Polysomnography may be used to predict which patients are at higher risk for adverse respiratory events after adenotonsillectomy. Such knowledge is valuable for planning optimal postoperative management and intraoperative anesthesia. Predictors of increased respiratory complications include apnea-hypopnea index, hypopnea index, body mass index, and nadir oxygen saturation.

Background Complement plays a major role in inflammatory diseases but its involvement and mechanisms of activation in chronic rhinosinusitis (CRS) are not known. Objectives Following earlier studies discovering autoantibodies in CRS, we sought to investigate the nature, extent, and location of complement activation in nasal tissue of patients with CRS. Specifically, we were interested in whether antibody-mediated activation via the classical pathway was a major mechanism for complement activation in CRS. Methods Nasal tissue was obtained from patients with CRS and control patients. Tissue homogenates were analyzed for complement activation products (ELISA-C5b-9, C4d, activated C1 and C5a) and major complement fixing antibodies (Luminex). Tissue sections were stained for C5b-9, C4d, and laminin. Antibodies were purified using protein A/G columns from nasal polyps (NP), matching patient serum and control serum, and assayed for basement membrane binding via ELISA. Results C5b-9 was significantly increased in NP tissue compared to UT (uncinate tissue) of CRS with NP (CRSwNP) and CRS without NP (CRSsNP) (p<0.01). Similarly, C4d was increased in NP compared to UT of CRSwNP, CRSsNP and control (p<0.05). Activated C1 was also increased in NP tissue compared to UT of CRSsNP and control (p<0.05) and was correlated with C5a (p<0.01), local immunoglobulins, especially IgM (p<0.0001) and anti-dsDNA IgG (p<0.05). Immunofluorescence showed that C5b-9 and C4d deposition occurred linearly along the epithelial basement membrane. NP tissue extracts had significantly more anti-basement membrane antibodies than sera from CRSwNP and control patients (p<0.0001). Conclusion C5b-9, C4d and activated C1 were significantly increased locally in NP tissue. C5b-9 and C4d were almost universally deposited linearly along the basement membrane of NP tissue. Furthermore, activated C1 was best correlated with local immunoglobulin levels and C5a levels. Together, these data suggest that the classical pathway plays a major role in complement activation in CRS.

Purpose of review This article reviews recently described techniques used to reconstruct lip defects. Emphasis is placed on the ability of these flaps to restore function and appearance of the lips as well as their limitations. Recent findings The focus of recent advances in lip reconstruction has been to achieve better oral competence, speech and improved cosmetic appearance. New modifications to the traditional Karapandzic and Abbé flaps have expanded their uses. A host of novel local tissue transfer techniques has become available with improved outcomes and less morbidity. Similarly, new free tissue transfer methods have allowed for the creation of a more normal appearing lip with improved sensory and motor function. Although still experimental, tissue engineering of a mucocutaneous junction shows promise in its ability to recreate a normal vermillion. Summary Lip reconstruction techniques have continued to become more sophisticated in order to achieve better functional and cosmetic outcomes after resection. Several new local tissue and free tissue transfer techniques have recently been described and can be included in contemporary reconstruction algorithms.

Despite advancements in protocols, a subset of melanocytic lesions continues to pose diagnostic challenges. This is particularly true in the pediatric population where certain congenital nevi mimic melanoma. Recently, comparative genomic hybridization (CGH) has been utilized to support diagnoses of melanocytic lesions based on DNA copy number changes. Because distinct differences in copy number changes have been shown to occur in malignant melanoma and benign nevi, CGH can be a useful adjunct when diagnosis based on histology alone is indeterminate. The authors discuss the benefits of using CGH to aid in the diagnosis of melanocytic lesions that are difficult to characterize as malignant or benign based on clinical and histologic features alone. This paper presents a brief clinical report and review of the literature. A 13-year-old Caucasian male presented to an academic tertiary care medical center after a shave biopsy unexpectedly revealed malignant melanoma with positive deep margins. Following complete excisional biopsy, the diagnosis of malignant melanoma with depth of 0.92 mm was confirmed, both by the home institution's pathologist and by consultant dermatopathologists at two separate academic tertiary medical centers. Sentinel lymph node biopsy revealed a small focus of metastatic melanoma, this lead to a left-sided modified radical neck dissection. All nodes removed were negative for disease, and surgical and postsurgical care was uncomplicated. Before proceeding with interferon therapy, CGH was performed on the tissue from the primary lesion. Other than a slight amplification of chromosome 16p, no other aberrations were detected favoring a benign lesion. Ultimately, the diagnosis was amended to compound melanocytic nevus of the nose with benign nevus cell rest in the sentinel node. While histopathologic evaluation is the current gold standard for the diagnosis of melanoma, there are many cases where it is inaccurate. The use of CGH in the evaluation of histologically equivocal lesions may allow certain patients to avoid invasive procedures and associated morbidities. The authors propose that, in these select diagnostically challenging cases, tissue analyses by CGH may be beneficial before proceeding to more invasive procedures such as sentinel node biopsy and complete lymphadenectomy.

Objective/Hypothesis The objective of this study was to perform a systematic review and meta‐analysis to determine the impact of dental care on head and neck (H&N) cancer survival. Methods A comprehensive literature search was performed using PubMed, MEDLINE, and CINAHL to find all relevant studies from the date of inception to March 2020. Systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, and meta‐analysis was performed using the random effects logistic regression model. Primary outcomes of interest were 5‐year survival and hazard ratios comparing survival between dental care subgroups. Results H&N cancer survival rates strongly correlate with dental care adherence. Patients with good dental care had significantly better survival than patients with poor dental care (HR = 0.67, 95% CI: 0.55–0.83), with similar improved survival among patients with moderate versus poor dental care (HR = 0.67, 95% CI: 0.57–0.80). In addition, patients with good dental care had significantly decreased mortality than those with moderate dental care (HR = 0.81, 95% CI: 0.69–0.96), indicating an exposure‐response gradient. Conclusions For patients with H&N cancer, survival is significantly higher in those who receive recommended dental care compared with those who do not. Level of Evidence NA Laryngoscope, 132:45–52, 2022