Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P188

P188
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.
dehydrogenase (SDHx) protein complex. Clinical practice
guidelines recommend SDHx mutation testing in all patients
with incident HNPGLs. We sought to identify trends in, and
factors predictive of, otolaryngologist referral for genetic testing in HNPGL over 2 decades.
Methods: This was a retrospective analysis of all patients
with untreated HNPGLs (ie, carotid body, jugular, vagal, or
sympathetic chain) treated at our institution from January
2000 to July 2019. Logistic regression was used to identify
factors associated with otolaryngologist referral for genetic
testing. Trend analysis was used to discover patterns of referrals in HNPGL patients over 2 decades.
Results: Of 200 patients, 121 (61.0%) were female and the
median (range) age was 53 (14-85) years. During the entire
study period, only 77 (38.5 %) patients were referred by their
otolaryngologist for SDHx testing. Factors associated with
referral included family history of paraganglioma (odds ratio
[OR] 10.3, 95% CI, 3.2-33.4, P < .001) and later decade of
diagnosis (ie, 2010-2019 vs 2000-2009; OR 11.6, 95% CI 4.232.0, P < .001). Older patients (OR 0.945, 95% CI 0.922-0.970,
P < .001) and those with isolated carotid body paraganglioma
(OR 0.256, 95% CI 0.075-0.873, P = .03) were less likely to be
referred. Over 2 decades, there was only a modest trend (r2 =
0.51) toward increased frequency of otolaryngologist referral
to genetics for incident HNPGL diagnoses.
Conclusions: Despite the frequency of heritable SDHx mutations in HNPGLs, otolaryngologist referral for genetic testing
remains sporadic and based mainly on traditional high-risk
patient factors.

Head and Neck

Hyoid Carotid Artery Syndrome: A Rare
Cause of Transient Ischemic Attacks
Albert J. Yang, MD (Presenter); Allen H. Young, MD;
Mike Wang; Tina P. Elkins, MD
Objectives: We present a case of transient ischemic attack
(TIA) caused by hyoid compression of the internal carotid
artery (ICA), reinforcing the paradigm of hyoid carotid
syndrome.
Methods: The patient was a 61-year-old woman with minimal history of cardiovascular disease who developed a TIA
when turning her head to the right while talking on the phone.
Symptoms include expressive aphasia, slurred speech, dysgraphia, and left extremity weakness. A head computed
tomography (CT) and magnetic resonant imaging were performed that ruled out acute stroke. The CT angiogram of the
neck vessels revealed 50% occlusion of right internal carotid
artery due to compression from the greater cornu of hyoid.
Carotid ultrasonography (US) also showed the ICA peak systolic velocities dropping from 54 cm/s to 38 cm/s with her
head turned rightward vs 60 cm/s turning left.
Results: Intraoperative findings: partial resection of right
hyoid confirmed a direct compression to the ICA and thus a
1.5-cm segment was resected. The patient was followed for
6 months postoperatively and was free of complications with
baseline speech, absent dysphagia, and further neurologic

symptoms. A follow-up neck US showed a baseline peak systolic velocity of the ICA.
Conclusions: The hyoid bone lies in close proximity of the
carotid bifurcation. Thus, similar to Eagle syndrome with stylohyoid compression, the hyoid carotid artery syndrome can
be a rare cause of neurologic symptoms and carotid abnormalities. Here we present a case supporting diagnosis of hyoid
carotid artery syndrome with CT angiogram and positional
ultrasonography. We also emphasize the safety profile and
definitive cure through a partial hyoidectomy.
Hypopharyngeal Toothpick-Induced
Granuloma Mimicking a Pyriform Sinus
Malignancy
Pauleatha Diggs (Presenter); Brandon Ithiel Esianor, MD;
Daniel Schuster, MD
Objectives: Adult foreign-body ingestion is a common
event. Rates are unknown, and complications can include
aspiration, perforation of the upper aerodigestive tract, or in
some instances, life-threatening infection. Here we present a
case of toothpick ingestion resulting in a granulomatous reaction mimicking a pyriform sinus malignancy.
Methods: A case report with literature review is presented.
Results: A 55-year-old male nonsmoker presented with a
3-month history of left-sided neck pain, odynophagia, and
dysphagia. Computed tomography (CT) revealed a heterogeneous enhancement in the left pyriform sinus. Direct laryngoscopy and biopsy were performed, and biopsy revealed
acute/chronic inflammation and granulation tissue with presence of a plant-based substance consistent with a toothpick.
No evidence of malignancy was appreciated. Follow-up CT
scan at 5 months showed complete resolution of the mass.
Conclusions: Foreign-body ingestions are commonly managed in the practice of otorhinolaryngology and have been
shown to account for approximately 11% of ear, nose, and
throat emergencies. Failure of patients to recall foreign-body
ingestion and nonspecific, varied presentation of symptoms
may complicate formulation of the proper diagnosis.
Nonetheless, workup of a new mass in the upper aerodigestive
tract is essentially unchanged, and malignancy should always
remain on the differential until proven otherwise.
Impact of c-Fos/c-Jun Complex Oncogenic
Activation in Oral Squamous Cell Carcinoma
Nicholas Mastronikolis (Presenter); Evangelos
Tsiambas, MD, PhD; Aristidis Chrysovergis; Spyridon Lygeros;
Sofianiki Mastronikoli; Vasileios Papanikolaou, MD, PhD;
Efthymios Kyrodimos, MD
Objectives: Oral squamous cell carcinoma (OSCC) is an
aggressive malignancy because of its increased capability to
locally metastasize combined with distant lymph node metastases. Among genes that are frequently deregulated in OSCC,
c-Fos/c-Jun complex forms the activator protein-1 (AP-1) acting as an early response transcription factor. Our aim was to

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

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