Reconstruction of cutaneous nasal defects following resection of sinonasal malignancies remains a complex surgical challenge because of the nose’s intricate anatomy and its critical aesthetic and functional roles. Multiple reconstructive options are available to restore nasal integrity; however, no universally accepted optimal approach exists. This review summarizes contemporary approaches to oncologic nasal reconstruction using local, regional, and free flaps, with emphasis on the aesthetic subunit principle as the foundation of surgical planning. Reconstructive decision-making is guided by defect size, depth, and subunit involvement, as well as patient-specific factors such as comorbidities, prior irradiation, and the anticipated need for adjuvant therapy. Local and regional flaps, including the nasolabial flap and the paramedian forehead flap, are preferred for small to moderate cutaneous nasal defects, whereas free flaps, particularly the radial forearm flap, provide reliable solutions for extensive composite defects. Immediate reconstruction is generally associated with superior aesthetic, functional, and psychosocial outcomes; however, delayed reconstruction may be appropriate in selected cases requiring margin surveillance or additional oncologic assessment. This review aims to provide practical insights into reconstructive decision-making based on the available literature and clinical experience, with the goal of optimizing aesthetic, functional, and oncologic outcomes in patients undergoing oncologic nasal reconstruction.

ABSTRACT Objective Combined lymphatic and venous insufficiency has been described as a consequence of lymph node dissections, but never in the context of selective neck dissections (SND). The objective of this retrospective cohort study was to compare two methods of SND: one (PEF), which preserves the facial vein (FV) and external jugular vein (EJV), and one (REF), which resects the FV and often the EJV. Methods Head and neck lymphedema was assessed with a modified external lymphedema‐fibrosis scale and with the revised Patterson Scale (internal lymphedema). The FACT‐HN questionnaire was used to assess quality of life (QoL). Regression modeling was used to determine the effect of the SND technique on lymphedema, controlling for other factors. Results A total of 79 patients were included in the analysis, with 60 (75.9%) PEF patients and 19 (24.1%) REF. There were no statistically significant differences in demographics or adjuvant therapy between the two treatment groups. The average score for QoL out of a possible 108 was 94.1 ± 10.4 for PEF and 88.3 ± 11.6 for REF (p = 0.043); regression analysis with covariates showed no significant associations with QoL (p = 0.113). REF patients were observed to have significantly higher external lymphedema scores compared to PEF patients (OR: 2.82, 95% CI: 1.00–8.02; p = 0.049). There were no significant differences in internal lymphedema scores between PEF and REF patients. Conclusion Results of this study showed resection of the FV and EJV was associated with more severe external lymphedema. A larger study that investigates differences in lymphedema between different SND techniques may therefore be warranted. Level of Evidence 3.

Importance:Actinic cheilitis is a condition of the lower lip with the potential for malignant transformation. Although many topical treatment options exist, most involve prolonged application periods with expected adverse effects that limit compliance. Objective:Trichloroacetic acid is a widely used chemical peel that has been used for the treatment of precancerous skin lesions. This study aims to study the efficacy of 35% trichloroacetic acid as a topical treatment for actinic cheilitis. Study Design:Prospective cohort study of patients with actinic cheilitis presenting to our institution between September 2020 and December 2023. After treatment completion, patients were followed twice yearly for a minimum of 2 years. Setting:Tertiary care center. Methods:All patients with actinic cheilitis presenting to an otolaryngologist-head and neck surgeon at our institution within the study time frame were eligible. Exclusion criteria include patients <18 years of age, patients who were pregnant, and patients with a biopsy-proven malignancy of the lip. A topical 35% trichloroacetic acid peel was applied to the lower lip in the minor procedure clinic following bilateral mental nerve blocks. Patients were brought back 1 month later for follow-up ± a repeat treatment. Photos were taken prior to treatment and 1 month following their final treatment. The severity of actinic cheilitis was graded using a proposed grading scale for actinic cheilitis, and the burden of the condition was assessed using Skindex-16 Surveys. Visual analog scales were used to study adverse events. Patients were monitored for remission and recurrence. Results:A total of 11 patients were enrolled, with the majority requiring one treatment to achieve clinical remission. All patients who completed their full treatment course entered clinical remission following their trichloroacetic acid treatment, and there have been no cases of recurrence to date. The most common reported side effects were redness and swelling. Patients reported a significant improvement in their quality of life following treatment. Conclusion:This study suggests that a 35% trichloroacetic acid peel is a safe, well-tolerated, and effective treatment option for patients presenting with actinic cheilitis. Further follow-up is indicated to study the longevity of the achieved results. Trial Registration:This study is registered on Clinicaltrials.gov (NCT04744103). https://clinicaltrials.gov/study/NCT04744103?locStr=Halifax,%20NS,%20Canada&country=Canada&state=Nova%20Scotia&city=Halifax&cond=actinic%20cheilitis&rank=1.

