The Georgia ENTertainer
Winter 2015 Issue
President's Message 
by: Stephen Rashleigh, MD

Welcome to the new "e-edition" of the ENTertainer.  We are bringing our association newsletter to you electronically for the first time.  We hope this will make it easier for you to view  and navigate, using clickable links to get more information where you want it.  It's also easy to print out if you want to take it with you and read it when you are not in front of the screen.  However you choose, we hope it helps you to stay connected to the Georgia Society of Otolaryngology/Head & Neck Surgery, YOUR professional association.

What I enjoy most being a member of the GSO/HNS is being a part of the fraternity of otolaryngologists in our state.  It's allowed me to meet Dr. Wendy Smith from Blairsville, catch up with Dr. Tom Crews from Statesboro and hear talks from Dr. Anita Sethna from Emory or Dr. Sarah Mowry of Georgia Regents University - not to mention meeting experts from all over the world.  All this in a low-key educational setting at beautiful resorts in the South.  If you have not yet joined our society, you are missing out.


The annual summer meeting this past July in Fernandina Beach at the Amelia Island Plantation was well attended.  Our past president Dr. Amy Chen hosted Dr. Jennifer Parker Porter lecturing on facial plastic surgery, Dr. Maisie Shindo on endocrine surgery of the head and neck and our Academy's president-elect, Dr. Sujana Chandresekhar who spoke on otology as well as the AAO-HNS Clinical Practice  Guidelines.


Our joint meeting of GSO/HNS and MAESO/OHNS this fall met at the Ritz Carlton Lodge at Reynolds Plantation and although our afternoon activities were rained out, we were honored to have as our guest speaker, Dr. Frederick Kuhn.


Upcoming events include: Coding and Reimbursement Update of Otolaryngology and ICD-10 Education for Otolaryngology with Karen Zupko and Associates Sunday March 22 through Monday March 23 at the Sonesta Hotel, Duluth Georgia and our summer meeting.


For the first time in years, our summer meeting will be in Hilton Head, SC at the Sonesta Resort on July 23-26, 2015. Our guest speakers will be Dr. Craig Buchman, chief, division of Otology/Neurotology and Skull Base Surgery at the University of North Carolina; Dr. Hassan Ramadan, professor and vice-chairman, Department of Otolaryngology and joint appointment Professor in the Department of Pediatrics, West Virginia school of medicine; and Dr. Brendan Stack, professor at the University of Arkansas for Medical Sciences. Please make plans now to join us for the GSO/HNS 2015 Annual Summer Meeting. 

While we are blessed with a strong state society with excellent participation and support from the otolaryngology departments at Emory and Georgia Regents University, as well as private practitioners across the state, we are only as strong as our members.  I encourage you to invite your new partners or colleagues to come to our meetings and become members of the Georgia Society of Otolaryngology/Head and Neck Surgery.


I look forward to seeing you all at the upcoming GSO/HNS Meetings. 

Coding Update

by: Grace Baynham 

GRU Otolaryngology Billing Coordinator



CMS gives us four new additions to modifier -59.

CMS has announced the establishment of four new modifiers that are subsets to modifier -59.  Due to abuse in the use of modifier -59 resulting in millions of dollars in overpayments, CMS wants to track how providers use modifier -59.  These new "X" modifiers became effective January 1, 2015. Modifier -59 will not be deleted and in some circumstances is still the more appropriate modifier to use, however the following modifiers give a little more detail for defining how the procedure is a "Distinct Procedural Service" and should be reimbursed separately.

  • -XE, separate encounter, a service that is distinct because it occurred during a separate encounter
  • -XS, separate structure, a service that is distinct because it was performed on a separate organ or structure
  • -XP, separate practitioner, a service that is distinct because it was performed by a different practitioner
  • -XU, unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service.

CMS will still accept modifier -59 for an undetermined grace period but they are encouraging physicians to begin migrating toward the more definitive -X modifiers.


New Zenker's Diverticulum CPT Code

A new CPT code was developed for 2015 to specifically describe a diverticulum that was treated endoscopically.  The American Academy of Otolaryngology-Head and Neck Surgery now recommends that you appropriately report endoscopic treatment of a Zenker's diverticulum using the newly created CPT code 43180.  Previously the procedure had to be reported using unlisted CPT code 43499.  The new CPT code is worded as follows:

  • 43180 Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg. Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed.
Legislative Report 
by: Jimmy Brown, MD
President-Elect, GSO-HNS
Legislative Representative, GSO-HNS

State of Georgia Legislative Update 2015 for Otolaryngology


The Georgia General Assembly began its Legislative Sessions for year 2015 with a 'bang'.  There were a sum total of 16 bills pertaining to the delivery healthcare that were introduced.  One such bill, Senate Bill 87 (SB-87) pertains to Otolaryngology broadly and potentially has far reaching consequences to the delivery of Otolaryngologic care in the state of Georgia. 


