Ultrasound has emerged as a cornerstone in the evaluation and management of salivary gland disease, providing a dynamic, radiation-free, and cost-effective modality for both diagnostic and intraoperative use. This chapter reviews normal salivary gland anatomy as visualized on ultrasound and outlines standardized approaches for assessing glandular and ductal structures.We will highlight the use of ultrasound for diagnosing obstructive salivary pathology and assessment of ductal obstruction, and proceed to discuss more interventional uses such as ultrasound-guided localization of sialolithiasis and intraoperative confirmation of stone clearance. The concept of sonopalpation, combining tactile feedback with real-time imaging, is introduced as a valuable technique for improving detection of submandibular calculi and enhancing surgical precision. Additional discussion focuses on structured ultrasound training, which has improved anatomic identification and diagnostic confidence among otolaryngology trainees. Together, these developments underscore the expanding role of salivary ultrasound as an essential diagnostic tool in contemporary otolaryngologic practice.

TPS6117 Background: HPV-OPC is caused primarily by HPV16. Prognosis following standard-of-care (SOC) treatment, (surgery followed by adjuvant radiotherapy (RT), or concurrent chemoRT (CRT)) is favorable, with >80% 5-year recurrence-free survival (RFS). However, RT toxicity including tissue fibrosis results in long-term swallowing dysfunction and impacts quality of life (QOL). NAC treatment (DC) followed by surgery has resulted in clinical-to-pathologic downstaging or pathologic complete response (pCR) and avoidance of RT in most pts, with >90% 5-year survival, and induces HPV-specific T cell immunity. PRGN-2009 is a gorilla adenoviral vector based gene therapy harboring a DNA payload designed to induce HPV specific T-cell responses. This trial will evaluate the rate of pCR with NAC (DC) alone or combined with PRGN-2009 (DCP) in pts with newly diagnosed HPV-OPC. Methods: This is an investigator-initiated, single-center, randomized controlled phase II trial. Newly diagnosed HPV-positive OPC pts of stage I (cT1-2, N0-1) or II (T1-3, N0-2), M0 (AJCC Cancer Staging Manual, 8 th ed.) planned for SOC surgery will be randomized to 2 treatment arms of 30 patients each, DC and DCP, to evaluate if PRGN-2009 may be associated with an increased rate of pathological CR (pCR) following neoadjuvant chemotherapy. DC consists of 3 cycles of intravenous cisplatin 75 mg/m 2 and docetaxel 75 mg/m 2 every 21 days (dose reductions allowed). DCP also includes PRGN-2009 induction dose pre-cycle 1, and one dose after each DC cycle (total 4 doses). Supportive measures include pre-infusion dexamethasone, antiemetics, neutropenia primary prophylaxis. Imaging (FDG PET, CT) will be performed at baseline. Research blood samples will be collected longitudinally. Mandatory research primary tumor biopsy will be performed at baseline and post-treatment tumor/tumor bed biopsy will be at the time of surgical resection. On-treatment tumor biopsies will be offered (optional). Study treatment and procedures will be performed at the NIH Clinical Center (Bethesda, MD). After treatment completion, pts will have surgery at their primary institution; adjuvant treatment determined per established risk factors. Primary endpoint is the rate of pCR in each arm. Secondary endpoints include safety and 2-year RFS in each arm. Exploratory objectives include assessment of changes in hearing (audiograms baseline/post-treatment), swallowing function (MD Anderson Dysphagia Inventory) and QOL (Functional Assessment of Cancer Therapy – Head & Neck); associations between changes in imaging, pathologic response, and circulating cell-free HPV DNA; changes in the tumor microenvironment and in HPV-specific T cell immunity. 8 of 60 pts planned have been enrolled. Clinical trial information: NCT06223568 .

