Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P29

Preventing and Treating Osteoradionecrosis
and Related Complications: A Stepwise
Approach With the Experts
Alice Tang, MD (Moderator); Matthew O. Old, MD;
Marita S. Teng, MD; Chad A. Zender, MD
Session Description: Osteoradionecrosis (ORN) and softtissue necrosis are causes of significant morbidity in head and
neck cancer survivors. An evidence-based approach of the
treatment of ORN continues to evolve both with surgical and
nonsurgical management. For advanced ORN, the goldstandard treatment is surgical resection of the hypoxic and
hypovascular necrotic bone with immediate reconstruction
with vascularized tissue into the irradiated fields. However,
there are special considerations for this type of intervention
given that previously irradiated and/or operated environments
offer unique challenges. Similarly, soft-tissue necrosis after
radiation can be a diagnostic challenge because tumor recurrence is always a consideration. Recognizing when to treat can
also be problematic because it is difficult to determine whether
and when these ulcers will heal without surgical intervention
with vascularized tissue. Experts will review the evidence and
share their personal experience of operating in these distinct
conditions. In addition, this session will also evaluate and
review the conservative management options and review
recently published protocols for early ORN. Panelist 1:
Prevention and treatment of early ORN: an update on nonsurgical treatment of osteoradionecrosis and soft-tissue necrosis
(hyperbaric oxygen therapy, tocopherol protocol, pentoxifylline
therapy, comorbidity control), timing of teeth extraction. Panelist
2: Special considerations in the surgical treatment of ORN of the
mandible (timing, duration of antibiotics, role of free tissue
transfer). Panelist 3: Surgical technique and considerations when
treating ORN with free tissue transfer (preferences for donor
sites, utility of virtual surgical planning, surgical tips and tricks
when preparing bed for free flap, extent of resection).
Outcome Objectives: (1) Diagnose ORN and soft-tissue
necrosis and recognize when to treat in head and neck cancer
survivors. (2) Discuss the unique challenges in performing
reconstructive surgery in the setting of ORN and soft tissue.
(3) Review conservative management options for ORN and
how to implement up-to-date protocols appropriately.
Prophylactic Antisepsis in Head and
Neck Surgery: The Past, the Present, and
Remaining Questions
Sidharth V. Puram, MD, PhD (Moderator); Joseph Zenga, MD;
Brent A. Chang, MD; Neal D. Futran, MD, DMD
Session Description: Surgical site infection after open and
endoscopic head and neck surgery represents an enormous
physical, psychosocial, and financial burden for patients.
Despite major advances in ablative and reconstructive head
and neck surgery, surgical site infection remains a central
problem, with rates exceeding 15% in some patient cohorts.
This presentation will review the history and current evidence
supporting antiseptic techniques in head and neck surgery,

P29
both for endoscopic and open approaches as well as for benign
and malignant diseases. This will include the range of preoperative and intraoperative topical preparations, systemic prophylactic antibiotics, and critical elements of postoperative
care. Future directions in preventing surgical site infection
will be discussed. This topic will be handled through a panel
presentation that will include didactic and interactive components. A brief expert lecture both on open and endoscopic perioperative antisepsis will be presented (10 minutes each, 20
minutes total) followed by a moderated 40-minute, 4-case presentation with expert input and interactive polling through the
audience-response system. Expert panelists will include a
combination of junior and senior faculty.
Outcome Objectives: (1) Discuss the current incidence,
extent, and time session of surgical site infection in head and
neck surgery. (2) Review the history and current state of antiseptic techniques in open and endoscopic head and neck surgery. (3) Implement evidence-based management into practice
to decrease surgical site infection and improve antibiotic
stewardship.
Teaching an Old Dog New Tricks: Managing
Depth of Invasion in Oral Cavity Cancer
Daniel L. Faden, MD (Moderator); Cherie-Ann O.
Nathan, MD; Mark A. Varvares, MD; Harry Quon, MD
Session Description: Oral cavity squamous cell carcinoma
(OCSCC) constitutes about one-third of all head and neck
cancers. Early-stage (T1/T2 N0) OCSCC is managed not only
by head and neck surgical oncologists at academic medical
centers but also general otolaryngologists. New staging guidelines provided in AJCC8 drastically changed early OCSCC
staging by including depth of invasion (DOI) because of its
clear prognostic significance. However, neither AJCC8 nor
the National Comprehensive Cancer Network (NCCN) have
addressed how to practically incorporate these changes into
clinical practice. In this expert panel presentation, we will (1)
discuss the literature supporting the prognostic significance of
DOI in OCSCC; (2) review the AJCC8 staging system for
early-stage OCSCC and the current NCCN guidelines, highlighting current gaps in guidance; (3) compare modalities for
preresection assessment of DOI-including imaging, palpation, and biopsy-and review emerging modalities such as
intraoperative ultrasound; (4) discuss operative and postoperative decision making regarding treatment of the N0 neck and
decisions regarding the need for adjuvant treatment; and (5)
we will present unanswered questions and areas for investigation. The overarching purpose of this presentation is to discuss
practical guidelines for assessing DOI and using this information for treatment choices in clinical practice, based on the
existing literature.
Outcome Objectives: (1) Describe the prognostic significance of DOI in OCSCC and the AJCC8 staging system
for early OCSCC. (2) Discuss the benefits and deficits of
different modalities for assessing DOI prior to surgery and
intraoperatively. (3) Compare options for management of the
neck based on DOI.

Head and Neck

Panel Presentations

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

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