The Georgia General Assembly officially convened its 153rd, 40-day legislative sessions in January of 2015 and the Chamber also formally introduced its state legislative priorities - which include several key issues focused on keeping Georgia at the forefront in a diversity of societal metrics nationally.
In the past few General Assembly sessions, Georgia lawmakers passed a number of healthcare specific bills important to our state's overall healthcare community.  SB-87, deserves close attention by physician advocates and subspecialty trained physicians such as pertains to Otolaryngology. The Bill: "Code Section 43-34A-3 of the Official Code of Georgia Annotated, relating to physician profiles, dissemination to public, content and maintenance requirements, corrections, judgments prior to April 11, 2001, sealed judgments, arbitration awards, and settlements prohibited, is amended as follows: Specialty board certification, as approved by the Accreditation Council on Graduate Medical Education and the American Board of Medical Specialties and its component boards, if applicable. The toll-free number of the American Board of Medical Specialties shall be included to verify current board certification status. Only specialties approved by the Accreditation Council on Graduate Medical Education or the American Board of Medical Specialties and its component boards shall be accepted and disseminated to the  public, including dissemination on the Internet;
" All laws and parts of laws in conflict with this Act are repealed.

SB-87 is heavily amalgamated with several components and will be widely and variably interpreted but its tenets will be far reaching and deserves strict attention and interpretation by our society's rank and file.



Coding and Reimbursement Update For Otolaryngology 
and ICD-10 Education Course
Course Information
SUNDAY, MARCH 22, 2015
Coding & Reimbursement Course
9:00AM - 4:00PM

MONDAY, MARCH 23, 2015  
ICD-10 Education for Otolaryngology
9:00AM - 4:00PM

For more information, visit
Hotel Information
Sonesta Hotel - Gwinnett Place 
1775 Pleasant Hill Road
Duluth, GA 30096 

We have a small block of rooms reserved at a discounted rate of $119/night. 

Call 1-855-463-3095 and use code 0320GEOSOC or click here to use the web-link to make your hotel reservation. 
Medical Association of GA Update 

by: Arthur Torsiglieri, MD, FACS

Representative, MAG Legislative Council 


Since our last ENTertainer article the Medical Association of Georgia (MAG) has maintained its role as the leading voice for physicians in every specialty and practice setting in Georgia.  Otolaryngologists can be particularly proud as William E. Silver, MD completed his one year term as MAG President at the 160th House of Delegates Meeting at Calloway Gardens this past October.  Dr. Silver was the first otolaryngologist to serve as President of MAG since its establishment in 1849. Congratulations to Billy for a job well done! Manoj H. Shaw MD, an OB-GYN from Warner Robins, was inducted as the new president. Our specialty is represented on the MAG Board of Directors by Billy, myself and Dr. Lisa Perry-Giles.


Recently MAG organized "Physicians Day at the Capitol", also known as "white coat day".  On January 28th approximately 50 doctors met with legislators and Governor Deal.  Issues involving Medicaid Parity Payment Continuation,  Professional Transparency legislation, Biosimilars and Interchangeable Biologics, and Medical Cannabidiol use were discussed.  Otolaryngologists in attendance included myself, Dr. Lisa Perry-Giles, and Dr. Jeff Gallups.  


Other topics that will probably be discussed during the session include bills expanding the sale of fireworks in Georgia, possibly  increasing the spectrum of vaccinations available at pharmacies, and changing the requirements on supervision of APRNs at walk-in clinics.


Future MAG events include the 2015 Legislative Update on July 31 - August 1, 2015 at Chateau Elan in Braselton. For more information or to join MAG visit

Membership Information
2015 GSO/HNS 
If you have not done so already, make sure to pay your 2015 dues. 

Not A Member? 
Become a GSO/HNS Member today! 
Board of Governors Update 

by: Peter Abramson, MD

Immediate-Past Chair, Board of Governors, AAO-HNS


The Academy welcomes James Denneny, MD as its newly minted Executive Vice President/CEO taking over the duties from David Nielsen,MD who did an exemplary job in over a decade of service in that role. We are excited to have Dr. Denneny's experience and energy at the helm of the Academy.