Background The feasibility and outcomes of neoadjuvant doublet chemotherapy with cisplatin and docetaxel followed by surgical resection of residual disease (NAC + S) for patients with newly diagnosed, resectable p16 positive (+) oropharyngeal squamous cell carcinoma (OPSCC) has been reported from a single institution. Here, we report pathologic responses, need for adjuvant treatment and recurrence-free survival (RFS) following this treatment from a second large academic institution. Methods A retrospective cohort study of patients with p16 + OPSCC receiving NAC + S and risk-adjusted adjuvant treatment between January 2017 and March 2024 was performed. Results Of the 76 patients who met the inclusion criteria, 43 (57%) patients developed clinical-to-pathologic downstaging; all remaining patients had clinical and pathologic stage I disease (AJCC 8th). Thirty-seven (49%) patients experienced complete pathologic response (pCR). Sixty-four (89%) patients avoided adjuvant treatment. Two-year overall survival (OS) and RFS were 93.7% and 75.4%, respectively. Development of a pCR did not statistically associate with improved RFS, but only 8 patients developed disease relapse. Of the 8 (11%) patients that recurred, 3 had developed a pCR and 5 had not. Conclusions Using risk-adjusted criteria from pathologic analysis, a high proportion of patients with newly diagnosed, resectable p16 + OPSCC appear to be able to avoid adjuvant treatment following the NAC + S treatment regimen without sacrificing disease control. Prospective clinical study of the NAC + S treatment strategy with clearly defined inclusion and adjuvant treatment criteria is warranted to determine whether this approach strategy can be safely offered to patients that wish to minimize the need for adjuvant radiation.

Objective:Sialendoscopy is a diagnostic and interventional treatment for patients with salivary disease. Patients and physicians leverage website information to acquire knowledge about sialendoscopy; thus, understanding the quality of this information is essential. This study analyzes the quality and readability of online information on sialendoscopy. Methods:"Sialendoscopy" was searched on Google, and the first 100 websites were evaluated. Each website was required to meet three criteria for inclusion: accessible when opened, content deemed relevant, and available in written format. Four validated readability and two validated reliability metrics were utilized. Additionally, a separate analysis was conducted for the top nine websites in the search engine, given most web traffic occurs on Google's first page. Results:In assessing readability, the mean Flesch Reading Ease Score for included and the top nine websites was 36.2 and 39.5, respectively, with a P-value of .543. Both scores aligned with the "difficult to read" category. Other readability metrics aligned with high school reading levels. For reliability, the mean Discern score for the included and the top nine websites was 36.9 and 45.0, respectively, with a P-value of .030. These scores aligned with the "poor" and "fair" categories, respectively. Discussion:The low readability and reliability scores implied that the online health information on sialendoscopy is not easily understandable at a reading level appropriate for the general public. Our findings showed that the most readable and highest quality websites were not the highest ranked in our search results. Factors such as search engine algorithms and complex medical terminology used in these informative websites contribute to the lack of readability and relability of online health education. Implications for Practice:As AI evolves, future studies should be conducted to assess its impact on readability and reliability of online health information. There is an opportunity to adjust search engine algorithms, collaborate with communications specialists, and utilize new technologies, such as artificial intelligence chatbots, for the benefit of health seekers.

OBJECTIVE:There is growing attention toward the implications of race and ethnicity on health disparities within otolaryngology. While race is an established predictor of adverse head and neck oncologic outcomes, there is paucity in the literature on studies employing national, multi-institutional data to assess the impact of race and ethnicity on head and neck autograft surgery. METHODS:Using the National Surgical Quality Improvement Program (NSQIP) database, trends in 30 days outcomes were assessed. Patients with ICD-10 codes for malignant head and neck neoplasms were isolated. Autograft surgeries were selected using Current Procedural Terminology (CPT) codes for free flap and pedicled flap reconstruction. Primary outcomes included surgical complications, reoperation, readmission, extended length of stay and operation time. Each binary categorical variable was compared to racial/ethnic identity via binary logistic regression. RESULTS:The study cohort consisted of 2447 patients who underwent head and neck autograft surgery (80.71% free flap reconstruction and 19.39% pedicled flap reconstruction). Black patients had significantly higher odds of overall surgical complications (odds ratio [OR] 1.583, 95% confidence interval [CI] 1.091, 2.298, p = 0.016) with much higher odds of perioperative blood transfusions (OR 2.291, 95% CI 1.532, 3.426, p = <.001). Hispanic patients were more likely to undergo reoperation within 30 days after surgery and were more likely to be hospitalized for more than 30 days post-operatively (OR 1.566, 95% CI 1.015, 2.418, p = 0.043 and OR 12.224, 95% CI 2.698, 55.377, p = 0.001, respectively). CONCLUSIONS:Race and ethnicity serve as independent predictors of complications in the post-operative period following head and neck autograft surgery. LEVEL OF EVIDENCE:3 Laryngoscope, 134:3595-3603, 2024.

