Objective/Hypothesis This study aimed to determine the incidence of facial pressure injuries associated with prone positioning for COVID‐19 patients as well as to characterize the location of injuries and treatments provided. Methods This was a retrospective chart review of 263 COVID‐19 positive patients requiring intubation in the intensive care units at MedStar Georgetown University Hospital and MedStar Washington Hospital Center between March 1st and July 26th, 2020. Information regarding proning status, duration of proning, presence, or absence of facial pressure injuries and interventions were collected. Paired two‐tailed t‐test was used to evaluate differences between proned patients who developed pressure injuries with those who did not. Results Overall, 143 COVID‐19 positive patients required proning while intubated with the average duration of proning being 5.15 days. Of those proned, 68 (47.6%) developed a facial pressure injury. The most common site involved was the cheek with a total of 57 (84%) followed by ears (50%). The average duration of proning for patients who developed a pressure injury was significantly longer when compared to those who did not develop pressure injuries (6.79 days vs. 3.64 days, P < .001). Conclusions Facial pressure injuries occur with high incidence in patients with COVID‐19 who undergo prone positioning. Longer duration of proning appears to confer greater risk for developing these pressure injuries. Hence, improved preventative measures and early interventions are needed. Level of Evidence 4 Laryngoscope, 131:E2139–E2142, 2021

Objectives/Hypothesis Prone positioning is frequently used in patients intubated for COVID‐19‐related lung injury to improve oxygenation. At our institution, we observed severe tongue edema develop in some of these patients. Hence, we sought to determine the incidence of tongue edema in this cohort and whether prone positioning was a risk factor associated with this complication. Study Design Retrospective cohort study. Methods A single‐system retrospective cohort study of patients intubated for respiratory failure secondary to COVID‐19 who subsequently developed clinically notable tongue edema from March 13 to July 5, 2020. Results 260 patients were intubated for COVID‐19‐related respiratory failure during the study period. 158 patients (60.8%) underwent at least one episode of proning. Twelve patients in total (4.6%) developed clinically significant tongue edema. Eleven of the twelve patients (91.7%) who developed tongue edema underwent proning prior to the development of edema. Prone positioning was associated with an increased incidence of tongue edema (odds ratio [OR] 7.56, 95% confidence interval [CI] 0.96–59.46, P = .027). In all proned patients who developed edema, this complication was noted during proning or shortly after supination (range, 0–4 days). Tongue edema was primarily managed with conservative measures; one patient required tracheostomy for definitive management. Conclusions Tongue edema appears to develop in a subset of patients with COVID‐19 who are intubated. It appears to be associated with prone positioning but is likely multifactorial in nature. Further investigation into its incidence and pathophysiology is warranted. Level of Evidence 4 Laryngoscope , 2021

Background: Higher body mass index (BMI) may have a protective effect on survival in patients with head and neck cancer. The aim of this study was to determine the effect of BMI on overall survival (OS) in veterans with head and neck squamous cell carcinoma (HNSCC).Methods: A cohort of 702 patients diagnosed with HNSCC between 1995 and 2019 were identified at the Washington DC Veterans Affairs Medical Center, and 342 patients were included for analysis. Records were queried for clinicaldemographic data, BMI, and outcomes. Results: HNSCC patients categorized as overweight or obese at time of diagnosis had a lower 3-year risk of death (p = 0.033) and improved OS (p < 0.001) compared to patients who were underweight or normal weight. The majority of locoregional recurrences occurred in patients with low or normal pretreatment BMI. Conclusions: Higher BMI at diagnosis may have a protective effect on OS in veterans with HNSCC.

Objective: To describe the surgical management of temporomandibular joint (TMJ) herniation with external auditory canal (EAC) reconstruction using autologous bone grafting from the mastoid cortex. Study Design: Retrospective case series. Setting: A tertiary university medical center. Patients: Three patients who presented to our Otolaryngology clinic with evidence of TMJ herniation through an anterior EAC defect, both on otoscopy and computed tomography (CT) imaging. Interventions: Reconstruction of the anterior EAC with mastoid cortex bone grafting using an endaural approach. Main Outcome Measures: Successful reconstruction of anterior EAC bony defect without recurrence of herniation. Results: All three patients presented with otalgia, hearing loss, and either tinnitus or a clicking sensation with jaw movement. Etiologies for TMJ herniation included osteoradionecrosis following external beam radiation therapy for head and neck carcinoma and iatrogenic injury following multiple tympanoplasties and canalplasties. A mastoid cortex bone graft was placed and secured anterior to the bony EAC defect through an endaural approach. Two patients wore a dental retainer postoperatively to keep the condyle in an open position. After reconstruction, patients reported an improvement in their presenting symptoms. There was no recurrence of TMJ herniation in all cases after 1, 4, and 9 years. Conclusions: Anterior EAC reconstruction with autologous bone grafting can be an effective definitive treatment in TMJ herniation. To our knowledge, this is the first report of the use of bone grafting to reconstruct the canal defect in TMJ herniation. Level of Evidence: V.

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