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To determine the preoperative risk factors most predictive of prolonged length of stay (LOS) or admission to a skilled nursing facility (SNF) or inpatient rehabilitation center (IPR) after free flap reconstruction of the head and neck.Retrospective cohort study.Tertiary academic medical center.Retrospective review of 1008 patients who underwent tumor resection and free flap reconstruction of the head and neck at a tertiary referral center from 2002 to 2019.Of 1008 patients (65.7% male; mean age of 61.4 years, SD 14.0 years), 161 (15.6%) were discharged to SNF/IPR, and the median LOS was 7 days. In multiple linear regression analysis, Charlson Comorbidity Index (CCI;Common tools for assessing frailty and need for additional care may be inadequate in a head and neck reconstructive population. CCI appears to be the best of the aggregate metrics assessed, with significant relationships to both LOS and placement in SNF/IPR.

To evaluate the associations between median household income (MHI) and area deprivation index (ADI) on postoperative outcomes in oral cavity cancer.Retrospective review (2000-2019).Single-institution tertiary medical center.MHI and ADI were matched from home zip codes. Main postoperative outcomes of interest were length of tracheostomy use, length of hospital stay, return to oral intake, discharge disposition, and 60-day readmissions. Linear and logistic regression controlled for age, sex, race, body mass index, tobacco and alcohol use history, primary tumor location, disease staging at presentation, and length of surgery. A secondary outcome was clinical disease staging (I-IV) at time of presentation.The cohort (N = 681) was 91.3% White and 38.0% female, and 51.7% presented with stage IV disease. The median age at the time of surgery was 62 years (interquartile range [IQR], 53-71). The median MHI was $47,659 (IQR, $39,324-$58,917), and the median ADI was 67 (IQR, 48-79). ADI and MHI were independently associated with time to return of oral intake (β = 0.130, P = .022; β = -0.092, P = .045, respectively). Neither was associated with length of tracheostomy, hospital stay, discharge disposition, or readmissions. MHI quartiles were associated with a lower risk of presenting with more advanced disease (Q3 vs Q1: adjusted odds ratio, 0.56 [95% CI, 0.32-0.97]).MHI is associated with oral cavity cancer staging at the time of presentation. MHI and ADI are independently associated with postoperative return to oral intake following intraoral tumor resection and free flap reconstruction.

Identify risk factors and outcomes of recurrent well-differentiated thyroid cancer.Retrospective case-control analysis.Tertiary care academic center in Nashville, Tennessee.This single-center analysis reviews 478 patients who underwent initial surgical management of well-differentiated thyroid carcinoma between 2002 and 2017. Patients were dichotomized with or without recurrent well-differentiated thyroid cancer. Demographic and clinicopathologic risk factors were carefully reviewed. Univariate, multiple regression, and survival analyses were used to evaluate predictors of recurrence.Thirty-eight patients (7.9%) who received initial surgical intervention for well-differentiated thyroid carcinoma at our institution recurred, with an average time to recurrence of 24 months. Male sex, tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, number of positive lymph nodes, and low lymph node yield were all significantly associated with locoregional recurrence (Extrathyroidal extension, number of positive lymph nodes, and low lymph node yield are independent clinicopathologic risk factors for postoperative recurrence of well-differentiated thyroid cancer. Metastatic lymph node ratio is uncommonly used but can be an important prognosticator of recurrence. Patients with metastatic lymph node ratio ≥0.3 should be counseled on their increased risk of recurrence and should undergo close surveillance following surgery.

Introduction: Access to care is a known challenge for head and neck cancer patients. The coronavirus disease 2019 (COVID-19) pandemic has placed further demands on the US health care system and oncologic care. This study aims to explore the impact of the COVID-19 pandemic on head and neck cancer care delivery. Method: A retrospective chart review was performed at a single tertiary care center from March 2020 to July 2020 (encompassing the initial outbreak of COVID-19) and March 2019 to July 2019 (serving as a control). All adult patients presenting as new referrals to the otolaryngology head and neck cancer clinic with known or suspected malignancy were included. Demographic variables collected included age, gender, race, insurance status, and distance traveled. Referral and treatment dates, telemedicine encounters, presenting symptoms, type of malignancy, and prior treatment were also collected. Results: In total, 449 new cancer patients were included, and comparison of 2019 (n = 236) vs 2020 (n = 213) revealed no significant differences in age, gender, race, insurance status, or malignancy type. Median distance traveled decreased from 61.7 miles (greatest distance of 713.8 miles) in 2019 to 48.4 miles (greatest distance of 302.2 miles) in 2020 (P = .588). Median time from referral to clinic significantly decreased from 11 days in 2019 to 9 days in 2020 (P < .001). Median time from referral to surgery also decreased (38 days in 2019 vs 27 days in 2020, P < .001). Thirteen telemedicine encounters occurred in 2020 for postoperative and surveillance follow-ups. Conclusion: Patients at our institution were seen in clinic and underwent surgery more quickly during the COVID-19 pandemic without significant amplification of any preexisting demographic disparities. Expedited care may be a result of initial slowdown of clinical and surgical volume at the start of the pandemic, prioritization of oncologic surgical cases, cancellation of elective procedures, and the use of telemedicine. The median decrease in distance traveled suggests a reduced catchment area and a potential barrier to care during the disruptions related to the pandemic.