Importance:Distant metastasis (DM) remains the leading cause of death in patients treated for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). An effective treatment strategy needs to address DM while reducing treatment-related toxic effects. Objective:To assess DM-free survival in patients with HPV-OPSCC treated with neoadjuvant chemotherapy followed by transoral robotic surgery (NECTORS) and neck dissection compared with standard of care, concurrent chemoradiation (CCRT). Design, Setting, and Participants:This multicenter retrospective cohort study compares prospective data from the NECTORS treatment group with a historical cohort of patients treated with CCRT. Patients with American Joint Committee on Cancer seventh edition stage III and IVa HPV-OPSCC treated with NECTORS and CCRT between February 2010 and September 2021 were included. Data were analyzed in September 2024. Exposures:Patients in the NECTORS arm were treated with 3 cycles of neoadjuvant docetaxel and cisplatin followed by TORS and neck dissection. Patients in the radiation therapy arm were treated with concurrent high-dose cisplatin and radiotherapy. Main Outcomes and Measures:DM-free survival was analyzed with Kaplan-Meier and Cox regression after adjusting for age, sex, tobacco and alcohol use, site, and cancer stage. Results:Of 342 included patients, 282 (82.5%) were male, and the mean (SD) age was 61.4 (9.4) years. A total of 232 patients were treated with CCRT and 110 patients were treated with NECTORS. Within the CCRT arm, 11 patients (4.7%) had locoregional recurrence (LRR), 5 (2.2%) had LRR and DM, and 28 (12.1%) developed distant-only metastasis. For patients treated with NECTORS, 5 (4.5%) developed LRR, 1 (0.9%) developed LRR plus DM, and no patients developed distant-only metastasis. With pseudorandomization matching for T and N stages, 209 patients were matched between the 2 treatment groups for further analysis (105 in the CCRT treatment arm and 104 in the NECTORS arm). The median (range) follow-up period for the CCRT and NECTORS groups were 5.8 (3.8-7.5) years and 5.1 (4.0-5.9) years, respectively. The hazard ratio of developing distant recurrence in the CCRT group was 10.77 (95% CI, 1.40-82.90) in univariate analysis and 9.98 (95% CI, 1.29-77.29) in multivariable analysis. In Kaplan-Meier survival analysis, the risk of developing DM was higher in the CCRT group. The hazard ratio for failure anywhere in the CCRT group was 3.32 (95% CI, 1.23-8.97) in univariate analysis and 3.21 (95% CI, 1.18-8.72) in multivariable analysis. Conclusions and Relevance:In this study, neoadjuvant chemotherapy followed by transoral robotic surgery and neck dissection was an effective treatment option for patients with stage III and IVa HPV-OPSCC. Findings from our study suggest lower rates of DM with NECTORS worthy of further investigation in prospective randomized trials.

AbstractBackgroundDe‐escalation strategies for newly‐diagnosed p16‐positive oropharyngeal squamous cell carcinoma (p16+ OPSCC), aim to reduce treatment‐related morbidity without compromising disease control. One strategy is neoadjuvant cisplatin and docetaxel chemotherapy (NAC + S) before transoral robotic surgery, with pathology‐based risk‐adapted adjuvant treatment.MethodsWe examined the recurrence‐free survival (RFS) for patients who received NAC + S.ResultsComparing outcomes in 103 patients between 2008 and 2023, 92% avoided adjuvant treatment and showed significantly higher 2‐year recurrence‐free survival (RFS) compared to those with adjuvant treatment (95.9% vs. 43.8%, p = 0.0049)ConclusionOur findings suggest that pathology‐based risk‐adapted omission of adjuvant treatment following NAC + S does not appear to elevate recurrence risk and that NAC may identify patients with favorable tumor biology, yielding a 2‐year RFS probability exceeding 95% without adjuvant treatment. Further, the study identifies a patient subset experiencing disease recurrence despite triple modality therapy. Despite limitations, including a retrospective design and modest sample size, the data advocate for controlled NAC + S studies.

