Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P180

P180
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
gross total curettage (n = 8, 9%), and subtotal curettage (n = 5,
5.6%). Overall, 47 of 51 (92.2%) gross total excisions, 20 of
25 (80.0%) subtotal excisions, 6 of 8 (75%) gross total curettages, and 1 of 5 (20%) subtotal curettages were successful.
Complications including facial palsy (n = 1, 16.7%), complete
anosmia (n = 1, 16.7%), facial numbness (n = 2, 33.3%), cerebrospinal fluid leakage (n = 1, 16.7 %), and bilateral blindness
(n = 1, 16.7 %) were reported.
Conclusions: CMFCBs are rare benign tumors that have a
fairly good prognosis. Patients can present with a wide array
of symptoms that depend on the location of the tumor in the
craniofacial bones. It is important to consider the tumor's clinical, imaging, and pathological features to determine an
appropriate differential diagnosis. Management involves total
tumor resection or curettage.

Head and Neck

Clinical Analysis of Tongue Squamous Cell
Carcinoma: A Comparison of the Staging
Systems Given in the Seventh and Eighth
Editions of the Union for International
Cancer Control
Ryuji Yasumatsu, MD, PhD (Presenter)
Objectives: Tongue squamous cell carcinoma (TSCC) is the
most common type of oral cancer. It has been reported that
depth of invasion (DOI) in oral cavity cancer is important in
determining prognosis. Currently, recommendation of elective neck dissection is based on the DOI of the primary tumor.
The TNM staging system of malignant tumors has been extensively used for the selection of treatment, assessment of prognosis, and evaluation of results. The Union for International
Cancer Control (UICC) has recently published the eighth edition of its staging system, which has some modifications in the
head and neck section. Among the changes, DOI has been
incorporated into the staging of oral cancer, and extranodal
extension has been added to the lymph node category. The aim
of this study was to evaluate the performance of the eighth
edition UICC staging system in TSCC and compare it with the
seventh edition UICC staging system.
Methods: The clinical records of 93 patients operated on for
TSCC from 2007 and 2016 were reviewed retrospectively and
evaluated for TNM classification according to the seventh and
eighth editions.
Results: The 3-year disease-specific survival rate was 72.3%.
The variable T was upstaged in 15 patients (16%) and was
downstaged in 17 patients (18%). In the N category, 5 of 35
cases were upstaged (14%). When patients were restaged,
there was an improvement in discrimination between T categories in relation to disease-specific survival, and confirmation of
the prognostic impact of the variable N. T stage and DOI are
complementary predictors of disease-specific survival, and
their combination results in the new UICC staging system giving a better prognosis.
Conclusions: The eighth edition UICC staging system is
more complex than its former version because of the inclusion
of DOI and extranodal extension.

Clinical Validation of Human
Papillomavirus+ Head and Neck Squamous
Cell Carcinoma Prognostic Biomarkers
Andrew C. Prince (Presenter); Emily Hollis; Hina
Rehmani, PhD; Natalia Issaeva; Wendell G. Yarbrough, MD
Objectives: The Cancer Genome Atlas (TCGA) has afforded
large-pool tumor specimen analysis. Comparisons between
human papillomavirus (HPV)+ and HPV- head and neck squamous cell carcinomas (HNSCCs) revealed unique mutation
profiles. A striking finding was approximately 30% of HPV+
tumors harbored a TRAF3 or CYLD mutation. Mutation types
were deep deletions as well as missense or truncation types with
predicated downstream loss of function. TRAF3 and CYLD are
2 negative nuclear factor (NF)-kB pathway regulators. Thus,
loss of TRAF3 or CYLD function results in constitutive NF-kB
activation. Kaplan-Meier stratification by TRAF3 or CYLD
mutational status revealed significantly improved 5-year survival in mutant compared to wild-type. Even more, HPV+
HNSCC with wild-type TRAF3 and CYLD genes demonstrated
poor survival patterns parallel to HPV- disease. We hypothesize that TRAF3/CYLD genotyping has the potential to provide
HPV+ HNSCC prognostication to facilitate treatment personalization. Prior to clinical translation, further validation of mutation significances must be conducted.
Methods: Eighty-nine HPV+ and 13 HPV- tumors with
paired normal tissues were obtained from the UNC Pathology
Core. Tumor specimens were obtained at a tertiary medical
center from 2004 to 2013. Tumor slides were subjected to
deparaffinization and subsequent genomic DNA extraction.
Sequencing efforts are ongoing.
Results: We are sequencing all HPV genes and 10 NF-kB
pathway players including TRAF3 and CYLD. Genotypic
analysis will be compared with clinical demographics and
outcomes including alcohol/tobacco use, tumor stage at presentation, 5-year survival, and treatment plan.
Conclusions: Validation of TCGA findings with this independent UNC cohort will encourage rapid, prospective clinical appraisal of these promising prognostic biomarkers.
Closing a Persistent Pharyngocutaneous
Fistula With a Novel Integra Parachuting
Technique
Kimberly A. Miller, MD (Presenter); Amy Anne D. Lassig, MD
Objectives: Pharyngocutaneous fistulae are a well-known and
dreaded complication of salvage laryngectomy that can be difficult to heal. We present a case study in a patient with poor wound
healing who, after a salvage laryngectomy, had a persistent pharyngocutaneous fistula that was eventually closed successfully
with Integra (bilayer matrix wound dressing) and Evicel.
Methods: The patient is a 63-year-old man with a history of
T4N2bM0 squamous cell carcinoma of the supraglottis who
received radiation and chemotherapy but unfortunately had
recurrence. He underwent complex total laryngectomy, pharyngeal reconstruction with pectoralis flap, and salivary bypass

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

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