OBJECTIVE:Standard 5-mm surgical margins in the oropharynx are challenging due to the intimate relationship with neurovascular structures and patient function. De-escalation of therapy with the acceptance of close surgical margins may improve functional patient outcomes. This study assesses locoregional recurrence with initial close (≤2 mm) margins following transoral surgery for p16+ oropharyngeal squamous cell carcinoma (SCC) with or without re-resection and adjuvant therapy. STUDY DESIGN:Retrospective cohort study. SETTING:Canadian tertiary care center. METHODS:Retrospective chart review of all patients who underwent transoral robotic surgery or transoral laser microsurgery with curative intent for p16+ oropharyngeal SCC and had ≤2 mm initial surgical margins with or without re-resection and adjuvant therapy between January 2019 and December 2023. The primary outcome was 2-year locoregional control. RESULTS:In total, 80 patients were included; 54 had a 2-year follow-up available. Initial margins were close (≤2 mm) in 44 patients (55%) and positive in 34 patients (42.5%). Re-resection was performed in 67 patients (83.8%). Following re-resections, three patients (3.8%) had positive margins and 77 (96.2%) had close or clear margins. Deep margins were most involved (67.5%). In total, 42 patients (52.5%) received adjuvant (chemo)-radiotherapy. Amongst the 54 patients eligible for 2-year follow-up, one had regional recurrence at 18 months postsurgery, resulting in a 2-year locoregional control rate of 98.1%. CONCLUSION:p16+ oropharyngeal SCC with close initial surgical margins results in low locoregional recurrence rates. Intraoperative re-resection with acceptance of close surgical margins may be an effective strategy to preserve both oncologic safety and functional outcomes.

AbstractObjectiveCarotid body tumors (CBTs) are rare neoplasms of the paraganglia at the carotid bifurcation. While typically benign, CBTs occasionally exhibit malignancy, metastasizing to nearby lymph nodes. Histopathologic analysis alone is insufficient to confirm malignancy, requiring metastases to non‐neuroendocrine tissue for a definitive diagnosis. The role of selective neck dissections (SNDs) in detecting malignancy and guiding subsequent management remains uncertain.MethodA retrospective case series through electronic chart review was performed on 21 patients undergoing CBT surgeries between 2002 and 2022 at a Canadian institution. SNDs were performed on all 21 patients. Data collection included patient demographics, genetic and laboratory testing results, preoperative imaging, intraoperative and postoperative complications, histologic analysis of neck SND and tumor specimen, and follow‐up results.ResultsOf the 21 surgical resections, there were three cases (14.3%) of carotid artery injuries and six cases (28.6%) of nerve injuries. One patient (4.8%) experienced three intraoperative strokes. Three patients (14.3%) were found to have lymph node involvement, confirming malignancy, and underwent further treatment with radiotherapy. Interestingly, two patients with carotid injuries had malignant tumors, demonstrating a statistical significance between carotid injury and malignancy (OR 34.00, 95% CI: 1.48, 781.83, p = .041).ConclusionSNDs are a useful adjunct in detecting malignancy during CBT surgeries. The incidence of malignancy in CBT is low but not negligible, and SND should be considered in patients to prevent inadvertent underdetection of metastatic disease. This study's 14.3% incidence of malignancy suggests that there may be a rationale for considering the universal implementation of SND during CBT resections.Level of Evidence4.