Background: Despite the growing literature on racial disparities in the utilization of total laryngectomy (TL), and survival following the treatment of laryngeal cancers, there is a paucity of research in TL cohorts evaluating disparities in the immediate postoperative setting. Methods: In a national multi-institutional cohort, TL cases between 2010 and 2021 were identified using relevant Current Procedural Terminology (CPT) codes. Logistic regression analyses investigated the association between race/ethnicity and adverse outcomes within 30 days postoperatively. Results: This study consisted of 1493 patients who underwent TL with or without radical neck dissection. Black patients underwent free flap and pedicled flap reconstruction more frequently than their counterparts ( P = .023) and exhibited a 1.532 times higher odds of surgical complications ( P < .001). Conclusions: There are increased rates of surgical complications in Black patients undergoing TL. Given the limited oncologic and socioeconomic variables available through National Surgical Quality Improvement Program, future study of disparate postoperative outcomes in this population is recommended.

Racial and ethnic minorities with skin cancer experience disproportionately worse prognoses and adverse outcomes compared to non-Hispanic, White patients. We analyzed patients diagnosed with any cutaneous malignancies of the head and neck between 2010 to 2021 using the data from the National Cancer Database to quantify disparities. The primary outcome variable was treatment refusal, and secondary variables included days from diagnosis to treatment, tumor depth, and mortality. Among the 151,733 patients analyzed, most were non-Hispanic White (99%) and male (71%). Black patients had the greatest odds of treatment refusal (4.166, 95% CI: 2.054-8.452, p < 0.001) across all cutaneous malignancies of the head and neck. Black and Hispanic patients also had increased times from diagnosis to treatment (p < 0.001). Black patients had higher odds of 90day mortality compared to non-Hispanic White patients (p < 0.001). This coincided with greater tumor depth in Black and Hispanic patients compared to that of non-Hispanic White patients (p < 0.001). Black patients were more likely to refuse treatment for head and neck cutaneous malignancies. Moreover, Black and Hispanic patients experienced more treatment delays. These findings may relate to the increased 90-day mortality among Black patients and increased tumor depth in Black and Hispanic patients. Further investigation into the quality of life and functional impairment is warranted alongside interventions to reduce these disparities. (c) 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Transoral sialolithotomy performed in-office under local anesthesia is routinely performed for distal submandibular stones. We demonstrate the senior author's novel practice of in-office transoral sialolithotomy for hilar and intraglandular stones. A review of cases performed by the senior author revealed similar rates of complication and stone recurrence as those reported in the literature from removal under general anesthesia. Laryngoscope, 134:4042-4044, 2024.

While branchial cleft cysts are often considered benign pathologies, the literature discusses cases of squamous cell carcinoma (SCC) arising from these cystic lesions as either a primary or metastatic tumor. We illustrate our institutional experience and review the current literature to identify recommendations for best diagnostic, surveillance, and treatment guidelines for SCC identified in a branchial cleft cyst. A 61-year-old male presented with a right sided neck mass, with suspicion of a branchial cleft cyst due to benign findings on fine needle aspiration. Following surgical excision, a focus of SCC was found on surgical pathology. Despite PET/CT and flexible laryngoscopy, no primary tumor was identified prompting routine surveillance every 3 months with cervical ultrasonography and flexible nasolaryngoscopy. Two and a half years following his initial presentation, pathologic right level II lymphadenopathy was detected on ultrasound without evidence of primary tumor. Subsequent transoral robotic surgery with right tonsillectomy and partial pharyngectomy, with right lateral neck dissection revealed a diagnosis of pT1N1 HPV-HNSCC and he was referred for adjuvant chemotherapy and radiation. To our knowledge there are less than 10 cases of confirmed HPV-associated oropharyngeal SCC arising from a branchial cleft cyst. Here we demonstrate the utility of ultrasound as a surveillance tool and emphasize a higher index of suspicion for carcinoma in adult patients with cystic neck masses.

Ultrasonographic descriptions of Warthin’s tumor (WT) vary from a predominately macrocystic appearance (anechoic with internal septations) to microcystic (multiple, diffuse, 1–2 mm anechoic areas). While the current first-line treatment for WTs is surgical excision, ultrasound-guided ethanol sclerotherapy (UGES) demonstrates success in macrocystic WTs, with aspiration of the cystic contents followed by injection of the sclerosing agent. Typically, microcystic tumors are thought to be unresponsive to sclerotherapy. In this case, we report the first application of ethanol sclerotherapy without ultrasound-guided aspiration for the treatment of a microcystic WT. The patient presented with a 2.0 cm × 1.97 cm × 3.05 cm right parotid mass of 9 years’ duration. UGES was performed in clinic under local anesthesia through injection of 97% ethanol in the three separate components of the target lesion. Six months postprocedure, ultrasound evaluation demonstrated a volume reduction rate of 78.53%. The patient reported significant cosmetic improvement and no observed complications.

