Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P190

P190
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.
Methods: A systematic review of management methods for
exposed mandibular plate in patients who underwent primary
reconstruction with vascularized bone free flaps following
oncologic excision of the oral cavity and mandible was conducted following Preferred Reporting Systems for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines to identify
all prospective studies, retrospective studies, and case reports
published prior to December 31, 2019.
Results: Of a total of 1252 search results, 97 studies met
the full inclusion criteria. Four studies were identified
detailing the management of mandibular plates exposures in
20 patients. Three were retrospective series, and 1 was a
case report. The average time from reconstruction to plate
exposure ranged from 1 week to 24 months. Two-thirds
(66.7%) of patients underwent adjuvant radiation prior to
their plate exposure. Following exposure, 9 plates (45%)
were removed, 4 (20%) were managed by a locoregional
flap, and no intervention was pursued in the remaining 7
(35%) cases. No study included long-term outcome data on
the success of the intervention, or requirement for a secondary procedure.
Conclusions: Evidence for efficacious management of mandibular plate exposures following reconstruction with a vascularized bone graft and plate is limited because of a paucity of
literature.

Head and Neck

Metastasis of Papillary Thyroid Carcinoma
to the Parapharyngeal Space
Kenric Tam (Presenter); Shabnam Ghazizadeh, MD;
Maie St. John, MD, PhD
Objectives: The thyroid is richly supplied by lymphatic
channels. While the thyroid drains into 4 principal lymph node
basins, Rouvière also described a lymphatic channel from the
superior-posterior lateral thyroid lobe to the lateral retropharyngeal and parapharyngeal nodes in 20% of dissections. We
describe a case of papillary thyroid carcinoma (PTC) metastasis to the parapharyngeal space (PPS) and performed a literature review.
Methods: We performed a PubMed literature search for
cases of PTC metastasis to the PPS.
Results: A 59-year-old woman presented with a PPS mass
initially noted after an upper respiratory infection. Magnetic
resonance imaging (MRI) demonstrated a large, 2-cm cystic
PPS mass. We performed an excisional biopsy of the PPS
mass using a transoral, endoscopic approach. Pathology
revealed metastatic PTC without extranodal extension. MRI
revealed no masses suspicious for ectopic thyroid tissue. The
patient underwent total thyroidectomy; final pathology demonstrated a 0.3-cm papillary thyroid microcarcinoma in the
left superior lobe. We identified 34 reported cases between
1985 and 2010 of PTC metastasis to the PPS. Approximately
half of PPS metastases derived from primary microtumors
were less than 1 cm in size.
Conclusions: The differential diagnosis for PPS mass
includes salivary gland tumors, neurogenic tumors, and paragangliomas. Differentiated thyroid carcinomas should also be

considered for isolated PPS masses, and thyroid ultrasound
and fine-needle aspiration biopsy should be part of the initial
workup to identify potential lesions. If a PPS mass biopsy
indicates PTC but no primary nodule-thyroid or ectopic thyroid can be identified, a total thyroidectomy should be performed to identify microcarcinomas.
Microsecretory Adenocarcinoma of the
Palate: A Case Report of a New Entity
Alexandra S. Ortiz, MD (Presenter); Nathan W. Hales, MD
Objectives: Microsecretory adenocarcinoma is a newly
described malignancy commonly occurring in the oral cavity
that has a distinct histologic appearance and a unique gene
fusion. This process was previously described as adenocarcinoma not otherwise specified (NOS). We present the first case
of microsecretory adenocarcinoma of the oral cavity in the
otolaryngology literature and the sixth case ever reported. The
goal of this study was to demonstrate the presentation, diagnosis, and management of this newly reported process.
Methods: We describe a case presentation from a tertiary
care medical center.
Results: A 69-year-old man was referred from oral surgery
for a 1-cm well-circumscribed lesion at the junction of the
hard and soft palate. The lesion was slow growing and asymptomatic. The patient underwent an incisional biopsy prior to
referral and pathology demonstrated the newly described lowgrade adenocarcinoma with a MEF2C-SS18 gene fusion,
characterizing it as a microsecretory adenocarcinoma. The
patient underwent primary surgical resection with partial palatectomy, partial maxillectomy, and split-thickness skin graft
reconstruction. Final pathology revealed negative margins and
no concerning features of perineural or lymphovascular invasion. No adjuvant therapy was recommended. The patient will
undergo clinical surveillance.
Conclusions: Microsecretory adenocarcinoma is a newly
described entity in head and neck cancer that has a distinct
histologic appearance and gene transfusion that the otolaryngologist should be familiar with. The treatment is the same as
for other low-grade adenocarcinomas with wide local excision with negative margins, and clinical surveillance is
recommended.
A National Analysis on Factors
Impacting Survival for Head and Neck
Dermatofibrosarcoma Protuberans
Aatin K. Dhanda (Presenter); Kirolos Georges; Jeff Gao;
Boris Paskhover, MD
Objectives: Head and neck dermatofibrosarcoma protuberans (DFSP) is a rare cancer of the skin that does not usually
metastasize. In this analysis, we seek to determine the effects
of demographic and treatment variables on mortality for head
and neck DFSP.
Methods: Data from the National Cancer Database were
used to identify a total of 804 patients with head and neck
DFSP from 2004 to 2016. The variables analyzed included

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

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