Importance There is a limited understanding of anterior commissure (AC) involvement in glottic squamous cell carcinoma (SCC), particularly when comparing T1b, T2a with AC involvement (T2AC), and T2a without AC involvement (T2noAC).Objective The aim of this study was to compare oncological and functional outcomes in T1b, T2AC, and T2noAC glottic SCC following transoral laser microsurgery (TLM).Design Retrospective chart review.Setting The Queen Elizabeth II Health Science Centre (Halifax, Nova Scotia) from January 1, 2002, to December 31, 2022.Intervention and Exposures A retrospective chart review was completed using prospectively-collected data for patients treated with TLM for T1b and T2a glottic SCC. Exclusion criteria included previous treatment for a laryngeal cancer and T2b glottic SCC.Main Outcome Measures Oncological outcomes were assessed using margin status, local control (LC), disease-specific survival (DSS), overall survival (OS), and laryngeal preservation (LP). Functional outcomes were measured using the abbreviated Voice Handicap Index-10 (VHI-10).Results In total, 117 patients were included (T1b = 46, T2AC = 53, T2noAC = 18). Positive margins were higher in the T2AC group (15.1%) than in T1b (4.3%) and T2noAC (5.6%; P = .208). At 5 years, there were no significant differences in LC (T1b = 80.8%, T2AC = 70.3%, T2noAC = 76.2%; P = .26), DSS (T1b = 100%, T2AC = 90.2%, T2noAC = 93.8%; P = .45), OS (T1b = 88.3%, T2AC = 76.1%, T2noAC = 93.8%; P = .69), or LP (T1b = 94.3%, T2AC = 92.1%, T2noAC = 94.4%; P = .74). Significant improvements in VHI-10 scores from the pre- to postoperative period were only noted in the T1b cohort, at the 6 months (P = .017) and the 12 months (P = .00143).Conclusions No significant differences in both oncological and functional outcomes were noted between T1b, T2AC, and T2noAC glottic SCCs. Further stratifying based on the degree and pattern of AC involvement with larger sample sizes may provide important prognostic factors.Relevance This study highlights that T2 glottic SCCs with normal vocal fold mobility are a heterogenous group, and it may be beneficial to further stratify these cancers according to AC involvement, particularly when considering TLM.

OBJECTIVE:Orbital exenteration (OE) impacts patients cosmetically, functionally, and psychosocially. Eye-sparing strategies with the advent of immunotherapy have developed the potential to avoid OE but may result in suboptimal oncologic outcomes and reduced survival. This study assesses patients' perceptions regarding quantity versus quality of life when considering OE compared to alternative treatment modalities. STUDY DESIGN:Mixed-methods study, utilizing quantitative health utility tasks and qualitative patient interviews. SETTING:Tertiary care center. METHODS:Fifty-one patients previously treated for head or neck cutaneous malignancies completed interviews utilizing well-established methodology to assess health state utility values (HSUVs) through time trade-off and standard gamble tasks. This methodology assessed the level of risk patients would be willing to accept to avoid OE in the context of alternate treatment options. Open-ended discussions regarding factors influencing decision-making facilitated an inductive qualitative analysis highlighting patient priorities. RESULTS:Patients were willing to accept 40.6% ± 28.7% risk of death or give up 3.2 ± 2.8 years of survival to avoid OE. This translated to an HSUV for OE of 0.68. The main factors influencing treatment decisions were (1) family, (2) healthcare perceptions, (3) age, (4) social consequences, and (5) risk tolerance. CONCLUSION:The consequences of OE on patients' quality of life impact their decision-making. Patients may be willing to accept relatively high levels of risk to avoid OE. This highlights the importance of eye-sparing strategies and shared decision-making to ensure patient-centered care, which may not be solely prioritized to survival when it comes to OE.

PURPOSE OF REVIEW:This review highlights recent advances in facial reanimation surgery particularly related to muscle transposition and free functional muscle transfer (FFMT). RECENT FINDINGS:FFMT and muscle transposition are mainstays in the treatment of chronic facial paralysis. Recent literature evaluates single versus dual innervated FFMT, reanimation of the periocular region and lower lip depressors, and indications for such methods over gold standard FFMT techniques. New donor sites for muscle transposition and FFMT are also described. SUMMARY:Gracilis FFMT (GFMT) continues to be the gold standard in dynamic facial reanimation for patients with chronic facial paralysis. Muscle transposition should be considered in older patients, those medically unfit for long operative procedures, and individuals who prefer more immediate results. With respect to FFMT, described nerve coaptation patterns, surgical stages, and donor muscle choice vary. Standardization of data reporting and outcome measures is needed in future studies.

