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Study Design: Retrospective cohort analysis. Objective: To examine the impact the COVID-19 pandemic and its accompanying societal measures had on the incidence, characteristics, and management of maxillofacial traumatic injuries. Methods: This cohort analysis compared facial trauma injuries presenting to the highest-volume Level I Trauma Center in New Jersey, USA from January 1 to July 31 in 2020 and 2019. Differences in demographics, mechanisms, and interventions were compared between the pandemic period (March 16–July 31, 2020) and the equivalent pre-pandemic date period in 2019 using X2, Fishers Exact, and Mann–Whitney U testing. Results: In total, 616 subjects were included. The daily incidence of facial trauma consults during the 2020 pandemic (1.81 ± 1.1) decreased compared to 2019 (2.15 ± 1.3) ( p = 0.042). During the outbreak, there was an increase in the proportion of subjects with positive urine drug screens (21.5% vs. 12.2%; p = 0.011) and injuries related to domestic violence (10.2% vs. 4.5%; p = 0.023). Patients were 30% less likely to be transferred from local hospitals (RR, 0.70 [0.53–0.93]; p = 0.014). Although subjects had a 25% increased risk of presenting with injuries deemed procedural (RR, 1.25 [95% CI, 1.05–1.56]; p = 0.048), a greater proportion were discharged with operative procedures scheduled as outpatients (16.0% vs. 4.9%; p = 0.005). Conclusions: The COVID-19 pandemic has impacted both the epidemiology and management of maxillofacial traumatic injuries, perhaps secondary to modifications in personal and community behaviors or the effects on healthcare systems in our region.

Background Osteoradionecrosis (ORN) of the mandible is a well-known complication of radiation therapy for head and neck cancer. However, few reports have described hyoid bone ORN and its clinical implications. Methods We describe a retrospective case series of previously irradiated patients who were seen with sudden airway compromise, found to have underlying pathological hyoid fractures secondary to osteoradionecrosis. Results Six patients within postchemoradiation period (3-9 months) for oropharyngeal squamous cell carcinoma were seen with acute-onset dyspnea. Computed topography (CT) imaging was remarkable for severe airway luminal narrowing and pathological hyoid fractures. All six patients required urgent intervention with direct laryngoscopy and tracheostomy. Intraoperatively, five patients were seen with exposed necrotic hyoid bones. Conclusion The hyoid and its associated musculature strongly influence upper airway patency. ORN may compromise its physiological function and leads to acute airway compromise. Hyoid ORN may hold significant and imperative clinical implications in head and neck cancer post-treatment surveillance.

A 32-year-old female with a history of bipolar disorder and schizophrenia was transported to our tertiary-care hospital after swallowing a large toilet paper holder bracket. Removal of the large foreign body required coordination between anesthesiology, otolaryngology, and trauma surgery. A tracheostomy airway was established, and the object was removed transorally. The object was found to be a toilet paper holder bracket measuring 7.5 cm × 5.4 cm × 5.4 cm with a 2.6 cm screw protruding from the end. A review of articles describing the removal of foreign bodies from the upper aerodigestive tract found our object to be the largest foreign body ingestion described in literature. One report suggested that 18% of adult patients with foreign body ingestions had primary neuropsychiatric disorders. Our patient’s psychiatric disorder was a major underlying factor leading to the ingestion, with our patient reporting hallucinations instructing her to ingest household objects.

To determine the incidence and significance of asymmetric hypermetabolic laryngeal findings on positron emission tomography-computed tomography (PET-CT) in patients with unilateral true vocal fold (TVF) motion abnormalities.Retrospective cohort.Single-center tertiary care institution.The medical records of patients with unilateral TVF motion abnormalities were reviewed. The incidence of normal and asymmetric hypermetabolic laryngeal findings was calculated in patients who underwent PET-CT and laryngeal examination, operative laryngoscopy with biopsy, or injection medialization laryngoplasty.A total of 135 patients with unilateral TVF motion abnormalities underwent PET-CT. After exclusion of patients who completed new or surveillance imaging for a laryngeal neoplasm (n = 27), asymmetric hypermetabolic findings in the larynx were noted in 21 (19%) cases: 13 (12%) on the contralateral side of the impaired TVF, 8 (7%) on the ipsilateral side. Two (25%) patients with ipsilateral hypermetabolism had concerning subsequent fiberoptic laryngeal examinations prompting operative biopsy. There was no evidence of inflammatory or neoplastic disease in all patients with contralateral hypermetabolic findings. Fifteen patients completed PET-CT scans after injection medialization procedures; 6 (40%) displayed avidity ipsilateral to the side of the injection. The median time from injection to scan was 27 days, as opposed to 193 days in the unremarkable scans (Contralateral hypermetabolism in patients with unilateral TVF motion abnormalities may represent a false-positive finding. Ipsilateral hypermetabolic uptake without recent fold instrumentation warrants prompt diagnostic evaluation.

