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Objectives/hypothesis: Free flap transfer offers a versatile option for reconstruction in head and neck surgery, with success rates over 95%. There remains a substantial re-exploration rate of roughly 5% to 15%, with early recognition of compromise essential to flap survival. Monitoring techniques are highly desirable, with the gold standard being clinical monitoring. The Cook-Swartz Doppler (CSD) probe utilizes Doppler technology to inform clinicians about real-time flow. We aim to describe our adoption of this technology in 100 consecutive free flaps., Study Design: Prospective case series., Methods: Prospective data were collected from July 2014 to June 2015 on 100 consecutive free flaps performed at a head and neck unit in London, Ontario. All patients had a CSD inserted for arterial and venous monitoring., Results: A total of 100 free flaps were performed on 99 patients. Sensitivity was 87.1% and specificity was 85.7%. Positive predictive value was 98.8% and negative predictive value was 33.3%. False-negative and false-positive rate were 1.0% and 12.0%, respectively. The exploration rate was 12%, with no flap loss and two partial debridements. The CSD was helpful in management in 9% of cases and was clinically unhelpful in 11% of cases, with 10 of 11 abnormal signals ignored. There were three unique CSD complications; one retained wire, one pedicle laceration during extraction, and one clot around the probe interrupting signal., Conclusions: The CSD is a helpful adjunct to clinical monitoring but has unique complications, which were not previously described. Pros and cons must be considered for new centers adopting this technology., Level of Evidence: 4 Laryngoscope, 131:E1854-E1859, 2021., (© 2021 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).)

The aim of this study was to gain insight into how online gaming can teach medical students about interprofessional collaborative practice and promote their development of interprofessional competencies prior to clerkship. This prospective cohort study involved third year medical students from the Schulich School of Medicine and Dentistry in London, Ontario, Canada who participated in the 'Circles of Care'© online board game. A total of 97 student reflections were obtained and subjected to conventional qualitative descriptive content analysis. The transcribed data were analyzed question by question and line by line. Themes evolved from four questions: (1) What surprised you the most about teamwork from this learning activity, (2) What did you learn about collaborative teamwork, (3) What will you take away from this learning event to use in your practice, and (4) Please comment on the value of using a game such as this one to develop your collaborative team practice. A total of seven themes emerged including: "Gaining insights", "What worked and what did not", "Openness to learning", "Comfort in sharing with others", "Commitment and skepticism", "Being a seeker", and "Continuum of value to learning and practice". Analysis of the student reflections illustrated the potential of using an online-based game to effectively introduce and teach interprofessional competencies to medical students.

Background: An epidemic of human papillomavirus (HPV)-related oropharyngeal squamous cell cancer (OPSCC) has been reported worldwide largely due to oral infection with HPV type-16, which is responsible for approximately 90% of HPV-positive cases. The purpose of this study was to determine the rate of HPV-positive oropharyngeal cancer in Southwestern Ontario, Canada., Methods: A retrospective search identified ninety-five patients diagnosed with OPSCC. Pre-treatment biopsy specimens were tested for p16 expression using immunohistochemistry and for HPV-16, HPV-18 and other high-risk subtypes, including 31,33,35,39,45,51,52,56,58,59,67,68, by real-time qPCR., Results: Fifty-nine tumours (62%) were positive for p16 expression and fifty (53%) were positive for known high-risk HPV types. Of the latter, 45 tumors (90%) were identified as HPV-16 positive, and five tumors (10%) were positive for other high-risk HPV types (HPV-18 (2), HPV-67 (2), HPV-33 (1)). HPV status by qPCR and p16 expression were extremely tightly correlated (p < 0.001, Fishers exact test). Patients with HPV-positive tumors had improved 3-year overall (OS) and disease-free survival (DFS) compared to patients with HPV-negative tumors (90% vs 65%, p = 0.001; and 85% vs 49%, p = 0.005; respectively). HPV-16 related OPSCC presented with cervical metastases more frequently than other high-risk HPV types (p = 0.005) and poorer disease-free survival was observed, although this was not statistically significant., Conclusion: HPV-16 infection is responsible for a significant proportion of OPSCC in Southwestern Ontario. Other high-risk subtypes are responsible for a smaller subset of OPSCC that present less frequently with cervical metastases and may have a different prognosis.

Background: The aim of this preliminary study was to determine the prevalence of trismus in head and neck cancer patients treated with radiotherapy with or without concomitant chemotherapy and surgery., Methods and Materials: Patients with malignant lesions in the head and neck treated with curative intent were comprehensively evaluated for trismus using subjective and objective measures., Results: A large proportion of the 70 patients recruited demonstrated moderate to severe subjective trismus (45.7%). Similarly, the vast majority of patients showed slight to severe trismus (91.4%) according to objective secondary outcome measures. Of these patients, 21 (65.6%) were also treated with concurrent chemoradiotherapy. When the radiation field involved the pterygoid muscles, 30 (93.8%) patients reported subjective trismus. Similarly, bilateral pterygoid muscle inclusion resulted in 28 (87.5%) patients with trismus., Conclusions: Trismus is a significantly prevalent consequence of treatment for head and neck cancer. Predictive factors include treatment with concurrent chemoradiotherapy and bilateral inclusion of the structures of mastication in the high-dose radiotherapy volume.

