Publications by authors named "Sina J Torabi"

48 Publications

Effects of COVID-19 on Facial Plastic and Reconstructive Surgery Fellowship Training and Director Practices.

OTO Open 2021 Apr-Jun;5(2):2473974X211014130. Epub 2021 May 13.

Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA.

Objectives: The objectives of this study include characterizing the practice patterns and testing strategies of facial plastic and reconstructive surgery (FPRS) fellowship directors (FDs) secondary to COVID-19 and to quantify the impact of COVID-19 on FPRS fellowship training.

Study Design: Cross-sectional survey.

Setting: Online.

Methods: A survey was sent to all American Academy of Facial Plastic and Reconstructive Surgery FDs and co-FDs in September 2020. Descriptive analyses were performed.

Results: Of 77 eligible FDs, 45 responded (58.4%) representing a diverse group across the United States. All but 1 FD routinely screened patients for COVID-19 in the preoperative setting. FDs largely believed that universal preoperative testing was cost-effective (66.7%), improved patient safety (80.0%) and health care worker safety (95.6%), and was not burdensome for patients (53.3%). With regard to volume of cosmetic/aesthetic, reconstructive, facial nerve, and trauma surgery, FDs indicated largely no change in volume (34.9%, 71.0%, 68.4%, and 80.0%, respectively) or fellow experience (67.4%, 80.6%, 84.2%, and 80.0%). Half (50.0%) of the FDs reported decreased volume of congenital/craniofacial surgery, but 75.0% did not believe that there was a change in fellow experience. Overall, of the 15 responses indicating "worsened training" across all domains of FPRS, 14 were located in the Northeast (93.33%).

Conclusions: The COVID-19 pandemic has had the least impact on the volume of reconstructive procedures, facial nerve operations, and trauma surgery and a negative impact on congenital/craniofacial surgery volume, and it has accelerated the demand for cosmetic/aesthetic operations. Overall, the majority of FDs did not feel as though their fellows' trainings would be adversely affected by the ongoing pandemic.
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http://dx.doi.org/10.1177/2473974X211014130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127772PMC
May 2021

Adverse Events Associated With Corticosteroid-Eluting Sinus Stents: A MAUDE Database Analysis.

Otolaryngol Head Neck Surg 2021 Apr 13:1945998211006930. Epub 2021 Apr 13.

Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objective: Corticosteroid-eluting stents (CESs) are increasingly used after endoscopic sinus surgery to reduce the need for revision surgery, but their use is not without risks. The objective of this study is to describe adverse events related to CESs.

Study Design: Retrospective cross-sectional study.

Setting: The US Food and Drug Administration's MAUDE database (2011-2020; Manufacturer and User Facility Device Experience).

Methods: The MAUDE database was queried for reports of adverse events involving the use of CESs approved by the Food and Drug Administration, including Propel, Propel Mini, Propel Contour, and Sinuva (Intersect ENT).

Results: There were 28 reported adverse events in total, with all events being related to the Propel family of stents and none related to Sinuva stents. Overall, 22 were categorized as patient-related adverse events and 6 as device-related events. The most common adverse event was related to postoperative infection, accounting for 39% (n = 11) of all complications. Four of these patients developed periorbital cellulitis, and 5 developed a fungal infection. The second-most common adverse event was migration of the stent, representing 21% of all complications (n = 6). Overall, 8 patients (29%) in our cohort required reintervention in the operating room, with subsequent removal of the CES.

Conclusion: The most commonly reported adverse events were postoperative infection, including multiple cases of fungal infection, followed by migration of the stent. An increased awareness of the complications associated with CESs can be used to better inform patients during the consenting process as well as surgeons in their surgical decision making.
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http://dx.doi.org/10.1177/01945998211006930DOI Listing
April 2021

A 2020 Update on Public Awareness of Head and Neck Cancers.

Otolaryngol Head Neck Surg 2021 Apr 13:1945998211006932. Epub 2021 Apr 13.

Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objective: To assess knowledge regarding head and neck cancers (HNCs) in 2020, factors associated with knowledge of the role of human papillomavirus (HPV) in HNCs, and factors associated with exposure to Oral, Head and Neck Cancer Awareness Week (OHANCAW).

Study Design: Cross-sectional survey.

Setting: Online.

Methods: The survey was distributed to 517 participants via a paid panel and utilized US Census-built quotas to represent the US population.

Results: Participants surpassed 50% awareness rates in only 5 of 10 (50.0%), 2 of 6 (33.3%), and 5 of 9 (55.5%) preselected answer choices for subsites, risk factors, and signs/symptoms of HNCs, respectively. Knowledge of HPV's role in oropharyngeal cancer was also low, at 30.6%. However, of the controlled variables, exposure to OHANCAW was closely associated with knowledge of HPV's role in HNC (odds ratio, 10.25; 95% CI, 5.36-19.62). Women and elderly individuals were less likely to be exposed to OHANCAW, while those with higher education, those who drink heavily (>4 drinks/d), and current but not former tobacco users were more likely to be exposed.

Conclusions: Knowledge of HNCs and the causal role of HPV remains suboptimal, though our results suggest that OHANCAW remains a viable educational pathway. However, certain at-risk populations, such as former smokers and older individuals, whom we may not be effectively reaching and screening, represent a priority for future outreach efforts.
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http://dx.doi.org/10.1177/01945998211006932DOI Listing
April 2021

Role and Growth of Independent Medicare-Billing Otolaryngologic Advanced Practice Providers.

Otolaryngol Head Neck Surg 2021 Mar 9:194599821994820. Epub 2021 Mar 9.

Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: To evaluate the role and growth of independently billing otolaryngology (ORL) advanced practice providers (APPs) within a Medicare population.

Study Design: Retrospective cross-sectional study.

Setting: Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data Files, 2012-2017.

Methods: This retrospective review included data and analysis of independent Medicare-billing ORL APPs. Total sums and medians were gathered for Medicare reimbursements, services performed, number of patients, and unique () codes used, along with geographic and sex distributions.

