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Introduction: The physical modification of cartilage grafts during rhinoplasty risks chondrocyte death at the margins where the tissue is cut. This study compares chondrocyte viability between diced, scaled, and pate samples in human models, and further computes percent chondrocyte viability as a function of sequential dicing size in a computational model. Methods: Septal cartilage from 11 individuals was prepared as follows: diced (1 mm cubic), scaled (shaved to <1 mm thickness ~ translucent), pate (0.02 g of scraped cartilage surface), positive control (2 × 2 mm diced), and negative control (2 × 2 mm diced soaked in 70% EtOH). Viability analysis was performed using Live/Dead assay™ and confocal microscopy. Numerical simulation of cartilage dicing in 0.05 mm increments was performed using MATLAB assuming 250 chondrocytes/mm3 with each average chondrocyte size of 65 μm2. Results: Chondrocyte viability was similar between 1 mm diced cartilage, scaled cartilage, and positive control samples (p > 0.05). Conversely, pate samples had significantly less viability compared to positive controls, diced samples, and scaled samples (all p < 0.01 after Bonferroni correction). Pate samples had similar chondrocyte viability compared to negative controls (p = 0.36). On computational modeling, cartilage viability decreased to 50% as the diced sample was cut from 1 mm edge length to 0.7–0.8 mm. Similarly, cartilage viability decreased to 26% at 0.55–0.65 mm, 11% at 0.4–0.5 mm, and <5% at <0.4 mm edge length. Conclusion: Modifying septal cartilage grafts into 1 mm diced or scaled samples maintains ideal chondrocyte viability whereas pate preparations result in significant chondrocyte death. According to computational analysis, chondrocyte viability sharply decreases as the cartilage is diced below 0.7–0.8 mm. Level of Evidence: N/A Laryngoscope, 134:4259–4265, 2024 [ABSTRACT FROM AUTHOR]

Objectives Head and neck mucosal melanoma (HNMM) is a rare malignancy with high mortality. This study evaluates the impact of treatment delays on overall survival in HNMM. Design/Setting/Participants A retrospective review of patients with surgically managed HNMM treated with adjuvant radiation was performed from the 2004–2016 National Cancer Database. Main Outcome Measures Durations of diagnosis-to-treatment initiation (DTI), surgery-to-radiotherapy initiation (SRT), duration of radiotherapy (RTD), surgery-to-immunotherapy initiation (SIT), diagnosis-to-treatment end (DTE), and total treatment package (TTP) were calculated. Results A total of 1,011 patients (50.7% female, 90.5% Caucasian) met inclusion criteria. Median DTI, SRT, RTD, SIT, DTE, and TTP were 30, 49, 41, 102, 119, and 87 days, respectively. Only longer DTE was associated with decreased mortality (hazard ratio, 0.720; 95% confidence interval, 0.536–0.965; p = 0.028). Conclusion DTI, SRT, RTD, SIT, and TTP do not significantly affect overall survival in patients with HNMM who undergo surgery and adjuvant radiation. Longer DTE is associated with improved survival in this population. Level of Evidence 4. [ABSTRACT FROM AUTHOR]

Objectives: We aim to evaluate the impact of MetS on the short-term postoperative outcomes of complex head and neck surgery patients. Methods: This is a retrospective cohort analysis of the 2005 to 2017 National Surgical Quality Improvement Program (NSQIP) database. NSQIP database was queried for 30-day outcomes of patients undergoing complex head and neck surgeries, defined as laryngectomy or mucosal resection followed by free tissue transfer, similar to prior NSQIP studies. Patients with hypertension, diabetes, and body mass index (BMI) >30 kg/m2 were defined as having MetS. Adverse events were defined as experiencing readmission, reoperation, surgical/medical complications, or mortality. Results: A total of 2764 patients (27.0% female) with a mean age of 62.0 ± 11.7 years were included. Patients with MetS (n = 108, 3.9%) were more likely to be female (P =.017) and have high ASA classification (P =.030). On univariate analysis, patients with MetS were more likely to require reoperation (25.9% vs 16.7%, P =.013) and experience medical complications (26.9% vs 15.4% P =.001) or any adverse events (61.1% vs 48.7%, P =.011) compared to patients without MetS. On multivariate logistic regression after adjusting for age, sex, race, ASA classification, and complex head and neck surgery type, MetS was an independent predictor of medical complications (odds ratio 2.34, 95% CI 1.28-4.27, P =.006). Conclusion: Patients with MetS undergoing complex head and neck surgery are at increased risk of experiencing medical complications. Identifying patients with MetS can therefore aid surgeons in preoperative risk assessment and help improve postoperative management. Level of Evidence: N/A [ABSTRACT FROM AUTHOR]