In the past, the Academy has had a staff member in charge of tracking state legislation ,but that position has been eliminated in favor of an in-district grassroots outreach program called In-District Grassroots outreach(I-GO).  There is also a state tracker group that watches legislation and healthcare trends reporting back to the Academy on a monthly call.  We have several Georgia Otolaryngologists participating in this program.  One of the best ways to stay abreast of the daily legislation that affects healthcare in the state is to sign up for the CQ roll call.  This is a daily email that sends alerts when a bill may affect you.  Please contact Rich Capparell at the Academy if you would like to participate in I-GO, be a state tracker and/or get the CQ Roll call.  His email is


A couple of follow up items.  After diligent efforts on the part of the Academy and other interested parties, the decision by Center for Medicare Services to eliminate coverage for osteointegrated bone conductive implants for hearing was reversed.  Also, the American Board of Otolaryngology has decided to proceed with a path for certification in "advanced" pediatric Otolaryngology.  The details of the certification process are to be forthcoming.  
Georgia Regents University Update 
by: Stil Kountakis, MD, PhD

Porubsky Professor and Chairman of Otolaryngology
Georgia Regents University




Transition time at GRU Otolaryngology

Expectations were running high in September of 2002 when Dr. David Terris became the chairman of the newly created Department of Otolaryngology at the Medical College of Georgia of Georgia Regents University. Twelve years later, Dr. Terris leaves behind a super successful department of 13 faculty members with top notch academic and clinical production. He is to be congratulated for his superb leadership that not only met, but exceeded, what was possible for the newly created department. 


Dr. Terris will remain at GRU to continue to grow his already thriving national thyroid and parathyroid surgical practice. For his stellar academic activity and for his services to the department and university, Dr. Terris was awarded the prestigious "Regents Professorship" by the Board of Regents of the University System of Georgia. It is his big shoes that I will try to fill as the new department chair effective September 2014, but I promise to continue the legacy and upward trajectory.


Dr. Gregory Postma is replacing me as the department's Vice Chairman and Dr. Michael Groves as the Residency Program Director. Both are energetic and excellent clinicians, but most importantly, skillful leaders. 

Expansion of the Division of Pediatric Otolaryngology

We are proud of the fact that our clinical program covers all otolaryngology subspecialties, but there is no time to rest. We are actively recruiting for an additional otologist-neurotologist and are happy to announce the addition of two pediatric otolaryngologists for the 2015-16 academic year. Dr. Jack Borders will join us as the new Chief of Pediatric Otolaryngology. Jack completed his pediatric fellowship at Johns Hopkins University and was a faculty member in our department from 2008 to 2011.  He then moved to the United Arab Emirates as CEO of Oasis Hospital. He is returning home to help elevate the pediatric division to the next level.

As previously reported, Dr. Drew Prosser will join us on July 1st as Assistant Professor of Pediatric Otolaryngology. Drew completed his residency at Georgia Regents University and is currently completing a two-year pediatric otolaryngology fellowship at the University of Cincinnati.  He will bring to the team unsurpassed training at the highest level and will use it for the benefit of our sick little ones. With these top shelf additions we expect our Division of Pediatric Otolaryngology to be one of the best in the nation.

The expansion of our pediatric division allows us to deliver our high caliper clinical services away from the GRHealth Downtown campus. George Harris, MD, a faculty member of our department since 2012 now sees children at the GRHealth West Wheeler Road Pediatric Practice Site as part of a multidisciplinary approach to pediatric problems in an outpatient facility setting. At Georgia Regents West Wheeler site there are more board-certified physicians, more specialties and more services than any other practice group in the region. 

GRHealth West Wheeler Road
GRU Otolaryngology Services at Lake Oconee

We are happy to welcome a friend and an excellent otolaryngologist into the GRU-Otolaryngology family. Dr. Art Torsiglieri will join us part-time as an Assistant Professor and will provide care to patients at our Georgia Regents Medical Associates location in Lake Oconee. Dr. Torsiglieri received his medical degree from the University Of Pennsylvania School Of Medicine and remained there for his internship and residency.  He has been in general otolaryngology private practice in Georgia since 1990, is a visible leader of the specialty in the state and always wanted a chance to interact with and teach residents.  Art is actively involved in the Medical Association of Georgia, is a Past President of the Georgia Society of Otolaryngology-HNS and is currently on the Board of Directors of the Society. We are excited to have Dr. Torsiglieri join us and we welcome him with open arms. 


