Head and Neck Squamous Cell Carcinoma in Adolescents and Young Adults: Survivorship Patterns and Disparities.

PURPOSE: Adolescent and young adult (AYA) head and neck cancer (HNC) patients require longer term follow-ups as they age; yet, little is known about factors associated with survivorship in this population. We aimed to describe nonclinical factors associated with HNC survivorship among AYAs. METHODS: In this retrospective cohort study, the Surveillance, Epidemiology and End Results 18 database from 2007 to 2014 was queried. Eligible cases were 15-39-year-old primary HNC patients with known cause of death (n = 1777). Kaplan-Meier survival curves stratified by age group (15-29, 30-34, and 35-39) and by health insurance status tested differences in HNC survival among groups with a log-rank test. Variables, including age, sex, race/ethnicity, county-level poverty, anatomic site, stage, and treatment, were controlled for in a competing risk proportional hazards model. RESULTS: Patients were mostly male (64%), with mean age of 33.4 years. Survival rate was 73% after 8 years of follow-up. There were no significant survival differences based on age at diagnosis. However, AYAs who were on Medicaid (adjusted hazard ratio [aHR] = 1.61, 95% confidence interval [CI] 1.22-2.12) or uninsured (aHR = 1.51, 95% CI 1.03-2.21), had an increased hazard of death from HNC, compared with those with private insurance. CONCLUSION: Health insurance status is the main nonclinical factor associated with survival among AYAs with HNC, and individuals with Medicaid do not fare better than the uninsured. With a potential longer term follow-up in this AYA population, there is need to optimize survivorship irrespective of health insurance status.

Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects.

Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent anatomy of the scalp presents challenges and may limit reconstructive options. Objective To describe and investigate the scalp rotation flap as a reconstructive technique for complex soft tissue defects. Design Retrospective case series with a mean follow-up of 13 months. Setting Tertiary academic center. Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation flap reconstruction. Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane. The flap is rotated into the defect, and a split-thickness skin graft is placed over the donor site periosteum. Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient satisfaction with cosmetic outcome. Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification was 2.8. Mean defect size was 41 cm(2) (range: 7.8-120 cm(2)), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was 181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications. Three patients with previous radiation therapy had distal flap necrosis. Twenty-one patients (95%) reported an acceptable cosmetic result. Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex soft tissue defects. This can be particularly important in patients with significant medical comorbidities who cannot tolerate a lengthy operative procedure.

Otolaryngologic surgery in children with trisomy 18 and 13.

OBJECTIVES: Trisomy 18 and 13 are the most common autosomal trisomy disorders after Down syndrome. Given the high mortality rate (5-10% one-year survival), trisomy 18 and 13 were historically characterized as uniformly lethal and palliation was the predominant management approach. Management strategy has shifted with recognition that through medical and surgical intervention, children with trisomy 18 and 13 can achieve developmental milestones, live meaningful lives, and exhibit long-term survival. Otolaryngologic surgery in children with trisomy 18 and 13 has not been described. The objective of this article is to describe the role of the otolaryngologist in the management of children with trisomy 18 and 13. METHODS AND MATERIALS: Retrospective cohort analysis of the surgery registry for the Support Organization for Trisomy 18, 13 and Related Disorders for otolaryngologic surgeries reported from 1988 through June 1, 2014. RESULTS: In the database of approximately 1349 children, 1380 procedures were reported, 231 (17%) of which were otolaryngologic. The most common otolaryngologic procedures were tympanostomy tube placement (57/231, 25%), cleft lip repair (40/231, 17%), tracheostomy (38/231, 16.5%), tonsillectomy and/or adenoidectomy (37/231, 16%), and cleft palate repair (30/231, 13%). Of the ten most common procedures reported, four were otolaryngologic. CONCLUSIONS: Seventeen percent of procedures performed in children with trisomy 18 and 13 were otolaryngologic, highlighting the significant role of the otolaryngologist in the treatment of these patients. Surgical intervention may be considered as part of a balanced approach to patient care.