Background: Head and neck solitary fibrous tumors (SFTs) are rare neoplasms, with few large‐scale studies describing this entity. We evaluated the demographics and correlates of survival in a large series of SFT patients. Methods: The 2004–2017 National Cancer Database was queried for head and neck SFT patients receiving definitive surgery. Cox proportional‐hazards and Kaplan–Meier analyses assessed overall survival (OS). Results: Of 135 patients, sinonasal (33.1%) and orbital (25.9%) SFTs were most common. Approximately 93% of SFTs were invasive and 64% were classified as hemangiopericytomas. The 5‐year OS of skull base SFTs (84.5%) was lower than sinonasal (98.7%) and orbital (90.7%) SFTs (all p < 0.05). Government insurance exhibited higher mortality (HR 5.116; p < 0.001) and lower OS (p = 0.001). Conclusion: Head and neck SFTs presented with distinct prognoses based on anatomical origin. Overall survival was particularly worse in patients with skull base SFTs or government insurance. Prognostically, hemangiopericytomas were indistinct from other SFTs. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to develop a deep neural network (DNN) for predicting surgical/medical complications and unplanned reoperations following thyroidectomy. Design, Setting, and Participants: The 2005–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database was queried to extract patients who underwent thyroidectomy. A DNN consisting of 10 layers was developed with an 80:20 breakdown for training and testing. Main Outcome Measures: Three primary outcomes of interest, including occurrence of surgical complications, medical complications, and unplanned reoperation were predicted. Results: Of the 21 550 patients who underwent thyroidectomy, medical complications, surgical complications and reoperation occurred in 1723 (8.0%), 943 (4.38%) and 2448 (11.36%) patients, respectively. The DNN performed with an area under the curve of receiver operating characteristics of.783 (medical complications),.709 (surgical complications) and.703 (reoperations). Accuracy, specificity and negative predictive values of the model for all outcome variables ranged 78.2%–97.2%, while sensitivity and positive predictive values ranged 11.6%–62.5%. Variables with high permutation importance included sex, inpatient versus outpatient and American Society of Anesthesiologists class. Conclusions: We predicted surgical/medical complications and unplanned reoperation following thyroidectomy via development of a well‐performing ML algorithm. We have also developed a web‐based application available on mobile devices to demonstrate the predictive capacity of our models in real time. [ABSTRACT FROM AUTHOR]

Objective: This cross‐sectional study aims to characterize current otolaryngology‐head and neck surgery department chairs and division chiefs and evaluate whether there have been significant changes in the occupants of these positions over time. Methods: All permanent department chairs or division chiefs at allopathic ACGME‐accredited otolaryngology residency programs (n = 109) were identified and academic and professional information were collected using publicly available websites. Results: After excluding 12 department chairs due to interim status, 97 chairs and chiefs (81 chairs and 16 chiefs) were included with mean and median current term length of 9 ± 8 and 7 ± 5 years, respectively (range = 0–35 years). The most commonly completed fellowship in the group was head and neck oncologic surgery (42%). Seventy‐seven percent of chairs previously held a faculty position within their institution. Seventy‐one percent did not complete residency or fellowship training at their current institution. The average time between completing training and being appointed chair was 15.5 ± 7.7 years. Those appointed within the last 6 years (n = 47) had more years of experience than those appointed previously (18.0 ± 7.2 vs. 13.1 ± 7.4 years, p = 0.002). The number of female chairs remains low (n = 9), and despite an increasing number of women being appointed in recent years, the most recent group of appointees did not demonstrate a significant increase in female appointment (4% vs. 15%, p = 0.065). Conclusions: A very large proportion of otolaryngology‐head and neck surgery department chairs are internally recruited from their home institution. Most chairs are male, and head and neck oncologic surgery is the most common subspecialty. Level of Evidence: NA Laryngoscope, 133:1356–1360, 2023 [ABSTRACT FROM AUTHOR]

