Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine carcinoma, thought to arise from Merkel cell mechanoreceptors in the basal layer of the epidermis.^1-3 The incidence of MCC is low, reported at 0.7 cases per 100 000 people per year in the US; however, the number of cases has increased by 95% since 2000, a rate much higher than that of melanoma or other solid tumors.⁴ This increase is attributed largely to longer life spans, with other risk factors including UV light exposure and immunosuppression from malignant neoplasms, organ transplant, and HIV infection.^1,2,4,5 In the northern hemisphere where there are lower levels of UV exposure, MCC cases are also associated with genetic alterations from the integration of the Merkel cell polyomavirus genome.^1,2,5

Importance: Oral cavity squamous cell carcinoma (OCSCC) is rare in patients ≤40 years, and their risk factors, presentation, and outcomes may differ from older patients. Objective: To assess the epidemiology, risk factors, and oncologic outcomes of young patients (≤40 years) with OCSCC compared to those >40 years. Design: A multi-institutional retrospective cohort study. Setting: Nine Canadian institutions from 2005 to 2019. Participants: In total, 4506 adults with OCSCC, of whom 205 (4.55%) were young and 4301 were older than 40. Interventions or Exposures: The primary outcomes were overall survival (OS) and disease-free survival (DFS), comparing young and older patients. The identification of risk factors for OCSCC development in young patients was a secondary outcome. Main Outcome Measures: OS, DFS, and risk factor identification. Results: Oral tongue cancer was the most common subsite (48.9%), with a significantly higher proportion of cases in young patients (73.4% vs 47.7%, P < .01). Young patients were more likely to present at an earlier clinical stage (T1: 44% young vs 31% old, P < .01) and were less likely to smoke (57% young vs 31% old, P < .01) or consume alcohol (72% young vs 58% old, P < .01). Multivariable analysis showed that smoking status, previous head and neck cancer, and advanced stage were significantly associated with decreased OS and DFS ( P < .05). No significant differences were found in local ( P = .61), regional ( P = .67), or distant ( P = .50) disease failure between age groups. Conclusions and Relevance: Young patients with OCSCC were less likely to smoke or drink and presented at earlier stages, but they did not experience improved OS or DFS compared to older patients. These findings emphasize the need for further research into biological differences in OCSCC between young and older patients.

Objectives: Necrotizing Fasciitis (NF) of the head and neck is a critical condition, known for its severe impact and high mortality rates, often linked with diabetes, odontogenic infections, and immunosuppression. Observations from the University of Ottawa's Department of Otolaryngology – Head and Neck Surgery indicate an increase in NF cases since the COVID-19 pandemic began, suggesting a possible association between COVID-19 and NF. This study aims to assess the incidence of NF since the pandemic's onset and explore its association with COVID-19. Design: Conducted as a single-center retrospective review from January 1, 2015, to April 7, 2023, this study included patients over 18 with histopathological confirmation of NF, analyzing clinical risk factors, treatment, and outcomes. Patients were divided into pre- and post-COVID-19 groups for comparison. Results: Out of 16 patients, 68.7% were in the post-COVID-19 group, with a notable increase in 2022. The most common risk factors were diabetes mellitus (43.8%) and history of odontogenic infection or extraction (31.3%). Only one patient (6.3%) presented with concomitant COVID-19 infection and NF. All patients underwent treatment with serial surgical debridement and IV antibiotics with mortality rates rising to 12.5% post-pandemic. Conclusion: Our study demonstrates an increased incidence of necrotizing fasciitis cases in our institution following the COVID-19 pandemic.

Hyalinizing clear cell carcinoma is an uncommon neoplasm arising in minor salivary glands. We present a rare case of hyalinizing clear cell carcinoma in the base of the tongue. We report a case of a 38-year-old female presented with a progressive history of hemoptysis and dysphagia over the course of 4 years. Examination revealed a mass originating from the base of the tongue with a biopsy confirmed as hyalinizing clear cell carcinoma . An Ovid MEDLINE and PubMed literature review was conducted due to the rarity of this type of tumor. The patient underwent surgical excision with immediate reconstruction with radial forearm free flap followed with adjuvant radiotherapy and was disease free at her most recent follow-up (12 months). Our review included a total of 13 new cases, including our case. The majority of the cases presented with dysphagia. Surgical excision is the mainstay of treatment, and overall these patients have a good prognosis. Our case highlights a rare presentation of hyalinizing clear cell carcinoma of the base of the tongue, successfully treated with surgical excision, free tissue reconstruction and adjuvant radiotherapy.

