Yin, Linda X

Objective(s): To (1) report on the long-term recurrence rate of surgically managed pleomorphic adenoma (PA) and (2) assess long-term surgical outcomes after parotidectomy Methods: Cross-sectional survey of all patients with a pathologic diagnosis of PA who underwent surgical management in a tertiary care center from 01/1997 to 12/2023 and had access to an electronic patient portal. Surveys were delivered via electronic patient portal or phone call with 6 questions to assess recurrence and long-term surgical outcomes. Time to first recurrence and recurrence free survival were analyzed using a Kaplan-Meier curve. Results: Seven hundred-forty-five patients met inclusion criteria and received the survey, with a 56% response rate (n = 420). The clinical median follow-up length was 51 days, which extended to a median length of 6.2 years following the survey. The median change in follow-up length was 5.37 years ( P < .001). The recurrence rate was 1% at 5 years, with a median time to first recurrence of 7.54 years. 13% and 9% of responders reported facial asymmetry and incisional cosmetic concerns, respectively. 33% of patients reported experiencing Frey syndrome, which increased from 5.2% of survey responders with documented Frey syndrome at their original post-operative assessment. Conclusion: Long-term assessment of PA outcomes confirms low recurrence rates, suggesting regular surveillance of recurrence is likely unnecessary. Complaints of Frey syndrome increased in frequency with longer term follow-up, which should be considered during patient counseling. Level of Evidence: 3

Abstract Objective Effective communication with humans and automated voice assistants (AVA) is essential for full participation in modern life. Because AVA relies on intelligible speech, individuals with speech impairments, such as those treated for oral cavity cancer (OCC), may face barriers when interacting with AVA. We assessed self‐reported communication difficulty in patients treated for OCC related to AVA and humans. Study Design Prospective cross‐sectional cohort study. Setting Out‐patient clinics in two tertiary care centers. Methods This study was conducted between July 2024 and March 2025 and included adults (≥18 years) diagnosed with and surgically treated for OCC (experimental group) and those without speech impairments (controls). Participants completed the Speech Communication Experience Survey (SCES), which assessed perceived intelligibility when communicating with familiar partners, strangers, and AVA; and, as reported elsewhere, the Speech Handicap Index (SHI). Results In total, 159 participants were included (69 OCC, 90 controls). OCC participants were more likely to report that familiar partners, strangers, and AVA “almost always” or “always” had difficulty understanding their speech ( P < .05). Free flap reconstruction and maxillectomy were associated with greater reported communication difficulty. AVA usage frequency and overall opinions toward AVA did not significantly differ between groups. Conclusion Patients treated for OCC report significantly greater difficulty being understood by both AVA and human listeners compared to controls. These perceptions may inform peri‐operative counseling and guide the development of more inclusive AVA technologies capable of accommodating diverse speakers. Level of Evidence : 3.

Background: To compare oncologic and postoperative outcomes in patients with scalp squamous cell carcinoma with periosteal, but not gross calvarial, involvement, treated with margin-clearing excision including either calvarial burring or periosteal excision alone. Study Design: Retrospective cohort study. Setting: Single tertiary academic referral center. Methods: We retrospectively reviewed surgical cases from January 2001 to January 2025. Inclusion criteria: patients ≥18 years with biopsy-proven scalp squamous cell carcinoma involving the periosteum without cortical invasion on imaging. Management of the deep margin included either burring of the outer table or periosteal excision alone. Demographic, surgical, and oncologic outcomes were collected and analyzed descriptively. Results: Twenty patients met inclusion criteria. Median age was 70 (range 56-92), and 18 (86%) were male. Thirteen (65%) patients underwent calvarial burring, 7 (35%) underwent periosteal excision. Local recurrence occurred in 31% and 29% of the burring group and non-burring group. Disease-free survival at 2 years was 46% and 57% in the burring and non-burring group, respectively. Overall survival at 2 years was 77% and 86% in the burring and non-burring group. Three patients in the burring group had local recurrences with intracranial extension, 1 died of disease, 1 died with disease and concurrent meningitis, 1 is alive with disease recurrence currently on palliative treatment. There were 7 disease-related deaths. Conclusion: Burring did not confer a significant oncologic advantage compared to periosteal excision alone when there was no gross cortical invasion. Local recurrence in patients undergoing calvarial burring was associated with intracranial extension of disease.