Objective: To assess how traditional, simple markers of health independently affect postoperative morbidity of mandibular fracture open reduction‐internal fixations (ORIFs). Study Design: Cohort study. Setting: National Surgical Quality Improvement Project (NSQIP) Database. Methods: The 2005 to 2017 NSQIP database was queried for patients who underwent mandibular ORIF. To control for the severity of the trauma, an additional "concurrent surgery" variable was created. A modified 5‐item frailty index was calculated based on the following: presurgery‐dependent functional status, chronic hypertension, diabetes mellitus, history of chronic obstructive pulmonary disease, and history of congestive heart failure. Results: Among 1806 patients with mandibular ORIFs (mean age 34.8 ± 15.4 years), modified frailty index (mFI) was associated with 30‐day medical complications (p <.001), reoperation (p <.001), and readmission (p =.005) on univariate analysis. Increased age was associated with prolonged hospitalization (p <.001) and medical complications (p <.001). The increased American Society of Anesthesiologists (ASA) score was associated with all endpoints (p ≤.003), while increased body mass index (BMI) was associated with none. On multivariate analysis, only increased ASA was associated with any adverse event (reference: ASA 1; ASA 2, odds ratio [OR]: 2.17 [95% confidence interval, CI: 2.17‐3.71], p =.004; ASA 3‐4, OR: 3.63 [95% CI: 1.91‐6.91], p <.001). Similarly, mFI and BMI were not independently associated with prolonged hospitalization (≥2 days) (p ≥.015), but 65+ age (reference: 18‐49; OR: 2.33 [95% CI: 1.40‐3.86], p =.001) and ASA 3 to 4 groups (reference: ASA 1; OR: 3.26 [95% CI: 2.06‐5.14], p <.001) were. Conclusion: ASA status and age are more useful modalities than mFI or BMI in predicting poor postoperative morbidity in mandibular ORIF. These simple metrics can assist with managing surgeons' expectations for mandibular ORIF patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate differences in treatment outcomes for head and neck mucosal melanoma (HNMM) patients seen at academic versus nonacademic centers and high versus low volume facilities. Study Design: Retrospective cohort study. Setting: National Cancer Database. Methods: Differences in treatment course and overall survival (OS) by facility type and volume were assessed for 2772 HNMM cases reported by the 2004 to 2017 National Cancer Database. A subgroup analysis was performed with a smaller cohort containing staging data. The analysis employed Kaplan‐Meier and Cox proportional hazards models. Results: A higher proportion of patients treated at academic centers within the HNMM cohort waited longer for surgery after diagnosis (p <.001), had negative surgical margins (p <.001), and were readmitted to the hospital within 30 days of surgery (p =.001); these relationships remained significant when controlling for cancer stage. Kaplan‐Meier analysis demonstrated higher 5‐year OS for patients treated at academic versus nonacademic facilities within the main cohort (32.5% ± 1.3% vs 27.3% ± 1.5%; p =.006) and within the stage‐controlled subgroup (34.8% ± 2.1% vs 27.2% ± 2.6%; p =.003). Treatment at high volume versus low volume facilities was associated with improved 5‐year OS for main cohort patients (33.5% ± 1.7% vs 28.8% ± 1.2%; p =.016) but not for subgroup patients (35.3% ± 2.7% vs 30.1% ± 2.1%; p =.100). Upon multivariate analysis controlling for demographic and oncologic factors, there was no significant difference in OS by facility type (main cohort: odds ratio [OR] = 1.07, 95% confidence interval [CI] = 1.01‐1.21; subgroup: OR = 1.13, 95% CI = 0.97‐1.32). Conclusion: Neither facility type nor surgical volume predicts overall survival in HNMM. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the variant‐specific survival benefits and usage patterns of standardized treatment combinations of surgery (S), radioactive iodine ablation (RAI), and thyroid‐stimulating hormone suppression therapy (THST) for high‐risk differentiated thyroid cancer. Study Design: Retrospective cohort study. Setting: National Cancer Database. Methods: The 2004‐2017 National Cancer Database was queried for patients receiving definitive surgery for high‐risk papillary, follicular, or Hurthle cell thyroid cancer. Cox proportional hazards and Kaplan‐Meier analyses assessed for treatment‐associated survival. Results: Of 21,076 cases, 18,214 underwent survival analysis with a mean ± SD age of 50.6 ± 17.1 years (71.3% female). When compared with surgery alone, S + RAI was associated with reduced mortality in papillary (hazard ratio [HR], 0.574; P <.001) and follicular (HR, 0.489; P =.004) thyroid cancer. S + RAI + THST was associated with reduced mortality in papillary (HR, 0.514; P <.001), follicular (HR, 0.602; P =.016), and Hurthle cell (HR, 0.504; P =.021) thyroid cancer. In papillary thyroid cancer, S + RAI (91.3%), S + THST (89.2%), and S + RAI + THST (92.7%) were associated with higher 5‐year overall survival rates than surgery (85.4%, all P <.001). Papillary thyroid cancer treatments involving THST were associated with higher 5‐year overall survival rates than corresponding regimens without THST (all P <.001). In follicular thyroid cancer, S + RAI (73.9%) and S + RAI + THST (78.7%) were associated with higher 5‐year overall survival rates than surgery (65.6%, all P <.05). In Hurthle cell thyroid cancer, S + RAI (66.5%) and S + RAI + THST (73.4%) were associated with higher 5‐year overall survival rates than surgery (53.7%, all P <.05). On linear regression, THST usage increased by 77.5% (R2 = 0.944, P <.001), while RAI usage declined by 11.3% (R2 = 0.320, P =.035). Conclusions: High‐risk differentiated thyroid cancer exhibited varying susceptibilities to different treatment combinations depending on histology, with greatest responses to regimens that included RAI. Physician practices have trended toward decreased RAI and increased THST usage. [ABSTRACT FROM AUTHOR]