Results: There has been near-linear growth in number of ORL APPs (13.7% to 18.4% growth per year), with a 115.4% growth from 2012 to 2017. Similarly, total Medicare-allowed reimbursement (2012: $15,568,850; 2017: $35,548,446.8), total number of services performed (2012: 313,676; 2017: 693,693.7), and total number of Medicare fee-for-service (FFS) patients (2012: 108,667; 2017: 238,506) increased. Medians of per APP number of unique codes used, Medicare-allowed reimbursement, number of services performed, and number of Medicare FFS patients have remained constant. There were consistently more female APPs than male APPs (female APP proportion range: 71.3%-76.7%). Compared to ORL physicians, there was a significantly greater proportion of APPs practicing in a rural setting as opposed to urban settings (2017: APP proportion 13.6% vs ORL proportion 8.4%; < .001).

Conclusion: Although their scope of practice has remained constant, independently billing ORL APPs are rapidly increasing in number, which has led to increased Medicare reimbursements, services, and patients. ORL APPs tend to be female and are used more heavily in regions with fewer ORL physicians.
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http://dx.doi.org/10.1177/0194599821994820DOI Listing
March 2021

Concerns Regarding a National Otolaryngology Residency Interview Calendar.

JAMA Otolaryngol Head Neck Surg 2021 May;147(5):485-486

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

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http://dx.doi.org/10.1001/jamaoto.2021.0043DOI Listing
May 2021

Adverse Events Associated With ClariFix Posterior Nasal Nerve Cryoablation: A MAUDE Database Analysis.

Otolaryngol Head Neck Surg 2021 Feb 2:194599820986581. Epub 2021 Feb 2.

Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.

Posterior nasal nerve (PNN) cryoablation is a novel surgical technique used to address chronic rhinitis. The purpose of this study is to review the medical device reports (MDRs) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events related to the use of ClariFix, a device designed for office-based cryosurgical ablation of the PNN. A total of 12 adverse events associated with ClariFix from January 2017 to August 2020 were identified and analyzed. The most common adverse events associated with ClariFix PNN cryoablation include epistaxis and nasal swelling. Further studies are needed to clarify whether PNN cryoablation is associated with epistaxis in certain populations.
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http://dx.doi.org/10.1177/0194599820986581DOI Listing
February 2021

Otolaryngology Applicant Characteristics and Trends: Comparing OTO-HNS with Peer Specialties.

Ann Otol Rhinol Laryngol 2021 Jan 13:3489420987408. Epub 2021 Jan 13.

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, USA.

Purpose: To evaluate the recent Otolaryngology-Head and Neck Surgery (OTO-HNS) applicant characteristics, to identify which applicant characteristics are associated with successful match into OTO-HNS, and to compare OTO-HNS applicant trends and characteristics to that of peer surgical specialties (PS).

Materials And Methods: Data were obtained from official reports by the National Residency Matching Program (NRMP) for OTO-HNS, plastic and reconstructive surgery, orthopedic surgery, neurosurgery, and dermatology from 2006 to 2019. Alpha Omega Alpha (AOA) membership, United States Medical Licensing Examination (USMLE) scores, research productivity, graduation from a top-40 NIH-funded U.S. medical school, and additional graduate degree were recorded. Odds ratios (OR) were calculated to evaluate the relationship between applicant qualifications and match success.

Results: From 2014 to 2018, the OTO-HNS applicant pool shrunk from 443 to 333, representing the largest drop of all PS. Furthermore, OTO-HNS reported the most unfilled positions and highest match rates in 2017 (n = 14; 92.1%) and 2018 (n = 12; 94.6%) among any PS. Despite recent trends, 2019 NRMP data revealed a 38.74% increase in OTO-HNS applicant numbers compared to 2018. AOA membership (OR, 7.3;  = .030), USMLE Step 2 scores between 241 and 260 (OR, 6.5;  = .009), and research productivity (OR, 5.6;  = .005) significantly increased the odds of matching into OTO-HNS.

Conclusions: Despite recent fluctuations in application trends, OTO-HNS continues to successfully match highly qualified applicants, including applicants with AOA membership, high Step 2 scores, and high research productivity. An understanding of the qualifications used to evaluate residency applicants may be helpful to both applicants and residency programs of OTO-HNS.
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http://dx.doi.org/10.1177/0003489420987408DOI Listing
January 2021

Characterizing the providers of and reimbursement for chronic migraine chemodenervation among the Medicare population.

Headache 2021 Feb 18;61(2):373-384. Epub 2020 Dec 18.

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.

Objective: To characterize reimbursement trends and providers for chronic migraine (CM) chemodenervation treatment within the Medicare population since the introduction of the migraine-specific CPT code in 2013.

Methods: We describe trends in procedure volume and total allowed charge on cross-sectional data obtained from 2013 to 2018 Medicare Part B National Summary files. We also utilized the 2017 Medicare Provider Utilization and Payment Data to analyze higher volume providers (>10 procedures) of this treatment modality.

Results: The total number of CM chemodenervation treatments rose from 37,863 in 2013 to 135,023 in 2018 in a near-linear pattern (r = 0.999) and total allowed charges rose from ~$5,217,712 to $19,166,160 (r = 0.999). The majority of high-volume providers were neurologists (78.4%; 1060 of 1352), but a substantial proportion were advanced practice providers (APPs) (10.2%; 138 of 1352). Of the physicians, neurologists performed a higher mean number of procedures per physician compared to non-neurologists (59.6 [95% CI: 56.6-62.6] vs. 45.4 [95% CI: 41.0-50.0], p < 0.001). When comparing physicians and APPs, APPs were paid significantly less ($146.5 [95% CI: $145.6-$147.5] vs. $119.7 [95% CI: $117.6-$121.8], p < 0.001). As a percent of the number of total beneficiaries in each state, the percent of Medicare patients receiving ≥1 CM chemodenervation treatment from a high-volume provider in 2017 ranged from 0.024% (24 patients of 98,033 beneficiaries) in Wyoming to 0.135% (997 of 736,521) in Arizona, with six states falling outside of this range.

