Most patients with ISS can be managed endoscopically, and IDI may be increased with steroid injection. Gastroesophageal reflux disease is a common co-morbidity. Body mass index did not change over time despite potential effects on exercise tolerance; BMI did not affect IDI. Methods to determine optimal timing for next intervention are warranted.

Objectives To determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy. Study Design Retrospective case series with chart review. Setting Five academic tertiary care centers. Subjects and Methods Patients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence. Results A total of 102 patients were included (76% OCSCC, 24% OPSCC). Five-year overall survival was 31% (95% CI, 21%-41%) and was significantly improved among patients with human papillomavirus–associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95% CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95% CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95% CI, 1.94-17.01). Twenty-five patients (25%) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control. Conclusion Patients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.

Background Diabetes mellitus (DM) is a risk factor for surgical complications and a common comorbidity in the setting of head and neck (H&N) cancer. Our objective was to determine if DM is associated with increased rates of H&N cancer surgery complications. Methods We conducted a search of Pubmed, Embase, and the national clinical trials database focusing on H&N cancer surgery or free flap reconstruction and diabetes. Two reviewers screened studies by title/abstract and then full text. We then collected data using a pre‐made template. Meta‐analysis was performed using Revman 5.3. Results Of the 272 results from Pubmed and 559 from Embase, we selected 16 studies for inclusion. Meta‐analysis revealed DM was associated with increased rates of flap failure (risk ratio [RR] = 1.83 95% confidence interval [CI], 1.18‐2.85; P = .007) and local complications (RR = 1.87 95% CI, 1.24‐2.80; P < .00001). Conclusion Although DM is associated with increased risk of flap failure and local H&N cancer surgery complications, further research is required to optimize care in this population.

Patient: Male, 59Final Diagnosis: Emphysematous epiglottitisSymptoms: Dysphonia • odynophagia • sore throatMedication: —Clinical Procedure: Direct laryngoscopy with incision and drainage of abscessSpecialty: OtolaryngologyObjective:Rare diseaseBackground:Despite a shift in the epidemiology of epiglottitis following the introduction of the Haemophilus influenzae type B vaccine, acute infectious epiglottitis continues to be a relatively common and potentially life-threatening infection in adults. Epiglottitis complicated by abscess is rare, and emphysematous abscess is even less common. Early diagnosis and intervention is paramount in reducing morbidity and mortality. Although case reports exist, photographic depiction of this complication is not readily available.Case Report:We present the case of a 59-year-old male with rapidly progressive emphysematous epiglottitis managed with awake fiber optic intubation followed by incision, drainage, and antibiotic therapy. Early recognition and intervention in this patient led to complete resolution of the infection, with no long-term sequelae.Conclusions:Clinicians should be familiar with the radiographic and endoscopic findings which support an emphysematous abscess, as well as the treatment and airway management concerns in such cases.

No abstract