Objectives:The Salivary Gland Committee of the American Academy of Otolaryngology-Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. Methods:Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. Results:A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. Conclusion:Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.

Abstract Objective Identify trends in swallowing outcomes in p16+ oropharyngeal squamous cell carcinoma following neoadjuvant chemotherapy+surgery (NAC+S) versus neoadjuvant chemotherapy+surgery+radiation (NAC+S+R). Study Design Cohort study. Setting Single academic institution. Methods Swallowing outcome was measured using a validated questionnaire, MD Anderson Dysphagia Inventory (MDADI). MDADI scores were compared between NAC+S and NAC+S+R groups in short‐term (<1 year), middle‐term (1‐3 years), and long‐term (>3 years). Clinical factors associated with MDADI scores were explored using a linear mixed model. Statistical significance was established at p < .05. Results Sixty‐seven patients met the inclusion criteria and were divided into 2 groups: NAC+S (57 [85.1%]) and NAC+S+R (10 [14.9%]). All patients had improved MDADI scores in the middle‐term compared to short‐term (NAC+S: score increase = 3.43, p = .002; NAC+S+R: score increase = 11.18, p = .044), long‐term compared to short‐term (NAC+S: score increase = 6.97, p < .001; NAC+S+R: score increase = 20.35, p < .001), and long‐term compared to middle‐term (NAC+S: score increase = 3.54, p = .043; NAC+S+R: score increase = 9.18, p = .026). NAC+S patients had better MDADI scores than NAC+S+R patients at short‐term (83.80 vs 71.26, p = .001). There was no significant difference in swallowing function in the middle‐term or long‐term. Conclusion Regardless of treatment type, swallowing will likely be improved in the middle‐term and long‐term compared to the short‐term. Patients treated with NAC+S+R will have worse short‐term swallowing function. However, in the middle‐term and long‐term, there is no significant difference in swallowing function between patients treated with NAC+S and NAC+S+R.

Treatment of patients with newly diagnosed HPV‐associated oropharyngeal squamous cell carcinoma (OPSCC) with neoadjuvant chemotherapy (NAC) results in a high rate of 5‐year recurrence free survival with few patients requiring adjuvant treatment. We hypothesized that NAC enhances primary tumor HPV‐specific T cell responses.

Objectives Microvascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti‐fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes. Methods Retrospective review of reconstruction for IFS (2010–2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed. Results Twenty‐seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing. Conclusion Patients with maxillectomy defects from IFS can undergo microvascular‐free flap reconstruction with good outcomes while on anti‐fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing. Level of Evidence 4 Laryngoscope , 134:1642–1647, 2024

L'utilisation de l'intelligence artificielle (IA) dans la recherche médicale est en constante augmentation. Cet article explore le rôle de l'utilisation de ChatGPT, un modèle de langage développé par OpenAI, dans la rédaction d'articles scientifiques médicaux. Le matériel et la méthode utilisés comprenaient une analyse comparative des articles scientifiques médicaux produits avec et sans l'utilisation de ChatGPT. Les résultats indiquent que l'utilisation de ChatGPT peut être un outil utile pour les scientifiques pour augmenter la production d'articles scientifiques médicaux de qualité supérieure, mais il est important de noter que l'IA ne peut pas remplacer complètement les auteurs humains. En conclusion, les scientifiques devraient considérer ChatGPT comme un outil supplémentaire pour produire des articles scientifiques médicaux de haute qualité plus rapidement.The use of artificial intelligence (AI) in medical research is on the rise. This article explores the role of using ChatGPT, a language model developed by OpenAI, in writing medical scientific articles. The material and methods used included a comparative analysis of medical scientific articles produced with and without the use of ChatGPT. The results suggest that the use of ChatGPT can be a useful tool for scientists to increase the production of higher quality medical scientific articles, but it is important to note that AI cannot fully replace human authors. In conclusion, scientists should consider ChatGPT as an additional tool to produce higher quality medical scientific articles more quickly.