Conclusion: Chemodenervation is an increasingly popular treatment for CM among neurologists and other providers, but the reason for this increase is unclear. There is substantial geographic variation in its use.
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http://dx.doi.org/10.1111/head.14040DOI Listing
February 2021

In Reference to Is Expecting the Emergency Department to Adhere to AAO-HNS Bell's Palsy Guidelines Unrealistic?

Laryngoscope 2021 02 7;131(2):E358. Epub 2020 Dec 7.

Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, U.S.A.

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http://dx.doi.org/10.1002/lary.29288DOI Listing
February 2021

High-Volume Billing and Reimbursement Trends for Endoscopic Swallowing Studies in the Medicare Population.

Dysphagia 2020 Nov 19. Epub 2020 Nov 19.

Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, 800 Howard Avenue, Fl 4., New Haven, CT, 06519, USA.

The aim of this study is to delineate the reimbursement trends in fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) and without sensory testing (FEES) in relation to that of speech-language pathology's (SLP) portion of modified barium swallow studies (MBS), as well as to document the types of providers billing for these procedures. We performed descriptive analyses of the volume of FEES/FEESST and MBS, and total reimbursements data obtained from 2013-2018 Medicare Part B National Summary files. We also utilized the 2017 Medicare Provider Utilization and Payment Data to analyze the higher volume providers (> 10 procedures annually) of either FEES and/or FEESST. From 2003 to 2018, there has been an average, annual increase of approximately 318 FEES/FEESST performed within the Medicare fee-for-service population (R = 0.9505 [95% CI 0.860-0.983]; p < 0.001) covered under Part B (which is largely outpatient coverage). Similarly, there was an increase in Medicare-specific FEES/FEESST reimbursement from $302,840 in 2003 to $1.2 million in 2018 (R = 0.9721 [95% CI 0.920-0.990; p < 0.001]). Prior to 2010, FEESST was performed more frequently than FEES (maximum annual difference of 1174), though from 2010 onward, relatively more annual FEES was performed. From 2003-2018, the reimbursement per procedure increased by $16.79 and $35.36 for FEESST and FEES, respectively, and by $32.84 for the SLP portion of the MBS. Among high-volume FEES/FEESST billers, 65.4% were otolaryngologists and 32.3% were independently billing SLPs. From 2003 to 2018, there has been a significant rise in the number of performed and reimbursed FEES/FEESST. From 2014 onward, compared to SLP-involved MBS, there has been a relative increase in performance of FEES/FEESST.
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http://dx.doi.org/10.1007/s00455-020-10215-xDOI Listing
November 2020

Revisiting the Radiation Therapy Oncology Group 1221 Hypothesis: Treatment for Stage III/IV HPV-Negative Oropharyngeal Cancer.

Otolaryngol Head Neck Surg 2021 06 17;164(6):1240-1248. Epub 2020 Nov 17.

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: In 2014, the Radiation Therapy Oncology Group 1221 trial was initiated to analyze whether surgery with risk-based radiation therapy or chemoradiation therapy was superior to chemoradiation therapy alone in patients with clinically staged T1-2N1-2bM0 HPV-negative oropharyngeal squamous cell carcinoma. However, the study was prematurely terminated. Given the lack of a randomized controlled trial, we retrospectively approached the same question using large national cancer databases.

Study Design: Retrospective cohort study.

Setting: The National Cancer Database and Surveillance, Epidemiology, and End Results (SEER) program from 2010 to 2016.

Methods: We identified 3004 patients in the National Cancer Database and 670 patients in the SEER database. Statistical techniques included Kaplan-Meier survival analysis, binary and multinomial logistic regressions, Cox proportional hazard regressions, and inverse propensity score weighting.

Results: On weighted multivariable Cox regression, patients recommended to receive frontline surgery had improved overall survival as compared with those recommended to receive chemoradiation therapy alone (hazard ratio [HR], 0.77; 95% CI, 0.68-0.86). On post hoc multivariable analysis based on therapy actually received, frontline surgery with adjuvant chemoradiation therapy was associated with improved overall survival (HR, 0.59; 95% CI, 0.50-0.71) as compared with chemoradiation therapy without surgery. Analysis of the SEER cohort revealed improved overall survival (HR, 0.69; 95% CI, 0.54-0.87) and head and neck cancer-specific survival (HR, 0.59; 95% CI, 0.41-0.84) in patients recommended to receive frontline surgery over chemoradiation therapy alone.

Conclusion: Our findings support the use of surgery with risk-based addition of adjuvant therapy in patients with cT1-2N1-2bM0 HPV-negative oropharyngeal cancer.
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http://dx.doi.org/10.1177/0194599820969613DOI Listing
June 2021

COVID-19's Impact on the 2020-2021 Resident Match: A Survey of Otolaryngology Program Directors.

Ann Otol Rhinol Laryngol 2021 Jul 22;130(7):666-673. Epub 2020 Oct 22.

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: To determine the impact coronavirus disease of 2019 (COVID-19) will have on the 2020-2021 otolaryngology (OTO-HNS) resident application cycle.

Methods: A cross-sectional survey targeting OTO-HNS program directors (PD) was created and disseminated via email to PDs on May 28th 2020. Descriptive analyses of the 19-question survey was performed, and free text responses for certain suitable questions were thematically categorized into groups determined to be relevant during analysis.

Results: Twenty-nine of 123 solicited PDs (23.6%) completed the survey. Nineteen (65.5%) respondents indicated they would not host away rotations (AR) in 2020, and 9 (31.0%) reported that they would consider away rotators without home programs. Regarding the historical importance of AR, 21 (72.4%) PDs stated they were either "extremely" or "very" important in evaluating candidates. Sixteen (55.2%) PDs stated that virtual interviews would impact their ability to properly gauge candidates and 12 (41.4%) were unsure. Eight PDs (27.6%) stated their evaluation of candidates will likely change, with a shift toward an increased reliance on letters of recommendation, research involvement, and clerkship grades. The large majority of PDs-25 (86.2%)-were not worried that the COVID-19 pandemic would affect the abilities of new interns beginning in 2021.