ABSTRACT Background Individuals with oral cavity cancer (OCC) have negatively impacted functional status and quality of life. Little is known regarding patients' perspectives of their speech impairments. This study compared self‐reported speech function between patients surgically treated for OCC and healthy controls using the Speech Handicap Index (SHI) and identified factors associated with worse scores. Methods This is a multiinstitutional cross‐sectional study of OCC patients and healthy controls recruited between July 2024 and March 2025. Participants completed the SHI and self‐reported speech quality. Demographics, tumor, and treatment details were abstracted from the electronic health record for OCC. Group differences were assessed with t ‐tests, χ 2 , and Fisher's exact tests. Results Among 69 OCC and 90 controls, OCC patients had significantly higher mean SHI scores (50.2 vs. 34.7, p < 0.01) and were less likely to rate their speech as “good” or “excellent” (47.8% vs. 85.6%, p < 0.01). Both speech and psychosocial domain scores were significantly worse among OCC. Free flap reconstruction was associated with worse scores (29.6 vs. 15.5, p = 0.02) and worse self‐rated speech quality. Conclusions Patients with surgically treated oral cavity cancer have significantly impaired self‐perceived speech and psychosocial functioning compared with healthy individuals. Greater deficits were observed in patients who required free flap reconstruction. Despite the functional deficit, nearly half of OCC patients reported satisfaction with their speech quality. These findings highlight the importance of using validated measures for speech function and support the need for early, multidisciplinary rehabilitation including speech therapy in this population, particularly for those undergoing free flap reconstruction.

Objective: To develop, implement, and evaluate a novel process used for residency application review that deemphasizes metrics known to create bias with the goal of interviewing and matching a more diverse resident cohort. Methods: Between 2020 and 2023, a novel standardized rubric and application review process were developed and implemented at the authors’ academic training program. The rubric deemphasized USMLE scores, honor society membership, and number of publications while utilizing an AI-driven pre-sort of applications, facilitating holistic review. This weighted applicant attributes identified in personal statements, life experiences, achievements in community, leadership roles, otolaryngology-specific impressions highlighted in letters of recommendation, and otolaryngology-specific research and publications similarly to academic metrics (clerkship grades and standardized test scores). Demographics of applicants interviewed and matched into our program were compared pre- and post-implementation using descriptive statistics. Results: Using a standardized rubric to review residency applications that deemphasizes traditional metrics, the authors’ otolaryngology residency program has interviewed, ranked, and matched more diverse candidates. As a result, from 2019 to 2022, the overall resident cohort has diversified from 4% historically marginalized residents to 24%, from 28% female residents to 44%, and from 33% of residents outside our geographic region to 66%. Conclusion: There is significant underrepresentation among otolaryngology residents. Selection based upon USMLE Step 1 scores, honor society membership, and number of publications have been shown to restrict diversity. Purposeful holistic review increases diversity in interviewed and matched resident cohort.

ABSTRACT Background Prompt detection and intervention are crucial for improving outcomes in acute invasive fungal rhinosinusitis (AIFS). Diagnostic prediction models assist in risk‐stratification, but their accuracy requires testing through external validation. This study aims to validate a previously published diagnostic prediction model for AIFS in an independent cohort. Methods A retrospective chart review was conducted at a tertiary care center (2008–2023) to identify patients with an otolaryngology consult for suspected AIFS. Of 65 patients identified, 11 (16.9%) were diagnosed with AIFS based on histopathology. Risk was calculated using Yin et al.’s predictive model. Predictive performance was assessed by calibration and discrimination. Results Patients had significantly higher rates of diabetes (46.2% vs. 26.1%, p = 0.002), long‐term steroid use (60% vs. 28.2%, p < 0.0001), and solid organ transplantation (38.5% vs. 8.5%, p < 0.001), compared with the development cohort, with conversely lower rates of hematologic malignancy (29.2% vs. 58.7, p < 0.001) and neutropenia (19.4% vs. 41%, p = 0.001). Despite these differences, both the three‐variable (C‐index: 0.844; 95% CI, 0.736–0.952) and four‐variable models (C‐index: 0.963; 95% CI, 0.919–1) showed adequate discrimination. Both models exhibited slight overprediction of risk, with a calibration‐in‐the‐large predicted risk of 24.1% (95% CI, 13.68–34.46) for the three‐variable model and 24.2% (95% CI, 13.76–34.57) for the four‐variable model. Calibration plots confirmed overprediction. Conclusion The AIFS diagnostic model demonstrates acceptable discrimination and calibration on external validation, with generalizability to patients with different comorbidities. Larger studies are recommended to further test the model's predictive performance and clinical applicability.

