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.

Oral Presentations P93Conclusions: In the absence of brainstem compression or concern of malignancy, initial observation of JPTs should be considered. A significant number of tumors do not grow after time of diagnosis, and symptoms frequently remain stable for many years. Even with disease progression, most JPTs exhibit indolent growth with slowly progressive cranial neuropathy affording satisfactory physiologic compensation in most patients. The Nervus Intermedius in Children withCochlear Nerve Deficiency Submitted to Auditory Brainstem Implantation Giacomo Colletti, MD (presenter); Marco Mandala, MD; Liliana Colletti; Vittorio Colletti, MD Objectives: Anatomical distortions of the neural structures surrounding the foramen of Luschka (FL) characterize children with cochlear nerve deficiency (CND). Our goal was to investigate the anatomical features of the nervus intermedius (NI) and cranial nerve 7 (CN) VII in children with CND and verify if the NI can provide an additional landmark during auditory brainstem implantation (ABI) surgery, preventing intraoperative injuries of the nearby vessels and nerves.Methods: Sixty-four CND children ranging in age from 8 months to 16 years (2.92 ± 1.54) were video-recorded during retrosigmoid surgery for fitting the ABI and retrospectively examined with particular reference to the number and variety of NI bundles, the associated malformations of CN VII, the relationship with CN VII, and the possibility that NI might represent a landmark for ABI insertion.Results: Absence of CNs VI, VII, and VIII was observed respectively in 3, 8, and all children. Eighteen children showed several abnormalities of CN VII in the cerebellopontine angle. The identification of CN VII and of the bundles comprising NI was possible anatomically in 46 children. In 12 the identification was obtained with the assistance of intraoperative monitoring. The number of bundles comprising the NI varied from 1 to 6. The NI and CN IX were useful landmarks for identifying the FL of the lateral recess.Conclusions: NI provides an additional landmark during ABI microsurgery. Knowledge of NI anatomy and its topographical relationship with the neurovascular structures around the FL may prevent iatrogenic injuries and ABI electrical stimulation of the surrounding cranial nerves.

An abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown.

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This is the first study to (1) quantify lateral skull base thickness and (2) significantly correlate obesity with lateral skull base attenuation. Patients who are obese with spontaneous CSF leaks have greater attenuation of their skull base than matched obese controls. This finding supports theories that an additional process, possibly congenital, has a pathoetiological role in skull base dehiscence.