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BACKGROUND: We sought to review our institutions experience with dental implant placement in free flap jaw reconstruction to determine factors impacting restoration of dental occlusion. METHODS: Exactly 48 patients underwent free flap jaw reconstruction with or without dental restoration from 2017 to 2022. Primary outcome was achievement of restored dental occlusion after jaw free flap reconstruction. RESULTS: A total of 48 patients with a mean age of 59.8 ± 16.4 years underwent jaw reconstruction from 2017 to 2022. Ten patients (20.8%) received osteointegrated dental implants. Two patients received a temporary dental prosthesis, 12 ± 4 months after initial reconstruction. Three patients received a final prosthesis, with a mean time to final prosthesis of 17.7 ± 12.4 months. Five patients did not receive any prosthesis despite placement of implants. CONCLUSION: A minority of patients received dental implant placement with free flap jaw reconstruction and only a small subset of these received a definitive dental prosthesis.

ImportanceDirect laryngoscopy, once an inpatient procedure, is now commonly performed in the outpatient setting. To ensure that safety follows the adoption of novel techniques and practice patterns, it is important to analyze the complication and revisit rates of these ambulatory surgery practices.ObjectiveTo determine revisit rates and complications after ambulatory adult direct laryngoscopy procedures.Design, setting, and participantsThis was a retrospective cross-sectional analysis of cases of adult patients who had undergone a direct laryngoscopic procedure extracted from multistate ambulatory surgery and hospital databases (State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010 and 2011). The analysis was performed on December 1, 2014. Index cases were linked to the corresponding State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring within a 7-day postoperative window. All index cases were ambulatory surgery, without overnight stay or 23-hour observation.ParticipantsAdult patients who had undergone a direct laryngoscopy procedure.ExposuresDirect laryngoscopy performed in an ambulatory setting. Patients who underwent flexible laryngoscopy, lesion destruction, laryngectomy, cordectomy, or a secondary nonlaryngoscopy procedure were specifically excluded.Main outcomes and measuresData regarding sex, age, revisit occurrence with associated complications, and mortality were analyzed.ResultsA total of 7743 cases of ambulatory laryngoscopy were identified (mean age, 60.4 years; 61% were male). The 7-day revisit rate was 3.0% (232 revisits). Serious airway complications occurred in 0.27% of cases (n = 21) and accounted for 9.1% of revisits. The rates of other major complications and minor complications were 0.15% (n = 12) and 0.75% (n = 58), respectively. There were no cases of anoxic brain injury. Two deaths occurred at the time of the revisit (7-day mortality rate, 0.03%; 95% CI, 0.01%-0.09%).Conclusions and relevanceAdult ambulatory direct laryngoscopy has a favorable safety profile. Serious airway complications occur in fewer than 3 patients per 1000 cases. The risk of death following outpatient laryngoscopy is extremely low. Outpatient laryngoscopy is not universally suited for all patients, and careful preoperative selection and counseling are imperative.

Objective(1) Obtain matrix-metalloproteinase (MMP) expression profiles for head and neck squamous cell carcinoma (HNSCC) specimens from the Cancer Genomic Atlas (TCGA). (2) Demonstrate HNSCC imaging using MMP-cleavable, fluorescently labeled ratiometric activatable cell-penetrating peptide (RACPP).Study designRetrospective human cohort study; prospective animal study.SettingTranslational research laboratory.Subjects and methodsPatient clinical data and mRNA expression levels of MMP genes were downloaded from TCGA data portal. RACPP provides complementary ratiometric fluorescent contrast (increased Cy5 and decreased Cy7 intensities) when cleaved by MMP2/9. HNSCC-tumor bearing mice were imaged in vivo after RACPP injection. Histology was evaluated by a pathologist blinded to experimental conditions. Zymography confirmed MMP-2/9 activity in xenografts. RACPP was applied to homogenized human HNSCC specimens, and ratiometric fluorescent signal was measured on a microplate reader for ex vivo analysis.ResultsExpression of multiple MMPs including MMP2/9 is greater in patient HNSCC tumors than matched control tissue. In patients with human papilloma virus positive (HPV+) tumors, higher MMP2 and MMP14 expression correlates with worse 5-year survival. Orthotopic tongue HNSCC xenografts showed excellent ratiometric fluorescent labeling with MMP2/9-cleavable RACPP (sensitivity = 95.4%, specificity = 95.0%). Fluorescence ratios were greater in areas of higher tumor burden (P < .03), which is useful for intraoperative margin assessment. Ex vivo, human HNSCC specimens showed greater cleavage of RACPP when compared to control tissue (P = .009).ConclusionsHuman HNSCC tumors show increased mRNA expression of multiple MMPs including MMP2/9. We used RACPP, a ratiometric fluorescence assay of MMP2/9 activity, to show improved occult tumor identification and margin clearance. Ex vivo assays using RACPP in biopsy specimens may identify patients who will benefit from intraoperative RACPP use.

