Objectives/Hypothesis To evaluate trends in contemporary positive surgical margin incidence in cT1‐T2 oral cavity squamous cell carcinoma and to evaluate factors associated with surgical margin status. Study Design Retrospective analysis of large dataset. Methods Retrospective analysis of the National Cancer Database. Results Between 2004 and 2016, 39,818 patients with cT1 or cT2 oral cavity squamous cell carcinoma received primary curative‐intent surgery. Positive surgical margins were present in 7.95% of patients, and univariable adjusted probability of positive surgical margins over the study period declined by 1% per year (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98–1.0; P = .049). Multivariable regression revealed the annual rate of positive surgical margins declined significantly (OR, 0.95 per year; 95% CI, 0.92–0.97; P < .001). Factors associated with increased odds of positive surgical margins included cT2 disease, subsite, understaged disease, lymphovascular invasion, tumor grade, and positive lymph nodes. Race and socioeconomic status were not associated with surgical margin status. Treatment at an academic center was associated with increased time to definitive surgery (median 35 days IQR 22–50 vs. median 27 days IQR 14–42; P < .001) and a 20% reduction in positive surgical margin rate (OR, 0.80; 95% CI, 0.71–0.90; P < .001). Treatment at high‐volume centers was less likely to be associated with positive surgical margins (OR, 0.85; 95% CI, 0.74–0.98; P = .02). Conclusion Surgical subsite, clinical T and N category, presence of lymphovascular invasion, and histologic grade were independent predictors of positive surgical margins. Patients are increasingly being treated at high‐volume and academic centers. Overall, the rate of positive surgical margins in cT1‐T2 oral cavity squamous cell carcinoma is decreasing. Level of Evidence 4 Laryngoscope, 132:1962–1970, 2022

Objectives: To characterize tracheal cartilage morphology in mouse models of fibroblast growth factor receptor (Fgfr2)related craniosynostosis syndromes. To establish relationships between specific Fgfr2 mutations and tracheal cartilaginous sleeve (TCS) phenotypes in these mouse models. Methods: Postnatal day 0 knock-in mouse lines with disease-specific genetic variations in the Fgfr2 gene (Fgfr2 C342Y/C342Y , Fgfr2 C342Y/+ , Fgfr2 +/Y394C , Fgfr2 +/S252W , and Fgfr2 +/P253R) as well as line-specific controls were utilized. Tracheal cartilage morphology as measured by gross analyses, microcomputed tomography (μCT), and histopathology were compared using Chi-squared and single-factor analysis of variance statistical tests. Results: A greater proportion of rings per trachea were abnormal in Fgfr2 C342Y/+ tracheas (63%) than Fgfr2 +/S252W (17%), Fgfr2 +/P253R (17%), Fgfr2 +/Y394C (12%), and controls (10%) (P < .001 for each vs. Fgfr2 C342Y/+). TCS segments were found only in Fgfr2 C342Y/C342Y (100%) and Fgfr2 C342Y/+ (72%) tracheas. Cricoid and first-tracheal ring fusion was noted in all Fgfr2 C342Y/C342Y and 94% of Fgfr2 C342Y/+ samples. The Fgfr2 C342Y/C342Y and Fgfr2 C342Y/+ groups were found to have greater areas and volumes of cartilage than other lines on gross analysis and μCT. Histologic analyses confirmed TCS among the Fgfr2 C342Y/C342Y and Fgfr2 C342Y/+ groups, without appreciable differences in cartilage morphology, cell size, or density; no histologic differences were observed among other Fgfr2 lines compared to controls. Conclusion: This study found TCS phenotypes only in the Fgfr2 C342Y mouse lines. These lines also had increased tracheal cartilage compared to other mutant lines and controls. These data support further study of the Fgfr2 mouse lines and the investigation of other Fgfr2 variants to better understand their role in tracheal development and TCS formation.