Conclusion: Virtual interviews and engagement activities will mostly supplant sub-Is and AR for the 2020-2021 OTO-HNS application cycle. Surveyed PDs largely believe these will be insufficient in providing a comprehensive assessment of candidates, and will similarly limit applicants' ability to gauge residency programs. Criteria utilized to evaluate students is expected to change.
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http://dx.doi.org/10.1177/0003489420967045DOI Listing
July 2021

Telemedicine Practices of Facial Plastic and Reconstructive Surgeons in the United States: The Effect of Novel Coronavirus-19.

Facial Plast Surg Aesthet Med 2020 Nov/Dec;22(6):464-470. Epub 2020 Oct 14.

Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA.

The objectives of this study among facial plastic and reconstructive surgeons (FPRS), include (1) quantifying the use of telemedicine, (2) examining the impact of novel coronavirus-19 (COVID-19) on telemedicine practices, (3) highlighting the types of telemedicine employed, (4) anticipating how telemedicine will be utilized in the future, and (5) describing FPRS' attitudes and understanding of telemedicine technologies. Cross-sectional survey. A 6-13 question survey was sent to the American Academy of Facial Plastic and Reconstructive Surgery membership. Descriptive analyses were performed, along with a Fisher's exact test. We received 100 responses from a diverse group of surgeons across the United States. Overall, 91% of responders utilize telemedicine, of which 76.9% began during the COVID-19 pandemic. 33.3% of responders thought that their platforms were not Health Insurance Portability and Accountability Act compliant or were unsure. Of those that utilize telemedicine, the two biggest concerns were difficulties with physical examination (69.2%) and lack of human connection (44%). 75.8% of telemedicine utilizers plan to incorporate telemedicine into their practice moving forward. Of all responders, 71% believed that telemedicine will have a positive effect on the field of FPRS, although on univariate analysis those in practice >20 years were more likely to believe that there will be no effect or a negative effect ( = 0.014). The COVID-19 pandemic has accelerated the adoption of telemedicine among FPRS in the United States. The great majority of responders plan to incorporate telemedicine into their practice even after the pandemic subsides and believe that telemedicine will have a net positive effect on the field of FPRS.
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http://dx.doi.org/10.1089/fpsam.2020.0409DOI Listing
November 2020

Resumption of Otolaryngology Surgical Practice in the Setting of Regionally Receding COVID-19.

Otolaryngol Head Neck Surg 2021 04 22;164(4):788-791. Epub 2020 Sep 22.

Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.

The practice of otolaryngology has been drastically altered as a consequence of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Geographic heterogeneity in COVID-19 burden has meant different regions have experienced the pandemic at different stages. Regional dynamics of COVID-19 incidence has dictated the available resources for the provision of surgical care. As regions navigate their own COVID-19 dynamics, illustrative examples of areas affected early by the COVID-19 pandemic may provide anticipatory guidance. In this commentary, we discuss our experience with performed and canceled surgical procedures across the various otolaryngology specialties at our institution over the course of regionally rising and falling incident COVID-19 cases.
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http://dx.doi.org/10.1177/0194599820959671DOI Listing
April 2021

Pediatric Otoplasty: Differences in Operative Time and Inpatient Stay Based on Surgical Specialty Training.

J Craniofac Surg 2021 Jan-Feb 01;32(1):367-369

Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, CT.

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http://dx.doi.org/10.1097/SCS.0000000000007016DOI Listing
May 2021

Prognostic Significance of Extranodal Extension in HPV-Mediated Oropharyngeal Carcinoma: A Systematic Review and Meta-analysis.

Otolaryngol Head Neck Surg 2021 04 25;164(4):720-732. Epub 2020 Aug 25.

Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objective: To determine the prognostic role of extranodal extension (ENE) among patients with human papilloma virus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) through a systematic review and meta-analysis of institutional studies.

Data Sources: MEDLINE, Embase, Scopus, and PubMed.

Review Methods: Two independent authors searched the databases on December 3, 2019, to identify studies of HPV+ OPSCC comparing prognostic outcomes stratified by ENE. The statistic was used to determine study heterogeneity. Fixed and random effects models were used to determine hazard ratios (HRs) with 95% CIs.

Results: Eighteen observational studies met inclusion criteria, yielding 3603 patients with HPV+ OPSCC (1521 ENE+ and 2082 ENE-) with a median follow-up of 49 months. The presence of pathologic ENE (pENE) and radiologic ENE (rENE) was associated with decreased overall survival (pENE HR, 1.89 [95% CI, 1.15-3.13], = 35%; rENE HR, 2.64 [95% CI, 1.46-4.78], = 75%) and distant recurrence (pENE HR, 3.23 [95% CI, 1.25-8.33], = 0%; rENE HR, 3.83 [95% CI, 1.88-7.80], = 0%). Neither pENE nor rENE was associated with locoregional recurrence (pENE HR, 0.75 [95% CI, 0.20-2.84], = 0%; rENE HR, 2.03 [95% CI, 0.86-4.79], = 0%). pENE was not associated with disease-specific survival (pENE HR, 1.45 [95% CI, 0.84-2.49], = 0%).

Conclusion: pENE and rENE are moderately associated with an increased risk of all-cause mortality and recurrence with distant metastasis in a cohort of patients with HPV+ OPSCC. These findings may be used to inform exclusion criteria for deintensification trials and assist in refined risk stratification.
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http://dx.doi.org/10.1177/0194599820951176DOI Listing
April 2021

Otolaryngology Match 2020-21: Survey of Prospective Applicants in the Setting of COVID-19.

Ann Otol Rhinol Laryngol 2021 May 19;130(5):450-458. Epub 2020 Aug 19.

Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, CT, USA.

Objectives: To capture the perspectives of candidates applying for otolaryngology residency positions in the 2020-21 cycle, in the context of disruption caused by the coronavirus disease 2019 (COVID-19) pandemic.

