Intraoperative frozen margins from the tumor bed are not ideal predictors of positive margins on the main specimen. Both frozen and specimen margins are associated with local recurrence, but the specimen margin has the stronger association. Importantly, we demonstrate that clearing positive frozen margins from the tumor bed is not associated with improved outcomes.

IMPORTANCE There is a lack of consistency in the literature regarding the definition of "close" resection margins in the surgical treatment of oral cavity squamous cell carcinoma (OCSCC), and the relationship between local recurrence (LR) rates and different distances of invasive tumor from surgical margin is not well characterized.OBJECTIVE To analyze the association between specific distances from invasive tumor to surgical margin and LR in patients with OCSCC. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 432 patients treated via en bloc resection for OCSCC between 2005 and 2014 at the University of Iowa Hospitals and Clinics. In all cases, permanent margin evaluation was performed on the main tumor specimen and with intraoperative frozen section margin assessment from the tumor bed. MAIN OUTCOMES AND MEASURESThe LR rate based on minimum millimeter distance between invasive tumor and inked main specimen margin. RESULTSOf the 432 participants, 252 (58%) were men and 180 (42%) were women (mean age, 62.14 years; range, 19-99 years). In each case, the LR rate was analyzed in relation to each millimeter distance of invasive cancer from the inked main specimen margin, with results showing an exponential inverse relationship. The LR rate for microscopic positive margins was 44% (95% CI, 34%-55%); for margins less than 1 mm, 28% (95% CI, 18%-41%); for 1 mm, 17% (95% CI, 8%-31%); for 2 mm, 13% (95% CI, 6%-27%); for 3 mm, 13% (95% CI, 5%-32%); for 4 mm, 14% (95% CI, 5%-35%); and for 5 mm or greater, 11% (95% CI, 6%-18%). Analysis of the receiver operating characteristic curve identified a cutoff of less than 1 mm as appropriate for classifying higher risk of local recurrence. Regardless of margin distance, resection of additional tissue beyond 1 mm based on intraoperative frozen section was not associated with improved local control. CONCLUSIONS AND RELEVANCEThe commonly used cutoff of 5 mm for a close margin lacks an evidential basis in predicting local recurrence. Invasive tumor within 1 mm of the permanent specimen margin is associated with a significantly higher local recurrence rate, though there is no significant difference for greater distances. This study suggests that a cutoff of less than 1 mm identifies patients at increased local recurrence risk who may benefit from additional treatment. Analysis of the tumor specimen rather than the tumor bed is necessary for this determination.

Aim The COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has put health care workers at risk when exposed to aerosolized viral particles during upper airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission. Methods A PubMed/MEDLINE database review of articles was performed querying topical preparations with virucidal activity against coronaviruses. Results Povidone‐iodine (PVP‐I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics including SARS‐CoV‐1 and MERS‐CoV. Conclusions While specific evidence regarding SARS‐CoV‐2 is lacking, PVP‐I‐based preparations have been successfully demonstrated to reduce viral loads of coronaviruses. They are relatively safe to use in the upper airway and may reduce risk of SARS‐CoV‐2 aerosolization during upper airway mucosal surgery.

of 0.84) and good inter-rater reliability between resident physicians (Cohen's kappa coefficient of 0.58). There was no correlation between total view count, video age, or number of likes/dislikes and the overall LAP-VEGaS score. The presence of audio or written commentary had a moderate positive correlation with LAP-VEGaS score (adjusted R 2 of 0.36). There was no statistically significant difference in video quality between videos posted by US and non-US based physicians (95% confidence interval À0.10 to 4.10; p = 0.06). However, videos made by an otolaryngology-trained physician had a LAP-VEGaS score that was 3.93 points higher (95% confidence interval 2.34-5.52; p < 0.001) than that of videos made by a nonotolaryngology-trained physician. CONCLUSIONS: Online videos of neck dissection represent an increasingly ubiquitous and appropriate resource for trainees in learning otolaryngology key indicator cases. While free-to-access video repositories, such as YouTube, have become increasingly popular among trainees as a primary resource for learning and preparing for surgical cases, they lack consistent quality and as such, global efforts should be taken to improve the breadth and depth of educational video content in otolaryngology.

Objective To conduct a multivariate analysis of a large cohort of oral cavity squamous cell carcinoma (OCSCC) cases for independent predictors of local recurrence (LR) and overall survival (OS), with emphasis on the relationship between (1) prognosis and (2) main specimen permanent margins and intraoperative tumor bed frozen margins. Study Design Retrospective cohort study. Setting Tertiary academic head and neck cancer program. Subjects and Methods This study included 426 patients treated with OCSCC resection between 2005 and 2014 at University of Iowa Hospitals and Clinics. Patients underwent excision of OCSCC with intraoperative tumor bed frozen margin sampling and main specimen permanent margin assessment. Multivariate analysis of the data set to predict LR and OS was performed. Results Independent predictors of LR included nodal involvement, histologic grade, and main specimen permanent margin status. Specifically, the presence of a positive margin (odds ratio, 6.21; 95% CI, 3.3-11.9) or <1-mm/carcinoma in situ margin (odds ratio, 2.41; 95% CI, 1.19-4.87) on the main specimen was an independent predictor of LR, whereas intraoperative tumor bed margins were not predictive of LR on multivariate analysis. Similarly, independent predictors of OS on multivariate analysis included nodal involvement, extracapsular extension, and a positive main specimen margin. Tumor bed margins did not independently predict OS. Conclusion The main specimen margin is a strong independent predictor of LR and OS on multivariate analysis. Intraoperative tumor bed frozen margins do not independently predict prognosis. We conclude that emphasis should be placed on evaluating the main specimen margins when estimating prognosis after OCSCC resection.