Objectives: To characterize clinical factors associated with esthesioneuroblastoma treatment delays and determine the impact of these delays on overall survival. Study Design: Retrospective database analysis. Methods: The 2004–2016 National Cancer Database was queried for patients with esthesioneuroblastoma managed by primary surgery and adjuvant radiation. Durations of diagnosis‐to‐treatment initiation (DTI), diagnosis‐to‐treatment end (DTE), surgery‐to‐RT initiation (SRT), radiotherapy treatment (RTD), and total treatment package (TTP) were analyzed. The cohort was split into two groups for each delay interval using the median time as the threshold. Results: A total of 814 patients (39.6% female, 88.5% white) with mean ± SD age of 52.6 ± 15.1 years who underwent both esthesioneuroblastoma surgery and adjuvant radiotherapy were queried. Median DTI, DTE, SRT, RTD, and TTP were 34, 140, 55, 45, and 101 days, respectively. A significant association was identified between increased regional radiation dose above 66 Gy and decreased DTI (OR = 0.54, 95% CI 0.35–0.83, p = 0.01) and increased RTD (OR = 3.94, 95% CI 2.36–6.58, p < 0.001) durations. Chemotherapy administration was linked with decreased SRT (OR = 0.64, 95% CI 0.47–0.89, p = 0.01) and TTP (OR = 0.59, 95% CI 0.43–0.82, p = 0.001) durations. Cox proportional‐hazards analysis revealed that increased RTD was associated with decreased survival (HR = 1.80, 95% CI 1.26–2.57, p < 0.005), independent of age, sex, race, regional radiation dose, facility volume, facility type, insurance status, modified Kadish stage, chemotherapy status, Charlson‐Deyo comorbidity index, and surgical margins. Conclusions: Delays during, and prolongation of radiotherapy for esthesioneuroblastoma appears to be associated with decreased survival. Level of Evidence: 4 Laryngoscope, 133:764–772, 2023 [ABSTRACT FROM AUTHOR]

Despite these limitations, this large-cohort study found that MetS was an independent risk factor of short-term postoperative medical complications, surgical complications, readmission, and mortality following skull base surgery. Keywords: complications; diabetes; Metabolic syndrome; NSQIP; obesity; outcomes; skull base surgery EN complications diabetes Metabolic syndrome NSQIP obesity outcomes skull base surgery 281 284 4 02/21/23 20230301 NES 230301 INTRODUCTION Metabolic syndrome (MetS) is the constellation of metabolic abnormalities including hypertension, diabetes, and obesity.[1] The prevalence of MetS is continuing to increase in the United States, particularly among young adults.[2] Emerging studies are suggesting an association between MetS and various adverse events following otolaryngologic and neurosurgical surgeries such as thyroidectomy,[3] head and neck microvascular reconstruction,[4] and intracranial tumor resection.[5] This study utilizes a large multicenter hospital-based database to evaluate associations between MetS and various short-term adverse events in skull base surgery. Association between metabolic syndrome and short-term adverse events in skull base surgery. [Extracted from the article]