Background: Delays in starting postoperative radiotherapy (PORT) have been established as negative predictors for clinical outcomes in head and neck squamous cell carcinomas (HNSCC). Our study aimed to examine the effect of delays during PORT, and the impact of national holidays in Canada, a publicly funded system, on oncologic outcomes such as Overall Survival (OS) and Local Recurrence (LR). Methods: The provincial cancer registry was queried to obtain demographic, pathologic, and outcomes data from cancer patients treated for all squamous cell carcinomas of the head and neck region treated between January 1, 2007 and November 30, 2019. All extracted information was cross-referenced and supplemented by chart review of patient electronic medical records. Extracted data were analyzed for OS and LR, in the context of Canadian national holidays causing delays during PORT. Results: 1433 patients treated for HNSCCs were identified, of whom 338 were treated curatively with surgery followed by PORT. 68.6% of patients experienced at least one day of interruption during treatments due to holidays. LR was 15.4% and OS was 59.6% at 5 years. Treatment interruptions by holidays were predictive of local recurrence (HR, 2.38; 95% CI 1.17-4.83; p = 0.017). Patients that developed early recurrence prior to PORT had very poor oncologic outcomes. Conclusion: Our findings were consistent with previously published studies in limiting the interval between surgery and PORT. We identified the novel finding of paired holidays as a significant predictor in determining LR, suggesting the importance of modifying RT delivery schedules and timing.

Purpose/Objective(s) To determine the pattern of relapse, outcomes, and predictors of patients with head and neck squamous cell carcinoma (HNSCC), treated with surgery who had evidence of early recurrence prior to postoperative radiotherapy (PORT). Materials/Methods A retrospective review was performed for patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, hypopharynx, and nasal cavity (HNSCC), treated with curative intent surgery followed by PORT, with or without systemic therapy between 2007 and 2019. Patients were classified into 3 groups: (1) Early recurrence patients, who presented with recurrence at either the primary site, or the neck, before or shortly after planned PORT started, (2) Later recurrence patients, who recurred locoregionally, after completing PORT, with no evidence of recurrence before or during PORT, and (3) patients who, during and after PORT, had no evidence of local recurrence. Multivariable analysis (MVA) was performed to identify predictors of early recurrence, local recurrence, and overall survival (OS). Results Three hundred and thirty-eight patients were treated with surgery followed by PORT; 33 patients (9.76%) had early recurrence before PORT. On MVA, smoking (at any time) (OR, 3.916 (1.539-9.967); p = 0.0102), N category (pN3, OR 2.956 (1.427-6.126); p<0.0001), perineural invasion (OR 2.180 (1.219-3.899); p = 0.0086) and increasing time from surgery to starting radiotherapy (OR 1.316(1.181-1.467); p<0.0001), were predictive of early recurrence. The local recurrence rate in patients with early recurrence was 60.5% (95% CI = 39.3-76.4%) at 5 years, compared to 15.6% (95% CI =11.6-20.2%) in patients who did not have early recurrence. The five-year OS for patients with early recurrence, later recurrence, or no local recurrence was 15.3% (95% CI = 4.9-31.1%), 16.5% (95% CI = 7.1-29.2%) and 69.8% (95% CI = 63.3-75.4%), respectively (p<0.0001). Conclusion Patients with early recurrence have significantly higher rates of local failure, distant metastases, and poor overall survival, compared to patients without early recurrence. Treatment paradigms investigating strategies to improve local failure and distant failure appear warranted in this unique patient group.

Background: Primary mucosal melanoma of the larynx is an extremely rare entity. Our case represents the seventeenth case reported to date globally, and the first Canadian case to be reported. Case presentation: We present the case of a 70-year-old male who was referred for hoarseness and found to have a T3N0M0 glottic mucosal melanoma involving the left true vocal cord. The laryngeal tumour was resected via a transoral laser microsurgery approach with a CO2 laser, wherein an extended partial laryngectomy with negative margins was achieved. There were no regional or distant metastases. Mucosal melanoma is a rare, but an aggressive malignancy as it is generally discovered at an advanced stage. Herein we present our diagnostic, treatment, and post-operative follow-up approaches. Conclusion: Owing to the rarity of mucosal melanoma, especially of the larynx, we believe additional reported cases to the literature will contribute to better understanding of this malignancy and improve treatment strategies.

