Primary laryngeal synovial sarcoma is an extremely rare tumor predominantly affecting young adults. There are currently no well-defined guidelines to direct investigation and management, and treatment is largely based on what is known for synovial sarcoma of the upper and lower limbs. This PROSPERO-registered study aims to review the diagnostic methods, treatment regimens, and survival outcomes for patients with synovial sarcoma of the larynx. A systematic search of databases Medline, Embase, SCOPUS, and Web of Science was undertaken in December 2017. The literature search identified 1031 potentially relevant studies, and after the deletion of duplicates and excluded papers, 98 full-text articles were screened. A total of 39 cases were reviewed from 32 studies in the data extraction. The average age at the time of laryngeal synovial sarcoma diagnosis was 32 years (range, 11-79 years). In all cases (n ¼ 39), patients underwent wide surgical excision, with 20 patients requiring a partial or total laryngectomy. A total of 18 patients received adjuvant and 3 received neoadjuvant radiotherapy. Chemotherapy was used in 10 cases, with ifosfamide the most frequently used agent. There was considerable variability in the order and combinations of the abovementioned treatments. No clinicopathologic factors or treatment regimens were associated with improved overall survival or lower rate of recurrence. There is a paucity of literature and heterogeneity in clinical approaches to this highly aggressive sarcoma. Reporting of cases must be standardized and formal guidelines must be established to guide clinical management.

Background: This study aims to map the coverage of Ear, Nose and Throat (ENT) outreach clinics in New South Wales (NSW) over a 5-year period [2012][2013][2014][2015][2016]. It also aims to determine the extent of engagement in outreach work among NSW and ACT-based ENT surgeons over this period. Methods: Online and telephone survey of ENT surgeons practising in NSW and ACT conducted between December 2016 and May 2017. The survey was designed to identify the location, frequency and the number of ENT surgeons providing outreach services in NSW. A secondary outcome of the survey was the current and future rates of participation in outreach projects by NSW and ACT-based ENT surgeons.Results: Eighteen surgeons provided at least one ENT outreach service in NSW between 2012 and 2016.The average yearly commitment was 5.5 days (SD 4.2 days). Eighteen distinct towns in NSW received an outreach service. In the majority of cases, a visiting surgeon provided outreach services to the same town for at least three consecutive years. Surgeons who obtained their Fellowship of the Royal Australasian College of Surgeons (FRACS) after 2005 had the highest interest in future participation.Conclusions: Approximately 1 in 5 NSW and ACT-based ENT surgeons perform outreach activities.The data suggests that many remote and rural towns within NSW are not receiving outreach services. Better coordination of services and a commitment to regular and well-constructed outreach programs could redress this imbalance. The expressed intention to become involved in future outreach programs, particularly among the younger surgeons, needs to be encouraged and supported for this to be realised.

Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.

BackgroundPrimary, specialist, and allied health services can assist in providing equitable access in rural and remote areas, where higher proportions of Aboriginal and Torres Strait Islander people (Aboriginal Australians) reside, to overcome the high rates of chronic diseases experienced by this population group. Little is currently known about the location and frequency of services and the extent to which providers believe delivery is occurring in a sustained and coordinated manner.ObjectiveThe objective of this study will be to determine the availability, accessibility, and level of coordination of a range of community-based health care services to Aboriginal people and identify potential barriers in accessing health care services from the perspectives of the health service providers.MethodsThis mixed-methods study will take place in 3 deidentified communities in New South Wales selected for their high population of Aboriginal people and geographical representation of location type (coastal, rural, and border). The study is designed and will be conducted in collaboration with the communities, Aboriginal Community Controlled Health Services (ACCHSs), and other local health services. Data collection will involve face-to-face and telephone interviews with participants who are health and community professionals and stakeholders. Participants will be recruited through snowball sampling and will answer structured, quantitative questions about the availability and accessibility of primary health care, specialist medical and allied health services and qualitative questions about accessing services. Quantitative data analysis will determine the frequency and accessibility of specific services across each community. Thematic and content analysis will identify issues relating to availability, accessibility, and coordination arising from the qualitative data. We will then combine the quantitative and qualitative data using a health ecosystems approach.ResultsWe identified 28 stakeholder participants across the ACCHSs for recruitment through snowball sampling (coastal, n=4; rural, n=12; and border, n=12) for data collection. The project was funded in 2017, and enrolment was completed in 2017. Data analysis is currently under way, and the first results are expected to be submitted for publication in 2019.ConclusionsThe study will give an indication of the scope and level of coordination of primary, specialist, and allied health services in rural communities with high Aboriginal populations from the perspectives of service providers from those communities. Identification of factors affecting the availability, accessibility, and coordination of services can assist ways of developing and implementing culturally sensitive service delivery. These findings could inform recommendations for the provision of health services for Aboriginal people in rural and remote settings. The study will also contribute to the broader literature of rural and remote health service provision.International Registered Report Identifier (IRRID)DERR1-10...

