Zaid Al-Qurayshi

Objectives: In cases of advanced parotid and skin cancer of the periauricular region, external ear, or ear canal, parotid surgery is combined with otologic procedures. There is limited data in this patient population regarding preoperative predictors of facial nerve (FN) tumor involvement and how this impacts recurrence and survival. The objective of this study is to review our institution's experience with patients who undergo parotidectomy and mastoidectomy/lateral temporal bone resection. Methods: A retrospective chart review was performed of patients treated with combined parotidectomy and otologic surgery at a single institution over a 20‐year period. Results: Of the 53 patients identified, 26 (49.1%) underwent FN preservation and 27 (50.9%) underwent FN sacrifice. Nine patients (17.0%) had a positive intraoperative nerve biopsy and 4 (7.5%) did not achieve tumor clearance. Higher rates of FN sacrifice were observed in patients with preoperative House–Brackmann (HB) II–VI (17/19; 89.5%) as compared to patients with HB I (7/31; 22.6%). HB scores were predictive of FN sacrifice and involvement on pathology (AUC = 0.829 and 0.913, respectively) whereas imaging was not predictive of FN sacrifice or involvement (AUC = 0.665 and 0.571, respectively). Additionally, intraoperative nerve biopsy was a prognostic factor for local recurrence ( p = 0.045) but did not affect survival ( p = 0.247). Conclusion: There are few prognostic indicators for FN tumor involvement besides clinical exam; FN weakness is the main predictor of FN sacrifice. When the FN is involved, more extensive surgery is likely performed, which is beneficial given that overall survival is not significantly affected by nerve involvement. Level of Evidence: 4.

Background: Reconstruction of total laryngectomy defects with vascularized tissue helps minimize the risk of pharyngocutaneous fistula development. Few studies have assessed outcomes following reconstruction with a parascapular free flap. Methods: We identified 28 patients who underwent laryngectomy with parascapular free flap reconstruction between 2020 and 2024. Chart review was directed toward operative characteristics and postoperative outcomes, which were summarized using descriptive statistics. Results: Thirteen out of 28 patients (46%) underwent salvage laryngectomy. Average operative time was 6.6 (±1.2) hours. Donor site morbidity was low; one patient experienced delayed wound dehiscence that was managed conservatively. Six patients developed pharyngocutaneous fistula; one patient required surgical intervention. The length of hospital stay ranged from 5 to 22 days, and the duration of postoperative nil per os status ranged from 7 to 56 days. Conclusions: Our experience demonstrates that the parascapular free flap is a viable option for reconstruction of defects secondary to laryngectomy.

Background To examine the pattern of utilization and outcomes of definitive radiotherapy (RT) versus primary robotic-assisted surgery in patients with early-stage oropharyngeal squamous cell carcinoma (OPSCC). Methods A retrospective cohort analysis of patients with clinically T1-2, N0 OPSCC was performed using the National Cancer Database, 2010-2016. Results A total of 1451 patients were included. Prevalence of human papillomavirus (HPV)-positive tumors was 58.30%. Primary surgery was performed in 30.25% of the sample. Tongue base and clinically T1 tumors were each associated with a higher likelihood of undergoing surgery (p < 0.05). Histopathology of patients who underwent surgery demonstrated a prevalence of 15.95% with lymphovascular invasion, 16.67% with extranodal extension, 19.36% were T updated, and 30.00% were N upstaged. Improved survival was observed in the surgery + adjuvant RT group compared to RT alone for HPV-positive tumors (HR: 0.27; 95%CI: 0.12, 0.62; p = 0.002). Conclusion This study provides epidemiological perspective regarding management pattern and outcomes of patients with early-stage OPSCC.