Introduction: Adductor spasmodic dysphonia (ADSD) is a focal dystonia treated most commonly by chemodenervation of the thyroarytenoid (TA) muscles with botulinum toxin. Currently, there are no consensus guidelines regarding this treatment and the management of ADSD. The objective of this study was to assess current practice patterns among physicians who treat ADSD., Methods: A cross-sectional survey study was conducted regarding treatment choices and specific technical aspects of injection technique and botulinum toxin use. The study population consisted of laryngologists from the Canadian Society of Otolaryngology-Head and Neck Surgery and laryngologists obtained from the American Laryngological Association member database and the American Academy of Otolaryngology-Head and Neck Surgery Neurolaryngology Study Group., Results: An overall response rate of 13% was achieved, with a high absolute number of physicians who manage ADSD responding (n = 37). Most respondents treat ADSD by injecting botulinum toxin type A (Botox) through the cricothyroid membrane submucosally at a mode starting dose of 2.5 units per TA muscle using electromyographic guidance with or without fibre-optic laryngoscopy every 3 to 4 months, with the frequency of reinjection being based on patient symptomatology. There is much variability with regard to starting injection dose, alternate treatments for ADSD, unilateral versus bilateral injections, and guidance technique. Most physicians (36 of 37) share one vial among more than one patient, and some (7 of 37) freeze a reconstituted vial that has remaining toxin for reuse at a later time., Conclusions: There is considerable variability in treatment practices for the management of ADSD. Further study is warranted to define an optimal therapeutic paradigm.

Objectives: To determine the feasibility and effectiveness of virtual-patient computer-assisted instruction (CAI) in pre-clerkship undergraduate otolaryngology education., Study Design: Prospective, randomized, controlled trial., Subjects and Methods: Second-year medical students at the University of Western Ontario, Canada, were randomized into two groups: group A was given a CAI module and group B was presented with two Internet review articles, both covered specific learning objectives for pediatric stridor. Students completed randomized pre- and post-tests and a questionnaire one week later., Results: Fifty-five students completed the study with 28 in group A and 27 in group B. Mean pretest scores were 59.1% in group A and 59.8% in group B (95% CI = -7.9% to 10.4%). Mean post-test scores were significantly elevated in group A (84.6%, P < 0.001) and group B (74.3%, P = 0.008). Group A had a significantly higher (P = 0.02) mean post-test score than group B (mean difference of 10.2%). Students spent significantly more time (P < 0.001) reading text articles (25.5 minutes) than completing the CAI (9.06 minutes). Forty-one (66%) students completed the survey. Thirty-six (88%) respondents indicated that they preferred CAI to online articles., Conclusion: CAI is a feasible, effective, and efficient means of enhancing self-directed learning as supplementation to the pre-clerkship undergraduate otolaryngology curriculum.

Background: Platelet-rich plasma (PRP) and platelet-poor plasma (PPP) have been used to improve hemostasis and wound healing after surgery; however, randomized controlled trials proving their efficacy are lacking., Methods: Hemithyroidectomy was performed on 52 patients. Autologous PRP and PPP were applied during wound closure in the treatment group, while saline was applied in the controls. Outcome measures were postoperative drainage, pain, analgesic use, and length of hospital stay., Results: The 24-hour cumulative drainage was reduced by 29.3% in the treatment group (44.9 mL vs 63.5 mL, p = .039). The treatment group required less analgesic medication despite similar pain scores; however, the difference was not significant. There was a trend toward decreased length of stay for the PRP/PPP group (p = .059)., Conclusions: Hemithyroidectomy served as a stringent test to evaluate the wound-healing capacity of platelet-rich and platelet-poor plasma. This study provides evidence that PRP and PPP reduced postoperative drainage in soft-tissue surgery., ((c) 2008 Wiley Periodicals, Inc.)

Objectives: To investigate the adequacy of otolaryngology teaching in undergraduate medical education (UME) and to determine the general level of comfort of family medicine residents in managing and assessing diseases affecting the ears, nose, and throat., Design: Cross-sectional survey., Methods: A sample of family medicine residents at the University of Western Ontario (N = 68) completed a questionnaire inquiring into their exposure to topics in otolaryngology during their UME. They were also asked to comment on their present comfort with knowledge and skills specific to otolaryngology., Results: Family medicine residents suggest that there is generally little otolaryngology training in UME; 66.7% of respondents who received UME in Canada suggested that they received very little classroom instruction and 75.6% received very little clinical otolaryngology instruction. Residents identified specific otolaryngologic conditions with which they felt particularly uncomfortable., Conclusions: This study demonstrated that students receive very little exposure to otolaryngology in UME and highlighted specific conditions and procedures that family medicine residents lack confidence in managing and performing.