Subjects And Methods: Candidates planning to apply to the otolaryngology 2020-21 match were invited to complete a cross-sectional online survey. Distribution was via otomatch.com and word of mouth. Descriptive statistics were performed.

Results: Of 85 eligible responses (estimated 18.9% of all applicants), many have had at least one board examination (71.8%) disrupted. A majority (85.9%) believe evaluation of candidates will change due to the pandemic, and 54.1% report they were now less confident in matching. Female applicants (37.6% of respondents) were found to have significantly higher odds of decreased confidence in matching (OR 2.781 [95% CI 1.045-7.4044]; = .041). Many report a move to virtual interviews would increase the number of applications submitted (45.9%) and the number of interviews attended (77.6%). Some applicants (36.5%) did not believe residency programs would gather sufficient information about their candidacy to make an informed decision, and most (62.4%) did not believe that they would gather sufficient information to inform their own rank list.

Conclusions: We find that candidates believe their candidacy will be assessed differently in light of the COVID-19 pandemic, are largely less confident in successfully matching, and are planning to apply and interview more broadly. These data are relevant to otolaryngology residency leadership to inform clear dialogue and a smooth transition into an unprecedented application cycle.
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http://dx.doi.org/10.1177/0003489420952470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481654PMC
May 2021

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous-site tumors.

Head Neck 2020 11 2;42(11):3352-3363. Epub 2020 Aug 2.

Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: The aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous-site tumors.

Methods: Descriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004-2016).

Results: Of 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5-year OS: 53.4% [SE: 2.5%]) compared with cartilage tumors (5-year OS: 84.6% [SE: 1.8%]) (log-rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio [HR] 0.495 [95% CI: 0.366-0.670]). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 [0.697-2.438]).

Conclusion: Treatment that included surgery was associated with an increased OS within our cohort of HN osseous-site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.
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http://dx.doi.org/10.1002/hed.26389DOI Listing
November 2020

Assessing National Utilization Trends and Outcomes of Robotic and Endoscopic Thyroidectomy in the United States.

Otolaryngol Head Neck Surg 2020 11 16;163(5):947-955. Epub 2020 Jun 16.

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: We aimed to evaluate trends and outcomes of surgical approaches to thyroid surgery. We hypothesized that there have been changes over time in the utilization of approaches to thyroidectomy, including endoscopic, robotic, and open approaches, and that patient outcomes may differ between open surgery and endoscopic or robotic approaches.

Study Design: Retrospective analysis.

Setting: The National Cancer Database (NCDB) was queried between 2010 and 2016.

Subjects And Methods: National cohort of patients. Descriptive statistics were performed using χ test, Mann-Whitney test, test and analysis of variance. To investigate complication rates, patient matching was performed with subsequent analysis using simple and multivariable logistic regressions.

Results: We identified 217,938 patients within the NCDB. While endoscopic thyroid surgery increased, relatively, in use over time (0.93% to 2.34% of cases in 2010 and 2016, respectively), robotic thyroid surgery started to decline relatively to other approaches from 2013 to 2016 (0.39% to 0.25% of cases, respectively). The endoscopic approach was performed more commonly than the robotic approach within individual facilities that have reported both procedures ( = .025). Robotic thyroid surgery was associated with increased risk of positive margins ( = .046), while endoscopic thyroid surgery was associated with a higher rate of unplanned hospital readmission (OR, 1.55; 95% CI, 1.09-2.22), longer inpatient stays (OR, 1.55; 95% CI, 1.19-2.02), and higher 90-day postoperative mortality (OR, 4.45; 95% CI, 1.58-12.6).

Conclusion: Endoscopic thyroid surgery has increased in utilization since 2004 but may have worse morbidity and mortality outcomes compared to open surgery.
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http://dx.doi.org/10.1177/0194599820927699DOI Listing
November 2020

Outpatient Otolaryngology in the Era of COVID-19: A Data-Driven Analysis of Practice Patterns.

Otolaryngol Head Neck Surg 2020 07 12;163(1):138-144. Epub 2020 May 12.

Division of Otolaryngology, School of Medicine, Yale University, New Haven, Connecticut, USA.

Introduction: Coronavirus disease 2019 (COVID-19) has induced a prioritization of acute care and telehealth, affecting the quantity of patients seen and the modality of their care.

Study Design: Retrospective review.

Setting: Single-institution study conducted within the Division of Otolaryngology at the Yale School of Medicine.

Subjects And Methods: Data on all outpatient appointments within the Division of Otolaryngology were obtained from administrative records of billing and scheduling from March 16 to April 10, 2020. For comparison, a corresponding period from 2019 was also utilized.

Results: Of 5913 scheduled visits, 3665 (62.0%) were seen between March 18 and April 12, 2019, in comparison with 649 of 5044 (12.9%) during the corresponding COVID-19-affected period. The majority of completed visits performed in weeks 1 and 2 were in person, while the majority in weeks 3 and 4 were via telehealth. Among subspecialties, a larger proportion of completed visits in 2020 were performed by pediatric and head and neck oncology otolaryngologists as compared with general/specialty otolaryngologists ( < .001). Older adults (≥65 years) were less likely to have telehealth visits than younger adults (18-64 years; 45.6% vs 59.6%, = .003).

Conclusions: A major decrease in the completion rates of scheduled visits was seen in the COVID-19-affected period, though this was not proportional among subspecialties. An associated increase in telehealth visits was observed. After COVID-19-related hospital policy changes, approximately 2 weeks passed before telehealth visits surpassed in-person visits, though this was not true among older adults.
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http://dx.doi.org/10.1177/0194599820928987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218354PMC
July 2020

Facial Fractures and the National Basketball Association: Epidemiology and Outcomes.

Laryngoscope 2020 12 20;130(12):E824-E832. Epub 2020 Apr 20.

Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.

Objectives/hypothesis: To identify the epidemiology and impact of facial fractures on player performance and return to play (RTP) in the National Basketball Association (NBA).

