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Background: International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. Methods: Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. Results: Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. Conclusions: Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.

Introduction: Opioid dependence is a major problem in the Western world. There have been significant efforts seeking to optimize pain control pathways and minimize risk of dependence on opioid pain relievers. However, little is known in low- to middle-income countries regarding current practices in postoperative pain control and its efficacy. This study evaluates subjective pain scores of patients following head and neck surgeries in a Ugandan hospital. These patients are unique in that most are opioid naive. We hope to contribute to the understanding of adequate postoperative pain control in opioid naive patients. Methods: Twenty-five patients without chronic opioid use underwent head and neck surgery during a semiannual surgical outreach trip. Ages ranged from 4-77 years (mean 38). The most common procedures performed were hemithyroidectomy (5), total thyroidectomy (3), parotidectomy (3), tonsillectomy (2), and cystic hygroma removal (2). Charts were reviewed retrospectively for daily subjective pain scores assessed on a numerical scale of 0-5, length of hospital stay, postoperative medications given for pain, surgery type, and postoperative analgesic medications administered, including dosage and frequency. Wilcoxon analysis was used to compare medians between groups receiving paracetamol alone or in combination with opioids or other analgesics. Results: All patients received IV paracetamol postoperatively; 16% of patients also requested opioids, and 8% requested another nonopioid analgesic. Average age for the 6 patients receiving paracetamol and either opioids or another nonopioid analgesic was 49.17 years compared to 34.47 years in the group that received paracetamol only (p=0.26; 95% CI -12.5, 42.9). For the whole study population, there was a reduction in the median pain score of -1.9 points (p Conclusion: Despite language and cultural barriers, we were able to assess postoperative pain scores in a Ugandan population. Intravenous paracetamol alone was effective and adequate for postoperative pain management for the majority of patients in this study. Although this study was limited in sample size, there was no significant improvement observed in pain score for patients using opioids or nonopioid analgesics other than paracetamol compared to paracetamol only. Opioids or additional analgesics were requested by a minority of patients, who tended to be older and/or have undergone more extensive procedures. Citation Format: Sara Maskal, Nilam Patel, Claudia Cabrera, Akina Tamaki, Fiona Kabagenyi, Ian Bwete, Isaac Mukiibi, Edrisa Kabazzi, Katrina Harrill, Jeffrey Otiti, Jason Thuener, Chad Zender. Postoperative analgesia in a Ugandan population [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A32.

Background There is an extreme shortage of head and neck surgeons in Africa. Fourteen head and neck surgeons have completed fellowships in Cape Town and Cameroon. This study determines whether such Africa-based fellowships are a good model for developing countries by making a sustainable impact on head and neck cancer care. Methods An observational study was conducted by emailing questionnaires to past fellows. Results All fellows had returned to teaching hospitals in their counties. Seven established new multidisciplinary cancer teams. Head and neck operations had increased by >335%, as had complexity of the surgery. There was effective transfer of surgical skills to trainees. All considered head and neck fellowships to be the best model to grow head and neck care. Conclusion Head and neck fellowships in developing countries are effective models for establishing training programs and for increasing provision of specialized surgical services in a sustainable fashion.

The University of Cape Town Karl Storz Head and Neck Surgery Fellowship is the only head and neck surgery fellowship in Sub-Saharan Africa. This article briefly describes this fellowship and outlines the experience and ongoing collaborative efforts of members of the American Academy of otolaryngology-head and neck surgery with graduates of this program who are now building head and neck surgery programs in East Africa. This educational collaboration avoids many common pitfalls associated with short-term humanitarian outreach and represents a successful model for international collaborative educational efforts with head and neck surgeons in developing countries in Africa.