Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P184

P184		
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.
whereas a minority require free flap reconstruction (FFR) for
large defects or hypopharyngeal involvement. We compare
functional outcomes between PC and FFR.
Methods: We conducted a retrospective review of all
patients receiving primary TL for laryngeal cancer at 1 institution from January 1, 2000, to December 31, 2018.
Results: A total of 132 patients were included with mean age
of 63 years (SD, 10 years) and median follow-up of 24 months
(interquartile range, 12-59 months). Forty-eight (36%)
patients received FFR. Disease was cT2 (3, 2%), cT3 (45,
34%), cT4a (84, 64%), cN0 (56, 42%), cN1 (19, 14%), cN2
(53, 40%), and cN3 (4, 3%). T-stage was similar, but FFR had
worse N-stage disease (P < .01). Of 48 inlay FFR, 35 (73%)
were anterolateral thigh, 11 (23%) radial forearm, and 2 (4%)
other. FFR adjuvant treatment was chemoradiation (CRT) (14,
29%), radiation (RT; 26, 54%), or none (8, 17%); vs CRT (16,
19%), RT (40, 48%), chemotherapy (2, 2%), or none (26,
31%) in PC (P = .16). At last follow-up, excluding those with
recurrence, 4 of 31 (13%) FFR versus 3 of 62 (5%) PC were
feeding tube dependent (P = .16); 4 (13%) FFR vs 7 (11%) PC
were on modified diet (P = .82). Three (10%) FFR vs 10
(16%) PC had stricture requiring dilation (P = .4). Before
treatment, 27 of 48 (56%) FFR vs 27 of 84 (32%) PC were on
a modified or tube-fed diet (P < .01). Forty-one (85%) FFR
and 78 (93%) PC received TEP (P = .17); 27 (66%) FFR vs
58 (74%) PC achieved fully understandable speech (P =
.33). Before TL, 35 (73%) FFR and 62 (74%) PC had voice
problems that indicated medical evaluation or tracheostomy
(P = 1).
Conclusions: Despite the need for FFR in patients with complex defects, swallowing and voice outcomes were similar to
PC. Given our small sample, more research is warranted.

Head and Neck

Endonasal Confocal Laser
Endomicroscopy-A Novel Avenue for
Real-Time Evaluation of Malignant and
Premalignant Disease
Nina Katrin Wenda, MD (Presenter); Jan Gosepath, MD;
Ralf Kiesslich
Objectives: Probe-based confocal laser endomicroscopy
(p-CLE) is a method for intravital visualization of mucosal
changes. Because of the size of the endoscopes, it has been
mainly used in the gastrointestinal tract so far. First investigations
on head and neck carcinoma described the oropharyngeal application. The further miniaturization of the laser probe now allows
for endonasal application and thus first experiences with the
investigation of endonasal neoplasms. Based on the malignancy
criteria validated in the oropharynx, it will now be investigated
whether these can be transferred in a similar way to endonasal
mucosa.
Methods: We used p-CLE (Cellvizio) with intravenous fluorescein staining in functional endoscopic sinus surgery in
patients with different neoplasms of the paranasal sinuses and
compared cellular visualization of pathological changes with
those of healthy mucosa.

Results: p-CLE allows for endonasal use and application of
morphological criteria of malignancy in analogy to classical
histological examination. The method also allows for assessment based on additional criteria resulting from the altered
kinetics of fluorescein used in neoplastic tissue.
Conclusions: Our results suggest that endonasal application
of p-CLE represents a valuable extension of the diagnostic
repertoire available to date by an additional real-time analysis
of nasal mucosa. This is of particular value in surgically challenging anatomical areas such as the paranasal sinus system.
Epithelioid Sarcoma of the Tongue: An
Unusual Tumor Mimicking Squamous Cell
Carcinoma
Aasif A. Kazi, MD (Presenter); Nima Vahidi, MD;
Austin Wiles, MD; Evan R. Reiter, MD
Objectives: The objective of this work is to present an
extremely rare case of primary epithelioid sarcoma of the
tongue and review the diagnosis and management of this
unusual malignancy.
Methods: We conducted a chart review and comprehensive
literature review using PubMed and Google Scholar.
Results: A 17-year-old nonsmoker was referred for evaluation of an ulcerative lesion of the right anterolateral tongue,
progressing over several months. Incisional biopsy was concerning for squamous cell carcinoma. He underwent partial
glossectomy and bilateral selective neck dissections, with
reconstruction using a radial forearm free flap. Final pathology was consistent with epithelioid sarcoma, proximal type,
demonstrating perineural invasion and close margins. A postoperative positron emission tomography scan did not show
any persistent disease. He was referred to radiation oncology
for postoperative radiation therapy.
Conclusions: Epithelioid sarcoma is a rare malignancy that
usually presents in the extremities of young adults, which
uncommonly presents in the head and neck as a primary or metastatic lesion. The infrequency of these lesions has prevented
development of evidence-based treatment recommendations.
As with most sarcomas, surgery is the mainstay of therapy for
epithelioid sarcoma. Radiation has been used in an adjunctive
role. Although a rare lesion, epithelioid sarcoma should be considered in the differential diagnosis for atypical epithelioid
lesions of the tongue and oral cavity when patient demographics, gross lesion characteristics, or histopathology and immunohistochemical studies are not entirely consistent or convincing
for more common lesions, such as squamous cell carcinoma.
Ewing Sarcoma of the Craniofacial Bones:
A Qualitative Systematic Review
Rafey Rehman (Presenter); Nathan Patrick Parry;
Nadeen Awada; Jacob Agemy; Khashayar Arianpour, MD;
Adam J. Folbe, MD
Objectives: The objective of this work is to conduct a systematic
review evaluating the demographics, characteristics, management,
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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