Study Design: Retrospective case-control series METHODS: Fifty-three NBA players who sustained facial fractures between 1984 and 2018 were identified. Players with pre- and postinjury statistics were included in the performance analysis. A control group was matched by age, body mass index (BMI), position, NBA experience, and player efficiency rating. Fisher exact tests and Student t tests were performed to analyze player demographics and performance variables.

Results: At the time of injury, the average player's age was 26.17 years, BMI was 24.80 kg/m , and NBA experience was 4.97 years. Players missed an average of 3.77 games and 18.21 days prior to RTP. Forty-eight players (90.6%) did RTP the subsequent season, whereas 43 of those players (81.1%) met inclusion criteria for performance analysis. There was no significant change in performance between pre- and postinjury seasons. Players managed operatively missed significantly more games (8.15 vs. 1.85; P = .034) and days (51.08 vs. 5.53; P = .003) than players managed nonoperatively, whereas performance was not impacted. Average career length following facial fracture was significantly shorter compared to controls (5.14 vs. 6.42 years; P = .010) and a decrease in three-pointer percentage (P = .004) was observed.

Conclusions: The majority of players who suffer facial fractures RTP in the NBA and do not experience significant decline in performance following injury. These results should aid physicians caring for basketball players at any level, and may help inform future guidelines for treatment and injury prevention.

Level Of Evidence: 3b Laryngoscope, 2020.
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http://dx.doi.org/10.1002/lary.28690DOI Listing
December 2020

Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery.

Otolaryngol Head Neck Surg 2020 Jun 14;162(6):969-978. Epub 2020 Apr 14.

Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.

Objective: To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS).

Study Design: Case series with planned data collection.

Setting: Tertiary referral medical center.

Subjects And Methods: We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7.

Results: A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3.

Conclusion: Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.
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http://dx.doi.org/10.1177/0194599820915472DOI Listing
June 2020

An Epidemiological Analysis and Comparison of Single Site and Multiple Site Fracture Repair: An NSQIP Analysis.

J Craniofac Surg 2020 Jul-Aug;31(5):1232-1237

Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, CT.

We aimed to utilize the 2010 to 2017 National Surgical Quality Improvement Program to evaluate the epidemiology and efficacy of facial fracture repairs, specifically comparing multiple fracture site repairs (MFR) compared to single fracture site repairs (SFR). Of 4739 patients, 718 (15.2%) were found to have undergone MFR. A total of 577 (80.4%) of the MFRs involved the midface only. A total of 2114 (52.6%) of the SFRs were mid-face fractures, while 1825 (45.4%) involved the lower-face and only 82 (2.0%) involved the upper-face. The most frequent MFR was combined orbital and malar/zygoma repair (230 cases [32.0%]). When comparing MFR and SFR of the mid-face, MFR patients were more commonly male, White, operated on by plastic surgeons, presented with contaminated wounds, and active smokers. While MFRs were associated with a longer operative time (P < 0.001) and a longer postoperative hospital stay (P < 0.001), there were no differences in reoperation or readmission. Overall, complication rates were low, but slightly higher in the mid-face MFR group (1.4% in mid-face SFR and 3.0% in mid-face MFR; P = 0.019). Sub-analysis of mid-face only MFRs and middle-lower-face MFRs revealed no difference in postoperative complication rates (3.0% and 7.0%, respectively; P = 0.071). The data presented suggests that MFR are a relatively common occurrence. Although plastic surgeons perform MFRs more frequently, it is currently unclear whether the underlying reason is a product of differences in training, coding patterns, or referral patterns. Though MFRs require more hospital resources, complications rates are low. This will help manage patient expectations and guide patient counseling before surgery, as well as help to plan postoperative care.
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http://dx.doi.org/10.1097/SCS.0000000000006425DOI Listing
January 2021

Multi-modality Treatment and Survival in Sinonasal Minor Salivary Gland Tumors.

J Neurol Surg B Skull Base 2020 Apr 1;81(2):198-205. Epub 2019 Apr 1.

Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

 The aim of this study was to analyze the effect of the multimodality treatment on survival in sinonasal minor salivary gland tumors.  Adult clinical American Joint Committee on Cancer (AJCC) tumor (T) 1-4a staged cases of sinonasal minor salivary gland tumors were isolated from the National Cancer Database (2004-2014). Multivariate regressions were performed to analyze the effect of multimodality treatment. A subset analysis was also performed in patients with positive margins following surgical management.  We identified 556 cases, of which 293 (52.7%) patients were treated with surgery and radiotherapy (RT), 160 (28.8%) were treated with surgery alone, and 52 (9.4%) were treated with surgery and chemoradiotherapy (CRT). No patients were treated with chemotherapy alone. With surgery and CRT as a reference, the only treatment modality associated with decreased survival was RT alone (hazard ratio [HR]: 3.213 [95% confidence interval (CI): 1.578-6.543];  = 0.001). Within a subset analysis of patients with positive margins, surgery was associated with decreased survival (HR: 2.021 [95% CI: 1.401-3.925];  = 0.038), but not triple modality therapy (HR: 1.700 [95% CI: 0.798-3.662]) when compared with surgery with RT.  The most common treatment was surgery and RT, consistent with National Comprehensive Cancer Network (NCCN) guidelines which recommends chemotherapy (CT) only in the most concerning cases. However, we found no difference in survival among most treatment modalities when compared with triple modality therapy, with the exception of RT alone. Although margins were prognostic within these cancers, we found no evidence that adjuvant CRT provides any survival benefit over surgery and RT, though surgery alone was associated with decreased survival.
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http://dx.doi.org/10.1055/s-0039-1683437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082160PMC
April 2020

Risk factors and effects of hypocalcemia prior to discharge following thyroidectomy.

Am J Otolaryngol 2020 May - Jun;41(3):102420. Epub 2020 Feb 13.

Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, CT, United States of America. Electronic address:

Purpose: To find patient and surgical characteristics associated with hypocalcemia prior to discharge (HPTD) in thyroidectomy patients.