Surgical specialty trips to third world countries have been praised and criticized. Our objective was to learn the usefulness of a yearly head and neck surgery trip through initial analysis of 2 years of patient data.We reviewed data from a prospectively maintained repository of surgical patients treated during head and neck surgical trips to Malindi, Kenya, in 2010 and 2011. Basic demographics, distance traveled for care, access to physicians, preoperative diagnosis, surgical procedure(s), and pathology were recorded when available.In 2 years, 226 surgeries were performed. Patient age ranged between 3 months and 85 years, and gender was evenly split. Half of patients came from outside the town of Malindi, and a third traveled over 100 kilometers for care. The majority reported access to a local physician, yet very few patients were offered prior surgical treatment. The most common operations performed were adenotonsillectomy and hemithyroidectomy. A wide variety of cases were performed, including parotidectomies, maxillectomies, mandibulectomies, cleft lip and palate repair, and free flap reconstructions. Local and national visiting otolaryngologist-head and neck surgeons participated or observed throughout our visits with teaching emphasis based on their skills and specific learning goals.Annual surgical specialty trips to rural, resource-limited regions are useful and worthwhile and offer procedures not otherwise available. On such trips, it is important to collect patient, surgical, and pathology data to help visiting surgeons determine the best procedures to teach local physicians and provide needed resources.

Objective. To evaluate clinician perception of voice quality, patient self-reported psychosocial impact of dysphonia, and glottic closure in patients who have undergone resection of the recurrent laryngeal nerve (RLN) and immediate opera- tive reconstruction during thyroid surgery. Study Design. Prospective observational study. Setting. Single tertiary care hospital. Subjects and Methods. Nine patients underwent immediate operative reconstruction of the RLN by the senior author from 2002 to present. Outcome measures included (1) per- ceptual voice ratings assessed using the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale, (2) psycho- social impact of dysphonia assessed using the Voice Handicap Index (VHI), and (3) assessment of glottic closure from laryngeal videostroboscopy. Results. The RLN was reconstructed with primary anasto- mosis (4), free nerve graft (3), or vagus-RLN anastomosis (2). Seven patients had voice samples and videostroboscopy examinations obtained at a minimum of 9 months from sur- gery. Six were judged to have slight disturbance of voice based on overall Grade scoring (G = 1). Five rated their voice as normal or mild on the VHI instrument (score range 8-29). Laryngeal analysis revealed the immobile vocal fold in the median, physiologic phonating position with preserved bulk, recovered tension, and glottic closure during phona- tion. Three patients less than 9 months from surgery had an expected severe self-reported rating of dysphonia. Conclusion. Primary anastomosis, free nerve grafting, and vagus- RLN anastomosis are viable options for RLN reconstruction. Patients who undergo resection and immediate reconstruction of the RLN are able to regain self-perceived functional voices.

Objectives:Total glossectomy is a morbid procedure offered to patients with advanced tumors of the oral cavity and oropharynx. Reconstruction of the resultant defect is typically performed immediately after resection, with regional and free tissue transfer being most commonly used. The goals of this study are to demonstrate: 1) long-term survival, 2) long-term swallowing outcomes, 3) rate of tracheostomy dependence, and 4) reconstructive techniques utilized after total glossectomy.Methods:Retrospective chart review of patients who received total glossectomy at Vanderbilt between 2000 and 2010. Survival and functional outcomes were followed from the day of the surgery to the last outpatient note.Results:22 patients were included in this study, and 15 patients were alive 1 year post-surgery. Average length of survival after the operation was 715 days. 4 patients received concomitant total laryngectomy. 14 of 18 patients that received tracheostomy were able to be decannulated, with an average time to decannu...

Objectives:Determine the feasibility and efficacy of microvascular free flap reconstruction of head and neck defects during foreign medical mission trips in the low resource setting.Methods:Retrospective review of foreign medical mission trips by a single tertiary care institution. Eight patients with benign tumors of the maxilla or mandible underwent microvascular free flap reconstruction of a head and neck defect following composite resection. Patient charts were reviewed for demographic data, reconstruction type, tumor location, pathology, length of stay, complications, and follow-up.Results:Eight patients underwent free flap reconstruction during four trips taking place over the span of two years in three different hospitals in Kenya. Seventy-five percent of patients were male and the average age was 26. Final pathology was benign in all patients. There were no flap failures. One patient had a small fistula managed with packing and secondary closure.Conclusions:Free flap reconstruction of head and nec...

Objective: Despite the NIH recommendation for transfusions based on the individual patient, many microvascular surgeons continue to use a trigger point to guide transfusion criteria in patients und...

Program Description: Iodine deficiency has largely been eradicated in the developed world, but many lower resource countries demonstrate persistent iodine deficiency, goitrogen abundance, or both. In addition, some areas with high rates of thyroid malignancy have not had the resource capacity to fully address the need. Thus, surgical treatment of thyroid disease has comprised a significant proportion of head and neck related humanitarian surgery. This miniseminar, which is endorsed by the Humanitarian Efforts and Endocrine Surgery Committees, will be targeted to an audience of thyroid surgeons and those experienced in humanitarian surgery in low to medium resource settings. The presentations will be didactic, but with opportunity for discussion as well as audience interaction for the potentially controversial aspects. After introductory remarks, the audience will be queried for experience in humanitarian thyroid surgery and current management practices. The ethics of defining standard care with respect to...