Radiographic and anatomic characterization of the nasal septal swell body.

OBJECTIVE: To analyze the radiographic, anatomic, and histologic characteristics of the nasal septal swell body. DESIGN: Computer-aided analysis of magnetic resonance images (MRIs) and histologic examination of cadaveric nasal septa. SETTING: Tertiary medical center. PATIENTS: Fifty-four head MRI studies were performed on adult live patients; we also used 10 cadaveric nasal septa. MAIN OUTCOME MEASURES: Radiographic dimensions of the swell body and distances to other nasal landmarks were measured. Nasal septa and swell body histologic characteristics were evaluated using light microscopy. Relative proportions of vascular, connective, and glandular tissues within the swell body and the adjacent septum were compared. RESULTS: The swell body was fusiform shaped and located anterior to the middle turbinate, with mean (SD) width of 12.4 (1.9) mm; height, 19.6 (3.2) mm; and length, 28.4 (3.5) mm. The epicenter was 24.8 (2.9) mm from the nasal floor, 43.9 (4.1) mm from the nasal tip, and 39.0 (4.6) mm from the sphenoid face. Histologic analyses revealed that, compared with adjacent septal mucosa, the swell body contained significantly more venous sinusoids (37% vs 16%, P < .001) and fewer glandular elements (28% vs 41%, P < .001). CONCLUSIONS: The swell body is a conserved region of the septum located anterior to the middle turbinate approximately 2.5 cm above the nasal floor. The high proportion of venous sinusoids within the swell body suggests the capacity to alter nasal airflow. Additional study is required before these findings are used in a clinical setting.

Advances in surgical navigation.

Surgical navigation technology provides real-time intraoperative localization of surgical instruments within the field. These systems are highly accurate, assist with preoperative planning, and improve surgeon confidence. The industry has recently responded to the growing trend of treatment in ambulatory surgical centers by offering surgical navigation devices that are more compact, less expensive and more user-friendly than conventional devices. Surgical navigation is indicated for complex sinonasal disease and may reduce the risk of complications. The indications for surgical navigation continue to expand as the technology improves and imaging data synthesis evolves to include multimodality fusion and real-time intraoperative data-set updates. Although now widely available, navigation systems are still considered state of the art, and not standard of care.

Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis.

OBJECTIVE: The purpose of this study was to determine the effectiveness of adenotonsillectomy (T&A) for treating obstructive sleep apnea (OSA) in obese children. DATA SOURCES: PubMed and Ovid databases. REVIEW METHODS: A meta-analysis of studies that reported sleep parameters in obese children with OSA before and after T&A. Data were analyzed using the random effects model. Statistical significance was P < or = 0.05. RESULTS: Data from four studies that included 110 children were analyzed. The mean sample size was 27.5 (range, 18-33). The mean body mass index z score was 2.81. The mean pre- and postoperative apnea-hypopnea index (AHI) was 29.4 (range, 22.2-34.3) and 10.3 (range, 6.0-12.2), respectively. The weighted mean difference between pre- and postoperative AHI was a significant reduction of 18.3 events per hour (95% confidence interval [CI], 11.2-25.5). The mean pre- and postoperative oxygen saturation nadir was 78.4 percent (range, 73.9%-81.1%) and 85.7 percent (range, 83.6%-89.9%), respectively. The weighted mean difference was a significant increase of the oxygen saturation nadir of 6.3 percent (95% CI, 3.9-8.7). Forty-nine percent of children had a postoperative AHI <5, 25 percent of children had a postoperative AHI <2, and 12 percent of children had a postoperative AHI <1. CONCLUSIONS: T&A improves but does not resolve OSA in the majority of obese children. The efficacy and role of additional therapeutic options require more study. The high incidence of obesity in children makes this a public health priority.