Objectives Patients with oropharyngeal cancer (OPC) have distinct risk factor profiles reflected in the human papillomavirus (HPV) status of their tumor, and these profiles may also be influenced by factors related to socioeconomic status (SES). The goal of this study was to describe the socioeconomic characteristics of a large cohort of patients with OPC according to HPV status, smoking status, and sexual behavior. Materials and Methods Patients with OPC prospectively provided information about their smoking and alcohol use, socioeconomic characteristics, and sexual behaviors. HPV status was determined by a composite of immunohistochemistry for p16 expression, HPV in situ hybridization, and PCR assay in 356 patients. Standard descriptive statistics and logistic regression were used to compare socioeconomic characteristics between patient subgroups. Results Patients with HPV-positive OPC had higher levels of education, income, and overall SES. Among patients with HPV-positive OPC, never/light smokers had more than 5 times the odds of having at least a bachelor’s degree and being in the highest level of SES compared with smokers. Patients with HPV-positive OPC and those with higher levels of education and SES had higher numbers of lifetime any and oral sex partners, although not all of these differences were significant. Conclusion Socioeconomic differences among subgroups of OPC patients have implications for OPC prevention efforts, including tobacco cessation, behavior modification, and vaccination programs.

BackgroundMonopolar cautery is the most commonly used surgical cutting and hemostatic tool for head and neck surgery. There are newer technologies that are being utilized with the goal of precise cutting, decreasing blood loss, reducing thermal damage, and allowing faster wound healing. Our study compares thermal damage caused by Harmonic scalpel and CO2 laser to cadaveric tongue.MethodsTwo fresh human cadaver heads were enrolled for the study. Oral tongue was exposed and incisions were made in the tongue akin to a tongue tumor resection using the harmonic scalpel and flexible C02 laser fiber at various settings recommended for surgery. The margins of resection were sampled, labeled, and sent for pathological analysis to assess depth of thermal damage calculated in millimeters. The pathologist was blinded to the surgical tool used. Control tongue tissue was also sent for comparison as a baseline for comparison.ResultsThree tongue samples were studied to assess depth of thermal damage by harmonic scalpel. The mean depth of thermal damage was 0.69 (range, 0.51 - 0.82). Five tongue samples were studied to assess depth of thermal damage by CO2 laser. The mean depth of thermal damage was 0.3 (range, 0.22 to 0.43). As expected, control samples showed 0 mm of thermal damage. There was a statistically significant difference between the depth of thermal injury to tongue resection margins by harmonic scalpel as compared to CO2 laser, (p = 0.003).ConclusionIn a cadaveric model, flexible CO2 laser fiber causes less depth of thermal damage when compared with harmonic scalpel at settings utilized in our study. However, the relevance of this information in terms of wound healing, hemostasis, safety, cost-effectiveness, and surgical outcomes needs to be further studied in clinical settings.

Endoscopic suture repair can be an effective method for treating PCF with less morbidity than flap reconstruction or conservative wound management.

Objectives: To compare thermal damage caused by Harmonic scalpel and CO2 laser to cadaveric tongue. Methods: Two fresh human cadaver heads were enrolled for the study. Oral tongue was exposed and incisions were made in the tongue akin to a tongue tumor resection using the harmonic scalpel and flexible C02 laser fiber at various settings recommended for surgery. The margins of resection were sampled, labeled, and sent for pathological analysis to assess depth of thermal damage calculated in millimeters. The pathologist was blinded to the surgical tool used. Control tongue tissue was also sent as a baseline for comparison. Results: Three tongue samples were studied to assess depth of thermal damage by harmonic scalpel. The mean depth of thermal damage was 0.69 mm, (range, 0.51 -0.82 mm). Five tongue samples were studied to assess depth of thermal damage by CO2 laser. The mean depth of thermal damage was 0.3mm, (range, 0.22 to 0.43mm). As expected, control samples showed 0 mm of thermal damage. There was a statistically significant difference between the depth of thermal injury to tongue resection margins by harmonic scalpel as compared to CO2 laser, (p=0.003). Conclusion: In a cadaveric model, flexible CO2 laser fiber causes less depth of thermal damage when compared with harmonic scalpel at settings utilized in our study. However, the relevance of this information in terms of wound healing, hemostasis, safety, costeffectiveness, and surgical outcomes needs to be further studied in clinical settings.The CO2 laser was first introduced into Otolaryngology by Jako and Strong in 1972 2. The laser can be an excellent tool for anterior oral cavity and anterior oral tongue resections. However, the bulk and cumbersome delivery system makes its use less attractive. 1,2 With the advent of the photonic band gap fiber assembly (PBFA), a flexible fiber CO2 delivery system developed by Omniguide Inc, it is now possible to overcome these limitations. 2,7 The PBFA system allows the direct delivery of CO2 energy to regions in the head and neck where direct visualization is limited. A variety of hand pieces allow laser energy to be provided along the plane of surgical dissection and in sync with the surgeon's line of sight. This facilitates precise surgery. In addition to increased maneuverability, a variable rate of gas is transmitted through the hollow core of the PBFA creating the added benefits of cooling the surgical site and clearing the field of debris, plume and blood. 2,7 The current limitations of the flexible CO2 laser fiber include a learning curve associated with its use, the PBFA also can be damaged if not used correctly, the tip of the fiber is not robust enough to serve as a surgical dissector, and inefficient with respect to coagulation (vessels up to 1-2mm in diameter). 1,2The new PBFA fiber can easily be focused to improve cutting and also defocused to coagulate by moving the tip of the laser fiber closer to the target or away from it 1 . However, a true assessment of the lasers utility and ease of use...