To determine the effects an incentive-based physician compensation model has on safety outcomes related to outpatient otolaryngology surgical procedures.A retrospective analysis of a prospectively maintained database assessing the difference in outpatient surgical volume and postoperative adverse outcomes before and after the implementation of a relative value unit (RVU)-based payment structure.Single-center academic otolaryngology practice operating at a hospital-owned ambulatory surgery center.Data prospectively collected from outpatient otolaryngology surgical cases performed at the surgery center from April 2013 to April 2018 were retrospectively reviewed. Equal pre-RVU and post-RVU study periods were calculated for 4 surgeons based on their chronological transition in payment structure (range, 46-56 months). Case volume and incidence rates of adverse outcomes, including postoperative infections, emergency department visits, unplanned hospital admissions, and returns to the operating room, were compared between the pre-RVU and post-RVU study periods at both the surgeon and group levels.At the group level, the post-RVU period was associated with a higher volume of surgical cases ( P = .001). No significant differences were observed in the overall incidence of adverse outcomes ( P = .21) or among the specific rates of postoperative hospitalizations ( P = .39), infections ( P = .45), unplanned returns to the operating room ( P = 1.00), or emergency department visits ( P = .39). Comparable results were observed at the individual surgeon level.The implementation of an incentive-based salary was not associated with a change in the incidence of adverse safety outcomes in the setting of increased outpatient otolaryngology procedures.

Objective To determine whether the use of fibrin sealant tissue adhesives during lateral neck dissections is associated with a change in postoperative outcomes. Study Design Retrospective cohort. Setting Institutionally affiliated tertiary care center. Methods Various demographic, disease, and surgical data were collected for patients who underwent lateral neck dissections. Univariate regression analysis was performed with the following outcomes: total drain output and duration of drain placement, as well as incidence of postoperative infection, hematoma, seroma, chyle leak, and salivary leak. Results A total of 133 patients underwent lateral neck dissections. Fibrin sealant was used in 35% of cases (n = 46). Its use was not associated with differences in total drain output ( P = .77) or the number of days that the drains were in place ( P = .83). On secondary analysis, the use of fibrin sealant was not associated with a difference in postoperative incidence of hematoma ( P = .65), seroma ( P = .68), chyle leak ( P = .42), or salivary leak ( P = .73). These results were consistent when stratified by the presence of intraoperative complications. Its use accompanied an average cost of $674 per case. Conclusions Fibrin sealant use during lateral neck dissections was not associated with a reduction in drain output or days that the drains remained in situ. Although the current study was limited by sample size, fibrin sealant use was not associated with a decreased risk of postoperative adverse events. The evidence in this report suggests that the routine use of these products adds cost without clear benefit.

Objectives/objectives We aimed to provide an otolaryngologist-targeted summary regarding the epidemiology, carcinogenesis, and cessation strategies for smokeless tobacco usage. Study design Evidence-based literature review. Methods We reviewed the current evidence-based literature concerning trends in smokeless tobacco use, associations with neoplastic change, and therapeutic interventions to assist with sustained abstinence. In complement, we present an actual case of laryngeal squamous cell carcinoma in the setting of chronic tobacco-dentifrice usage in a lifelong nonsmoker. Results This report provides a synopsis of epidemiological data and evidence-based recommendations for general, pharmaceutical, and behavioral cessation strategies. Conclusions Smokeless tobacco use continues to be prevalent among patients seen by otolaryngologists, particularly of various Indian and Southeast Asian descent. The data presented in this article will aid in the identification of at risk patients. The provided recommended cessation strategies will tool otolaryngologists for patient counseling and management, ultimately aimed at improving health outcomes. Laryngoscope, 128:2067-2071, 2018.

Kikuchi-Fujimoto Disease (KFD) is a benign, self-limiting entity seen in Asia with only a few reports in the United States. Patients present with a triad of cervical lymphadenopathy, headache, and fever. Laboratory and imaging findings are nonspecific. Diagnosis is made on histopathological examination of the affected lymph nodes. This disease mimics infectious, autoimmune, and malignant processes. It is important to include this on the differential diagnosis for cervical lymphadenopathy because treatment and prognosis differ. We present a case of KFD in a 34 year old Guatemalan female who presented with cervical lymphadenopathy, headache, and fever, and a review of the current literature.

Solitary fibrous tumors (SFT) arising in the head and neck region are uncommon yet well-recognized entities. Their biologic behavior and management still need to be elucidated. Systematically reviewing all published cases of SFT involving the head and neck region since 1991, a pooled meta-analysis was conducted to evaluate various demographic and tumor characteristics. 587 SFT in the head and neck have been reported; 343 met pooled analysis inclusion criteria. 61% of cases presented as a new mass; 89% were painless. Median onset of symptoms prior to evaluation was 8 months. Pre-operative local invasion and malignant histological features (hemorrhage, necrosis, mitoses > 4/10 hpf) were not statistically associated with decreased recurrence-free survival. Positive surgical margins was the only factor associated with shorter recurrence-free survival (p

BACKGROUND We aim to provide a review of inbound medical tourism and the legal process of obtaining a visa for medical/surgical treatment for the patients with head and neck cancer. METHODS We reviewed current statistics and the medical and legal literature regarding inbound medical tourism and the process of obtaining a visa for patients traveling to the United States for medical treatment. To illustrate this process, we present a case of an advanced-staged and disfiguring facial polymorphous high-grade adenocarcinoma in a previously healthy 29-year-old woman from Liberia. RESULTS This report provides a synopsis of available statistical data on inbound medical tourism and the legal aspects of obtaining a visa for patients seeking medical care from abroad. CONCLUSIONS Medical tourists traveling to the United States for treatment of head and neck pathologies face considerable barriers in obtaining prompt care, leading to a possible increased disease burden and difficulty in rendering oncologic treatment.

