Predictors of nodal metastasis in sinonasal squamous cell carcinoma:A national cancer database analysis

Objective:We present the largest population based study of sinonasal squamous cell carcinoma(SCC)to identify risk factors for presentation with nodal metastasis.Methods:The National Cancer Database(NCDB)was used for this study.Location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy were queried.Logistic regression analysis was performed to identify factors associated with presentation with nodal metastasis.Results:6448 cases met inclusion criteria.Nodal metastasis at presentation was seen in 13.2%of patients,with the sinus subsite(19.3%)being a significant risk factor for nodal metastasis at presentation when compared to the nasal cavity(7.9%).Logistic regression analysis showed black,uninsured and Medicaid patients were more likely than white and privately insured patients,respectively,to present with nodal metastasis.Conclusions:In sinonasal SCC,the sinus subsite has a significantly increased risk of nodal metastasis compared to the nasal cavity.Black race,uninsured and Medicaid patients are more likely to have nodal metastasis at presentation.

Use of the O-Z flap as an alternative to free tissue transfer for reconstruction of large scalp defects

Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperative complications remain significant limitations.The purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques employed.Methods:This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June 2019.The parameters included in this study were patient demographics,tumor characteristics,and postoperative management,collected for at least a year after surgery.Results:In this cohort,the mean age was 76.1 years and 90%were male.All patients were treated for neoplastic skin lesions,with 70%located on the vertex and 30%located on the temporoparietal region.The mean size of defect was 52.0 cm^(2)(range:38.6 to 63.8 cm^(2)).The maximum hospital stay was two days,and no patients were readmitted within 30 days of surgery.There were no cases of wound infection or flap necrosis.All patients reported pain control with acetaminophen and ibuprofen.Four patients received adjuvant radiation,and there was no delay to receiving treatment following surgery.Conclusions:The O-Z flap is a reliable alternative for the reconstruction of non-irradiated scalp defects in the vertex and temporoparietal regions up to 63 cm^(2).This technique provides advantages for patients,including hairline preservation,shorter hospital stays,and decreased postoperative complications.

Evaluation of an interactive virtual surgical rotation during the COVID-19 pandemic

Objective:To evaluate medical student and attending surgeon experiences with a novel interactive virtual Otolaryngology-Head and Neck Surgery(OHNS)medical student elective during the COVID-19 pandemic.Study Design:A virtual OHNS elective was created,with three components:(1)interactive virtual operating room(OR)experience using live-stream video-conferencing,(2)telehealth clinic,(3)virtual didactics.Setting:OHNS Department at the University of Pennsylvania(May 2020 to June 2020).Methods:Six medical students from the University of Pennsylvania;five attending otolaryngologists.Two surveys were designed and distributed to participating medical students and attending surgeons.Surveys included 5-point Likert scale items,with 1 indicating"not at all"and 5 indicating"very much so".Results:Response rate was 100%for both surveys.Students on average rated the educational value of the telehealth experience as 4.2±1.2,and the virtual OR experience as 4.0±0.6.Most students(n=5,83%)indicated that they had enough exposure to faculty they met on this rotation to ask for a letter of recommendation(LOR)for residency if needed,while attending surgeons had an average response of 3.0±1.0 when asked how comfortable they would feel writing a LOR for a student they met through the rotation.A majority of students(n=4,67%)felt they connected enough with faculty during the rotation to ask for mentorship.Half the students(n=5,50%)indicated that the rotation allowed them to evaluate the department's culture either"extremely well"or"somewhat well".Conclusions:Overall,participating students described this innovative virtual surgical rotation as an educationally and professionally valuable experience.With the continued suspension of visiting student rotations due to the COVID-19 pandemic,this virtual model may have continued relevance to medical education.

Innovations in otorhinolaryngology in the age of COVID-19: A systematic literature review

Objective: Otolaryngologists are at increased occupational risk of Coronavirus Disease 2019 (COVID-19) infection due to exposure from respiratory droplets and aerosols generated during otologic, nasal, and oropharyngeal examinations and procedures. There have been a variety of guidelines and precautions developed to help mitigate this risk. While many reviews have focused on the personal protective equipment (PPE) and preparation guidelines for surgery in the COVID-19 era, none have focused on the more creative and unusual solutions designed to limit viral transmission. This review aims to fill that need.Data Sources: PubMed, Ovid/Medline, and ScopusMethods: A comprehensive review of literature was performed on September 28, 2020 using PubMed, Ovid/Medline, and Scopus databases. All English-language studies were included if they proposed or assessed novel interventions developed for Otolaryngology practice during the COVID-19 pandemic. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.Results: A total of 41 papers met inclusion criteria and were organized into 5 categories ("General Recommendations for Otolaryngologic Surgery’, "Equipment Shortage Solutions’, "Airway Procedures’, "Nasal Endoscopy and Skull Base Procedures’, and "Otologic Procedures’). Articles were summarized, highlighting the innovations created and evaluated during the COVID-19 pandemic. Creative solutions such as application of topical viricidal agents, make-shift mask filters, three-dimensional (3-D) printable adapters for headlights, aerosol containing separation boxes, and a variety of new draping techniques have been developed to limit the risk of COVID-19 transmission.Conclusions: Persistent risk of COVID-19 exposure remains high. Thus, there is an increased need for solutions that mitigate the risk of viral transmission during office procedures and surgeries, especially given that most COVID-19 positive patients present asymptomatically. This review examines and organizes creative solutions that have been proposed and utilized in the otolaryngology. These solutions have a potential to minimize the risk of viral transmission in the current clinical environment and to create safer outpatient and operating room conditions for patients and healthcare staff.