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IMPORTANCE This study addresses the most common initial symptoms of oropharyngeal squamous cell carcinoma (OPSCC) and investigates differences between human papillomavirus (HPV)–positive vs HPV-negative tumors. OBJECTIVES To analyze the most common initial symptoms in patients with OPSCC and to determine if any differences in initial symptoms occur between HPV-positive and HPV-negative tumors. DESIGN, SETTING, AND PATIENTS Retrospective single-institution review of medical records of previously untreated patients with OPSCC diagnosed from January 1, 2008, toMay 20, 2013, who were evaluated by 1 physician (the senior author, T.A.D.) at the Medical University of South Carolina. MAIN OUTCOMES AND MEASURES We determined the most common initial symptoms of OPSCC and analyzed differences between HPV-positive and HPV-negative tumors. RESULTS Neck mass (in 39 patients [44%]) and sore throat (in 29 patients [33%]) comprised the most common initial symptoms in OPSCC. Patients who were HPV-positive were more likely to initially notice a neck mass than HPV-negative patients (51% vs 18%; P = .02), whereas HPV-negative patients were more likely to notice sore throat (53%vs 28%; P = .09), dysphagia (41% vs 10%; P = .05), or odynophagia (24%vs 6%; P = .04). CONCLUSIONS AND RELEVANCE This study provides preliminary evidence supporting neck mass and sore throat as the initial symptoms of patients with OPSCC. Patients who were HPV-positive more commonly complained of a neck mass as the initial symptom, whereas HPV-negative patients more commonly had symptoms related to the primary tumor site, including sore throat, dysphagia, and/or odynophagia.

Objectives: Determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. Methods: Systematic review and meta-analysis. A comprehensive literature search was conducted using the PubMed-NCBI database from 1970 to 2014. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs. control). Primary and secondary endpoints were defined as immediate postoperative and permanent facial nerve weakness (≥2 House-Brackmann score), respectively. Results: A total of 1414 articles were reviewed, resulting in 8 articles that met inclusion criteria. In total, 626 patients were included in the final meta-analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared with the unmonitored group (22.4% vs 35.0%, P = .001). The incidence of permanent weakness was also lower, but this difference was not statistically significant (4.2% vs 7.6%, P = .10). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 8 given an absolute risk reduction of 12.6%. This corresponded to a 49% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.51; 95% confidence interval, 0.34 to 0.76, P = .001). Conclusions: In primary cases of parotidectomy, intraoperative facial nerve monitoring decreases the risk of immediate postoperative facial nerve weakness, but does not appear to influence the final outcome of permanent facial nerve weakness.

Purpose: We studied the impact of mTOR signaling inhibition with rapamycin in head and neck squamous cell carcinoma (HNSCC) in the neoadjuvant setting. The goals were to evaluate the mTOR pathway as a therapeutic target for patients with advanced HNSCC, and the clinical safety, antitumor, and molecular activity of rapamycin administration on HNSCC.Patients and Methods: Patients with untreated stage II-IVA HNSCC received rapamycin for 21 days (day 1, 15 mg; days 2-12, 5 mg) prior to definitive treatment with surgery or chemoradiation. Treatment responses were assessed clinically and radiographically with CT and FDG-PET. Pre-and posttreatment biopsies and blood were obtained for toxicity, immune monitoring, and IHC assessment of mTOR signaling, as well as exome sequencing.Results: Sixteen patients (eight oral cavity, eight oropharyngeal) completed rapamycin and definitive treatment.

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