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Warthin tumor is the second most common benign salivary gland tumor that classically arises in the parotid gland. It can be synchronous, metachronous, multifocal, bilateral, or unilateral, which complicates diagnosis and management. Rare cases of Warthin tumor of the minor salivary gland are described, but no cases of unilateral, synchronous Warthin tumor involving the parotid and minor salivary gland have been reported. We present a case of Warthin tumor arising from a minor salivary gland in the left oropharynx of a 71-year-old male with a previous history of left parotid Warthin tumor, later determined to be synchronous.

Purpose: Locally recurrent, previously irradiated primary head and neck tumors have historically been associated with poor outcomes. Stereotactic body radiation therapy has emerged as a feasible and promising treatment option for tumor recurrence, particularly in nonsurgical candidates. This study aimed to assess the associated outcomes of stereotactic body radiation therapy used in this setting. Methods: Retrospective analysis of a prospectively collected database of 25 patients treated with CyberKnife for unresectable, recurrent head and neck cancer in a previously irradiated field. The primary end points evaluated were rates of survival, tumor control, and treatment-related toxicities. Results: Median survival of the study population was 7.5 months (range, 1.5-47.0 months). Median survival of the 20 (80%) patients who were treated with curative purpose was 8.3 months. One-year overall survival rate for the entire population was 32%. The respective 1-year and 2-year survival rates for the curative subcohort were 40% and 20%, respectively. Local and locoregional failure occurred in 8 (32%) and 7 (28%) patients, respectively. Low severe acute (4%) and late (6%) treatment-related toxicity rates were observed. No grade 4 or 5 toxicities were observed. Conclusion: Stereotactic body radiation therapy is a viable treatment option for patients with unresectable, recurrent head and neck cancer. Significant tumor control rates are achievable with minimal severe toxicity. Although perhaps associated with patient selection and a heterogeneous sample, overall survival of stereotactic body radiation therapy outcomes appears unfavorable.

Objective The goal of this study was to gain a better understanding of the potential functional specialization of palatine and pharyngeal tonsils, by comparing their cellular composition in paired specimens from a large cohort of adenotonsillectomy patients. Design Resident B cell, T cell, dendritic cell, and stromal cell subsets were characterized using multicolor flow cytometry in palatine and pharyngeal tonsil specimens from 27 patients, age 2–34 years. Results Paired comparisons showed highly significant intra-individual differences in resident cell subsets of palatine and pharyngeal tonsils. Palatine tonsils harbored higher fractions of germinal center B cells/plasmablasts and IgD- CD27- double-negative B cells, and conversely lower fractions of IgD + CD38- resting naive B cells compared to pharyngeal tonsils. Palatine tonsils also showed lower fractions of plasmacytoid dendritic cells, and higher percentages of two subsets of stromal cells - fibroblastic reticular cells and lymphatic endothelial cells - compared to pharyngeal tonsils from the same individual. Conclusions Despite their physical proximity and histological similarities, palatine and pharyngeal tonsils display marked intra-individual differences in their cellular composition with regard to functionally important immune and stromal subsets. These differences are likely to have immunologic, pathologic, and physiologic significance.

We conducted a retrospective study to determine the incidence and treatment outcomes of neck metastases in patients with squamous cell carcinoma (SCC) of the hard palate and/or maxillary alveolus after surgical excision of the primary tumor. We also sought to identify any risk factors for recurrence. Our study population was made up of 20 patients—9 men and 11 women, aged 46 to 88 years (mean: 72.6)—who had undergone excision of an SCC of the hard palate and/or maxillary alveolus at a tertiary care cancer center over a 7-year period. Half of all patients were former tobacco users. Of the 20 tumors, 10 involved the maxillary alveolus, 4 involved the hard palate, and 6 involved both sites. Three patients were clinically categorized as T1, 9 as T2, 6 as T3, and 2 as T4; pathologically, 8 tumors were categorized as T4a. In addition to maxillectomy, a neck dissection was performed in 7 patients—4 therapeutically and 3 electively. Eight of 20 patients experienced a recurrence: 4 local, 6 regional, and 2 distant (several patients had a recurrence at more than one site). Univariate analysis identified perineural invasion (p = 0.04) as a statistically significant risk factor for recurrence. Of 14 patients with a clinicopathologically negative neck, 5 (36%) developed a cervical recurrence, and 4 of them died of their disease. An advanced stage (T4 vs.