Andrew W. Joseph

Epidemiology of Human Papillomavirus-Related Head and Neck Cancer

Human papillomavirus (HPV) is now recognized to cause a subset of head and neck squamous cell carcinomas (HNSCC). Although excessive tobacco and alcohol use continue to be important risk factors for HNSCC, epidemiologic studies suggest that more than 25% of HNSCC are now caused by HPV. The incidence of HPV-related HNSCC is increasing, highlighting the need to understand the oral HPV infections causing these cancers. This article reviews the evidence for a causal association between HPV and HNSCC, examines the changing epidemiologic trends of HNSCC, and discusses what is currently known about oral HPV infection, natural history, and transmission.

Long-term prognosis and risk factors among patients with HPV-associated oropharyngeal squamous cell carcinoma.

A subset of patients with human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma (HPV‐OSCC) experience poor clinical outcomes. The authors of this report explored prognostic risk factors for overall survival (OS) and recurrence‐free survival (RFS).

Molecular etiology of second primary tumors in contralateral tonsils of human papillomavirus-associated index tonsillar carcinomas.

OBJECTIVES For patients with tobacco-related head and neck squamous cell carcinoma (HNSCC), the occurrence of a second primary tumor (SPT) is an ominous development that is attributed to a field cancerization effect and portends a poor clinical outcome. The goal of this study was to determine whether patients with human papillomavirus (HPV)-related index tonsillar carcinomas can also develop SPTs in the contralateral tonsil, and to discern the molecular etiology of HPV-related tumor multifocality. MATERIALS AND METHODS The surgical pathology archives of The Johns Hopkins Hospital were searched for all patients with primary HPV-related tonsillar squamous cell carcinoma who developed a synchronous or metachronous carcinoma in the contralateral tonsil. The HPV-16 E6 exon was sequenced from each independent cancer site to determine whether the tumor pairs harbored the same or a different HPV-16 variant. RESULTS Four patients with bilateral HPV-related tonsillar carcinomas were identified. In every case, the HPV DNA sequences derived from the index tumor and corresponding SPT were 100% concordant, indicating that the index and SPTs were caused by the same HPV-16 variant. CONCLUSION For the small subset of patients with tonsillar carcinomas who develop SPTs in the contralateral tonsil, the index case and the SPT consistently harbored the same HPV variant. This finding suggests that HPV-related tumor multi-focality can be attributed either to independent inoculation events by the same virus, or by migration of HPV-infected cells from a single inoculation site to other regions of Waldeyers ring.

Disease-free survival after salvage therapy for recurrent oropharyngeal squamous cell carcinoma

Factors associated with disease‐free survival (DFS) after salvage therapy for recurrent oropharyngeal squamous cell carcinoma (SCC) in the context of human papillomavirus (HPV) are poorly understood.

The Cost of Facial Deformity: A Health Utility and Valuation Study

IMPORTANCE The impact of facial defects on quality of life as perceived by society and the value society places on facial reconstruction are important outcomes measures. OBJECTIVE To measure the health state utility and dollar value of surgically reconstructing facial defects as perceived by society. DESIGN, SETTING, AND PARTICIPANTS A randomized observational study conducted in an academic tertiary referral center using a socioeconomically diverse group of 200 casual observers. MAIN OUTCOMES AND MEASURES Observers viewed images of faces with defects of varying sizes and locations before and after surgical reconstruction. Observers imagined if the defect in each image were on their own face and rated (1) their health state utility with the defect and (2) how much they would be willing to pay to have the defect surgically repaired to normal (perfect repair). Established health state utility and contingent valuation metrics were used. RESULTS Data from 200 observers were analyzed. Facial defects significantly decreased perceived health state utility with the greatest penalty attributed to large and centrally located defects. Surgical reconstruction of the facial defects increased health state utility to near-normal ranges for all groups except large central defects. Participants were willing to pay an average of

Prevalence of Body Dysmorphic Disorder and Surgeon Diagnostic Accuracy in Facial Plastic and Oculoplastic Surgery Clinics

1170 (95% CI,

Evaluation of Patients with Facial Palsy and Ophthalmic Sequelae: A 23-Year Retrospective Review

767-

Long term prognosis and risk factors among HPV-associated oropharyngeal squamous cell carcinoma patients

1572) to repair a de novo small peripheral defect; they were willing to pay

Management of Flaccid Facial Paralysis of Less Than Two Years’ Duration

4274 more than the average (95% CI,

Characteristics, Diagnosis, and Management of Ehlers-Danlos Syndromes: A Review

3296-