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Objective: Oral cavity malignancies (OCC) and oropharyngeal malignancies (OPC) historically have higher rates of positive surgical margins (PSM) compared to other solid malignancies. The objective of this study is to understand trends and predictors in positive surgical margins (PSM) for OPSCC and OCSCC using the National Cancer Database (NCDB)., Study Design: Retrospective Cohort Study., Setting: National Cancer Database., Methods: Retrospective analysis of patients with OCC and OPC between 2004 and 2020 in the NCDB. Linear regression analysis between PSM rates and year was performed. Multivariable logistic regression was used to investigate the effect of the year of diagnosis on PSM after adjusting for patient, tumor, and healthcare system-related factors., Results: We analyzed 60,695 patients with OCC and 31,950 patients with OPC. Overall PSM rate was 16.1% in OCC and 33.1% in OPC. OCC PSM rate decreased from 17.7% in 2004 to 15.8% in 2020. OPC PSM rate decreased from 32.5% to 25.0%. Later date of diagnosis was associated with a reduction in positive margins for both OCC (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.99-1.0, P < .001) and OPC (0.99, 0.98-0.99, P < .001). For patients with available minimally-invasive surgery data, both later year of diagnosis (0.95, 0.93-0.96, P < .001) and use of minimally-invasive techniques (0.830, 0.75-0.92, P < .001) were associated with a reduction in PSM in OPC., Conclusion: Positive margins for OCC/OPC have been decreasing over the past 2 decades. Robot use has been associated with a reduced PSM rate in OPC. Understanding factors that may contribute to trends in PSM is important in promoting continued improvement., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objectives: A subset of laryngeal squamous cell carcinoma (LSCC) patients undergoing larynx preserving treatment ultimately require total laryngectomy (TL) for oncologic or functional reasons. This study aims to identify TL risk factors in these patients., Methods: Retrospective cohort study using Veterans Affairs (VA) database. T1-T4 LSCC cases treated with primary radiotherapy (XRT) or chemoradiotherapy (CRT) were assessed for TL and recurrence. Binary logistic and Cox regression and Kaplan-Meier analyses were implemented., Results: Of 5390 cases, 863 (16.0%) underwent TL. On multivariable analysis, age (adjusted odds ratio: 0.97 [0.96-0.98]; p  < .001) and N3 disease (0.42 [0.18-1.00]; p  = .050) were associated with reduced risk of TL, whereas current alcohol use (1.22 [1.04-1.43]; p  = .015) and >T1 disease (T2, 1.76 [1.44-2.17]; p  < .001; T3, 2.06 [1.58-2.68]; p  < .001; T4, 1.79 [1.26-2.53]; p  = .001) were associated with increased risk of TL. However, N2 (adjusted hazard ratio: 1.30 [1.10-1.55]; p  = .003) and N3 (2.02 [1.25-3.26]; p  = .004) disease were associated with an increased risk for local recurrence. Compared to XRT, treatment with CRT was associated with reduced risk for local recurrence after adjusting for other factors (0.84 [0.70-0.99]; p  = .044). Those who do not receive TL following local recurrence have poorer disease-specific survival (log-rank, p  < .001). In patients without local recurrence, N2 disease was associated with a fourfold increase in risk of TL (4.24 [1.83-9.82]; p  < .001)., Conclusion: Advanced nodal stage was associated with reduced rates of salvage TL in the setting of local recurrence, and subsequent worse prognosis after recurrence. Conversely, advanced nodal stage may increase the risk for functional salvage TL in patients without recurrence., Level of Evidence: Level 3., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objectives: This study aimed to evaluate the outcomes of a hands-on simulation-based course with emphasis on procedural techniques, clinical reasoning, and communication skills developed to improve junior Otolaryngology - Head and Neck Surgery (OHNS) residents' preparedness in managing otolaryngologic emergencies., Methods: Junior OHNS residents and faculty from residency programs in California, Nevada, and Arizona participated in this workshop in 2020 and 2021. The stations featured airway management techniques, ultrasound-guided needle aspiration, nasoseptal hematoma evacuation, and facial fracture repair using various models and cadavers. Participants completed a pre-workshop survey, post-workshop survey, and 2-month follow-up survey that assessed resident anxiety and confidence in three OHNS emergency situations across knowledge, manual skills, and teamwork using a 5-point Likert scale., Results: Pre-workshop surveys reported the least anxiety and most confidence in teamwork, but the most anxiety and least confidence in technical skills and knowledge related to foreign body retrieval and airway management. Immediately post-workshop participants reported significant reductions in anxiety and increases in confidence, largest in the manual skills domain, in foreign body retrieval (anxiety: -0.99, confidence: +0.95, p  < .01) and airway management stations (anxiety: -0.68, confidence: +1.07, p  < .01). Data collected for the epistaxis station showed decreasing confidence and increasing anxiety following the workshop., Conclusion: Our findings demonstrate the effectiveness of a workshop in preparing junior residents in potentially lifesaving otolaryngologic techniques that residents will encounter. Optimizing use of simulation centered training can inform the future of residency education, improving confidence and decreasing anxiety in residents responsible for the safety of patients., Level of Evidence: III., Competing Interests: The authors have no disclosures and declare no conflicts of interest., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: The purpose of this study was to evaluate the influence of sex and race/ethnicity upon prevalence trends of human papillomavirus (HPV) in oropharyngeal cancer (OPC) and survival after OPC., Method: This was a cohort study of patients included in the United States National Cancer Database who had been diagnosed with OPC between 2010 and 2015. Outcomes were HPV status of tumor specimens and overall survival. Sex- and race-stratified trends in HPV prevalence were estimated using generalized linear modeling. The influence of sex, race, and HPV tumor status on overall survival was compared by Kaplan-Meier method and Cox Proportional Hazards models., Results: This analysis included 20,886 HPV-positive and 10,364 HPV-negative OPC patients. The prevalence of HPV-positive tumors was higher among men (70.6%) than women (56.3%) and increased significantly over time at a rate of 3.5% and 3.2% per year among men and women, respectively. The prevalence of HPV-positive tumors was highest among whites (70.2%), followed by Hispanics (61.3%), Asians (55.8%), and blacks (46.3%). Blacks and Hispanics experienced significantly more rapid increases in prevalence of HPV-positive tumors over time compared with whites (6.5% vs 5.6% vs 3.2% per year, respectively). In HPV-positive OPC, neither sex nor race/ethnicity was associated with survival among patients with HPV-positive OPC. In contrast, for HPV-negative OPC, risk of death was significantly higher for women versus men (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.08-1.26) and blacks versus whites (aHR, 1.21; 95% CI, 1.10-1.33)., Conclusion: The prevalence of HPV-positive tumors is increasing for all sex and race/ethnicity groups in the United States. Sex and race are independently associated with survival for HPV-negative but not HPV-positive OPC., (© 2018 American Cancer Society.)