Lott, David G.

Introduction There is currently a lack of available data clearly addressing whether the proportion of young patients diagnosed with head and neck cancer (HNC) within the U.S. has increased over the last several decades in comparison to other age cohorts. This study attempts to elucidate any trends in oral cavity, oropharynx, larynx and hypopharynx cancer age distribution in the United States population from 1975-2016. Unlike previous studies, this paper does not track incidence, but rather reports proportional changes of prevalence within age cohorts over time. Methods This is a retrospective chart review centered on data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI). Each decade interval from 1975-2016 displays the proportion of HNC patients, classified by primary tumor subsite, within each age cohort. Results Mean age at diagnosis increased for three of the four HNC evaluated. Oropharyngeal cancer was the only subsite to demonstrate an overall proportional increase, mainly in middle age (40-59 years) patients. Cancers of the oral cavity were the only subset to show a true increase in the proportion of young (0-39 years) patients. When stratifying by gender, the proportion of young patients in female HNC cases is higher than the proportion of young male HNC cases. Conclusion Overall, this study demonstrates an increased proportion of older HNC patients that is consistent with the aging population. Oral cavity is the only cancer to demonstrate a true increase in the proportion of young patients, likely from the increased incidence of young women diagnosed with this cancer. Case reports citing more young patients becoming diagnosed with other types of HNC are not currently supported by the data. Lastly, the increased proportion of middle-age patients with oropharyngeal cancer likely reflects the increase in HPV-related cancers.

Objectives/HypothesisTo evaluate whether antithrombotic status impacts the incidence of perioperative or postoperative bleeding in direct microlaryngoscopy (DML).Study DesignRetrospective chart review.MethodsPatients undergoing DML in a single surgeon's practice from September 2012 to September 2017 were studied. Included patients underwent DML with or without biopsy, balloon dilation, microsurgery, laser ablation, or vocal fold injection. Patients were stratified based on perioperative antithrombotic status and assessed for rates of peri‐ and postoperative bleeding and other complications.ResultsOf the 581 patients meeting inclusion criteria, 179 patients (31%) had a history of baseline antithrombotic therapy. Of these patients, 124 had perioperative continuation of their therapy. Medicated patients were older (P < .01), predominately male (P < .01), and increasingly comorbid (P < .01). Perioperative complications unrelated to bleeding occurred in 22 patients (4%), minor perioperative bleeding occurred in four patients (0.7%), and minor postoperative bleeding occurred in 12 of the 479 patients with recorded follow‐up (2.5%). There were no postoperative bleeds requiring intervention or readmission, and no recorded thrombotic events during the peri‐ and postoperative period. There was no difference in perioperative bleeding based on baseline antithrombotic status (P = .81). Patients on baseline antithrombotic therapy were more likely to have a postoperative bleed in comparison to patients without history of antithrombotic use (P < .01). However, there were no significant differences in postoperative bleeding between patients on baseline anticoagulation who continued or ceased their medication perioperatively (P = .45).ConclusionsPerioperative continuation of antithrombotic medications appears to be safe when performing routine DML.Level of Evidence4 Laryngoscope, 2020

Objective: To review pregnancy outcomes and the safety of jet ventilation use in the gravid patient undergoing surgical airway intervention. Methods: A multi-institutional retrospective review of medical records was performed to identify women who underwent low-frequency jet ventilation during pregnancy for surgical treatment of airway stenosis. Postoperative complications were noted, and patients were interviewed regarding pregnancy outcomes. Results: Six women were included in this series. No immediate complications relating to anesthesia or surgical intervention were noted in five of the six women. One patient with a well-known history of uncontrolled seizures experienced seizure activity postoperatively. One patient returned to the operating room at a later date for debridement of tracheal crusts. Five mothers delivered via cesarean section and one via spontaneous vaginal delivery. The mean gestation age was 37.3 weeks. One of the six infants delivered prematurely and three were delivered at low birth weight. Three of the six infants required elevated care immediately post-delivery but, at present, all are in good health. Conclusion: Low-frequency jet ventilation and surgical management of airway stenosis should be recognized as a safe treatment option in the gravid patient. Surgical intervention should not be delayed in patients with severe symptoms, particularly given the potential risk associated with prolonged corticosteroid use. Level of evidence: 4

