Oral cancer patients achieve comparable survival at high safety-net burden hospitals.

PURPOSE: To evaluate the impact of hospital safety-net burden and social demographics on the overall survival of patients with oral cavity squamous cell carcinoma. MATERIALS AND METHODS: We identified 48,176 oral cancer patients diagnosed between the years 2004 to 2015 from the National Cancer Database and categorized treatment facilities as no, low, or high safety-net burden hospitals based on the percentage of uninsured or Medicaid patients treated. Using the Kaplan Meier method and multivariate analysis, we examined the effect of hospital safety-net burden, sociodemographic variables, and clinical factors on overall survival. RESULTS: Of the 1269 treatment facilities assessed, the median percentage of uninsured/Medicaid patients treated was 0% at no, 11.6% at low, and 23.5% at high safety-net burden hospitals and median survival was 68.6, 74.8, and 55.0 months, respectively (p < 0.0001). High safety-net burden hospitals treated more non-white populations (15.4%), lower median household income (<$30,000) (23.2%), and advanced stage cancers (AJCC III/IV) (54.6%). Patients treated at low (aHR = 0.97; 95% CI = 0.91-1.04, p = 0.405) and high (aHR = 1.05; 95% CI = 0.98-1.13, p = 0.175) safety-net burden hospitals did not experience worse survival outcomes compared to patients treated at no safety-net burden hospitals. CONCLUSION: High safety-net burden hospitals treated more oral cancer patients of lower socioeconomic status and advanced disease. Multivariate analysis showed high safety-net burden hospitals achieved comparable patient survival to lower burden hospitals.

Surgery with Post-Operative Endoscopy Improves Recurrence Detection in Sinonasal Malignancies.

OBJECTIVE: The mainstay of treatment in sinonasal malignancy (SNM) is surgery, and when combined with chemoradiation therapy, often leads to the best overall prognosis. Nasal endoscopy is essential for post-treatment surveillance along with physical exam and radiologic evaluation. The ability to directly visualize the sinus cavities after surgery may also improve early detection of tumor recurrence and is another reason to potentially advocate for surgery in these patients. METHODS: A retrospective chart review of medical records of patients with pathologically proven SNM was conducted from 2005 to 2019. RESULTS: The nasal cavity and maxillary sinus were the most common primary tumor sub-sites. The most common pathology was squamous cell carcinoma (42%). The median time to recurrence was 9.8 months. Recurrence was initially detected endoscopically in 34.3% patients, by imaging in 62.7% patients, and by physical exam in 3.0% patients. 67 (29%) total recurrences were detected on follow-up, of which 46 (68.7%) were local. Twenty-three of the local recurrences were identified via nasal endoscopy. Thirteen recurrences were identified via endoscopic surveillance within the surgically patent paranasal sinuses while 13 were identified within the nasal cavity; 5 patients had multiple sites of recurrence. CONCLUSION: Local recurrence of SNM is the most common site for recurrent disease and nasal endoscopy identified half of these cases. 50% of these recurrences were within the paranasal sinuses and would not have been easily identified if the sinuses were not open for inspection. Thus, open sinus cavities aid in the detection of tumor recurrence and is another advantage of surgery in the management of SNM.

Delayed onset of tooth decay in a routine pediatric adenotonsillectomy.

Adenotonsillectomy is a common pediatric surgical procedure with a well-defined safety profile. Major complications from this procedure include bleeding/hemorrhage, infection, pain leading to dehydration, and airway obstruction or edema. Though rare, oral endotracheal intubation and oral retractor placement may result in injuries to the teeth and the surrounding soft tissue. We describe a rare case of delayed tooth decay in a 3-year-old female following an otherwise routine adenotonsillectomy.

Lemierre's syndrome in the pediatric population: Trends in disease presentation and management in literature.

OBJECTIVE: This study aims to examine literature on Lemierre's Syndrome (LS) in the pediatric population over time in order to describe patterns in disease progression, management, and prognosis. In addition, this study assesses specific rate of literature output and the location of research over the past 10 years. METHODS: A literature review was conducted through two databases, PubMed.gov and PMC. A search was conducted using the keywords "Lemierre syndrome" and "postanginal sepsis." Literature was primarily reviewed for demographic, radiographic, and clinical data. Articles were included in the study if they were published in English and within the last 10 years. All types of research studies were recorded, however primary data collection came from case reports and series. Publications were grouped into two time periods: 2009-2013 and 2014-2019, allowing for comparison of various characteristics between these two groups. RESULTS: A total of 124 research studies on LS met inclusion criteria and were reviewed. Of these, 98 case reports (79.0%) were examined. Disease Characteristics: Fusobacterium necrophorum was the most common precipitating pathogen isolated from cultures (66.2%). The main primary treatment modalities used were antimicrobials, surgery, anticoagulation, or a combination of these treatments. A total of 63.9% of the case reports indicated use of anticoagulation at some point during treatment. Publication Trends: The number of published studies has not significantly changed in the last decade, with a non-statistically significant decline of 5.6%, when comparing 2014-2019 to 2009-2013 (p = 0.21). Case reports/series were the most common study design (82.2% vs 69.5%) and level of evidence for published studies continued to be stable (level 4-5) through the years (86.9%). The number of publications within an international journal vs US based journal has also remained steady during both time periods (p = 0.698). CONCLUSION: LS is an uncommon condition but one that is important for physicians to be aware of in the pediatric population. Treatment regimens including antibiotics and anticoagulation have remained stable through the past 10 years, however the efficacy of anticoagulation in treating LS continues to be debated. Though LS is considered a severe illness with potentially life threatening complications, publications on this topic, in pediatrics specifically, have decreased within the past five years.

The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review.

OBJECTIVES: For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment. RESULTS: We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid-2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways-adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure-can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity. CONCLUSIONS: We may need new and different treatments for obesity-associated OSA as adenotonsillectomy-which is effective at reversing failure to thrive in OSA-is not as effective at treating OSA in children with obesity. One option is drug-induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 129:2414-2419, 2019.