Objective: To determine demographic factors and clinicopathologic characteristics associated with survival in young patients (age <45 years) with early‐ (I‐II) or late‐stage (III‐IV) oral tongue squamous cell carcinoma (OTSCC). Study Design: Retrospective database review. Setting: National Cancer Database. Methods: A retrospective review of 3262 OTSCC cases in young patients between 2005 and 2014 was performed by using data from the National Cancer Database. Factors affecting 2‐year survival in patients with early‐ and late‐stage disease were evaluated via univariate and multivariate analyses. Results: Overall, 1899 patients with early‐stage OTSCC and 1363 with late‐stage OTSCC were analyzed. In multivariate analysis of early‐stage OTSCC, high tumor grade (hazard ratio, 2.08 [95% CI, 1.45‐2.99]), local metastasis (2.85 [1.37‐5.95]), and tumor size (1.04 [1.02‐1.07]) were predictors of mortality. In late‐stage OTSCC, African American race (2.79 [1.40‐5.56]), positive surgical margins (1.77 [1.07‐2.93]), local metastasis (2.20 [1.03‐4.72]), distant metastasis (11.66 [2.10‐64.73]), depth of invasion (1.03 [1.01‐1.05]), and tumor size (1.01 [1.003‐1.01]) were predictors of mortality. Subset analysis of clinical N0‐stage tumors revealed that treatment with surgery alone was associated with improved survival (P <.001). Conclusion: Positive lymph nodes, high tumor grade, and larger tumor size were associated with increased mortality risk in early‐ and late‐stage young OTSCC. More aggressive up‐front treatment, including extirpative surgery and elective neck dissection, may be associated with improved outcomes and should be considered in early‐stage cases with high‐risk features. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the influence of facility case‐volume on survival in patients with locally advanced papillary thyroid cancer (PTC), and to identify prognostic case‐volume thresholds for facilities managing this patient population. Study Design: Retrospective database study. Methods: The 2004–2017 National Cancer Database was queried for patients receiving definitive surgery for locally advanced PTC. Using K‐means clustering and multivariable Cox proportional‐hazards (CPH) regression, two groups with distinct spectrums of facility case‐volumes were generated. Multivariable CPH regression and Kaplan–Meier analysis assessed for the influence of facility case‐volume and the prognostic value of its stratification on overall survival (OS). Results: Of 48,899 patients treated at 1304 facilities, there were 34,312 (70.2%) females and the mean age was 48.0 ± 16.0 years. Increased facility volume was significantly associated with reduced all‐cause mortality (HR 0.996; 95% CI, 0.992–0.999; p = 0.008). Five facility clusters were generated, from which two distinct cohorts were identified: low (LVF; <27 cases/year) and high (HVF; ≥27 cases/year) facility case‐volume. Patients at HVFs were associated with reduced mortality compared to those at LVFs (HR 0.791; 95% CI, 0.678–0.923, p = 0.003). Kaplan–Meier analysis of propensity score‐matched N0 and N1 patients demonstrated higher OS in HVF cohorts (all p < 0.001). Conclusions: Facility case‐volume was an independent predictor of improved OS in locally advanced PTC, indicating a possible survival benefit at high‐volume medical centers. Specifically, independent of a number of sociodemographic and clinical factors, facilities that treated ≥27 cases per year were associated with increased OS. Patients with locally advanced PTC may, therefore, benefit from referrals to higher‐volume facilities. Level of Evidence: 4 Laryngoscope, 133:443–450, 2023 [ABSTRACT FROM AUTHOR]

Objectives Skull base chordomas are locally aggressive malignant tumors derived from the notochord remnant. There are limited large-scale studies examining the role and extent of surgery and radiation therapy. Design Analysis of the National Cancer Database (NCDB) was performed to evaluate the survival outcomes of various treatments, and to assess for predictors of overall survival (OS). Participants This is a retrospective, population-based cohort study of patients diagnosed with a clival/skull base chordoma between 2004 and 2015 in the NCDB. Main Outcome Measures The primary outcome was overall survival (OS). Results In all, 468 cases were identified. Forty-nine percent of patients received surgery and 20.7% had positive margins. Mean age at diagnosis was 48.4 years in the surgical cohort, and 55% were males. Of the surgical cohort, 33.8% had negative margins, 20.7% had positive margins, and 45.5% had unknown margin status. Age ≥ 65 (hazard ratio [HR]: 3.07; 95% confidence interval [CI]: 1.63–5.76; p < 0.001), diagnosis between 2010 and 2015 (HR: 0.49; 95% CI: 0.26–0.90; p = 0.022), tumor size >5 cm (HR: 2.29; 95% CI: 1.26–4.15; p = 0.007), and government insurance (HR: 2.28; 95% CI: 1.24–4.2; p = 0.008) were independent predictors of OS. When comparing surgery with or without adjuvant radiation, no survival differences were found, regardless of margin status (p = 0.66). Conclusion Surgery remains the mainstay of therapy. Advanced age (>65 years), large tumor size, and government insurance were predictors of worse OS. Whereas negative margins and the use of adjuvant radiation did not appear to impact OS, these may very well reduce local recurrences. A multidisciplinary approach is critical in achieving optimal outcomes in this challenging disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prognostic strengths of American Joint Committee on Cancer (AJCC) staging and American Thyroid Association (ATA) risk classification in well‐differentiated thyroid cancer (DTC), and their implications in guiding medical decision‐making and epidemiological study designs. Methods: The 2004–2017 National Cancer Database was queried for DTC patients. Cox proportional hazards (CPH) and Kaplan–Meier analyses modeled patient mortality and overall survival, respectively. Each CPH model was evaluated by its concordance index, measure of explained randomness (MER), Akaike information criterion (AIC), and area under receiver operating characteristic curve (AUC). Results: Overall, 134,226 patients were analyzed, with an average age of 48.1 ± 15.1 years (76.9% female). Univariate CPH models using AJCC staging demonstrated higher concordance indices, MERs, and AUCs than those using ATA risk classification (all p < 0.001). Multivariable CPH models using AJCC staging demonstrated higher concordance indices (p = 0.049), MERs (p = 0.046), and AUCs (p = 0.002) than those using ATA risk classification. The AICs of multivariable AJCC staging and ATA risk models were 7.564 × 104 and 7.603 × 104, respectively. AJCC stage I tumors were associated with greater overall survival than those classified as ATA low risk, whereas AJCC stages II‐III and stage IV tumors demonstrated worse survival than ATA intermediate‐ and high‐risk tumors, respectively (all p < 0.001). Conclusion: AJCC staging may be a more predictive system for patient survival than ATA risk. The prognostic utility of these two systems converges when additional demographic and clinical factors are considered. AJCC staging was found to classify patients across a wider range of survival patterns than the ATA risk stratification system. Level of Evidence: 4 Laryngoscope, 133:205–211, 2023 [ABSTRACT FROM AUTHOR]