Introduction: The ability to treat more advanced laryngeal cancers by transoral approaches has expanded significantly in the past several decades. Transoral management of laryngeal cancers that require removal of the laryngeal framework is controversial. Resecting cartilage through endoscopic means carries inherent technical challenges and the question of oncologic safety. Methods: We describe a retrospective review of patients undergoing resection of the thyroid cartilage during transoral laser microsurgery (TLM) for laryngeal cancer over a 10-year period. Only patients with 5-year follow-up were included. Results: Fourteen patients were identified that underwent attempted endoscopic resection of the thyroid cartilage. Preoperative staging ranged from T1 to T4 laryngeal cancers. Most patients underwent resection of the thyroid cartilage either for close proximity of the tumor to cartilage or microscopic involvement of the inner perichondrium, although 6 patients had gross invasion of the cartilage. Twelve patients underwent successful endoscopic clearance. Two patients were converted to total laryngectomy either at the time of surgery or shortly after due to extent of disease that was deemed not amenable to endoscopic resection. Overall 5-year survival was 71%. Disease-free survival was 62% at 5 years. The majority of patients avoided gastrostomy and tracheostomy tube dependence. One patient underwent total laryngectomy following initial TLM for chronic aspiration. Conclusion: We conclude that TLM for laryngeal cancer performed with removal of thyroid cartilage is feasible. Both oncologic and functional outcomes are reasonable in a select group of patients. This paper describes that cartilage can be resected endoscopically in the appropriate setting and not necessarily that cartilage invasion should routinely be treated with TLM.

ObjectiveThe study aims to demonstrate the reproducibility and feasibility of creating a hemilaryngeal model with a medialized vocal fold (VF) using 3‐dimensional (3D) modeling techniques in both healthy larynges and those affected by cancer.Study DesignThree‐dimensional modeling of human larynges.SettingTertiary academic referral center and regenerative medicine laboratory.Subjects and MethodsComputed tomography (CT) scans from 10 healthy control and 10 patients with laryngeal cancer were segmented and imported into 3D modeling software. The larynx was cut sagittally to create a hemilaryngeal model and the vocal fold medialized. Measurements were taken from the CT and 3D model data and compared.ResultsAll control modeling data closely matched the CT data and were not statistically different from each other. There was a significant correlation between subglottic anteroposterior diameter and VF length (r2 = 0.78, P =. 0008), and it may be a valuable tool to infer true VF dimension in cases where disruption has occurred. The modeling data from patients with cancer did not show statistical difference to the control data, showing that accurate modeling can also be achieved in patients with laryngeal cancer.ConclusionCT scan‐based 3D modeling of the larynx and VF is possible and reproducible. The results closely match those previously reported in the literature and can also be replicated in cases with laryngeal cancer. This study paves the way for future de novo fabricated laryngeal scaffolds that can be synthesized using 3D printers and tailored to meet surgical demands.

AbstractBackgroundThe American Joint Committee on Cancer (AJCC) eighth edition introduces a staging system specific for human papilloma virus positive oropharyngeal cancer with separate clinical (AJCC 8c) and pathological (AJCC 8p) criteria.MethodsIn this retrospective cohort study, preoperative imaging and pathology reports were used to stage patients based on the AJCC 8c and AJCC 8p criteria, respectively. The primary endpoint was agreement between AJCC 8c and AJCC 8p.ResultsA total of 213 patients met inclusion criteria. Kappa statistics showed poor agreement (κ = 0.3275) between AJCC 8c and AJCC 8p. In total, 30.3% of patient's preoperative AJCC 8c stage changed based on the postoperative pathologic staging (AJCC 8p) with 73.4% of those being upstaged.ConclusionThese data suggest that disagreement exists between AJCC 8c and AJCC 8p, in part due to the separate clinical and pathological staging criteria. This discrepancy should be considered as the new system is implemented.

As the treatment of hematopoietic cancers evolves, otolaryngologists will see a higher incidence of opportunistic infections. We discuss a case of invasive fungal disease that invaded the larynx, pharynx, trachea, and pulmonary parenchyma after chemotherapy. The patient, a 46-year-old woman, presented 1 week after undergoing induction chemotherapy. Her initial symptoms were odynophagia and dysphagia. Despite encouraging findings on physical examination, her health rapidly declined and she required an urgent tracheotomy and multiple operations to address spreading necrosis. Because of her inability to heal, she was not a candidate for laryngectomy, so she was treated with conservative management. The patient was then lost to follow-up, but she returned 5 months later with laryngeal destruction and a complete laryngotracheal separation. While noninvasive fungal laryngitis is routinely encountered, its invasive counterpart is rare. The literature demonstrates that some cases completely resolve with medical therapy alone but that surgery is necessary in others. We recommend surgical debridement of all necrotic tissue.