Surgical Resection is Justifiable for Oral T4b Squamous Cell Cancers With Masticator Space Invasion.

OBJECTIVES: To examine survival endpoints in patients with tumor (T)4b oral cavity squamous cell carcinoma (OCSCC) with pathologically proven masticator space invasion treated with primary surgery followed by adjuvant therapy. STUDY DESIGN: Retrospective review at an academic cancer center. METHODS: Twenty-five patients with T4b OCSCC with pathologic masticator space invasion were treated with primary surgery from May 2012 to December 2016. Only patients with ≥ 2 years follow-up from date of surgery were included. Sixteen patients received adjuvant chemoradiation. RESULTS: Median follow-up time was 39 months from date of surgery. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival at 24 months were 44.0%, 63.2%, and 52.6%, respectively. On univariate analyses, adjuvant chemoradiation was associated with improved OS. Advanced age and prolonged length of hospital stay was associated with worse OS. CONCLUSION: For pT4b OCSCCA involving the masticator space, primary surgical resection followed by adjuvant chemoradiation demonstrates 24-month DSS of > 50% and OS of 44%. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E466-E472, 2021.

A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room.

OBJECTIVES/HYPOTHESIS: To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR). STUDY DESIGN: Retrospective review of billing records. METHODS: Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures. RESULTS: Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures. CONCLUSIONS: For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures. LEVEL OF EVIDENCE: NA Laryngoscope, 126:1385-1389, 2016.

The utility of narrow band imaging in the treatment of laryngeal papillomatosis in awake patients.

OBJECTIVE: To determine the value of narrow band imaging (NBI) in visualizing laryngeal papillomatosis (LP), specifically in the awake patient. STUDY DESIGN: Retrospective chart review followed by trial of intervention. METHODS: Ten patients treated for LP in the awake setting were included in the study. Still shots of the same diseased region of the larynx were taken from each procedure, one under white light and one under NBI. The 10 pairs of pictures were then sent to multiple fellowship-trained laryngologists, along with a questionnaire designed to evaluate visualization with NBI versus white light. RESULTS: Raters concluded that NBI improved visualization of diseased tissue 90.0% of the time and showed areas of diseased tissue unappreciated by halogen light in 46.7% of the procedures. They believed that NBI better defined the borders of diseased tissue in 76.7% of the photo sets, and that in 70.0% of the sets, NBI was the better visualization technique in general. However, it was found that 16.7% of the time it was more difficult to visualize areas of diseased tissue with NBI. CONCLUSION: This study suggests that NBI may provide some benefit in the visualization and treatment of LP in the awake patient. Further work should be done to evaluate its utility in pathology of the larynx.

Office surgery for paranasal sinus recirculation.

BACKGROUND: Circular flow of mucus between adjacent openings of a single paranasal sinus is known as recirculation, and can cause persistent sinonasal symptoms. Removing the bridging tissues allows the surgical ostium to connect to the natural ostium. This procedure prevents the circular flow between the 2 ostia, and allows the mucociliary system to provide for physiologic drainage of the sinuses. Traditionally this has taken place in the operating room; however, performing this procedure in the office is possible, even when there is significant intervening bone. Here we report a series patients with recirculation successfully treated in the office. METHODS: A prospective study of 10 patients endoscopically diagnosed with recirculation, 9 involving the maxillary sinus and 1 involving the sphenoid. Symptoms included facial pressure, mucus stasis, congestion, and recurrent sinusitis. All patients had previous sinus surgery. All patients were treated in the office under topical ± local anesthesia. The bridging tissues between ostia were removed, 6 of which consisted of mucosal bands within the middle meatus, 1 with mucosa and intervening bone within the middle meatus, 2 with mucosa and inferior turbinate bone between ostia in the inferior and middle meatus, and 1 involving bone of the face of the sphenoid sinus. RESULTS: All 10 patients had significant improvement or resolution of the symptoms associated with recirculation, with no further endoscopic evidence of mucus recirculation. CONCLUSION: This case series demonstrates that mucus recirculation can be successfully treated in the office setting, even across bony structures. This leads to significant savings to the healthcare system and less missed work/school compared to an operating room procedure.

The place of the osteoplastic flap in the endoscopic era: indications and pitfalls.

OBJECTIVES/HYPOTHESIS: To evaluate the osteoplastic flap (OPF) procedure for frontal sinus pathology at our institution, including indications, revisions, obliteration vs. nonobliteration, and obliteration materials. STUDY DESIGN: Single-institution retrospective review from 1998 to 2013. METHODS: Current Procedural Terminology codes identified all OPF procedures. Demographic data, diagnoses, previous frontal procedures, obliteration materials, and outcomes were evaluated. Diagnoses were divided into two groups: inflammatory (refractory sinusitis, mucoceles, surgical material infections) and noninflammatory (tumors, cerebrospinal fluid leaks). RESULTS: Fifty-seven patients underwent 73 OPF procedures: 36 obliterative and 37 nonobliterative/unobliterative. Inflammatory indications accounted for 76% of obliterated patients, but only 38% of nonobliterative procedures. Ten patients (17.5%) required revision, 90% of whom had an OPF for inflammatory indications. Only one patient who underwent an OPF procedure for noninflammatory pathology required revision. Twenty-four percent of patients obliterated with bone cement ultimately required complete removal to resolve infection. CONCLUSIONS: The OPF approach is still valuable for pathology refractory to or inaccessible to endoscopic approaches. Infectious etiologies have a much higher revision rate. Careful selection of pathologies can reduce revision rates, but in some cases a repeated OPF procedure is the only viable alternative. When bone cement becomes infected the only resolution is complete removal.

Mechanisms and efficacy of vismodegib in the treatment of basal cell carcinoma.

Historically patients with advanced basal cell carcinoma have been subjected to large surgical resections for the treatment of their disease. However, with the development of vismodegib, a first in class molecule that acts to inhibit the hedgehog pathway, patients with advanced and metastatic basal cell carcinoma may have renewed hope in limiting the morbidity involved with surgery. Preliminary data shows a relatively good safety profile and promising results, although further research remains to be conducted. Current progress on utilization of vismodegib for the treatment of advanced basal cell carcinoma is reviewed in this article. Only literature with objective clinical evidence was included in this review.