Objective: To determine the implications of obesity on postoperative adverse events following skull base surgery. Methods: The 2005-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for adverse events in skull base surgery cases. Patients were stratified by body mass index (BMI) into normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) cohorts. Logistic regression was used to assess the association of overweight or obese BMI with various 30-day postoperative adverse events. Results: A total of 2305 patients were included for analysis, of which 732 (31.8%) and 935 (40.6%) were overweight or obese, respectively. The mean age was 53.8 ± 15.3 years and 1214 (52.7%) patients were female. Obese patients were younger (P =.033) and possessed higher frailty (P <.001) and ASA scores (P <.001). Operation times and lengths of hospitalization were not significantly different across patient cohorts (all P >.05). On propensity score-adjusted multivariable analysis, only bleeding (OR = 0.42, P <.001) and deep vein thrombosis (OR = 6.46, P =.015) were significantly associated with obesity. There were no significant differences in rates of readmission, reoperation, or mortality between normal weight and obese patients (all P >.05). Conclusions: Obesity was associated with decreased postoperative bleeding and increased deep vein thromboses. Obese patients were otherwise at no higher risk for medical or surgical complications. Elevated BMI did not confer an increased risk for readmission, reoperation, or death. Thus, patient obesity should not be a major determinant in offering skull base surgery in individuals who would otherwise benefit from treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: This study presents an evaluation of the clinical and sociodemographic factors predictive of surgery refusal in pituitary adenoma (PA) patients and the effect of surgical receipt on overall survival outcomes based on patient data from the National Cancer Database. To our knowledge, the impact of pituitary refusal on outcomes has not been investigated by a research team. Here, we identified age > 65, African American race, increased comorbidities, and government insurance or being uninsured as independent predictors of surgery refusal. We also demonstrate a significant decrease in overall survival in PA patients with macroadenoma who refuse surgery compared to those who receive surgery. We hope these findings can help physicians understand the sociodemographic factors that influence surgery refusal in PA patients, as well as the importance of surgery in appropriate patients with macroadenomas. We characterized the clinical and sociodemographic factors predictive of surgery refusal in pituitary adenoma (PA) patients. We queried the National Cancer Database (NCDB) to identify adult PA patients treated from 2004–2015 receiving or refusing surgery. Multivariate logistic regression and Cox proportional-hazards analysis identified clinical and/or sociodemographic factors predictive of surgery refusal or mortality, respectively. Of the 34,226 patients identified, 280 (0.8%) refused surgery. On multivariate logistic regression, age > 65 (OR: 2.64; p < 0.001), African American race (OR: 1.70; p < 0.001), Charlson-Deyo Comorbidity (C/D) Index > 2 (OR: 1.52; p = 0.047), and government insurance (OR: 2.03; p < 0.001) or being uninsured (OR: 2.16; p = 0.03) were all significantly associated with surgery refusal. On multivariate cox-proportional hazard analysis, age > 65 (HR: 2.66; p < 0.001), tumor size > 2 cm (HR: 1.30; p < 0.001), C/D index > 1 (HR: 1.53; p < 0.001), having government insurance (HR: 1.66; p < 0.001) or being uninsured (HR: 1.67; p < 0.001), and surgery refusal (HR: 2.28; p < 0.001) were all significant predictors of increased mortality. Macroadenoma patients receiving surgery had a significant increase in overall survival (OS) compared to those who refused surgery (p < 0.001). There are significant sociodemographic factors that influence surgery refusal in PA patients. An individualized approach is warranted that considers functional status, clinical presentations, and patient choice. [ABSTRACT FROM AUTHOR]

