Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P157

Poster Presentations

Foramen Ovale and Foramen Spinosum Size
on CT Imaging in Patients With IIH, CSF
Leak, or Encephalocele
Steven D. Curry, MD (Presenter); Kleve W. Granger, MD;
Evan Richman; Jonathan L. Hatch, MD
Objectives: Spontaneous cerebrospinal fluid (CSF) leaks are
associated with elevated intracranial pressure (EIP) and idiopathic intracranial hypertension (IIH). EIP is also associated
with erosion of the osseous skull base. Widening of the foramen ovale has been reported in patients with IIH. This study
sought to investigate changes in the size of the foramen ovale
and foramen spinosum in patients with IIH, spontaneous CSF
leak, and encephalocele to identify radiologic markers of
associated with these diseases.
Methods: A retrospective study was conducted of adult
patients treated from January 1, 2014, to December 31, 2018,
who had radiologic imaging of the head with computed tomography (CT) and were diagnosed with IIH (including older
terms pseudotumor cerebri and benign intracranial hyperten-
sion), encephalocele, or CSF leak. The length and width of the
foramen ovale and foramen spinosum were measured on axial
CT images and used to calculate the approximate elliptical
cross-sectional area.
Results: A total of 264 patients were identified meeting
inclusion criteria. There were 170 patients with IIH, 48 with
spontaneous CSF leak or encephalocele, and 46 patients with
traumatic or iatrogenic CSF leak. Mean foramen length, width,
and cross-sectional area were not significantly increased in the
spontaneous CSF leak and encephalocele group (area: 20.07 ±
5.37 mm2) compared with the IIH (17.69 ± 5.37 mm2) and traumatic or iatrogenic CSF leak groups (19.01 ± 5.37 mm2; P >
.05). No significant differences in measurements of the foramen spinosum were found between groups.
Conclusions: Diagnoses indicative of either increased intracranial pressure (IIH) or skull-base defects (spontaneous CSF
leak or encephalocele) were not associated with enlargement
of the foramen ovale or foramen spinosum on axial CT
imaging.
Frogman With a Frog Neck: Rare
Presentation of a Submental Epidermoid
Cyst
Michael Baxter (Presenter); Justin D. Wilson, MD;
Art A. Ambrosio, MD, MBA
A 36-year-old male active-duty Navy SEAL presents with
2 years of "looking like a bullfrog." He has a slowly enlarging
bilateral submandibular mass with mild tenderness to palpation. A change in diet and workout routine during this time
resulted in weight loss, but the prominence of submandibular

tissue remained. It has not fluctuated in size, there is no relationship to eating, and he denies any difficulty with breathing,
speech, or swallow. He has a remote history of cigarette smoking and chewing tobacco but is otherwise healthy. Computed
tomography (CT) with contrast revealed a cystic mass craniad
to the mylohyoid. Magnetic resonance imaging (MRI) showed
a 7-cm floor of mouth mass with mild T2 hyperintensity, mild
T1 hypointensity, and restriction on diffusion-weighted imaging that extends into the tongue splaying the genioglossus
musculature. There was no appreciable extension to the foramen cecum or the hyoid. The mass was approached through a
transcervical incision. Avoidance of simultaneous intraoral
and transcervical incisions has the advantage of reducing fistula risk. Although an isolated intraoral incision avoids a visible scar, prior literature references the difficulty in removing
large masses such as this through the floor of mouth. Both dermoid and epidermoid cysts are ectoderm-lined inclusion cysts.
In this case, care differentiation of an epidermoid cyst from
thyroglossal duct cyst and ranula among other midline neck
pathologies helped the patient avoid unnecessary morbidity in
surgical treatment of this issue.
Gender Distribution of Speaking Roles at
Combined Otolaryngology Spring Meetings
Nicolette Jabbour (Presenter); Kah Whye Ryan Lim;
Lindsay B. Sobin, MD; Jessica R. Levi, MD;
Jeremiah C. Tracy, MD; Lauren F. Tracy, MD
Objectives: Despite an increasing number of women in academic otolaryngology to 15.8% in 2018, women remain
underrepresented relative to men in senior academic positions.
Invited speaking roles and recognition awards at national conferences are valuable opportunities for career advancement. In
otolaryngology, gender disparity in invited speaker positions
has not previously been studied. Investigation may identify
gender differences and opportunities for improvement.
Methods: Combined Otolaryngology Spring Meeting
(COSM) programs from 2015 to 2019 were assessed for the
numbers of women and men with invited speaking roles.
Roles included moderator, panelist, and keynote speaker/
invited lecturer across 9 societies within COSM. Chi-square
tests compared differences in gender representation across all
roles.
Results: Of 1434 otolaryngologists with invited speaking
roles at COSM from 2015 to 2019, 376 (26.2%) were women.
Women were significantly less likely to be keynote speakers/
invited lecturers in comparison with panelists or moderators
(15%, 28%, 28%, respectively; P = .03). There was no significant difference between the 9 societies in overall gender
representation (P = .07) and no significant change in the relative proportion of women speakers with time (P = .93). From
2015 to 2019, the proportion of women speakers increased
significantly in the American Otological Society (P = .02)
and decreased within the American Society of Pediatric Oto-
laryngology and American Rhinologic Society (P = .005 and
.02).

Comprehensive

Conclusions: A straight needle can migrate through muscle
as a result of lingual activity. Imaging studies can confirm its
location to facilitate its extraction. The narrow gauge was akin
to "finding a needle in a haystack."

P157

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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