Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P198

P198
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.
Preventing Neck Contracture After
Cervical Necrotizing Fasciitis: A Proposed
Reconstructive Algorithm
Zachary V. Anderson; Brendan C. Stack, MD; Ozlem E.
Tulunay-Ugur, MD; Alissa Kanaan, MD; Emre A. Vural, MD;
Jennings R. Boyette, MD; Mauricio A. Moreno-Vera, MD
Objectives: The mortality from cervical necrotizing fasciitis
(CNF) has dropped from 50% to 13%. As such, attention to preventing neck contracture-a common sequela of CFN-is paramount. We sought to identify functional outcome predictors
and to develop a disease-specific reconstructive algorithm.
Methods: A retrospective chart review was conducted of 8
CNF patients with cutaneous defects, treated from January
2016 to July 2019 at a tertiary academic institution, with a
minimum of 6 months' follow-up. The primary end point was
neck range of motion (ROM) assessed through a certified
physical therapist on direct examination or virtual video interview. Goniometric measurements were obtained to determine
the limitations due to neck contracture.
Results: The cohort included 7 men, and the mean age was
45 years. Reconstructive techniques included: skin graft (5),
fasciocutaneous free flap (1), myofascial rotational flap (1),
and secondary intention (1). Significant reduction in neck
ROM occurred in 60% of patients with skin grafting alone.
These patients had large defects of the anterior/lateral neck
above the level of the thyroid cartilage causing contracture.
Defects below the thyroid cartilage were successfully skin
grafted with normal ROM. The largest neck defect was extensive and bilateral, but free flap reconstruction allowed for
normal ROM. A large posterior neck defect healed by secondary intention without contracture, but 50% reduction in
ROM.
Conclusions: Location/extent of soft-tissue defect and reconstructive technique used have long-term functional implications. Skin grafting is appropriate for small-sized, lower
cervical defects, whereas others benefit from flap reconstruction. We expand on these findings in our proposed reconstructive algorithm.

Head and Neck

Primary Malignant Melanoma of the
Submandibular Salivary Gland: A Unique
Neoplasm
Phillip K. Pellitteri, DO (Presenter); James Biery
Malignant melanoma is an unusual neoplasm affecting
salivary tissue. Most salivary melanomas have been reported
to occur as a result of metastatic lesions from cutaneous primary sites, often in the head and neck. Evidence suggesting
salivary tissue as a primary site for malignant melanoma is
sparse and not definitive because these salivary neoplasms
may result from occult primary cutaneous sites. Further,
metastasis from cutaneous lesions has been demonstrated following what was felt to be curative treatment of the initial
primary site, leading to speculation that all salivary mela-
nomas occur as a result of metastasis. We report a patient with

a progressively enlarging submandibular gland mass that ultimately proved to be malignant melanoma and in whom an
active primary cutaneous (or mucosal) site could not be clinically or radiographically established, despite a remote history
of curatively treated melanoma in situ. This patient underwent gland removal with concurrent selective neck dissection, the pathologic findings of which demonstrated the
presence of intraglandular melanoma without involvement of
any regional nodal tissue. Targeted postoperative adjuvant
chemotherapy was well tolerated, and the patient remains disease free 4 years after therapy. The histopathologic findings
and clinical scenario suggest that disease developed within
the submandibular gland and not through metastasis from an
extraglandular site, an example of which has not been previously described. This presentation focuses on details of the
management of this unique patient, particularly in regard to
the efficacy of fine-needle cytopathology in making the diagnosis together with implementation of multimodality treatment. The relevant literature is reviewed.
Prognostic Significance of Regression in
Primary Cutaneous Melanoma of the Head
and Neck
Elizabeth Kim (Presenter); Isaac P. Obermeyer;
Nathan Rubin; Samir Khariwala, MD
Objectives: Although regression is a commonly reported
microscopic feature of melanoma, its prognostic significance
is unclear. This study examines the association of histologic
features of primary cutaneous melanoma of the head and neck
with sentinel node positivity and recurrence.
Methods: We conducted a single-institution retrospective
chart review of adult patients who underwent surgical management of primary cutaneous melanoma of the head and neck
between May 2002 and March 2019. Logistic regression models were used to study the association between presence of
regression and likelihood of a positive sentinel node or recurrence while adjusting for histologic subtype (nodular vs nonnodular), age at diagnosis, ulceration, Breslow depth (> or
≤1), and mitoses (> or ≤2).
Results: Among 830 patients identified, 300 met the inclusion criteria, and 179 had information reported regarding
regression status. A total of 13.4% of these 179 patients had
presence of regression. The mean Breslow thickness was 1.3
mm in those with regression and 1.8 mm in those without
regression. In patients with regression, 18.8% had a positive
sentinel node, and 13.6% experienced a recurrence. In patients
without regression, 25.8% had a positive sentinel node, and
30.2% experienced a recurrence. When adjusted for other factors above, regression was not significantly associated with
positive sentinel node (odds ratio [OR] 0.79, CI 0.09-3.60) or
recurrence (OR 0.47, CI 0.10-1.64). Mitotic rate >2 was significantly associated with any recurrence (OR 3.69, CI
1.38-10.35).
Conclusions: Patients with presence of regression had thinner melanomas and decreased rates of sentinel node positivity

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

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