Facial nerve (FN) injury can lead to debilitating and permanent facial paresis/paralysis (FP), where facial muscles progressively lose tone, atrophy, and ultimately reduce to scar tissue. Despite considerable efforts in the recent decades, therapies for FP still possess high failure rates and provide inadequate recovery of muscle function. In this pilot study, we used a feline model to demonstrate the potential for chronically implanted multichannel dual-cuff electrodes (MCE) to selectively stimulate injured facial nerves at low current intensities to avoid stimulus-induced neural injury. Selective facial muscle activation was achieved over six months after FN injury and MCE implantation in two domestic shorthaired cats (Felis catus). Through utilization of bipolar stimulation, specific muscles were activated at significantly lower electrical currents than was achievable with single channel stimulation. Moreover, interval increases in subthreshold current intensities using bipolar stimulation enabled a graded EMG voltage response while maintaining muscle selectivity. Histological examination of neural tissue at implant sites showed no appreciable signs of stimulation-induced nerve injury. Thus, by selectively activating facial musculature six months following initial FN injury and MCE implantation, we demonstrated the potential for our neural stimulator system to be safely and effectively applied to the chronic setting, with implications for FP treatment. [ABSTRACT FROM AUTHOR]

Background: Hospital volume has emerged as a prognostic factor in oncology but is not currently known whether volume is associated with improved outcomes for cutaneous head and neck (HN) melanoma. Methods: A total of 556 079 cutaneous melanoma cases reported by the 2004–2016 National Cancer Database were separated into two cohorts (HN and non‐HN) and facilities within each cohort were classified by case volume. Analysis employed chi‐square, analysis of variance, Kaplan–Meier, and Cox proportional hazards models. Results: Only 41 facilities (3.1% of 1326) treating HN melanoma and 50 facilities (3.7% of 1344) treating non‐HN melanoma were classified as high‐volume facilities (HVFs). The estimated 5‐year overall survival (OS) was 62.7% (standard error [SE]: 0.4%) for patients with HN at low‐volume facilities (LVFs), 69.3% (SE: 0.4%) at IVFs, and 71.8% (SE 0.4%) at HVFs (p < 0.001). Differences in OS remained significant between HVFs versus LVFs after adjusting for confounders. Conclusion: Volume is independently associated with OS and improved surgical outcomes for HN melanoma. [ABSTRACT FROM AUTHOR]

Objective: To investigate the use of near-infrared (NIR) imaging as a tool for outpatient clinicians to quickly and accurately assess for maxillary sinusitis and to characterize its accuracy compared to computerized tomography (CT) scan. Methods: In a prospective investigational study, NIR and CT images from 65 patients who presented to a tertiary care rhinology clinic were compared to determine the sensitivity and specificity of NIR as an imaging modality. Results: The sensitivity and specificity of NIR imaging in distinguishing normal versus maxillary sinus disease was found to be 90% and 84%, normal versus mild maxillary sinus disease to be 76% and 91%, and mild versus severe maxillary sinus disease to be 96% and 81%, respectively. The average pixel intensity was also calculated and compared to the modified Lund-Mackay scores from CT scans to assess the ability of NIR imaging to stratify the severity of maxillary sinus disease. Average pixel intensity over a region of interest was significantly different (P <.001) between normal, mild, and severe disease, as well as when comparing normal versus mild (P <.001, 95% CI 42.22-105.39), normal versus severe (P <.001, 95% CI 119.43-174.14), and mild versus severe (P <.001, 95% CI 41.39-104.56) maxillary sinus disease. Conclusion: Based on this data, NIR shows promise as a tool for identifying patients with potential maxillary sinus disease as well as providing information on severity of disease that may guide administration of appropriate treatments. [ABSTRACT FROM AUTHOR]

