Methods The SEER registry was utilized to calculate survival trends for patients with FOM SCC between 1973 and 2013. Patient data were analyzed with respect to age, sex, race, primary site, stage at presentation, tumor size, grade, and treatment modalities (surgery and radiotherapy). Overall survival (OS) and disease-specific survival (DSS) were calculated. Results A total of 14,010 FOM SCC cases were identified. The cohort was 69.5% male, and the median age at diagnosis was 62 years. Forty-six percent of cases were treated with surgery, while 14% received radiotherapy. Kaplan-Meier analysis demonstrated OS and DSS of 39% and 59% at 5 years, respectively. Multivariate analysis showed that age, grade, stage, size, and surgery were determinants for OS and DSS (all P < .05). For early- and advanced-stage cancers, age, grade, size, and surgery predicted OS and DSS, while radiotherapy was a predictor of OS and DSS in advanced-stage tumors only (all P < .05). Conclusion To our knowledge, this study is the largest to date investigating prognostic factors for survival of patients diagnosed with FOM SCC. Determinants of survival include age, grade, stage, size, and surgery. Surgery appears to play a critical role in the management of these tumors.

Sequelae of Index Complications following Inpatient Head and Neck Surgery: Characterizing Secondary Complications.

Objective To characterize patterns of secondary complications after inpatient head and neck surgery. Study Design Retrospective cohort study. Setting National Surgical Quality Improvement Program (2005-2015). Subjects and Methods We identified 18,584 patients who underwent inpatient otolaryngologic surgery. Four index complications were studied: pneumonia, bleeding or transfusion event (BTE), deep/organ space surgical site infection (SSI), and myocardial infarction (MI). Each patient with an index complication was matched to a control patient based on propensity for the index event and event-free days. Rates of 30-day secondary complications and mortality were compared. Results Index pneumonia (n = 254) was associated with several complications, including reintubation (odds ratio [OR], 11.7; 95% confidence interval [CI], 5.2-26.4), sepsis (OR, 8.8; 95% CI, 4.5-17.2), and death (OR, 5.3; 95% CI, 1.9-14.9). Index MI (n = 50) was associated with increased odds of reintubation (OR, 17.2; 95% CI, 3.5-84.1), ventilatory failure (OR, 5.8; 95% CI, 1.8-19.1), and death (OR, 24.8; 95% CI, 2.9-211.4). Index deep/organ space SSI (n = 271) was associated with dehiscence (OR, 7.2; 95% CI, 3.6-14.2) and sepsis (OR, 38.3; 95% CI, 11.6-126.4). Index BTE (n = 1009) increased the odds of cardiac arrest (OR, 3.9; 95% CI, 1.8-8.5) and death (OR, 2.9; 95% CI, 1.6-5.1). Conclusions Our study is the first to quantify the effect of index complications on the risk of specific secondary complications following inpatient head and neck surgery. These associations may be used to identify patients most at risk postoperatively and target specific interventions aimed to prevent or interrupt further complications.

Cytomegalovirus, Macrophages and Breast Cancer.

The human cytomegalovirus (HCMV) is a betaherpesvirus that is highly host specific, infects among others epithelial cells and macrophages, and has been recently mentioned as having oncomodulatory properties. HCMV is detected in the breast tumor tissue where macrophages, especially tumor associated macrophages, are associated with a poor prognosis. In this review, we will discuss the potential implication of HCMV in breast cancer with emphasis on the role played by macrophages.