BackgroundEffective nasal reconstruction requires skin and soft tissue cover, cartilage or bone structure, and mucosal lining. Ideal lining is thin, pliable and vascularised, making reconstruction challenging. This paper presents the first case series with long-term outcomes of pericranial flaps used as inner lining for nasal reconstruction. MethodsPatients undergoing paramedial forehead flaps from 2007 to 2019 were identified using second-stage nasal reconstruction billing codes. Patients with pericranial flaps for lining, for whom there were data on resulting outcomes and complications, were identified. ResultsSixty-six patients underwent second-stage nasal reconstruction. Eighteen patients had paramedian forehead and pericranial flaps for inner lining reconstruction. The flap lining had no immediate post-operative complications. Three patients suffered partial to major reconstructive failure post radiotherapy. Other complications included nasal stenosis and orocutaneous fistula. ConclusionCombined with paramedian forehead flaps, the pericranial flap is reliable as inner lining for nasal reconstruction. It is easily accessible and useful in resections with limited mucosal options.

Abstract Objectives The current literature provides limited guidance on the management of positive margins (PMs) following transoral laser microsurgery (TLM) for glottic squamous cell carcinoma (SCC). Long‐term data exploring the treatment of PMs with both initial observation and re‐resection are limited. Our objective was to determine the optimal treatment for PM patients following TLM for glottic SCC. Methods Clinical information on glottic SCC patients with PMs following treatment with TLM was prospectively collected at our institution from 2007 to 2018. We use a laryngeal template during the initial TLM where the area of resection is outlined for future reference. Data were compared with univariate analysis and survival plots were generated using the Kaplan–Meier method. Results A total of 29 patients with PMs were treated with either re‐resection (19 patients), close observation (6 patients), or adjuvant radiation alone (4 patients). Re‐resection patients had SCC or severe dysplasia on initial margin pathology and 23% with early‐stage disease had recurrence (T1–T2). Five (83%) patients who underwent close observation required re‐resection based on clinical suspicion of recurrence (confirmed on final pathology), which was significantly different from the re‐resection patients (p < .05). Close observation was therefore discontinued as a management of PMs. Four patients (21%) had no residual malignancy on re‐resection specimens. Deep margins only accounted for 17% of all PMs. Disease‐specific survival for all PM patients at 5 years was 82.4% (SE 9.6%, CI 53.4%–91.6%). Conclusions Our long‐term experience with treating early‐stage glottic SCC with TLM supports re‐resection as an appropriate management for cases of PMs. Level of Evidence 4.

Background Stage T4a cancers are associated with a 5-year survival of 21.6–59.0%. Adequate resection of these tumors is a critical factor in maximizing survival. Tumors invading bone pose a unique challenge to intraoperative bone margin assessment. Due to processing limitations, there had been no formal standardized protocol for intraoperative bone sampling at the QEII Health Sciences Centre. These resections often involve extensive reconstruction, making salvage surgery difficult if positive margins are detected post-surgically. The purpose of this study was to assess the accuracy and frequency of intraoperative bone margin assessment during the study period and to determine survival and recurrence rates associated with positive final bone margins. Methods A retrospective chart review was conducted including patients with stage T4a head and neck cancer involving bone that underwent primary surgical resection in Nova Scotia between 2009 and 2019. Eligible patients were identified through the Cancer Care Nova Scotia registry. Exclusion criteria included patients with stage T4a tumors involving bone that did not receive primary surgical treatment with curative intent and patients with stage T4a tumors that did not invade bone. Results Of 67 patients included, 50 were amenable to intraoperative bone margin sampling while 18 had intraoperative sampling. Four patients had positive intraoperative margins and one had final positive bone margins. The incidence of final bone margin positivity was 7.5%. Median survival following surgery was 4.56 years for patients with final negative bone margins (n = 62) and 3.98 years for patients with positive final bone margins (n = 5). All patients with final positive bone margins received adjuvant radiation therapy. Of patients with negative final bone margins, 16.1% received no adjuvant therapy, 61.3% received adjuvant radiation therapy and 21.0% received adjuvant chemoradiation therapy. Conclusion Intraoperative bone margin sampling occurred in 26.8% of all cases and 36.0% of amenable cases. Median survival of patients with positive final bone margins was 0.58 years lower than those with negative final bone margins, although this difference did not reach statistical significance. This will provide baseline data for comparison of the standardized intraoperative bone margin sampling protocol implemented at the QEII Health Sciences Centre. Graphical Abstract