Background: The purpose of this study was to evaluate the outcomes of our polyneural, zone-based reanimation approach for patients with neoplasm-induced facial paralysis. Methods: A retrospective review of consecutive patients who underwent facial reanimation surgery using multiple donor nerve transfers was undertaken. In each case, the selection of donor nerves was based on the availability of donor nerve and the viability of the motor endplate on the affected side. Sources of the neural inputs utilized included the remnant facial nerve stump, masseteric nerve, partial hypoglossal nerve, and branches of the contralateral facial nerve. Clinical outcomes were scored by expert raters. Ratings were undertaken using the modified House-Brackmann, eFACE and MEEI FACEgram scoring systems. Results: Between 2017 and 2020, 12 patients were included in the study (mean age 60 years; range 26-81 years). Eight patients (67%) achieved a grade III outcome on the modified House-Brackmann grading scale. Mean eFACE static and dynamic scores were 76 and 57 respectively, reflecting a high degree of symmetry at rest and moderate restoration of dynamic movement. Mean time to movement was 5.4 months (SD 1.9). Objective FACE-gram measurements confirmed restoration of midface movement with an average improvement in smile excursion and mouth angle excursion of 3.19 mm (SD 3.18) and 4.81 (SD 2.90) respectively. Conclusion: Facial reanimation using multiple nerve transfers is effective in achieving improvements in facial function and symmetry.

Focal dermal hypoplasia is a rare condition affecting organ systems of mesodermal origin. We present a rare case of this condition presenting with apparent palatine tonsillar regrowth and outline our management. Airway management should always be a consideration in this rare condition.

Background: Primary, specialist and allied health services can assist in providing equitable access in rural and remote areas where higher proportions of Aboriginal and Torres Strait Islander people (Aboriginal Australians) reside to overcome high rates of chronic disease experienced by this population group. Little is currently known about the location and frequency of services and the extent to which providers believe delivery is occurring in a sustained and coordinated manner. Objective: To determine the availability, accessibility and level of coordination of a range of community-based healthcare services to Aboriginal people and identify potential barriers in accessing healthcare services from the perspectives of the health service providers. Methods: This mixed-methods study will take place in three de-identified communities in New South Wales selected for their high population of Aboriginal people and geographical representation of particular location type (coastal, rural and border). The study is designed and conducted in collaboration with communities, Aboriginal Community Controlled Health Services (ACCHSs) and other local health services. Data collection will involve face to face and telephone interviews. Participants will be recruited through snowball sampling and will answer structured, quantitative questions about the availability and accessibility of primary healthcare, specialist medical and allied health services and qualitative questions about accessing services. Quantitative data analysis will determine the frequency and accessibility of specific services across each community. Qualitative data will be analyzed thematically to identify issues relating to availability, accessibility and coordination. The quantitative and qualitative data will then be combined and analyzed using a health ecosystems approach. Results: Twenty eight stakeholder participants across the ACCHSs were identified for recruitment through snowball sampling (N=4 coastal, N=12 rural and N=12 border) for data collection. Conclusions: The study will determine the scope and level of coordination of primary, specialist and allied health services in rural communities with high Aboriginal populations from the perspectives of service providers from those communities. Identification of factors affecting availability, accessibility and coordination of services can assist ways of developing and implementing culturally sensitive service delivery. These findings will inform recommendations for the provision of health services for Aboriginal people in rural and remote settings. The study will also contribute to the broader literature of rural and remote health service provision.