Background: Guidelines regarding head and neck surgical care have evolved during the coronavirus-19 (COVID-19) pandemic. Data on operative management have been limited. Methods: We compared two cohorts of patients undergoing head and neck or

Introduction Following acute injury to the recurrent laryngeal nerve (RLN), laryngeal electromyography (LEMG) is increasingly being used to determine prognosis for recovery. The LEMG findings change during the recovery process, but the timing of these changes is not well described. In this canine study, LEMGs were obtained serially following model RLN injuries. Methods 36 canine RLNs underwent crush (n=6), complete transection with reanastomosis (n=6), half-transection-half-crush (n=5), cautery (n=5), stretch (n=5), inferior crush (n=4), or inferior transection with reanastomosis (n=5) injuries. Injuries were performed 5cm from cricoid, or were 5cm further inferior. Under light sedation, LEMG of thyroarytenoid muscles was performed monthly for 6 months following injury. At 6 months, spontaneous and induced vocal fold motion was assessed. Results Except for the stretch injury, the remaining groups showed very similar recovery patterns. Fibrillation potentials (FPs) and/or positive sharp waves (PSWs) (signs of “bad prognosis”) were seen in all cases at one month and lasted on average for 2.26 months (range 1–4). Motor unit potentials of at least 2+ (scale 0–4+) (signs of “good prognosis”) were seen beginning at 3.61 months (range 2–6). The stretch injury was less severe, with 3/5 showing no FPs/PSWs at one month; all recovered full mobility. Ten of the 36 TA muscles (27.8%) had one EMG showing both bad prognosis and good prognosis signs simultaneously, at 2–4 months post-injury. Conclusion LEMG can be used to predict RNL recovery, but timing is important and LEMG results earlier than 3 months may overestimate a negative prognosis.

NA Laryngoscope, 127:1525-1530, 2017.

The CMAP is a measure of vocal fold innervation. The technique could be further developed for clinical and experimental applications.

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Objective/Hypothesis Functional recovery after a recurrent laryngeal nerve or facial nerve injury may be impaired due to aberrant reinnervation. Previous work in a rat peripheral nerve injury model found vincristine to be a potent inhibitor of reinnervation, and it has since been used to effectively block neural regeneration in other animal models. However, vincristine’s narrow therapeutic index may limit its utility; therefore, another microtubule inhibitor, paclitaxel, which has a higher therapeutic index, was tested. Study Design Animal (rat) study. Methods After controlled injury to the rat posterior tibial (PT) nerve, the gasctrocnemius/soleus complex was injected with saline (control, n=14), vincristine (n=30), or paclitaxel (n=20). Injections without a crush injury were performed using saline (n=5) or paclitaxel (n=9). The functional recovery (FR) of the posterior tibial nerve was assessed using walking track analysis. Results At six weeks, controls had already recovered to baseline (FR=1.0) while the paclitaxel group had FR =0.724 ±0.064 and the vincristine group had FR =0.709 ±0.078. At six months the paclitaxel rats had FR = 0.798 ±0.167 and the vincristine rats had FR =0.754 ±0.240. These differences were significantly different from baseline, but the two agents were not different from each other. Paclitaxel did not affect the FR in the absence of a nerve injury. Conclusion Intramuscular paclitaxel and vincristine both significantly inhibit regeneration of the PT nerve after crush injury for at least 6 months. Potential clinical uses of inhibition of reinnervation are discussed. Level of Evidence NA

Objective/Hypothesis: For patients undergoing microvascular free tissue transfer (MFTT), we evaluated risk factors and financial implications of operating room (OR) take-back procedures.Study Design: Retrospective review at a tertiary care center. Methods: Patients who underwent MFTT for head and neck reconstruction from 2011 to 2018 were identified. We compared hospital length of stay and overall costs associated with OR take-back procedures. Multivariable regression analysis evaluated factors associated with OR take-backs during the same hospitalization.Results: A total of 727 free flaps were reviewed, and 70 OR take-backs (9.6%) were identified. Mean total length of stay (LOS) in the ICU was 3.4 days versus 6.7 days for non-take-back and take-back flaps, respectively (P < .001). Mean total LOS on the regular floor was 6.3 days versus 13.1 days, respectively (P < .001). This resulted in a cost differential of $33,507 (94.3% increase relative to non-take-back flaps). The total cost associated with an OR take-back was $39,786. Hematomas were the most common cause of take-backs and wound dehiscence was associated with the highest costs. On multivariable analysis, higher ASA class (OR, 2.06; 95% CI, 1.11-3.99; P = .026) and shorter ischemia times (OR, 0.52; 95% CI, 0.29-0.95; P = .030) were independently associated with increased risk of take-backs.Conclusions: OR take-backs infrequently occur but are associated with a significant increase in financial burden when compared to free flap cases not requiring OR take-back. The large majority of the cost differential lies in a substantial increase of ICU and floor LOS for take-back flaps when compared to non-take-back flaps.

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