Shrinkage in oral squamous cell carcinoma: An analysis of tumor and margin measurements in vivo, post-resection, and post-formalin fixation.

PURPOSE: To quantify changes in tumor size and tumor-free margins following surgical resection and formalin fixation of oral cavity squamous cell carcinoma. MATERIALS AND METHODS: Nineteen patients were studied via cohort design. Between May and December 2011, measurements of tumor size and tumor-free margin were made in patients with squamous cell carcinoma of the oral cavity. Mucosal reference points were marked with sutures, representing tumor diameter and two separate resection margins. Measurements were recorded immediately before resection, after resection, and following fixation in formalin. RESULTS: The overall mean shrinkage in tumor size was 10.7% (95% CI 3.4-18.0, p=0.006). When comparing mean tumor measurements, most of the tumor size decrease (6.4%, 95% CI 0.4-12.4, p=0.039) occurred between pre- and post-excision measurements. To a lesser extent, tumor size decreased following formalin fixation. Comparison of tumor-free margin measurements revealed a pre-excision to post-fixation mean decrease of 11.3% (95% CI 2.9-19.6%, p=0.011), with a statistically significant decrease of 14.9% (95% CI 8.5-21.3%, p<0.001) occurring between pre- and post-excision, and no significant decrease from post-excision to post-formalin fixation. CONCLUSION: Mucosal dimensions of both tumor and tumor-free margins in oral cavity squamous cell carcinoma specimens decrease between surgical resection and pathologic analysis. Most of this decrease occurs prior to fixation, especially for margins, and may be due to intrinsic tissue properties rather than formalin effects.

Effects of a reward system on resident research productivity.

IMPORTANCE: With the changing academic medical environment, nontraditional methods may need to be considered to foster research and scholarly activity during the otolaryngology residency experience. OBJECTIVE: To evaluate the results of a reward system on resident research activity. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of publications and approved institutional review board (IRB) projects between July 1, 1997, and June 30, 2011, among otolaryngology residents at a single otolaryngology residency program at the University of Missouri. INTERVENTION: A resident reward system, which awards points for research efforts for each progressive step along the research path from project design to acceptance for publication, was implemented on July 1, 2004. Residents can convert points to a monetary amount to be used for academic enrichment. MAIN OUTCOMES AND MEASURES: Publication rate and IRB approval rate were compared before and after institution of the reward system. Study design types that were published and study design types that received IRB approval were evaluated as well. We hypothesized that the reward system would increase research quantity and quality. RESULTS: The mean publication output per resident per year increased from 0.13 (95% CI, 0.03-0.23) before commencement of the reward system to 0.43 (95% CI, 0.26-0.60) after implementation of the reward system (P = .004). Significantly more case reports were published compared with other study design types. The number of approved IRB projects before institution of the reward system was 0.47 (95% CI, 0.18-0.75) per resident per year. After instituting the reward system, this increased significantly to 1.29 (95% CI, 0.96-1.63) per resident per year (P = .007). Significant increases in IRB-approved case reports and retrospective clinical studies were noted. CONCLUSIONS AND RELEVANCE: After implementation of a point-based reward system, resident research activity increased. The data suggest that this system may encourage resident research, although further refinement may be required to promote higher-quality research endeavors.

Predictors of tonsillectomy after previous adenoidectomy for upper airway obstruction.

OBJECTIVE: (1) Characterize risk factors for subsequent tonsillectomy in pediatric patients undergoing primary adenoidectomy for upper airway obstruction. (2) Compare rates of subsequent tonsillectomy between adenoidectomy patients with and without upper airway obstruction. STUDY DESIGN: Historical cohort study with a nested case-control study. Cohort data were analyzed using Kaplan-Meier plots and a multiple regression model. Case-control data were analyzed using logistic regression. SUBJECTS AND METHODS: Patients undergoing adenoidectomy without tonsillectomy at the University of Missouri between 1995 and 2010 were identified using billing records and selected chart review. A nested case-control study with detailed chart review was conducted to determine predictors of subsequent tonsillectomy in patients with upper airway obstruction. RESULTS: Of 1291 patients identified in the historical cohort, 7.8% later underwent tonsillectomy. Age younger than 3 years (P = .027), female sex (P < .0001), and upper airway obstruction (P = .001) were found to be significant predictors of subsequent tonsillectomy. In the nested case-control study, potential predictors investigated included adenoidectomy indications, symptoms, smoke exposure, weight, comorbidities, and tonsil size at the time of adenoidectomy. Of these, only tonsil size was significant, with an increased odds of future tonsillectomy of 2.5 (P = .01) for each unit increase in tonsil size. CONCLUSION: Patients undergoing adenoidectomy for upper airway obstruction are likely to be at an increased risk of subsequent tonsillectomy when compared with those with other indications. Within this subgroup of patients with upper airway obstruction, young age, female sex, and large tonsil size may further increase the risk of subsequent tonsillectomy.