Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P165

Methods: A prospective observational study was conducted
using video laryngoscopy to assess the larynx and subglottic airway. Transnasal fiber-optic laryngoscopy was performed in 50
adult patients presenting to an outpatient airway disorders clinic
at a tertiary care hospital from June 2019 to December 2019 for
workup of dyspnea or surveillance airway disorders. Videos were
captured in the neutral head position (traditional sniffing posture)
and flexion posture. Laryngoscopy operators and reviewers
included attendings, fellows, and residents from otolaryngology
and pulmonology. Reviews were conducted to rate glottic view in
accordance with the Modified Cormack-Lehane (CL) grading
scale, a subjective view of the subglottis from above the cords by
visual analog scale (VAS), and the airway grade (AG) as determined by the ability to view most distally the subglottis, anterior
cricoid, or trachea. Statistical analysis was performed via
Kruskal-Wallis rank-sum test and analysis of variance.
Results: Neck flexion significantly improved the distal view
of the subglottic airway on the VAS (P < .003) and AG (P <
.002), but there was no difference between flexion and neutral
position for CL grade (P = .87). Patient age, sex, height, and
body mass index did not have an effect on VAS, AG, or CL
scores in either the neutral or flexed posture.
Conclusions: Neck flexion provides a more optimal, distal
view of the subglottic airway during transnasal laryngoscopy.

Endocrine Surgery
Ambulatory Surgery Versus Overnight
Observation for Total Thyroidectomy:
Outcomes and Cost Analysis
Philip D. Rosen (Presenter); Luke Bailey, MS;
Christopher M. Gentile; Sudhir Manickavel; Erin J. Buczek, MD
Objectives: In a select population, total thyroidectomy can
safely be performed in an ambulatory setting. However, it
remains common practice to monitor patients overnight for
postoperative concerns. Our study aims to compare the outcomes and financial impact between patients undergoing ambulatory vs overnight admission after total thyroidectomy.
Methods: A retrospective review of all patients undergoing
total thyroidectomy was performed between October 2011 and
July 2017 at the University of Alabama (UAB) at Birmingham
Medical Center. Demographics, comorbidities, admission status, postoperative minor and major complications, and costs
were collected. Admission status was categorized as inpatient
(admission to hospital ≥1 night) or outpatient (discharged from
the recovery unit). Costs were obtained from all related hospital, clinic, and emergency department visits at the UAB within
30 days of surgery. After statistical analysis, outcomes and cost
were compared between inpatient and outpatient groups.
Results: A total of 870 total thyroidectomy patients were
included. There were 367 who (42.2%) met outpatient criteria.
Of these, 169 patients (19.4%) had a complication, and none
occurred more in the outpatient cohort. Only hypocalcemia
occurred significantly more in the inpatient group (14.3% vs
9.3%). No mortalities occurred. There was a significant

P165
difference between the total cost of inpatient and outpatient
thyroidectomies, with outpatient surgery costing on average
$2367 less per patient (P < .05).
Conclusions: Total thyroidectomy can safely be performed
in an ambulatory setting. The significant cost reduction of
ambulatory total thyroidectomy should be considered in this
population given its impact on the health care community.
Atypical Distant Metastases of Papillary
Thyroid Carcinoma-A Case Series
Madeline Ann Sauer (Presenter); Brette C. Harding, MD;
Tabitha L. Galloway, MD
Objectives: The American Thyroid Association has recently
changed the management guidelines for papillary thyroid
cancer (PTC) so that the treatment of PTC is no longer as
aggressive as it has been in the past. With only a lobectomy
and no further treatment, such as radioactive iodine, patients
are still achieving excellent outcomes. However, we present
3 cases of atypical follicular PTC, highlighting the potentially
complex nature of this variant of the disease. All of these
patients presented with metastasis of their follicular PTC
either on initial presentation or years later after an incorrect
diagnosis of a follicular adenoma.
Methods: This case series was a retrospective review of the
electronic health record at the University of Missouri to identify 3 cases of follicular variant PTC that presented atypically
with isolated distant metastases. The charts were reviewed to
determine initial presentation, treatment plan, pathologic
diagnosis, and follow-up.
Results: The 3 patients identified were diagnosed with atypical metastatic follicular PTC to unusual sites in the body,
including the iliac crest, thoracic spine, parietooccipital scalp,
and retro-orbital tissues without any evidence of locoregional
spread in any of the patients. These cases of metastatic disease
were noted to be very unusual in that the primary tumor was
either very small, less than 1 cm, or was resected many years
prior to presentation.
Conclusions: PTC has the ability to metastasis to distant
sites, even with very small tumors or years after initial presentation and treatment. Although PTC has been shown to have
very good outcomes with less aggressive treatment, these
cases highlight the potential for metastasis, even many years
after initial treatment, of this disease.
Diagnostic Value of Machine-Learning
Approach to Thyroid Cancer Patients
Valeria Dell'Era (Presenter); Massimiliano Garzaro, MD;
Melissa Raia; Michele Starnini, PhD; Alan Perotti, PhD;
Paolo Aluffi Valletti
Objectives: Thyroid nodules are very common, and 5% to
15% are malignant. Despite the low mortality rate of welldifferentiated thyroid cancer, some variants may behave aggressively, making nodule differentiation mandatory. Ultrasound
and fine-needle aspiration biopsy are simple, safe, cost-effective, and accurate diagnostic tools but could have some limits.

Endocrine

Poster Presentations

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

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