OBJECTIVE:Previous studies have highlighted the poor survival of patients with cutaneous angiosarcoma of the head and neck. Therapeutic options are limited, and effective treatment strategies are yet to be discovered. The objective of this study is to evaluate overall survival following intensified adjuvant treatment for high-risk resected angiosarcoma of the head and neck.STUDY DESIGN:Retrospective observational.SETTING:National Cancer Database (NCDB).METHODS:Patients diagnosed with nonmetastatic cutaneous angiosarcoma of the head and neck from 2004 to 2016 were identified by NCDB. We retrospectively compared demographics and overall survival between patients who received surgery and radiation therapy (SR) and patients who received surgery and chemoradiation (SRC). The χ2 test, Kaplan-Meier method, and Cox regression models were used to analyze data.RESULTS:A total of 249 patients were identified, of which 79.5% were treated with surgery and radiation alone and 20.5% were treated with surgery and chemoradiation. The addition of chemotherapy, regardless of the sequence of administration, was not associated with significantly higher overall survival. Factors associated with worse survival in both groups included positive nodal status and positive margins. Patients with positive nodes had higher overall survival with radiation doses >50.4 Gy compared to ≤50.4 Gy (hazard ratio: 2.93, confidence interval: 1.60-5.36, p < 0.001).CONCLUSION:Adjuvant chemotherapy was not significantly associated with higher overall survival for resected nonmetastatic angiosarcoma of the head and neck. Higher radiation doses appear to be prognostic for high-risk diseases.

Introduction: Locoregionally advanced p16+ squamous cell carcinoma of the oropharynx (OPSCC) is most often treated either with primary chemoradiation (CRT) or surgery followed by adjuvant treatment. Surgery alone is often insufficient treatment as adverse features such as extranodal extension, close or positive margins, lymphovascular invasion, or multiple positive lymph nodes are often identified, resulting in the need for adjuvant radiation or CRT. Primary surgery is often not pursued in more advanced cases since surgical pathology may show adverse features requiring adjuvant CRT, resulting in "triple therapy", the effects of which may worsen risk of long-term treatment toxicity. Our institution has demonstrated excellent oncologic and quality of life outcomes using a neoadjuvant chemotherapy (NAC) regimen of cisplatin and docetaxel prior to surgical treatment with TORS and neck dissection. Due to high rates of clinical-to-pathologic downstaging, adjuvant treatment is often avoided entirely. Here, we explore whether the development of a complete pathologic (pCR) response following NAC associates with 2-year recurrence free survival. Methods: A retrospective cohort study of patients receiving neoadjuvant doublet cisplatin and docetaxel followed by surgery (NAC+S) at a single institution between October 2015 and March 2023 was performed and pathologic responses and 2-year recurrence free survival was recorded following IRB exemption. Results: Fifty-four patients with p16+ OPSCC treated with NAC+S were identified. 49 patients (91%) received three cycles of NAC; 5 patients (9%) received two cycles. Comparing clinical staging to pathologic analysis of surgical specimens, 40 of 54 patients (68%) experienced clinical-to-pathologic downstaging after NAC. A pCR was identified in 23 of 54 patients (43%). Of patients that did not develop a pCR, 9 of 31 patients (29%) received adjuvant treatment due to the identification of high-risk pathologic features. Of patients that developed a pCR, 1 of 23 (4%) developed disease relapse within 2 years. Of patients that did not develop a pCR but did not require adjuvant treatment, 2 of 22 (9%) developed disease relapse within 2 years. Of patients that did not develop a pCR but did require adjuvant treatment, 2 of 9 (22%) developed disease relapse within 2 years. A trend toward reduced risk of disease relapse was observed in patients that develop a pCR following NAC compared to those that do not but did not reach statistical significance (1 of 23 relapses with pCR, 4 of 31 relapses without pCR; P>0.05, two-sided Chi-square test). Conclusion: High rates of pCR following NAC were observed in this small retrospective cohort of patients with newly diagnosed p16+ OPSCC despite 84% of patients avoiding any adjuvant treatment. Patients that develop a pCR after NAC trend toward reduced risk of recurrence compared to those that do not. The development of pCR after NAC may be a suitable short-term clinical outcome measure in prospective clinical trials of NAC for patients with newly diagnosed p16+ OPSCC. Citation Format: Alisha R. Pershad, Maxwell Madani, Timothy B. Shaver, Arjun Joshi, Clint T. Allen, Joseph F. Goodman. Complete pathological response following neoadjuvant chemotherapy and recurrence free survival in patients with p16-positive oropharyngeal cancer [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr PO-066.