FLEX January 2024

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Otolaryngology–Head and Neck Surgery 164(2)

Table 4. Single Predictor Models Evaluating Tumor Growth Following Resection and Requirement for Radiation by Binary Logistic Regression With Odds Ratio (OR), 95% Confidence Interval (95% CI), and P Value.

Recurrence following surgery

Radiation

Predictor

OR

95%CI

95%CI

P

OR

95%CI

95%CI

P

Age

0.98 3.29 0.49 0.57 1.38 0.45 1.38

0.93 0.60 0.05 0.10 0.38 0.08 0.38

1.02

.32 .17 .55 .54 .62 .37 .62

1.01 1.47 0.55 1.38 2.57 1.05 1.07

0.97 0.32 0.05 0.26 0.69 0.21 0.29

1.06 6.83 5.79 7.19 9.55 5.19 3.92

.55 .62 .62 .71 .16 .95 .92 Ref .14 .61 .84

Female gender

18

PGL family history

5.16

Indication

Tumor growth CN involvement

3.38 4.98 2.59 4.98

Other

Patient preference

GJ staging I-II

Ref

Ref

Ref

Ref

Ref

Ref

Ref

III IV

0.56 1.23 1.39

0.09 0.26 0.40

3.52 5.73 4.92

.39 .45 .61

0.22 0.67 1.14

0.03 0.15 0.32

1.60 3.08 4.08

Embolization

STR type Type 1

11.9

1.99

71

.007

2.50

0.57

11

.23 Ref

Type 2/3

Ref

Ref

Ref

Ref

Ref

Ref

Ref

Preoperative

Tumor volume

1.02

0.96

1.10

.50

0.99

0.93

1.05

.72

Postoperative

Tumor volume

1.00 1.00

0.92 0.97

1.09 1.03

.97 .96

1.05 0.97

0.96 0.94

1.16 1.01

.31 .10

EOR

Abbreviations: EOR, extent of resection; GTR, gross total resection; IQR, interquartile range; PGL, paraganglioma; STR, subtotal resection.

Table 5. Frequency of Pre- and Posttreatment Lower Cranial Nerve Neuropathy.

Cranial Nerve

Preoperative, n (%)

Postoperative, n (%)

IX

5 (12)

5 (12)

X

10 (24)

3 (7)

XI

4 (10)

5 (12)

XII

11 (27)

1 (2)

Facial Nerve Outcomes Six patients (15%) had CN VII weakness at presentation. Preoperatively, HB grade was 1 (n = 35, 85%), 3 (n = 3, 7%), or 6 (n = 3, 7%). All 3 patients with HB grade 6 required intraoperative CN VII sacrifice. Of the 35 patients with preoperative HB grade 1, 32 had postoperative facial nerve examinations documented between 3 and 12 months of follow-up. A total of 29 patients (91%) continued to have HB grade 1, whereas 2 patients (6%) had HB grade 2 and 1 patient (3%) had HB grade 3. Complications Two patients had cerebrospinal fluid leaks (n = 2, 5%), which required operative repair. One patient had a pseudo meningocele (n = 1, 2%), which resolved with the use of

Figure5. Kaplan-Meier plot of salvage therapy-free survival following subtotal resection. 95% confidence intervals are represented by dotted lines. Number of patients at risk are displayed below the x -axis.

IX (n = 5) and XI (n = 5) in 12% of cases. CN X (n = 3) and XII (n = 1) were also rarely affected following surgery. Ten patients (24%) underwent medialization laryngoplasty for voice rehabilitation, but only 2 (5%) of these were for new, postoperative CN X dysfunction. Five patients required intervention for dysphagia, either undergoing placement a nasogastric (n = 1, 2%) or PEG (n = 4, 10%) tubes.