Background: The role of fine-needle aspiration (FNA) in diagnosing parotid tumors remains debated due to varying accuracy. This study evaluates FNA’s accuracy in diagnosing Warthin’s tumor (WT) and its safety in guiding observational management. Study design: Retrospective cohort study. Setting: Single institution, Tertiary referral center. Methods: Data from 2010 to 2022 including demographics, cytology, pathology, and surgical outcomes were extracted. Accuracy was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Among 808 patients with parotid tumors, 234 were WTs. Seventy-eight patients underwent surgery with pathology while 156 underwent observation. FNA sensitivity, specificity, PPV, and NPV for WTs were 98.2%, 98.1%, 91.8%, and 99.6% respectively. No observational patients developed clinical signs of malignancy, and the median change in tumor size was 0 cm (range −3.1 to 2.1). Conclusions: FNA is highly specific for WT but limited by nondiagnostic results. Observation is a safe approach with minimal risk of growth, malignancy, or infection.

AbstractObjectiveLow‐grade parotid malignancies have high overall survival rates; however, controversy remains about the appropriate extent of surgery. We aim to explore the trends in the extent of parotidectomy performed over time in low‐grade parotid malignancies in the United States, with a hypothesis that there has been a trend towards less aggressive surgery.Study DesignRetrospective cohort study of all low‐grade (grade I) acinic cell carcinoma (ACC) and mucoepidermoid carcinoma (MEC) in the Surveillance, Epidemiology, and End Results (SEER) from 2004 to 2020.SettingGeographic areas served by SEER.MethodsTrends were assessed using Cochran‐Armitage tests and logistic regression; Kaplan‐Meier survival curves were used to analyze overall and cancer‐specific survival, and chi‐square tests were used to analyze patient characteristics.ResultsIn total, 1288 patients were identified (916 MEC; 372 ACC). Most patients (n = 772, 60%) were non‐Hispanic white, with an average age of 50.6 years and had a slight female predominance (1.58:1). Most of the cohort presented with tumor stage T1 or T2 (84%), N0 (90.1%), and M0 (96.9%). Treatment with total parotidectomy decreased significantly (34.6 vs 17.7%, P = .02) whereas sacrificing the facial nerve (FN) slightly decreased (20 vs 15.7%, P = .1). A significant increase in N0 patients (71%‐94%, P < .0001) was observed, whereas T staging remained stable (61%‐64%, P = .3). Overall, both ACC and MEC had excellent cancer‐specific survival.ConclusionOver the last 17 years, there has been a significant de‐escalation in the extent of parotidectomy for low‐grade parotid malignancy in the United States.

Background: Malignant mesenchymal tumors involving the parotid gland are uncommon, characteristically aggressive, and little is known with few reports documented. Study Design: Retrospective case series. Setting: Single institution tertiary care center, 2010 to 2022. Method: Patients were identified from an institutional parotid tumor database. Patient history, demographics, pathologic diagnosis, treatment, and follow up were documented. Results: Eight patients were identified, 3 were males. The average age was 61 years old, and the most common tumors identified were pleomorphic sarcomas (3 patients). Presenting symptoms included: preauricular/cheek mass in 7 patients, facial pain (4), otalgia (4), aural fullness (3), and numbness (1). All patients received a parotidectomy, and 4 patients received adjuvant therapy of either radiation or chemoradiation. Post-operatively, there were 3 cases of distant recurrence, 2 cases of regional recurrence, and 1 case of local recurrence. There were 2 reports of death. Conclusion: Malignant mesenchymal tumors of the parotid are rare, represent varied histologies. Due to their aggressive nature, surgical resection with radiation and close follow-up may be an appropriate treatment regimen in controlling the disease.

Objective: To assess the impact of extent of parotidectomy on surgical and oncologic outcomes in low grade mucoepidermoid carcinoma (LGMEC). Methods: A retrospective chart review of all patients undergoing primary surgical treatment for LGMEC from 2000 to 2022 was conducted. Clinical features collected included demographics, facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence. Results: 58 patients were included; 10 patients underwent partial parotidectomy (PP), 38 underwent superficial parotidectomy (SP), and 10 underwent near-total/total parotidectomy. PP and SP patients had smaller tumors and more superficial tumors compared to near-total/total parotidectomy group ( P = .03). PP and SP were more likely to have negative margins and less locoregional disease compared to near-total/total parotidectomy patients ( P < .01). Near-total/total parotidectomy were more likely to undergo facial nerve resection (20% vs 0% for PP & SP respectively) ( P = .05). Immediate postoperative facial nerve function was significantly better among PP patients (73% HB I) compared to SP (44% HB I) and near-total/total parotidectomy patients (0% HB I) ( P < .01). Most patients regained their facial nerve function although only 40% of the near-total/total parotidectomy patients had a HB I at the time of last follow up ( P < .01). Patients were followed for a median of 6.2 years, during which only 1 patient (total parotidectomy) had a recurrence. Conclusions: PP offers a safe and effective approach for small LGMEC tumors, ensuring better facial nerve function postoperatively with minimal complications compared to more extensive surgery.