Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons.

Background: Research has not explicitly explored differences between male and female microvascular head and neck (MHN) surgeon burnout, which should be identified and addressed to ensure career satisfaction and longevity. Objective: To measure and compare the prevalence of burnout among male versus female MHN surgeons. Methods: A prospective questionnaire based on the Maslach Burnout Inventory (MBI) was distributed through a web-based survey to the American Association of Facial Plastic and Reconstructive Surgeons and American Head and Neck Society in 2021 and 2022. Additional variables collected included demographics, relationship and parental status, academic rank, annual salary, and COVID-19-related questions. Results: One hundred thirteen surveys were collected. Twenty-nine (25.7%) were women and all completed MHN surgery fellowships. Women trended toward more emotional exhaustion than men (2.8 mean MBI vs. 2.3 mean MBI) but reported similar personal achievement (4.8 mean MBI vs. 4.9 mean MBI). Men experienced less workplace sexual harassment (p < 0.001). Women experienced more burnout (69% vs. 39%, p = 0.006) during the COVID-19 pandemic. Conclusion: Female MHN surgeons reported in this survey to experience more workplace sexual harassment and higher COVID-19-related burnout than their male counterparts.

Base of Tongue Squamous Cell Carcinoma With Metastasis to the Mandibular Symphysis: A Case Report.

Squamous cell carcinoma (SCC) is the most common malignancy of the oropharynx (OP). Treatment of OP SCC includes chemotherapy, radiation, and/or surgery. OP SCC can spread via direct extension, lymphatics, or hematogenously. Although rare, distant metastases can occur in OP SCC. The most common sites of metastasis include the lungs, bone, and liver. Other less common sites include the skin, bone marrow, brain, kidneys, eyes, and heart. Patients who present with distant metastases usually have a poor prognosis. Sites of bone metastases from more common to less common include the spine, skull, ribs, and axial bones. In this article, we discuss a patient who presents with HPV+ base of tongue SCC with metastases to the lungs and mandible symphysis. Base of tongue SCC metastasizing to the mandible symphysis is a rarely reported location of metastasis.

TNM staging compared with a new clinicopathological model in predicting oral tongue squamous cell carcinoma survival.

BACKGROUND: The purpose of this study was to investigate the prognostic impact of comorbidity and of demographic and pathological factors on oral tongue squamous cell carcinoma (SCC) survival, and to compare the prognostic performance of a new clinicopathological model against the routinely used TNM staging. METHODS: We conducted a retrospective study of demographic, clinical, and pathological information of 166 patients with oral tongue SCC. Cox regression was used for multivariate analysis, model building, and model discriminatory analysis. RESULTS: Comorbidity had the most significant impact on overall survival (OS; log-rank test, chi-square = 36.34; p < .0001). Comorbidity, tumor dimension >2 cm, and presence of extracapsular spread (ECS) or vascular invasion were independent predictors of survival. A clinicopathological model based on these 4 variables (chi-square = 60.23; p < .0001) was better (c-statistic = 0.736) at predicting survival compared to pathological TNM staging (c-statistic = 0.645). CONCLUSION: Comorbidity combined with tumor dimension, ECS, and vascular invasion provide a better prediction of oral tongue SCC survival than TNM staging alone.

Patient and physician views on providing cancer patient-specific survival information.

OBJECTIVES/HYPOTHESIS: To gather input regarding the presentation, content, and understanding of survival and support information for Prognostigram, a computer-based program that uses standard cancer registry data elements to present individualized survival estimates. STUDY DESIGN: Cross-sectional survey research. METHODS: Two groups of patients (total n=40) and one group of physicians (n=5) were interviewed. The patient groups were interviewed to assess baseline patient numeracy and health literacy, and patient desire for prognostic information. The first group (n=20) was introduced to generalized survival curves in a paper booklet. The second group (n=20) was introduced to individualized survival curves from Prognostigram on the computer. Both patient groups were queried about the survival curves. The physicians were asked their opinions on sharing prognostic information with patients. RESULTS: Numeracy assessments indicated that the patients are able to understand concepts and statistics presented by Prognostigram. According to the patient interviews, the Internet is the most frequent source for survival statistics. Of the 40 patient participants, 39 reported survival statistics as being somewhat or very useful to cancer patients. All five physicians believed survival statistics were useful to patients and physicians, and noted accurate and understandable survival statistics are fundamental to facilitate discussions with patients regarding prognosis and expectations. CONCLUSIONS: Formative research indicates that cancer patients and their families actively seek survival statistics on their own. All patients indicated strong interest in Prognostigram, which is a software tool designed to produce individualized survival statistics to oncologists and cancer patients in a user-friendly manner. LEVEL OF EVIDENCE: 4.

Functional connectivity during modulation of tinnitus with orofacial maneuvers.

OBJECTIVE: To determine changes in cortical neural networks as defined by resting-state functional connectivity magnetic resonance imaging during voluntary modulation of tinnitus with orofacial maneuvers. STUDY DESIGN: Cross-sectional study. SETTING: Academic medical center. SUBJECTS AND METHODS: Participants were scanned during the maneuver and also at baseline to serve as their own control. The authors chose, a priori, 58 seed regions to evaluate previously described cortical neural networks by computing temporal correlations between all seed region pairs. Seed regions whose correlations significantly differed between rest and maneuver (P < .05, uncorrected) entered into a second-stage analysis of computing the correlation coefficient between the seed region and time courses in each of the remaining brain voxels. A threshold-free cluster enhancement permutation analysis evaluated the distribution of these correlation coefficients after transformation to Fisher z scores and registration to a surface-based reconstruction using Freesurfer. RESULTS: The median age for the 16 subjects was 54 years (range, 27-72 years), and all had subjective, unilateral or bilateral, nonpulsatile tinnitus for 6 months or longer. In 9 subjects who could voluntarily increase the loudness of their tinnitus, there were no significant differences in functional connectivity in any cortical networks. A separate analysis evaluated results from 3 patients who decreased the loudness of their tinnitus. Four subjects were excluded because of excessive motion in the scanner. CONCLUSION: The absence of significant differences in functional connectivity due to voluntary orofacial maneuvers that increased tinnitus loudness failed to confirm prior reports of altered cerebral blood flows during somatomotor behaviors.