Objective: Pain control is an important topic that has not been extensively studied in patients undergoing endoscopic skull base surgery (ESBS). The purpose of this study is to identify opioid requirements after ESBS and the risk factors predictive of increased use. Methods: This study was a retrospective review of all patients undergoing ESBS at a tertiary academic skull base surgery program between July 2018 and August 2020. The primary outcome variable was total morphine equivalent dose (MED) requirements after surgery, calculated as the sum of all morphine milligram equivalents over a 24‐h period, and summated across the duration of each participant's hospital course. Results: 94 patients were included in this review. Average daily MED requirements were 14.00 ± 6.79 mg. Average total MED requirements were 83.78 ± 92.99 mg during hospitalization. Average length of stay (LOS) was 5.71 ± 4.42 days, with 22 (23.4%) patients not requiring opioid use upon discharge. On multivariate analysis, female sex (β = 49.62; 95% CI [13.53, 85.71], p = 0.008), nasoseptal flap (NSF) reconstruction (β = 49.56; 95% CI [13.51, 85.61], p = 0.008) and LOS (β = 4.02; 95% CI [0.001, 8.04], p = 0.050) were independently associated with higher total MED requirements. Conclusions: We report average total MED requirements of 83.78 mg after ESBS, with female sex, intraoperative use of an NSF, and increased LOS as predictors of higher MED use. This data indicates a subset of patients who may benefit from more aggressive pain control strategies upfront, including consideration of non‐opioid, multimodal pain regimens. Level of Evidence: 3 Laryngoscope, 132:1939–1945, 2022 [ABSTRACT FROM AUTHOR]

Objective: Inverted papilloma (IP) is the most common benign neoplasm of the nasal cavity with known risk of recurrence. There is no standardized approach to definitive treatment for attachment sites. This systematic review aims to determine whether surgeon choice of technique differs by anatomic attachment site and whether different surgical techniques contribute to reduced rates of recurrence. Data Sources: PubMed and Ovid Medline. Review Methods: A systematic review was conducted for studies reporting on IP. Those that included IP recurrence rates and primary tumor attachment site were reviewed. Results: Of 122 published studies, 14 met eligibility criteria, representing 585 patients and a recurrence rate of 5.8%. The maxillary sinus (50.9%) was the most common primary attachment site, and the sphenoid sinus was associated with the highest rate of recurrence (10.4%). The most utilized technique included debulking the tumor, removing mucosa over the attachment site, and drilling the underlying bone. The most common Krouse stage represented was T3 (53.3%). No single technique predicted a propensity for recurrence, but certain techniques are favored depending on IP attachment site. Finally, frozen sections to obtain evidence of clear margins intraoperatively significantly reduced rates of recurrence (3.4% vs 7.3%, P =.045). Conclusion: Based on the current literature, the most common technique to address site of attachment involves resecting mucosa and drilling the tumor base. Choice of technique appears to differ for various sites of attachment. Use of intraoperative frozen section analysis appears to be associated with decreased recurrence overall. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the associations between geographic locations, rankings, and size/funding of medical schools and residency programs among the current otolaryngology residents. Methods: This retrospective cross-sectional study queried otolaryngology residency program websites for relevant publicly accessible information. Location was categorized as Midwest, Northeast, South, and West. Ranking was according to Doximity (residency) and US News and World Report (medical school). Medical school and residency programs were labeled large if they had >704 students or >15 residents, respectively. Results: A total of 1413 residents from 98 (89%) otolaryngology residency programs were included. Residents attending their home medical schools (18%) were equally distributed among regions (P =.845). Residents who attended medical schools in the same US regions (54%) were more likely from top-25 (P =.001) or private (P <.001) medical schools. Southern residents were most likely (64%) and Western residents were least likely (39%) from regional medical schools (P <.001), while residents from Midwest and Northeast had similar rates (54%-55%). The percentage of Midwest residents coming from regional medical schools has decreased from the 2013 to 2014 residency cycle (P =.037). Completing undergraduate school, medical school, and residency in the same region (38%) was also highest in the South (45%) and lowest in the West (25%) (P <.001). Residents at top-ranked residency programs were more likely from top-ranked (P <.001), large (P =.025), and private (P =.018) medical schools. Conclusion: There exist significant associations between otolaryngology residents' medical school location, ranking, size, and funding source and their residency destination. More than half of the current otolaryngology residents attended medical school in the same geographic region, and about one-fifth have attended medical school and residency at the same institution. Future studies are warranted to evaluate how these results change as the match process evolves in the future. Level of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Medical complications were independently predicted by ASA 4-5 compared with ASA 1-2 (OR = 4.09, 95% CI 1.94-8.64, I p i < 0.001). This study aims to evaluate the value of frailty, age, and American Society of Anesthesiologists (ASA) classification in predicting postoperative outcomes after minimally invasive pituitary surgery. Keywords: age; ASA; frailty; pituitary surgery EN age ASA frailty pituitary surgery 780 783 4 04/28/22 20220501 NES 220501 INTRODUCTION Pituitary adenomas are common intracranial tumors, with an estimated prevalence of 16.7%.1 Minimally invasive pituitary surgery is the standard of care in the treatment of most pituitary neoplasms and often requires a complex and multidisciplinary management plan. [Extracted from the article]