Background:Opioid abuse is widespread in North America and the over-prescription of opioids are a contributing factor. The goal of this prospective study was to quantify over-prescription rates, evaluate postoperative experiences of pain, and understand the impact of peri-operative factors such as adequate pain counseling and use of non-opioid analgesia. Methods:Consecutive recruitment of patients undergoing head and neck endocrine surgery was undertaken from January 1st 2020 to December 31st 2021 at four Canadian hospitals in Ontario and Nova Scotia. Postoperative tracking of pain levels and analgesic requirements were employed. Chart review and preoperative and postoperative surveys provided information on counseling, use of local anesthesia, and disposal plans. Results:A total of 125 adult patients were included in the final analysis. Total thyroidectomy was the most common procedure (40.8%). Median use of opioid tablets was 2 (IQR 0-4), with 79.5% of prescribed tablets unused. Patients who reported inadequate counseling (n = 35, 28.0%) were more likely to use opioids (57.2% vs. 37.8%, p < .05) and less likely to use non-opioid analgesia in the early postoperative course (42.9% vs. 63.3%, p < .05). Patients who received local anesthesia peri-operatively (46.4%, n = 58) reported less severe pain on average [2.86 (2.13) vs. 4.86 (2.19), p < .05] and used less analgesia on postoperative day one [0 MME (IQR 0-4) vs. 4 MME (IQR 0-8), p < .05]. Conclusion:Over-prescription of opioid analgesia following head and neck endocrine surgery is common. Patient counseling, use of non-opioid analgesia, and peri-operative local anesthesia were important factors in narcotic use reduction. Level of evidence:Level 3.

Background Knowledge dissemination is paramount so physicians may practice the most up-to-date, evidence-based medicine to best serve their patients. Medical conferences are a commonly employed method of facilitating this. By determining the publication rate of research presented at a conference, the quality of the conference is indirectly assessed. Therefore, this study aimed to determine the publication rate, along with other conference metrics, of abstracts presented at the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) meetings from 2008 to 2018. Methods All abstracts presented at the CSOHNS Annual Meetings from 2008 to 2018 were reviewed from publicly available records. Presentation year, presentation type (i.e. oral or poster), whether each abstract was presented in the Poliquin Resident Research Competition, and the country in which the lead author's institution was located, were collected. Publication status of each abstract was then determined using a six-tiered search strategy in PubMed and Google Scholar. All data were then analyzed using SPSS Version 27.0. Results From 2008 to 2018, 1947 abstracts were analyzed, yielding an overall publication rate of 58.7%. There was a significantly increasing trend in publication rate over the 11 years (p = 0.015). The rate of publication differed based on type of presentation (oral 65.1%, poster 50.2%; p = 0.001). Most presentations were presented by a first author associated with a Canadian institution (94.4%). The top journal in which research was published was Journal of Otolaryngology- Head and Neck Surgery (37.3%). The mean impact factor of the journals in which presentations were published was 2.92. Finally, the median time to publication was 14 months (IQR: 9.0–25.0). Conclusions Research presented at 2008–2018 CSOHNS annual meetings was published in academic journals at higher rates than research at comparable conferences. Oral presentations have a significantly greater publication rate, compared to poster presentations. Additionally, the upward trend in publication rate over the 11 meetings suggests a steady increase in the quality of research being presented. Graphical Abstract