Materials And Methods: In a retrospective analysis of the 2016-2017 National Surgical Quality Improvement Program, eligible total thyroidectomy patients were stratified into cohorts based on development of HPTD. We identified demographic and surgical risk factors for the development of hypocalcemia via binary logistic regression and identified the negative sequelae of HPTD utilizing univariate and multivariate methods.

Results: We identified a total of 6519 patients who underwent total thyroidectomy, of which 450 (6.9%) had HPTD. Predictors associated with an increased incidence of HPTD included female sex (OR: 1.737 [95% CI: 1.319-2.288]; p < .001), increased operative time (OR: 1.003 [1.002-1.004]; p < .001), and central neck dissection (OR: 1.484 [1.190-1.850]; p < .001). However, factors that decreased incidence of HPTD included increased age, obesity (OR: 0.648 [0.501-0.837]; p = .001), and the use of vessel sealant devices (VSD) (OR: 0.650 [0.527-0.803]; p < .001). Multivariate analysis further revealed that HPTD independently led to an increased hospitalization length after surgery (B: 0.708 [0.607-0.809]; p < .001) and an increased 30-day readmission rate (OR: 2.429 [1.594-3.704]; p < .001).

Conclusion: Obesity, increased age, and intra-operative VSD use were significantly associated with decreased rates of HPTD after total thyroidectomy. Female sex, longer operations, and central neck dissections were associated with HPTD. Delineating risk factors and protective factors for HPTD in total thyroidectomy patients is important as patients with HPTD were found to be at a significantly higher risk for longer post-operative stays, increased odds of 30-day readmission, and increased hypocalcemia-related event.
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http://dx.doi.org/10.1016/j.amjoto.2020.102420DOI Listing
September 2020

Pediatric thyroidectomies: A surgical subspecialty comparison.

Int J Pediatr Otorhinolaryngol 2020 May 13;132:109945. Epub 2020 Feb 13.

Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA.

Objective: This study aims to establish the typical population, safety, and outcomes of pediatric thyroidectomies, specifically identifying surgical complication rates. Furthermore, the study compares management and complication differences between the two specialties that most often manage these patients - Pediatric General Surgery and Otolaryngology.

Methods: National Surgical Quality Improvement Program - Pediatrics (NSQIP-P) data between the years of 2012 and 2016 was reviewed and analyzed for patient characteristics, perioperative course and outcomes. Sub-group analysis was used to compare groups based on surgeon sub-specialty: Otolaryngology or Pediatric General Surgery.

Results: The study identified 516 cases pediatric patients operated on by Pediatric Otolaryngology (229; 44.4%) and Pediatric General Surgery (287; 55.6%). Overall, rates of surgical and medical adverse events were low (1.2% and 0.7%, respectively). Upon univariate analysis, there were no differences between specialties in surgical adverse events (p = 1.000), medical adverse events (p = 0.196), reoperation (p = 0.505), or readmission (p = 0.262). Indication for surgery differed between specialties, with benign neoplasm more common in the Pediatric Otolaryngology group (48.9% vs. 35.2%), and thyrotoxicosis more common in the Pediatric General Surgery group (43.9% vs. 23.1%) (p < 0.001). Compared to cases done by Otolaryngology, Pediatric General Surgery was independently associated with a shorter operative time (B: -31.583 min [95% CI: -42.802 to -20.364]; p < 0.001).

Conclusion: Thyroidectomy in the pediatric population is a safe procedure with no differences in adverse outcomes noted when comparing Pediatric General Surgeons to Pediatric Otolaryngologists. Pediatric General Surgeons were observed to have a significantly shorter operative time.
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http://dx.doi.org/10.1016/j.ijporl.2020.109945DOI Listing
May 2020

Medicare Reimbursement for Balloon Catheter Dilations Among Surgeons Performing High Volumes of the Procedures to Treat Chronic Rhinosinusitis.

JAMA Otolaryngol Head Neck Surg 2020 03;146(3):264-269

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

Importance: Chronic rhinosinusitis is among the most common and costly conditions treated by physicians. After failure of medical treatment, surgical intervention in the form of endoscopic sinus surgery is traditionally offered. Balloon catheter dilation (BCD) has become a less-invasive alternative with increasing popularity among otolaryngologists.

Objective: To evaluate the most recent BCD data in the Medicare population, with a specific focus on the percentage of procedures performed by surgeons who perform high volumes of this procedure, their reimbursements, and their national geographic distributions.

Design, Setting, And Participants: This retrospective review included data from 2011 through 2017 from Medicare Part B National Summary Data Files and Medicare Provider Utilization and Payment Data. Patients with procedures including Current Procedural Terminology codes 31295 (maxillary sinus dilation), 31296 (frontal sinus dilation), and 31297 (sphenoid sinus dilation) were included.

Exposures: Balloon catheter dilation of the paranasal sinuses.

Main Outcomes And Measures: Total and mean reimbursements over time to physicians for BCDs, as well as the percentage of BCDs performed by and reimbursed to ear, nose, and throat (ENT) surgeons who perform high volumes of BCDs (>10 procedures) in a given year.

Results: The total number of BCDs rose from 7496 in 2011 to 43 936 in 2017 (a 486% increase). The overall reimbursement increased from $11 773 049 in 2011 to $63 927 591 in 2017 (a 433% increase). From 2012 to 2016, ENT surgeons who performed high volumes of the procedures rose from 101 to 382 surgeons (a 270% increase). In 2016, 25 214 of 41 960 BCDs (60.1%) were performed by ENT surgeons performing high volumes of the procedure, compared with 5603 of 13 109 procedures (42.7%) in 2012. In a line of best fit, at the 75th percentile of procedure volume, there was an increase of 4.2 BCDs in the median number of procedures done per physician per year, compared with an increase of 1.5 BCD procedures per physician per year in the line of best fit for the 50th percentile.

Conclusions And Relevance: Balloon catheter dilation continues to increase in popularity among otolaryngologists treating chronic rhinosinusitis. Most BCDs are performed by ENT surgeons who perform high volumes of the procedure.
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http://dx.doi.org/10.1001/jamaoto.2019.4357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990810PMC
March 2020

Clinical characteristics and treatment-associated survival of head and neck Ewing sarcoma.

