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At risk populations of oropharyngeal HPV SCC. 1. Sexual exposure to oral HPV (Men >5 lifetime oral sexual partners, Women >2) 2. Persistent oral HPV DNA 3. Persistent HPV E6 antibodies 4. Positive smoking status

What is my risk of oropharyngeal HPV SCC? D'Souza 2017

Distant metastasis (DM) in HPV positive oropharyngeal SCC. • Overall DM rate is 7.0% (95% CI: 5.9–8.2) • T3 or T4 disease associated with a 5-fold (95% CI: 1.92–12.40) risk of DM compared to T1 or T2 disease • Most common sites: Lung (61%)>Abdomen>Skin Crossley et al. 2022

Transoral surgery. Electrosurgical units have been shown to ignite and propagate fires at 15 W and when the fraction of inspired oxygen (FiO2) is greater than 50%.

Curative management considerations of locally advanced & metastatic cutaneous squamous cell carcinoma. Claveau et al. 2020

Incidence of Laryngeal Malignancy in a 3-year follow up of laryngeal leukoplakia biopsies. No dysplasia ~4% Mild/moderate dysplasia ~ 10% Severe dysplasia/carcinoma in situ ~18%

Skeletal Actions of PTH 1. Immediate: Mobilization of readily available calcium from skeletal stores. 2. Delayed: Activation of bone resorption leading to more calcium and phosphate release. (Talmage and Elliott 1958)

Salvage laryngectomy complications Hasan Z et al Systematic review Eur J Surg Oncol 2017 · 50 studies, n=3292 · Overall complication rate = 67.5% · Pharyngocutaneous fistula (28.9%) · Wound infection (14.1%) · Pharyngeal stenosis (14.3%) · Bleeding (5.9%) · Dysphagia (18.6)

• Most commonly injured nerve in rhytidectomy is Great Auricular nerve. • Emerges from the posterior border of the sternocleidomastoid muscle at a point 6.5 cm inferior to the external auditory meatus, also known as McKinney's point.

Head & Neck CUP Immunohistochemistry • p16 - surrogate for HPV-associated oropharyngeal ca • Epstein-Barr virus-encoded RNA, associated with nasopharyngeal ca • Calcitonin for medullary thyroid ca • Thyroid-transcription factor to distinguish from lung SCC (Lung is positive)

Calcium Bioavailability (BA). Calcium Carbonate (CC) • Alkaline • BA 15-40% • Low solubility, &inconsistent absorption rate Calcium Citrate • Acidic • Requires less stomach acid for absorption • BA~ 40% • Absorbed 22% (empty stomach) to 27% (food) better than CC