The extent to which patients with laryngeal trauma undergo investigation and intervention is largely unknown. The objective of this study was to therefore determine the association between hospital volume and processes of care in patients sustaining laryngeal trauma. This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥ 18) who sustained traumatic laryngeal injuries between 2012 and 2016 were eligible. The exposure of interest was average annual laryngeal trauma volume categorized into quartiles. The primary and secondary outcomes of interest were the performances of diagnostic and therapeutic laryngeal procedures respectively. Multivariable logistic regression under a generalized estimating equations approach was utilized. In total, 1164 patients were included. The average number of laryngeal trauma cases per hospital ranged from 0.2 to 7.2 per year. Diagnostic procedures were performed in 31% of patients and therapeutic in 19%. In patients with severe laryngeal injuries, diagnostic procedures were performed on a higher proportion of patients at high volume centers than low volume centers (46% vs 25%). In adjusted analysis, volume was not associated with the performance of diagnostic procedures. Patients treated at centers in the second (OR 1.94 [95% CI 1.29–2.90]) and third (OR 1.67 [95% CI 1.08–2.57]) volume quartiles had higher odds of undergoing a therapeutic procedure compared to the lowest volume quartile. Hospital volume may be associated with processes of care in laryngeal trauma. Additional research is required to investigate how these findings relate to patient and health system outcomes.

Flexible nasopharyngoscopy (FNP) is a specialized skill commonly used by otolaryngologists as an important component of the head and neck examination. FNP can be diagnostic and therapeutic for many head and neck pathologies. Mastering this skill facilitates the effective performance of other specialized skills and procedures such as fibreoptic nasal intubations and flexible bronchoscopies. During otolaryngology rotations and electives, medical students are exposed to a high volume of FNP. Often, they are also asked to perform this procedure in clinic and on-call. There is currently no widely available simulation tool for medical students to practice using FNP, and medical students at our institution do not receive any formal training prior to performing FNP. The following is an introductory guide for medical students to become proficient at performing FNP while on their otolaryngology rotation.

Background: Facial paralysis has profound effects on the functional and psychosocial well-being of patients. Various surgical facial reanimation techniques have been described to address this devastating condition. While traditional surgical approaches have proved successful in restoring either facial tone or facial movement, newer combination nerve transfer techniques are addressing the limitations of the traditional single nerve transfer approaches. Methods: This study aimed to describe a promising new surgical approach to facial reanimation utilizing a dual nerve transfer to maximize both resting and active symmetry while minimizing postoperative synkinesis. Here, we use the masseteric nerve to selectively innervate the midface in combination with a hypoglossal facial nerve graft to reanimate the remaining facial regions. Results: To date, we have performed this operation on four patients, all of whom tolerated the procedure well. Our patients are showing significant improvements in both resting facial tone and facial movement with no signs of synkinesis at 9 months postoperative. Conclusions: We believe this dual nerve transfer to be superior in restoring the combination of tone, symmetry, and movement to the paralyzed face when compared with traditional single nerve transfer approaches.

Objective To compare the association of margin sampling technique on survival outcomes in surgically treated cT1-2 oral cavity and oropharyngeal squamous cell carcinoma. Study Design A prospective longitudinal cohort study. Setting Tertiary care academic teaching hospital in Halifax, Nova Scotia. Methods All cases of surgically treated cT1-2 oral cavity and oropharyngeal cancer undergoing specimen-oriented margin analysis between January 1, 2017, and December 31, 2018 were analyzed. The specimen-oriented cohort was compared with a cohort of patients from January 1, 2009, to December 31, 2014, where a defect-oriented margin sampling protocol was used. Kaplan-Meier survival curves were used to estimate 2-year overall survival, disease-specific survival, local control, and recurrence-free survival rates in oral cavity and p16-positive oropharyngeal squamous cell carcinoma. Cox proportional hazards models were used to assess the effect of margin sampling method on disease-specific survival and local control. Results There was no significant association between margin sampling technique and 2-year survival outcomes for surgically treated cT1-2 oral cavity and oropharyngeal squamous cell carcinoma. In the multivariate Cox proportional hazard model, the hazard ratio (HR) of specimen-oriented sampling was not significantly different for disease-specific survival (HR, 1.32; 95% CI, 0.3032-5.727; P = .713) or local control (HR, 0.4087; 95% CI, 0.0795-2.099; P = .284). Conclusion Intraoperative margin sampling method was not associated with a significant change in 2-year survival outcomes. Despite no effect on survival outcomes, implementation of a specimen-oriented sampling method has potential for cost avoidance by decreasing the number of re-resections for positive or close margins.