Continuous high-dose vasopressors in free anterolateral thigh flap transfer for pharyngeal reconstruction: a report of two cases.

Use of vasopressors is controversial in patients undergoing free flap reconstruction. Recent literature has suggested that it is safe to administer vasopressors intraoperatively during these procedures. However studies have not addressed whether this safety extends to continuous high dose use. We present two cases of patients who underwent surgery for squamous cell carcinoma of the pharyngeal region, requiring laryngopharyngectomy. Both had pharyngeal reconstruction with a free anterolateral thigh (ALT) flap. The first required intraoperative vasopressors throughout the surgery, extending into the postoperative period. The second required vasopressors in the postoperative period continuously for weeks after surgery. Vasopressors were administered at treatment levels for shock. Neither developed flap compromise, suggesting that pharyngeal reconstruction with an ALT flap may be safely performed in the setting of continuous high-dose vasopressors.

The Role of Sialendoscopy in Parotid Duct Stenosis in Graft-Versus-Host Disease.

Sialendoscopy, a minimally invasive procedure for concurrent diagnosis and treatment of salivary gland ductal pathologies, was used to alleviate recurrent left parotid gland swelling and dry mouth in a 58-year-old man with chronic graft-versus-host disease. Laryngoscope, 133:279-281, 2023.

Major Salivary Gland Cancer With Distant Metastasis Upon Presentation: Patterns, Outcomes, and Imaging Implications.

OBJECTIVES: Given limited data availability on distant metastasis (DM) in major salivary gland (MSG) malignancy presentation, we aimed to evaluate the rate, histologic patterns, location, and predictors of DM at first MSG cancer presentation and suggest potential implications on diagnostic workup. STUDY DESIGN: Retrospective cohort. SETTING: Commission on Cancer-accredited hospitals. METHODS: We included patients in the National Cancer Database (2010-2016) with MSG malignancy. Site and rate of DM were stratified by histologic subtype. Factors predictive of DM at presentation were determined by multivariate regression analysis. Survival analyses were conducted via the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS: Of 5776 patients with MSG carcinoma, 333 (5.8%) presented with DM. The most common DM site was the lung (57.1%), followed by bone (46.8%) and liver (19.5%). DM was most common in adenocarcinoma-not otherwise specified (15.1%, 132/874) and salivary duct carcinoma (10.4%, 30/288). High-grade mucoepidermoid carcinoma had the highest rate of lung metastases (81.6%, 31/38). Conversely, myoepithelial carcinoma had the highest rate of bone metastases (85.7%, 6/7). DM at presentation was independently associated with an increased mortality risk (hazard ratio, 1.62; 95% CI, 1.40-1.90). CONCLUSION: We identified a DM rate of 5.8% in MSG malignancy at presentation. Overall 43% of patients presented without DM to the lung but with DM to the bones, liver, and/or brain. The most common metastatic sites differed by tumor histology. Staging with computed tomography neck and chest alone may fail to detect sites of DM; this work can be used for patient counseling in the clinical setting.

Otolaryngology Match 2020-21: Survey of Prospective Applicants in the Setting of COVID-19.

OBJECTIVES: To capture the perspectives of candidates applying for otolaryngology residency positions in the 2020-21 cycle, in the context of disruption caused by the coronavirus disease 2019 (COVID-19) pandemic. SUBJECTS AND METHODS: Candidates planning to apply to the otolaryngology 2020-21 match were invited to complete a cross-sectional online survey. Distribution was via otomatch.com and word of mouth. Descriptive statistics were performed. RESULTS: Of 85 eligible responses (estimated 18.9% of all applicants), many have had at least one board examination (71.8%) disrupted. A majority (85.9%) believe evaluation of candidates will change due to the pandemic, and 54.1% report they were now less confident in matching. Female applicants (37.6% of respondents) were found to have significantly higher odds of decreased confidence in matching (OR 2.781 [95% CI 1.045-7.4044]; P = .041). Many report a move to virtual interviews would increase the number of applications submitted (45.9%) and the number of interviews attended (77.6%). Some applicants (36.5%) did not believe residency programs would gather sufficient information about their candidacy to make an informed decision, and most (62.4%) did not believe that they would gather sufficient information to inform their own rank list. CONCLUSIONS: We find that candidates believe their candidacy will be assessed differently in light of the COVID-19 pandemic, are largely less confident in successfully matching, and are planning to apply and interview more broadly. These data are relevant to otolaryngology residency leadership to inform clear dialogue and a smooth transition into an unprecedented application cycle.

COVID-19's Impact on the 2020-2021 Resident Match: A Survey of Otolaryngology Program Directors.

OBJECTIVE: To determine the impact coronavirus disease of 2019 (COVID-19) will have on the 2020-2021 otolaryngology (OTO-HNS) resident application cycle. METHODS: A cross-sectional survey targeting OTO-HNS program directors (PD) was created and disseminated via email to PDs on May 28th 2020. Descriptive analyses of the 19-question survey was performed, and free text responses for certain suitable questions were thematically categorized into groups determined to be relevant during analysis. RESULTS: Twenty-nine of 123 solicited PDs (23.6%) completed the survey. Nineteen (65.5%) respondents indicated they would not host away rotations (AR) in 2020, and 9 (31.0%) reported that they would consider away rotators without home programs. Regarding the historical importance of AR, 21 (72.4%) PDs stated they were either "extremely" or "very" important in evaluating candidates. Sixteen (55.2%) PDs stated that virtual interviews would impact their ability to properly gauge candidates and 12 (41.4%) were unsure. Eight PDs (27.6%) stated their evaluation of candidates will likely change, with a shift toward an increased reliance on letters of recommendation, research involvement, and clerkship grades. The large majority of PDs-25 (86.2%)-were not worried that the COVID-19 pandemic would affect the abilities of new interns beginning in 2021. CONCLUSION: Virtual interviews and engagement activities will mostly supplant sub-Is and AR for the 2020-2021 OTO-HNS application cycle. Surveyed PDs largely believe these will be insufficient in providing a comprehensive assessment of candidates, and will similarly limit applicants' ability to gauge residency programs. Criteria utilized to evaluate students is expected to change.

The role of vitamin D in head and neck cancer.

OBJECTIVE: Head and neck squamous cell carcinoma (HNSCC) describes a set of malignancies of the head and neck that continue to inflict considerable morbidity and mortality. Because HNSCC often presents at an advanced stage, patients frequently undergo intensive multi-modal therapy with an intent to cure. Vitamin D is a precursor to the biologically active hormone calcitriol which governs bone and calcium physiology that is obtained from diet and UV-B exposure. Vitamin D is known to have pleiotropic effects on health and disease. In this review, we examine the role of vitamin D in cancer with emphasis on HNSCC and discuss potential avenues for further research that might better elucidate the role of vitamin D in the management of HNSCC. REVIEW METHODS: A review of MEDLINE database indexed literature concerning the role and biology of vitamin D in HNSCC was conducted, with special consideration of recently published work and research involving immunobiology and HNSCC. CONCLUSIONS: The available evidence suggests that vitamin D may play a role in protecting against HNSCC, particularly in persons who smoke, although conflicting and limited data exists. Promising initial work encourages the pursuit of further study. IMPLICATIONS FOR PRACTICE: The significant morbidity and mortality that HNSCC brings warrants continued research in available and safe interventions that improve patient outcomes. With the rise of immunotherapy as an effective modality for treatment, continued research of vitamin D as an adjunct in the treatment of HNSCC is supported.