Background: Oral cavity carcinomas individually are the fifth-leading cause of overall cancer mortality in the Northern Mariana Islands, which is likely a representative statistic for many other betel-nut-endemic Pacific islands. Factors associated with survival have been minimally evaluated in this region. The purpose of this study is to further characterize oral cavity carcinoma outcomes and associated prognostic factors in the United States commonwealth of the Northern Mariana Islands (CNMI). Methods: A single-institution retrospective review was undertaken for 81 patients diagnosed with head and neck cancers at the CNMI's only regional hospital complex from 2005 to 2019. A subset of patients diagnosed with oral cavity carcinoma was further evaluated for survival outcomes. Cox proportional hazard regressions were performed to evaluate for variables associated with survival. Results: A majority of patients had cancer of the oral cavity (64/81, 79%). Fifty-five of these patients had sufficient data for review. The average age at the time of diagnosis was 48 and over half were diagnosed with stage IV disease (29/55, 53%). Five-year overall survival (OS) was 49.5% (95% CI, 33.3-63.7%). Factors associated with worse OS were lymph node metastases at presentation (P =.031), higher overall stage (III or IV vs I or II, P =.016), and higher T-stage (III or IV vs I or II, P =.027). Those who used betel nut were diagnosed at a significantly younger age than those who did not (47.2 vs 55.4, P =.001). Conclusions: The head and neck cancer burden in the CNMI is dominated by betel nut related oral cavity disease that is characterized by delayed presentations in younger patients and decreased OS. Future studies are indicated to improve health literacy as well as to investigate the potential for screening programs. [ABSTRACT FROM AUTHOR]

Objectives: Surgical oncology patients have multiple comorbidities and are at high risk of readmission. Prior studies are limited in their ability to capture readmissions outside of the index hospital that performed the surgery. Our goal is to evaluate risk factors for readmission for head and neck cancer patients on a national scale.Material and Methods: A retrospective cohort study of head and neck cancer patients in the Nationwide Readmissions Database (2013). Our main outcome was 30-day readmission. Statistical analysis included 2-sided t tests, χ2, and multivariate logistic regression analysis.Results: Within 30days, 16.1% of 11,832 patients were readmitted and 20% of readmissions were at non-index hospitals, costing $31million. Hypopharyngeal cancer patients had the highest readmission rate (29.6%), followed by laryngeal (21.8%), oropharyngeal (18.2%), and oral cavity (11.6%) cancers (P<0.001). Half of readmissions occurred within 10days and were often associated with infections (27%) or wound complications (12%). Patients from lower household income areas were more likely to be readmitted (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.16-2.05). Patients with valvular disease (OR, 2.07; 95% CI, 1.16-3.69), rheumatoid arthritis/collagen vascular disease (OR, 2.05; 95% CI, 1.27-3.31), liver disease (OR, 2.02, 95% CI, 1.37-2.99), and hypothyroidism (OR 1.30; 95% CI, 1.02-1.66) were at highest risk of readmission.Conclusion: The true rate of 30-day readmissions after head and neck cancer surgery is 16%, capturing non-index hospital readmissions which make up 20% of readmissions. Readmissions after head and neck cancer surgery are most commonly associated with infections and wound complications. [ABSTRACT FROM AUTHOR]