Thorough assessment of dynamic upper airway obstruction (UAO) in Robin sequence (RS) is critical, but traditional evaluation modalities have significant limitations. Four-dimensional computed tomography (4D-CT) is promising in that it enables objective and quantitative evaluation throughout all phases of respiration. However, there exist few protocols or analysis tools to assist in obtaining and interpreting the vast amounts of obtained data. A protocol and set of data analysis tools were developed to enable quantification and visualization of dynamic 4D-CT data. This methodology was applied to a sample case at 2 time points. In the patient with RS, overall increases in normalized airway caliber were observed from 5 weeks to 1 year. There was, however, continued dynamic obstruction at all airway levels, though objective measures of UAO did improve at the nasopharynx and oropharynx. Use of 4D-CT and novel analyses provide additional quantitative information to evaluate UAO in patients with RS.

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This patient population demonstrates significant symptomatology and functional impairment. Because of the severity of their OSA, they are at increased risk of complications. In order to mitigate the detrimental effects of OSA, these significantly impacted patients should be identified and encouraged to seek CPAP alternatives clinics that specialize in the treatment of this population.

Objective To assess the practice characteristics of adult sleep otolaryngologists within US otolaryngology residency training programs. Study Design Cross-sectional online survey. Setting Otolaryngology residency training programs. Subjects and Methods Program directors from 106 otolaryngology training programs in the United States were contacted. Program directors were instructed to forward a survey to otolaryngologists within the institution who provided Accreditation Council for Graduate Medical Education (ACGME) Otolaryngology Milestone Project feedback in "sleep-disordered breathing." The survey assessed demographics, nonsurgical practices, and surgical/procedural practices of adult sleep otolaryngologists. Data were collected and analyzed. Results Forty-six surveys met inclusion criteria, representing 40 of 106 (38%) programs. Ninety-three percent of respondents reported that residents gained a significant portion of their sleep medicine training from themselves (ie, the respondents), yet only 36% of respondents spent ≥50% of their time on sleep medicine/surgery. Forty-one percent reported being board certified in sleep, with 18% having completed an ACGME fellowship in sleep medicine. Respondents with board certification were more likely to spend greater portions of their practice on sleep medicine/surgery, χ(3, n = 44) = 23.161 ( P < .001), treat non-obstructive sleep apnea sleep disorders (13 of 18 vs 1 of 26, P < .001), interpret polysomnograms (13 of 17 vs 1 of 15, P < .001), and perform drug-induced sleep endoscopy, χ(1, n = 43) = 5.43, ( P = .02). A similar pattern was seen with stratification by ACGME sleep medicine fellowship. Conclusion This study highlights the variance in practice patterns among sleep otolaryngologists who instruct residents. Board certification and fellowship training in sleep medicine significantly influence breadth of trainee exposure to this field. The highly disparate trainee experiences to sleep otolaryngology across US programs require attention.

Objectives/Hypothesis: To investigate perceptual speech outcomes following sphincter pharyngoplasty (SP) and to identify patient characteristics associated with velopharyngeal insufficiency (VPI) resolution or improvement.Methods: Retrospective review of prospectively collected data was performed of consecutive patients that underwent SP for management of VPI between 1994 and 2016 at a single tertiary care pediatric hospital. Demographic data, nasendoscopic findings, and speech characteristics were recorded using a standardized protocol. Pre-and post-operative VPI was graded on a five-point Likert scale. Frequency of post-operative VPI resolution and improvement was assessed and associations with patient characteristics were analyzed. The association between odds of VPI resolution or improvement and five patient characteristics identified a priori was performed controlling for confounding factors.Results: Two-hundred ninety-six subjects were included. All patients had at least minimal VPI pre-operatively; 72% were graded moderate or severe. Sixty-four percent experienced resolution and 83% improved at least one point on the VPI-severity scale. Of the five patient characteristics, only history of cleft palate repair was significantly associated with decreased odds of VPI improvement but not resolution when controlling for other variables.Conclusions: Sphincter pharyngoplasty resulted in resolution of VPI in 64% and improvement in 83% of subjects. Children with a history of cleft palate had significantly decreased odds of VPI improvement compared to those without a history of cleft palate. Neither syndrome diagnosis nor 22q11 deletion had a significant association with speech outcomes after sphincter pharyngoplasty.

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