Background: Patients with surgical airways experience barriers to high quality end‐of‐life (EOL) care. Recognizing differences in healthcare utilization and location of death among patients with surgical airways may inform improvements in EOL care delivery. This study aimed to compare location of death and selected aspects of healthcare in the last 90 days of life between head and neck cancer (HNC) patients with and without a surgical airway. Methods: Retrospective decedent cohort study of health administrative data from the Institute of Clinical Evaluative Sciences in Ontario, Canada of individuals with HNC who died between January 1, 2008, and December 31, 2018. The exposure group included those with a total laryngectomy any time prior to death or emergency tracheostomy within 90 days prior to death. Primary outcomes included location of death and length of stay in hospital, palliative care encounters, and burdensome transitions of care in the last 90 days of life. Secondary outcomes included healthcare costs during the last 90 days of life. Results: Patients with surgical airways ( n = 1280, 7.8%) were more likely to die in a subacute care center (OR = 1.51 [95% CI: 1.26–1.81], p < 0.001) than those without surgical airways. There were no significant differences between the groups for deaths occurring in acute care (OR = 1.11 [95% CI: 0.97–1.27], p = 0.14) or long‐term care settings (OR = 0.85 [95% CI: 0.62–1.16], p = 0.30). In the last 90 days of life, they spent more time in acute care hospitals (6.37 days [95% CI: 5.40–7.39], p < 0.001), had higher odds of experiencing burdensome transitions (OR = 1.46 [95% CI: 1.29–1.67], p < 0.001) and had greater costs associated with their care (mean cost ratio = 1.43 [95% CI: 1.36–1.51], p < 0.001). However, after adjusting for covariates, there was no statistically significant difference in palliative care involvement between patients with and without surgical airways (OR = 1.14 [95% CI: 0.98–1.31], p = 0.09). Conclusions: Patients with surgical airways were more likely to die in subacute care centers and experienced increased healthcare utilization, including longer hospital stays, higher rates of burdensome transitions, and greater costs in the last 90 days of life. There was no statistically significant difference in palliative care involvement between groups after adjustment. These findings should be interpreted with caution, as adjustment for disease stage and tumor site was not possible due to missing data. Further research is needed to better understand the underlying drivers of these differences and their implications for EOL care.

Background/Objective: Dizziness is managed using various therapies, including lifestyle changes, nutritional supplementation, pharmaceutical therapies, and physical therapy, each offering differing efficacy. With legalization of cannabis in Canada, patients are exploring its use in treating their dizziness and related symptoms. Limited knowledge exists regarding usage patterns, forms, doses, and effects on these symptoms. The current study aims to examine cannabis use in patients experiencing dizziness. Methods: We conducted a cross-sectional study at the Ottawa Hospital outpatient neuro-otology clinic. Eligible participants included new patients presenting with a primary complaint of dizziness and follow-up patients reporting new-onset dizziness. Participants completed a questionnaire capturing demographic data, dizziness and related symptoms, attitudes toward cannabis use, consumption patterns, and its perceived effects on their symptoms. Results: Of 154 participants, 118 (77%) expressed willingness to consider cannabis for dizziness and 78 (51%) reported previous cannabis use. Of those patients, 44 (56%) consumed it recreationally, largely via smoking (29/78, 37%). Approximately 21% of these patients reported a moderate–large subjective relief from dizziness after use of cannabis. The most common diagnoses amongst cannabis users were migraine/vestibular migraine (24%), persistent postural perceptive dizziness (22%), and benign paroxysmal positional vertigo (17%). Other related symptoms relieved by cannabis included sleep (28/78, 36%), emotional difficulties (17/78, 22%), neck pain/stiffness (14/78, 18%) and headaches/migraines (9/78, 12%). Conclusions: There is generally a positive attitude towards cannabis use in treating dizziness amongst patients, with a subset of patients reporting a subjective improvement of dizziness and its related symptoms, such as sleep and emotional difficulties.