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Bleier B, Workman A, Burks C, Maxfield A, Stack BC, Nathan CA, McCammon S, Varvares M, Schmalbach C, Wang S, Califano J, Shnayder Y, Gillespie MB, Enepekides D, Witterick I, El-Sayed I, Lin D, Patel U, Kraus D, Randolph G. AHNS endocrine surgery section consensus statement on nasopharyngolaryngoscopy and clinic reopening during COVID-19: How to get back to optimal safe care. Head Neck 2020; 43:733-738. [PMID: 33205536 PMCID: PMC7753703 DOI: 10.1002/hed.26525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
This article provides best practice guidelines regarding nasopharyngolaryngoscopy and OHNS clinic reopening during the COVID-19 pandemic. The aim is to provide evidence-based recommendations defining the risks of COVID-19 in clinic, the importance of pre-visit screening in addition to testing, along with ways to adhere to CDC guidelines for environmental, source, and engineering controls.
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Affiliation(s)
- Benjamin Bleier
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Alan Workman
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Ciersten Burks
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Alice Maxfield
- Department Otolaryngology Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Illinois, IL
| | - Cherie-Ann Nathan
- Department of Otolaryngology-Head and Neck Surgery, LSUHSC, Louisiana New Orleans
| | - Susan McCammon
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Mark Varvares
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Cecelia Schmalbach
- Department of Otolaryngology-HNS Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Steven Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Tucson, AZ
| | - Joseph Califano
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Yelizaveta Shnayder
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Danny Enepekides
- Sunnybrook Health Sciences Centre, Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, CA
| | - Ian Witterick
- Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, CA
| | - Ivan El-Sayed
- Department of Otolaryngology, Northwestern University, Evanston, IL
| | - Derrick Lin
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Urjeet Patel
- Department of Otolaryngology, Northwestern University, Evanston, IL
| | - Dennis Kraus
- Department of Otolaryngology - Head & Neck Surgery Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York
| | - Gregory Randolph
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
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Abstract
Objective: Proliferative verrucous leukoplakia (PVL) is a rare, recalcitrant, and lethal form of leukoplakia necessitating special attention. The purpose of this review is to further educate the otolaryngology community and to characterize the risk factors, clinical course, and optimal treatment for this highly aggressive, premalignant oral lesion. Method: A retrospective review was performed on all PVL cases treated at WMHC from 1985 to 2010. This data was pooled with additional PVL cases identified following a systemic review of the English-language literature. Only articles addressing epidemiology, histopathology, treatment outcomes, and malignant progression were pooled and analyzed with our data. Results: A total of 243 PVL cases met inclusion criteria. The mean patient age was 66 years. The majority of patients were female (72%) and nonsmokers (64.6%). HPV has not been found to be a risk factor. The average length of follow-up was 5.5 years, with an average of 10.7 biopsies per patient during this period. PVL exhibits histopathologic features along a progressive spectrum, evolving from leukoplakia and verrucous hyperplasia eventually to invasive carcinoma. Definitive treatment was rarely successful, with PVL recurrence rates reaching 88%. Rate of progression to verrucous carcinoma or oral squamous cell carcinoma was high (63.6%). Conclusion: PVL is a rare but recalcitrant form of leukoplakia with a malignant transformation rate reaching 64%. PVL warrants high clinical suspicion, to include a lifetime of close follow-up by a physician well versed in oral carcinoma. Repeat biopsy should be considered an integral part of this routine follow-up.
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