Objectives Ludwig's angina is a potentially lethal submandibular space infection. We aim to describe the epidemiological characteristics of Ludwig's angina patients presenting to the emergency department (ED) and to examine outcomes and resource utilization to determine their burden on ED and hospitals. Methods Using the Nationwide Emergency Department Sample database, a nationally representative all‐payer database, we retrospectively reviewed all ED visits between 2006 and 2014 for patients admitted with a primary diagnosis of Ludwig's angina (International Classification of Diseases, Ninth Revision, 528.3). We collected information including demographics, ED and inpatient charges, airway interventions, length of stay, and mortality. Results A total of 5,855 patients met our inclusion criteria. In our study population, the mean age was 44.5 years, with 54% males and 46% females. There were 75% insured and 25% uninsured. Overall median ED charges were $1,352 and median inpatient charges were $18,017.54, with a median length of stay of 3 days. As part of their management, 47.2% of the patients received a surgical drainage procedure, 3.3% required a surgical airway, and 4.6% required a nonsurgical airway. The overall mortality rate was 0.3%. Conclusion Ludwig's angina remains a rare and potentially life‐threatening condition. The mortality rate appears to be decreased from previous historical accounts, with airway intervention remaining a significant part of management. Level of Evidence 3 Laryngoscope, 129:2041–2044, 2019

4. Laryngoscope, 127:720-724, 2017.

FA is the major IBMFS with associated hearing loss, which is most commonly conductive. Radial hypoplasia or aplasia and characteristic congenital ear malformations are associated with hearing loss in patients with FA. Recognition of these syndrome-specific abnormalities should lead to earlier management of hearing loss.

Extranodal natural killer (NK)/T-cell lymphoma, nasal type (NNKTL) is a rare and highly aggressive non-Hodgkin lymphoma originating from NK or γδ T cells infected by Epstein-Barr virus (EBV). In the United States, NNKTL is usually noted in people of Asian or Hispanic descent. Natural killer/T-cell lymphoma, nasal type commonly involves the upper aerodigestive tract, including the nasopharynx, nasal cavity, Waldeyer’s ring, and oropharynx. Extensive local destruction and invasion has been noted, especially of the paranasal sinuses, hard palate, and central nervous system; involvement of the nasolacrimal duct with dacryocystitis is yet to be reported. We report a rare case of a Hispanic man with extranodal NNKTL masquerading as persistent dacryocystitis and necrotizing sinusitis unresponsive to antibiotics and surgical intervention. An extensive background of necrosis and inflammation was noted on pathology, and additional analysis with immunohistochemistry and in situ hybridization after repeat biopsy were necessary for accurate diagnosis.

Poster PresentationsP213 a nylon brush through the tracheostoma. Tacrolimus (0.2 or 1.0 mg/kg i.m.) was systemically administered for 5 days. The pathological changes at the airway mucosa and the tracheal lumen were assessed at 7 days after the scraping. The percentage of stenosis was calculated by image analysis software.Results: Both hyperplasia of airway epithelium and thickened submucosal layer with extensive fibrosis, angiogenesis, and collagen deposition provoked lumen stenosis. There was significant preventive effect on airway stenosis in the lower dose of Tacrolimus (0.2mg/kg) compared to brushing only group (P < 0.05). The high dose of Tacrolimus group (1.0mg/kg) also showed a trend to potential protection of airway stenosis.Conclusions: This study suggests that the systemic immunosuppressive agent, Tacrolimus, has a preventive effect on LTS from mucosal injury of the airway.Objectives: Describe the clinical and radiographic features of a massive laryngeal lipoma and discuss the management through a transoral robotic approach.Methods: Retrospective case report. An otherwise healthy 66 year old male presented with 6 months of progressive dysphagia, dyspnea, and muffled voice. On flexible endoscopy a massive, smooth mass was seen filling the oropharynx and obstructing visualization of the vocal folds and hypopharynx. Computed tomography imaging revealed an 8.5x4.9 cm lowattenuation mass extending from the right paraglottic space posteriorly into the hypopharynx and oropharynx. On magnetic resonance imaging, the mass was T1 hyperintense with slight rim enhancement and complete suppression on T2 weighted fat saturation. The patient underwent tracheotomy under local anesthesia and excision of the mass through a transoral robotic approach.Results: Final pathology was consistent with lipoma. The patient began tolerating oral intake on postoperative day 1 and was decannulated on postoperative day 8. At 2 months followup, he had right vocal cord paresis but had significant improvement in both his vocal quality and dysphagia and no recurrent mass in the oropharynx or hypopharynx.Conclusions: Lipomas of the larynx are rare, accounting for 0.6% of benign laryngeal lesions. Despite their benign nature, removal is indicated to manage airway obstruction and dysphagia. To our knowledge, this is the first report of transoral robotic resection of a laryngeal lipoma. We propose the use of transoral robotic surgery for large benign lesions of the larynx in order to avoid the morbidity of an open cervical approach.

No abstract

No abstract

Five succinct key points: -Otolaryngologists are at high risk for ergonomic injury, particularly in the neck and cervical spine region. - There is a need to use validated ergonomic assessment tools to quantify the amount of risk in specific otolaryngology procedures and identify alternative methods to decrease that risk. -The physical positioning of the senior author was studied using the RULA score during two different operative approaches to tonsillectomy: one using an endoscope and one using direct visualization without the aid of an endoscope. - The RULA score for the traditional, non-endoscopic approach was 5, with a Neck, Trunk, and Leg Score of 6 and a Wrist/Arm score of 1, demonstrating a high risk and suggesting a need for further investigation and change. The RULA score for the endoscopic-assisted approach was 3, with a Neck, Trunk, and Leg score of 4 and a Wrist/Arm score of 1. -An endoscopic-assisted approach to tonsillectomy allowed for a lower RULA score than traditional tonsillectomy. This study suggests that an endoscopic approach may decrease the potential for musculoskeletal strain and reduce occupational-related pain and injury seen in practicing otolaryngologists.