OBJECTIVE To describe a modified technique for pediatric microlaryngoscopy and bronchoscopy for use in the COVID-19 era and present a case series of patients for whom the technique has been used. DESIGN, SETTING, AND PARTICIPANTS Observational case series of pediatric patients undergoing emergency or urgent airway procedures performed at a tertiary pediatric otolaryngology department in Australia. Procedures were completed between March 23 and April 9, 2020, with a median (range) follow-up of 24.5 (11-28) days. EXPOSURES Modified technique for microlaryngoscopy and bronchoscopy, minimizing aerosolization of respiratory tract secretions. MAIN OUTCOMES AND MEASURESThe main outcome was the feasibility of technique, which was measured by ability to perform microlaryngoscopy and bronchoscopy with comparable success to the usual technique (ie, adequate examination of the patient for diagnostic procedures and ability to perform interventional procedures). RESULTSThe technique was used successfully in 8 patients (median [range] age, 160 days [27 days to 2 years 6 months]); 5 patients were male, and 3 were female. Intervention was performed on 6 patients; 2 balloon dilations for subglottic stenosis, 2 injections of hyaluronic acid for type 1 clefts, and 2 cold-steel supraglottoplasties. No adverse events occurred.CONCLUSIONS AND RELEVANCE In this case series, feasibility of a modified technique for pediatric microlaryngoscopy and bronchoscopy was demonstrated. By reconsidering the surgical approach in light of specific COVID-19 infection risks, this technique may be associated with reduced spread of aerosolized respiratory secretions perioperatively and intraoperatively, but the technique and patient outcomes require further study.

Objectives The financial burden of treatment for oral squamous cell carcinoma in Australia has never been reported, and there is a paucity of international data. Here, we report the direct costs of treatment of surgically resectable oral cancer in a tertiary public hospital in Australia over a 15‐year period. Materials and Methods Pathology department records, records of hospital attendance and hospital finance department records were interrogated to determine the direct costs of inpatient and outpatient treatment. Costs were adjusted using the total health price index so that all costs were equivalent to costings for the 2016/2017 financial year. Results A total of 113 cases were identified as suitable for inclusion. Complete inpatient and outpatient hospital attendance and costing data for treatment and subsequent 2‐year follow‐up was available for 29 cases. The average total cost over the 2‐year period was $92 958AUD (median $102 722, range $11 662‐$181 512). On average, 92.8% of costs were incurred in the first year post‐diagnosis. Inpatient costs, outpatient costs and total costs increased with increasing pathological cancer stage. Both 1‐ and 2‐year post‐diagnosis overall cost for patients with Stage 4 oral cavity cancer were more than two times greater than for patients with Stage 1 oral cancer. Conclusion It is well documented that patients diagnosed at an earlier stage will have better survival outcomes, and it is assumed that the economic burden of their treatment will be less. We have shown that there is a direct correlation between cancer stage and cancer treatment cost. The findings provide clear economic support for oral cancer screening initiatives to detect earlier stage cancers, and the need to investigate novel techniques and technologies to detect oral squamous cell carcinoma early and reduce recurrence and mortality rates.

Objectives: Lip, oral cavity and oropharyngeal cancer (OCC-OPC) represents a significant global health burden. The epidemiology and prediction of future burden of these cancers in Oceania is reported along with a critical description of cancer registries in the region. Methods: Data are extracted from GLOBOCAN 2012 and from published literature, as well as from local cancer registries, where available. Results: In Oceania in 2012, GLOBOCAN estimates the age-standardized incidence rates per 100,000 per annum for OCC-OPC to be 12.6 and 5.9 for males and females, respectively. Age-standardized mortality rates are predicted to have been 4.0 per 100,000 for males and 2.2 per 100,000 for females. Papua New Guinea is recorded as having the highest incidence rate of OCC-OPC in the world. It is predicted that 6500 new cases of OCC-OPC will be diagnosed in Oceania overall by 2030, an almost 45% increase compared to the 2012 incidence. Conclusion: Future research and resource allocation is needed to establish or improve the quality of cancer registries in the island nations of Oceania. Prevention as a primary intervention should be promoted by local authorities to control the increasing burden of lip plus OCC-OPC in this region.

A 31-year-old male presented with a history of chronic right-sided facial and mastoid tip pain with associated tinnitus and hearing loss. These symptoms were aggravated by the regular aeroplane trips he made to work as a “fly-in, fly-out” worker in regional Australia. Imaging revealed significant pneumocephalus secondary to mastoid air cell defects, which were repaired via a transmastoid approach. This is the fourth case of spontaneous otogenic pneumocephalus associated with air travel at altitude reported in the literature. This case is remarkable for the chronic nature of the symptoms, which were aggravated by the patient’s regular aeroplane travel. This has implications for occupations which require frequent flying in those patients who may be at risk.