Laryngoscope 2020 10 27;130(10):2385-2392. Epub 2019 Nov 27.

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.

Objectives: Ewing sarcoma of the head and neck (ESHN) is a rare malignancy for which limited data exists. Herein we examine anatomic distribution of ESHN, demographic characteristics, and multi-modal therapy as potential determinants in the overall survival (OS) of patients with ESHN.

Methods: A retrospective study of the National Cancer Database (NCDB) from 2004-2016 was performed. A multivariate Cox regression and univariate Kaplan-Meier survival analyses were conducted.

Results: We identified 284 patients with ESHN eligible for demographic analysis and 223 for survival analysis. Approximately half (50.3%) of patients with ESHN were under the age of 18. Pediatric patients (<18) were less likely to present with distant metastases (≤8.0% vs. 9.5-19.0%, P = .006) and more likely to present with osseous disease (90.2% vs. 75.2%, P = .001) than adults. Adult age (HR: 2.727, 95% CI, 1.381-5.384, P = .004) and distant metastatic disease at the time of presentation (HR: 8.161, 95% CI, 2.922-22.790, P < .001) were independently associated with worse OS. The addition of local therapy (either surgery, radiotherapy, or both) to chemotherapy was not associated with improved survival when compared to treatment with chemotherapy alone.

Conclusion: Predictors of OS in patients with ESHN included age < 18 years and non-metastatic disease at the time of diagnosis. Tumor site of origin (osseous vs. extraosseous primary) or the addition of local therapy to chemotherapy had no impact on OS. Our analysis suggests that chemotherapy serves as the primary modality in treating ESHN, while further study of this rare malignancy is required to discern the utility of combined systemic and local therapy. Laryngoscope, 130:2385-2392, 2020.
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http://dx.doi.org/10.1002/lary.28412DOI Listing
October 2020

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach.

Laryngoscope 2020 06 22;130(6):E388-E396. Epub 2019 Nov 22.

Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.

Objectives: To identify factors associated with positive margins following surgical management of sinonasal squamous cell carcinoma (SNSCC), especially with regard to endoscopic treatment.

Methods: In a retrospective analysis of adult patients with clinically staged tumor (T)1 to T4a SNSCC within the National Cancer Database (NCDB) from 2004 to 2014, factors were associated with positive margins using multivariable binary logistic regression. Cases from 2010 to 2014 had surgical approach (open vs. endoscopic) available and were analyzed in a subgroup to assess the association of surgical approach with margin status. The association of margin status with overall survival (OS) and additional therapy administration was also assessed.

Results: We identified 2,968 cases, of which 807 (27.2%) had positive margins. On multivariable analysis, factors associated with positive margins included higher T stage (T4a vs. T1: odds ratio [OR] 2.768 [95% CI 2.143-3.577]), less differentiated tumors (poorly differentiated vs. well differentiated: OR 1.403 [95% CI 1.060-1.856]), and tumors in the ethmoid sinus (vs. nasal cavity; OR 1.889 [95% CI 1.305-2.734]). Cases treated at higher volume facilities (HVFs) were associated with a lower likelihood of positive margins (OR 0.716 [95% CI 0.582-0.881]). Positive margins were associated with decreased OS (hazard ratio 1.672 [95% CI 1.464-1.908]) and an increased rate of additional therapy (OR 1.966 [95% confidence interval 1.597-2.421]). An endoscopic approach was not associated with an increased likelihood of obtaining positive margins (vs. open; OR 1.151 [0.903-1.651]).

Conclusion: Positive margins were less likely when performed at HVFs and more likely in the ethmoid sinus than other subsites. Importantly, there was no association between positive margins and surgical approach. Endoscopic surgery may offer a safe, less invasive alternative to open surgery for select patients.

Level Of Evidence: NA Laryngoscope, 130:E388-E396, 2020.
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http://dx.doi.org/10.1002/lary.28315DOI Listing
June 2020

Head and Neck Reconstructive Surgery: Characterization of the One-Team and Two-Team Approaches.

J Oral Maxillofac Surg 2020 Feb 18;78(2):295-304. Epub 2019 Sep 18.

Assistant Professor, Section of Plastic and Reconstructive Surgery Department of Surgery, Yale University School of Medicine, New Haven, CT. Electronic address:

Purpose: To the best of our knowledge, no studies have compared the patient profiles for 1- versus 2-team surgery within head and neck oncosurgery.

Patients And Methods: A retrospective study of the data from 2968 patients who had undergone concurrent head and neck extirpative and reconstructive surgery in the National Surgical Quality Improvement Program (2010 to 2017) was conducted. Patients were stratified into 1- and 2-team surgery groups, and the demographic data were compared. Univariate analyses of the outcomes before and after propensity score matching were conducted.

Results: Most ablative and reconstructive head and neck procedures (68.5%) were performed using a 1-team approach. The patients who had undergone 2-team surgery were more likely to have a higher American Society of Anesthesiologists classification (P < .001), to require mandibulectomy (P < .001) or glossectomy (P < .001), and to receive a microvascular free flap (P < .001) but were less likely to require parotidectomy (P < .001) or to receive a rotational flap (P < .001). Before propensity score matching, the patients undergoing 2-team surgery had longer operative times (P < .001), longer postoperative stays (P < .001), greater rates of a return to the operating room (P = .001), and an increased rate of complications (P < .001). After propensity score matching, the 2-team approach continued to have longer operative times (P < .001) and an increased incidence of complications (P < .001) but no significant differences in the length of stay or rate of return to the operating room after Bonferroni's correction.

Conclusions: Nationally, most head and neck ablative and reconstructive surgeries were completed by 1 team. More complicated reconstructive procedures involving microvascular free flaps have been more commonly performed by 2 teams, resulting in slightly longer operative times and greater associated complication rates.
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http://dx.doi.org/10.1016/j.joms.2019.09.011DOI Listing
February 2020