The Clinical Utility and Cost of Routine Staging Exam under Anesthesia for Oral Cavity Squamous Cell Carcinoma.

INTRODUCTION: The standard complete evaluation of patients with head and neck squamous cell carcinoma (HNSCC) has included a staging exam under anesthesia (EUA) since the 1970s. The EUA for all sites of HNSCC has historically consisted of panendoscopy for the purpose of diagnostic biopsy, accurate staging of primary disease, and identification of second primary tumors. However, due to the accessibility of the oral cavity, the sole purpose of EUA for tumors of this site is to identify second primary tumors. Since the EUA became the gold standard for evaluation of HNSCC, there have been significant advancements in less invasive technologies such as CT, PET-CT, MRI, and fiberoptic examination. In this study, we sought to determine the value to patient care and cost-effectiveness of EUA in patients with oral cavity squamous cell carcinoma (OCSCC). METHODS: A retrospective chart review identified 77 patients who underwent EUA for OCSCC. RESULTS: The most common subsites were the oral tongue and floor of mouth (59.7% and 24.7% respectively). All underwent direct laryngoscopy, 94.8% underwent esophagoscopy, and 20.8% underwent flexible transnasal examination in clinic prior to EUA. For 90.9% of patients, the EUA did not change initial T-staging based on clinical examination and imaging. The remaining 9.1% of patients were upstaged after EUA, however this change did not impact the treatment plan. Second primary tumors were identified in 3.9% of patients, all were found in either the oral cavity or oropharynx, and were also identified with clinical examination or imaging. Analysis of patient charges determined an average cost of $8,022.93 per patient under the current paradigm involving EUA, however with a new algorithm eliminating mandatory EUA average cost decreases to $1,448.44. CONCLUSION: Formal EUA has historically been the gold standard for all HNSCC tumors. However, when performed for cases of oral cavity carcinoma, it is safe and cost effective to limit its use to select clinical scenarios.

An innovative photographic database for cutaneous facial defects.

OBJECTIVES/HYPOTHESIS: To construct an easy-to-use server-based database that stores photographs of patients undergoing reconstructive surgery for cutaneous facial defects and organizes them in a manner best suited for rapid search and education. STUDY DESIGN: An institutional review board-approved user-modifiable database was designed using OnBase software (Hyland Software Inc., Westlake, OH) to store both the photographs of patients undergoing reconstructive surgery and the pertinent clinical data. METHODS: We designed a database using the OnBase software system (Hyland Software Inc.) to catalog patient data and photographs (pre-, intra-, and postoperative) and allow searches based on key data points. The database operates on three different frames: an upload frame, retrieval frame, and patient document frame. Data entry was based on patients undergoing facial reconstruction of Mohs defects, and upload is in the form of 25 keywords for which data values are entered via dropdown menus. Keyword entry describes defect description, flap nomenclature, flap design, outcomes, and complications. RESULTS: The database allows easy and rapid searches of case examples based on a number of criteria. It allows the user to view multiple examples of different patients with a given defect as defined by location, depth, and size. CONCLUSION: Server-based database systems such as OnBase (Hyland Software Inc.) provide platforms that can be used to create user-friendly photograph and data collection systems. Our database provides a way to educate medical students and surgeons-in-training, review personal outcomes, and exercise continued practice-based learning. Implementation of similar databases could potentially be utilized around the globe to facilitate education and self-assessment because OnBase (Hyland Software Inc.) and other similar software platforms are widely available within healthcare systems. Laryngoscope, 2016 Laryngoscope, 126:2451-2455, 2016.