Background: Pituitary tumors surgery is increasingly performed via endoscopic transsphenoidal approach (TSP). This study describes outcomes of TSP surgery in the United States.Methods: A retrospective cross‐sectional analysis of adult patients with pituitary adenoma was performed using the Nationwide Readmissions Database, 2010–2015.Results: A total of 5891 patients were identified. The average age was 51.29 ± 0.29 years. The risk of postoperative epistaxis, diabetes insipidus, cerebrospinal fluid (CSF) leak, and other general postoperative complications was 0.71%, 10.20%, 8.35%, and 2.37%, respectively. Independent risk factors of CSF leak included: age p < 0.001 each). The prevalence of CSF leak was not associated with hospital TSP volume and teaching status.Conclusion: This study provides a national epidemiological perspective on TSP in the United States. The risk of postoperative CSF leak appears to be associated with intrinsic patient factors rather than resource and expertise availability.

Objective: Under the Affordable Care Act (ACA), Medicaid expansion became effective in states that have adopted it. We aim to examine its impact on head and neck cancers.Methods: A retrospective study that utilizes the Surveillance, Epidemiology, and End Results database, 2010–2016. Study population included patients with head and neck squamous cell carcinoma (HNSCC), differentiated thyroid carcinoma, and head and neck cutaneous melanoma. The objective is to examine disease‐specific survival before and after Medicaid expansion.Results: In states that adopted Medicaid expansion, the ratio of Medicaid: uninsured patients increased from 3:1 to 9:1 (p < 0.001). In states that did not adopt Medicaid expansion, the ratio increased from 1:1 to 2:1 (p < 0.001), making the increase in Medicaid coverage in states that adopted the expansion significantly higher (p < 0.001). Patients diagnosed with HNSCC before the expansion had worse survival (hazard ratio [HR]: 1.24, 95% confidence interval: 1.11, 1.39, p < 0.001) in states that adopted Medicaid expansion.Conclusions: Early data indicate that implementation of ACA improved disease‐specific survival of patients with HNSCC.Level of Evidence: 3 Laryngoscope, 133:1409–1414, 2023

Background: Describe the epidemiology and characteristics of patients with a history of mental illness undergoing otolaryngologic procedures. Methods: A retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010 to 2015. The study sample included adult (≥18 years) patients undergoing otolaryngologic procedures. Results: A total of 146 182 patients were included, 18.3% with mental illness history. The prevalence of patients who required otolaryngologic surgeries with history of mental illness increased significantly from 14.9% in 2010 to 25.0% in 2015 ( P < .001). Mental illness diagnoses included: depression (6.9%), anxiety (5.8%), alcohol dependence (4.2%), substance dependence (2.9%), bipolar disorder (1.4%), memory disorders (1.2%), delusional disorders (0.6%), self-harm (0.1%). Patients with a history of mental illness were more likely to be <65 years, female, and have multiple comorbidities ( P < .05 each). Patients with history of mental illness had a higher risk of complications [OR:1.59, 95% CI:1.50,1.69, P < .001]. Conclusions: Patients with a history of mental illness are increasingly encountered in otolaryngology service. This study provides an epidemiological perspective that warrants increasing clinical investigation of this subpopulation.

Objectives: Examine the role of elective neck dissection (END) and adjuvant radiotherapy (RT) in early‐stage clinically N0 parotid mucoepidermoid carcinoma (MEC).Methods: The study is a retrospective analysis of the National Cancer Database, 2004–2016. The study population included adult patients with MEC who underwent parotidectomy.Results: A total of 1233 patients were included. Histopathology demonstrated well, moderately, and poorly differentiated MEC 47.12%, 39.98%, and 12.90% of the time, respectively. END was performed in 78.67% of patients, resulting in nodal upstaging in 4.43% and identification of extracapsular extension (ECE) in 0.72%. RT was utilized in 67.33% of patients with advanced pathological features. Neither END nor RT improved overall survival separately (p < 0.05) or combined (adjusted HR: 1.19, 95%CI: 0.52, 2.70, p = 0.68).Conclusion: This study provides an epidemiological perspective regarding patients with clinically T1‐2, N0 MEC. There was no observed survival advantage with END and RT.