Background: Information about national trends and predictors of malpractice payments can constructively add to the hotly debated topic of medical malpractice. We sought to evaluate predictors of surgical malpractice payments and to explore national trends. Study Design: Retrospective analysis of surgery-related malpractice payments using the National Practitioner Data Bank from 1990 to 2006. Payments were adjusted to 2006 dollars. We evaluated predictors of payment size and large payments (defined as those >$1 million). Statutory law in the states demonstrating significant predictive values was analyzed. Results: In total, 58,518 surgical malpractice payments met inclusion criteria. Patients were predominantly female (62%) and inpatient (63%), with a mean age of 42 years. The number of payments decreased and payment sums increased during the study period. Median payment was $132,915 (95th percentile $983,263). Claims most frequently cited improper performance (42%). Patient outcomes were the strongest predictor of both payment size and likelihood of a large payment. Children younger than 10 years old were 70% more likely to receive a large payment (p = 0.005); and patients older than 70 years were 80% less likely (p < 0.0005). Large variations across states were seen for both payment size and likelihood of large payment. The likelihood of reaching out-of-court settlement did not appear to be correlated with known factors. Conclusions: Nationwide, surgical malpractice claims show rising payment amounts. Patient outcomes are the strongest predictor of payment size. Considerable variation in payment size between states suggests a profound impact from local legal environments. [ABSTRACT FROM AUTHOR]

Objective: Posterior neck masses are a relatively poorly characterized entity. The authors attempt to further characterize the anatomy and pathology of the posterior neck by way of a combined single-institution retrospective chart review and systematic review of the literature. Methods: A single-institution retrospective chart review was undertaken for all patients undergoing excision of a posterior neck mass between January 1, 2012, and January 1, 2017. A systematic review of the Medline, Embase, Web of Science, and Cochrane database was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in search of case reports and series describing posterior neck masses. Results: A total of 28 patients who underwent excision of a posterior neck mass were encountered during the retrospective chart review. All pathologies were benign, the most prevalent of which was lipoma (22/28, 79%). A total of 19 articles describing a collective 36 posterior neck masses were encountered during the systematic review. Lipomas were the most common pathology (15/36, 42%). All but one of the masses reported were benign (35/36, 97%). Conclusions: Patients presenting with posterior neck masses can be reassured of a low risk of malignancy. The majority of posterior neck masses can be appropriately evaluated via physical examination and ultrasound. [ABSTRACT FROM AUTHOR]

Introduction: Medical malpractice litigation continues to be hotly debated, particularly given recent healthcare reform legislation. In this study the National Practitioner Data Bank (NPDB) data was scrutinized to evaluate predictors of malpractice claims ending in large payments. Methods: Retrospective analysis of the NPDB from 1990-2006 involving physicians and/or residents. Payments were adjusted to 2006 dollars. Large payments defined as those exceeding one million dollars. Multivariate regression evaluated predictors of large payments. Statutory law in the states demonstrating significant predictive values was analyzed. Results: A total of 58,518 claims were included. Patients were predominantly female (62%) and inpatient (63%) with mean age of 42 years. Claims per year decreased and payment sums increased over the study period. Median payment was $132,915 (95th percentile $983,263). Claims most frequently cited improper performance (42%). Adjusted analysis explored predictors of large settlements. Patient outcomes of quadriplegia/brain damage/life-long care (OR 142), major permanent injury (OR 66), and death (OR 28) increased the likelihood of large settlements. Compared to 20-69 year-olds, claims involving children less than 10 years-old were 1.7 times more likely to receive large payments (p=0.005); and patients over 70 years were 80% less likely (p<0.0005). Other positive predictors included claims in Illinois, Connecticut, Wisconsin, Rhode Island, New York, Massachusetts, and Georgia. Conclusions: Nationwide, surgical malpractice claims are decreasing in number with rising payment amounts. Patient outcome is the strongest predictor of payment size although significant variation in payments between states exists. Heterogeneity of payment sizes among states suggests a profound impact from the local legal environments. [Copyright &y& Elsevier]