Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P182

P182
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.
an otolaryngologist. Rarely, they can migrate outside the laryngopharyngeal tissue and may require open surgery for extraction. In addition to a thorough history, it is recommended for
the patient to undergo CT scanning to confirm diagnosis.
A Description of the Anatomy of the
Hypopharyngeal Lateral Wall and the
Superior Laryngeal Artery in Transoral
Approach
Junxiao Jia (Presenter); Shui Fang Xiao, MD

Head and Neck

Objectives: The objective of this work is to illustrate the precise anatomy of the hypopharyngeal lateral wall (HPLW) and
superior laryngeal artery (SLA) as encountered during transoral surgery.
Methods: Five color-injected cadaveric heads (10 sides)
were dissected transorally and verified by the transcervical
approach. The HPLW was demonstrated layer by layer until at
the carotid sheath. The anatomical measurements of the SLA
were recorded, including origins, branches, and relationship
with the superior laryngeal nerve (SLN), superior horn of thyroid cartilage, and hyoid bone.
Results: The layers of the HPLW until the carotid sheath are
usually mucosa, thyroid cartilage, pharyngeal constrictors,
and lymph-fat tissues. However, the sheath sometimes will be
below the constrictors closing to the lateral-posterior wall of
hypopharynx under suspension laryngoscopy. The SLA origins from the superior thyroid artery in 4 cadaveric heads
(8 sides), and aberrant origins are noted in 1 cadaveric head, in
which the SLA is from the external carotid artery in the left
side and the lingual artery in the right side. The SLA passes
through constrictors and the thyrohyoid membrane, then travels in the pharyngoepiglottic fold. When approaching the epiglottis, the branch appears to supply the epiglottis, then the
main trunk runs into the thyroarytenoid muscle. The SLN parallels the course of the SLA, and the SLA is in front of the
SLN around the superior horn of the thyroid cartilage. The
average distances between the SLA and SLN are 5.0 ± 1.9 mm
(left side) and 6.0 ± 1.2 mm (right side), between the SLA and
superior horn of thyroid cartilage are 5.8 ± 0.8 mm (left side)
and 5.0 ± 1.0 mm (right side), and between the SLA and the
hyoid bone are 1.4 ± 0.4 mm (left side) and 1.4 ± 0.5 mm
(right side).
Conclusions: The detailed anatomy of the HPLW and the
SLA in transoral approach makes transoral microsurgery safer.
Determining the Effect of Preoperative
Dehydration on Microvascular Free Flap
Reconstruction of the Head and Neck
Gregory L. Barinsky, PharmD (Presenter); Dongmin C. Kim;
Yash M. Shah; Brandon Nguyen, MD; Soly Baredes, MD;
Richard C. Park, MD
Objectives: The purpose of this study is to assess the effect
of preoperative dehydration on postoperative outcomes after
microvascular free flap procedures.

Methods: In this retrospective database analysis, the
National Surgical Quality Improvement Program database
was queried, using Current Procedural Terminology codes, for
patients who underwent head and neck free flap procedures by
otolaryngologists. A ratio of blood urea nitrogen to creatine
greater than 20 was used as a proxy for dehydration. Exclusion
criteria included emergency cases, infection, and acute renal
injury to isolate elective cases. Patient demographics and outcomes were analyzed using univariate analysis and multivariate logistic regression.
Results: A total of 2793 cases met the inclusion criteria, of
which 835 cases (29.9%) had preoperative dehydration and
1958 cases (70.1%) did not. Univariate analysis showed
increased associations between dehydration and the following
comorbidities: dyspnea (10.2% vs 7.6%; P = .030), congestive
heart failure (1.3% vs 0.4%; P = .011), and dependent functional health status (2.5% vs 1.0%; P = .003). Current smoking status was protective for dehydration (odds ratio [OR]
0.796; P = .02). After multivariate logistic regression analysis,
preoperative dehydration was independently associated with
receiving a blood transfusion (OR 1.33; P = .002). No other
medical or surgical postoperative complications were significantly associated with dehydration.
Conclusions: Preoperative dehydration prior to head and
neck microvascular free flap reconstruction may increase the
risk of blood transfusion but otherwise has no effect on the
rate of postoperative complications.
The Development of Foreign Accent
Syndrome Following Oral Cavity Surgery: A
Case Series and Review of the Literature
Nicole M. Fowler, MD; Claudia I. Cabrera, MD, MS
Objectives: Foreign accent syndrome (FAS) was first
described in 1907. Diagnostic criteria require (1) the onset of
a foreign accent, (2) without previous speech training, (3)
absence of neurological cause, and (4) the presence of a psychological condition. The occurrence of FAS after oral cavity surgery has never been published in the literature. Case 1: A
30-year-old woman with oral tongue squamous cell carcinoma
(SCCa) status post (s/p) hemiglossectomy with free flap reconstruction. After surgery, she began speaking with a British
accent. Her accent persisted during radiation but resolved soon
after completion of cancer treatment. Case 2: A 46-year-old
woman with floor-of-mouth SCCa s/p composite resection,
mandibulectomy, and free flap reconstruction. She developed a
Caribbean accent. This became more prominent during her adjuvant chemoradiation therapy. Case 3: A 50-year-old woman with
right alveolar SCCa s/p oral cavity resection including mandibulectomy and free flap reconstruction. During the course of her
adjuvant radiation therapy, she developed a Southern accent.
Her accent resolved once she completed cancer treatment; however, she subsequently developed 2 cancer recurrences. With
each of these recurrences, her Southern accent reappeared.
Conclusions: FAS is an unusual diagnosis usually associated
with a neurologic or psychiatric disorder. There is no previous

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

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