Background: Recurrent laryngeal nerve (RLN) invasion by thyroid carcinoma represents an advanced disease status with potentially significant co‐morbidity.Methods: In a retrospective single‐center study, we included patients with invaded RLNs operated on while using nerve monitoring techniques. We studied pre‐, intra‐, and postoperative parameters associated with postoperative vocal cord paralysis (VCP); 5‐year recurrence‐free survival (RFS); and 5‐year overall survival (OS) in addition to two subgroup analyses of postoperative VCP in patients without preoperative VCP and based on source of RLN invasion.Results: Of 65 patients with 66 nerves‐at‐risk, 39.3% reported preoperative voice complaints. Preoperative VCP was documented in 43.5%. The RLN was invaded by primary tumor in 59.3% and nodal metastasis in 30.5%. Papillary thyroid carcinoma was the most common pathologic subtype (80%). After 6 months, 81.8% had VCP. Complete tumor resection of the RLN was not associated with 5‐year RFS (p = 0.24) or 5‐year OS (p = 0.9). Resecting the RLN did not offer statistically significant benefit on 5‐year RFS (p = 0.5) or 5‐year OS (p = 0.38). Radioactive Iodine (RAI) administration was associated with improvement in 5‐year RFS (p = 0.006) and 5‐year OS (p = 0.004). Patients without preoperative VCP had higher IONM amplitude compared with patients with VCP. After a mean follow‐up of 65.8 months, 35.9% of patients had distant metastases, whereas 36.4% had recurrence.Conclusion: Preoperative VCP accompanies less than half of patients with RLN invasion. Invaded RLNs may have existent electrophysiologic stimulability. Complete tumor resection and RLN resection were not associated with better 5‐year RFS or OS, but postoperative RAI was.Level of Evidence: 4 Laryngoscope, 132:2285–2292, 2022

Background Early-stage supraglottic squamous cell carcinoma (SCC) is usually treated with a single modality. The aim of this study is to examine the role of radiotherapy (RT) versus partial laryngectomy (open, robotic-assisted, or endoscopic) with elective neck dissection (PL + END). Methods A retrospective analysis of the National Cancer Database, 2010–2016. The study population included adult patients with clinically T1-2, N0 supraglottic SCC. Results 3301 patients were included. RT was performed in 93.52%, open PL + END in 2.64%, robotic-assisted PL + END in 1.33%, and endoscopic surgical resection in 2.51%. In the surgery group, T was upstaged in 23.36% and N was upstage in 16.36%. Five-year survival in the primary surgery group compared to RT group was 61.89% versus 77.46% (HR: 0.56, 95%CI: 0.43, 0.72). Conclusions T was upstaged in 23% of surgical patients. This accurate staging is likely missed in patients who undergo RT and possibly contributes to lower overall survival of this treatment group.

Objective: Red blood cell distribution width (RDW), a reported biomarker for morbidity and mortality in chronic disease and following certain surgeries, has not been well-studied in head and neck cancer patients. The aim of the study was to examine the association of RDW with postoperative complications and survival among patients who underwent primary or salvage laryngectomy. Methods: We analyzed a retrospective case series study of patients diagnosed with squamous cell carcinoma of the larynx treated with total laryngectomy. Survival outcomes were examined using Kaplan-Meier analysis. Results: One hundred seventy-seven patients were included in the final analysis. The most common tumor subsite was the supraglottis (60%). On bivariate analysis, patients with RDW ≥14.5 had higher prevalence of non-surgical, systemic complications, including deep venous thrombosis, pneumonia, cardiovascular events, and difficulty weaning from mechanical ventilation. However, there was no significant difference in laryngectomy-specific post-operative complications, including pharyngocutaneous fistula, wound infection, stoma complications, and chyle leak. RDW was not found to be associated with survival outcomes following laryngectomy. Conclusions: Among laryngectomy patients, RDW ≥14.5 is associated with higher prevalence of systemic morbidity, but not with specific local surgical complications or decreased survival.