Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P282

P282
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.
patient raises questions regarding how the clinical course of
our patient may support hypotheses regarding the etiology of
silent sinus syndrome.
Pediatric Case Series Utilizing a Minimally
Invasive Approach for Transoral
Management of Piriform Fossa Anomalies
Ryan C. Borek, MD (Presenter); Ken Kazahaya, MD, MBA
Objectives: In the pediatric population, unilateral neck
masses, deep neck infections, and suppurative thyroiditis can
be clinical manifestations of third or fourth branchial cleft
anomalies. These anomalies are often associated with piriform
fossa sinus tracts. Management of these has historically
included an open surgical approach with consideration of ipsilateral thyroidectomy. We present our experience using a transoral technique in the management of these disorders.
Methods: This was a retrospective chart review from 2019
to 2020 of pediatric patients diagnosed with a third or fourth
branchial cleft anomaly and managed with transoral microscopic electrocautery of a piriform fossa sinus tract. In addition, the utilization of neuromonitoring of the recurrent
laryngeal nerve (RLN) to assist in the localization and preservation of the RLN was investigated.
Results: Six patients were identified who underwent endoscopic cauterization of a left-sided piriform fossa sinus tract.
Patients presented with recurrent deep neck infections, unilateral neck mass, or thyroiditis. All patients had resolution of
cervical disease without an external approach. No complications were noted.
Conclusions: Third and fourth branchial cleft anomalies are
often left sided and associated with recurrent deep neck space
infections, unilateral neck masses, or thyroiditis. We describe
our pediatric case series of successful management of these
patients with a minimally invasive transoral piriform fossa
sinus tract cauterization without the need for external surgery.
Review of embryology and anatomy of these lesions will be
presented along with a review of the literature.

Pediatric

Pediatric Cervical Spine Fractures Associated With
Mandibular or Facial Fractures
Jonathan A. Harounian, MD (Presenter); Garrett Kungho
Ni; Michele M. Carr, MD, DDS, PhD
Objectives: To determine the incidence, demographics, and
outcomes of concurrent cervical spine (C-spine) fractures in
pediatric facial trauma.
Methods: The Kids' Inpatient Database (KID) from the
2016 Healthcare Cost Utilization Project (HCUP) was queried
for various facial fractures using the International Classification
of Diseases, 10th revision, diagnosis codes. Mandible fractures were further subdivided into fracture site. Patients aged
0 to 18 years were included, and rates of C-spine fracture were
analyzed with regard to demographic factors, length of stay,

total charges, mortality rate, hospital characteristics, and concurrent facial fractures.
Results: Of 5568 patients included, 4.18% presented with
C-spine fracture. Children with C-spine fractures were significantly older (15.02 vs 12.76 years; P < .001), and length of
stay was significantly longer (11.33 vs 6.44 days; P < .001).
There was no difference in rate of C-spine fracture when stratified by sex, time of week and/or year, hospital location and/
or type, or facial fracture other than condylar and/or subcondylar fractures. Condylar fractures were positively associated
with C-spine fractures (odds ratio [OR], 2.04), as were subcondylar (OR, 1.96). Cervical spine fractures were associated
with significantly higher mortality, longer length of stay,
higher rate of tracheotomy and transfer out of index hospital,
and total hospital charges.
Conclusions: A significant association exists between condylar/subcondylar mandible and C-spine fractures. Awareness of
this information is vital for clinicians who manage pediatric
facial trauma and alerts them to the need to rule out C-spine
fractures in this group.
Pediatric Dog Bite Injuries to the Face and
Cost of Care
Tyler J. Van Heest, MD (Presenter); Cynthia Kay
Koenigsberg; Hanan Zavala, PhD; Sivakumar
Chinnadurai, MD, MPH; Brianne B. Roby, MD
Objectives: Pediatric facial trauma from dog bites poses a
significant financial burden to the health care system. The
total cost for dog bite-related hospitalizations in the United
States was $53.9 million in 2008, and the average cost per day
for a dog bite-related hospitalization is $5500. This study
aimed to understand the effect that injury severity and the setting of injury repair have on cost of care.
Methods: A retrospective chart review of clinical and financial information for all patients who required repair of a dogbite-related injury to the face between January 1, 2014, and
December 31, 2018, at a pediatric tertiary care hospital was
performed. Demographic and clinical information was obtained
from the patient medical charts. Injury severity was classified
using the modified Lackmann's classification of facial bite
injuries. Hospital cost for each patient encounter was obtained
from the hospital cost accounting department.
Results: Data from 73 patient encounters were analyzed.
When comparing the cost of care based on injury severity, modified Lackmann's type IIA/IIB injuries cost 4.8 times more than
type I injuries, and type IIIA/IIIB injuries cost 3.2 times more
than type I injuries. Injuries repaired in the operating room cost
7.0 times more than injuries repaired at the bedside.
Conclusions: This study demonstrates that cost of care is
dependent on injury severity and repair setting. More severe
injuries and injuries repaired in the operating room have
higher costs of care compared with less severe injuries and
injuries repaired at the bedside.

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

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