We continue to conduct meaningful research and have a strong presence in otolaryngology national scientific meetings. We presented 8 papers at the fall 2014 ARS and AAO-HNS annual meetings in Orlando, FL and taught 4 courses and miniseminars.  At the Triological Society's Sections Meeting in San Diego, we presented 3 papers and participated in 3 panels, confirming our top notch academic performance. Our 4th year resident, Lauren White, won the James Harrill, MD Resident Research Award for her paper titled "Why Sinonasal Disease Spares the Inferior Turbinate-An Immunohistochemical Analysis". Dr. White conducted her basic science research during the required resident research rotation she completed in the third year of her training. Congratulations to Dr. White!


Our faculty members continue to serve in multiple leadership positions with Dr. Jimmy Brown, MD, Professor and Chief, Division of Head and Neck and Endocrine Surgery being the President-Elect of the Georgia Society of Otolaryngology-Head and Neck Surgery. Our senior faculty have already served as presidents of their subspecialty societies and I am honored to serve as the Vice President of the Southern Section of the Triological Society. I want to wholeheartedly thank the members of the southern section for their trust in me. Our meeting in San Diego was successful and well attended.  

Audiology News

Our Audiology department is expanding to new heights in 2015!  In order to accommodate the otology and pediatric growth and continue to expand volumes, we hired a new Director of Audiology and are currently recruiting two pediatric audiologists. To support the additional staff, space and equipment is necessary to continue our patient and family centered care practice. We are in the process of adding another audiometric booth, which will include state of the art ABR technology and an interacoustics middle ear analyzer. To further expand our innovation in technology, a new VNG/Rotary chair and a fully automated, non-invasive awake ABR will be installed in 2016. We are one out of two hospitals in the state of Georgia that offer vertigo testing at this level of technology and the first hospital in the CSRA to provide non-sedated ABR testing for children.

Emory University Update 

by: Douglas E. Mattox, MD

Professor and William Chester Warren Jr., M.D. Chair

Department of Otolaryngology - Head & Neck Surgery


All of us in the Department of Otolaryngology - Head and Neck Surgery at Emory hope that all of you had a healthy and successful New Year.  Although I did not think it was possible to have the growth we have experienced over the past six months, it certainly has come to pass.  Here are a few highlights:


Clinical Service:

Faculty members continue to enjoy the facilities from our consolidation to the Emory University Hospital Midtown campus, formerly Crawford Long Hospital.  The clinics have dedicated sections for Head and Neck, Otology, Rhinology and Laryngology.  Emory University Hospital Midtown is located directly on the Atlanta Downtown Connector with easy access for patients traveling to Atlanta via I-75, I-85, or Route 20. 


The Department of Otolaryngology - Head & Neck Surgery, in coordination with the Winship Cancer Institute, established a marquee Otolaryngology - Head and Neck Cancer Surgery Center to provide pivotal oncologic and microvascular / reconstructive surgical services related to cancerous and non-cancerous tumors of the head and neck, and thyroid/parathyroid surgery. Medical Director, Mark W. El-Deiry, MD and partners J. Trad Wadsworth, MD, Amy Chen, MD,and Mihir Patel, MD provide comprehensive evaluation and treatment of head and neck disorders in collaboration with a highly specialized, multidisciplinary team of healthcare professionals comprised of surgeons, medical and radiation oncologists, gastroenterologists, rehabilitative medicine physicians, neuroradiologists, speech pathologists, psychologists, and audiologists affiliated with Emory Healthcare and the Winship Cancer Institute.

Mihir R. Patel, MD is a newly appointed Assistant Professor at Emory University School of Medicine Department of Otolaryngology.  Dr. Patel focuses on minimally invasive surgical techniques to treat head and neck cancers. His interest in preserving functional outcomes for patients led to Fellowship training in TransOral Robotic Surgery (TORS) at the University of Pennsylvania, where the world's first TORS Program was started. As you know, the clinical research from Penn was used by the FDA to assess TORS and approved use of the da Vinci System in 2009 for selected malignant lesions of the throat as well as all benign disease.


Photo: Dr. Patel demonstrating to Emory Otolaryngology residents TORS set-up and approach. 

Over the past few months at Emory, Dr. Patel has successfully performed multiple procedures for benign and malignant disease with all of these patients maintaining swallow function without a need for a gastrostomy tube.  In addition to developing a TORS program in Georgia, where he is dedicated to teaching residents the indications and nuances of these procedures, he is also dedicated to translational research efforts in head and neck cancer genomics.  Like his peers, Dr. Patel is a member of the Winship National Cancer Institute-Designated Cancer Center and the team that has just started enrolling in the ECOG 3311 Human Papilloma Virus (HPV) oropharyngeal de-escalation clinical trial as of January 2015.  

New Faces: We wish to welcome all of our new faculty members!


Kara Prickett, MD is a graduate of our program who joined the faculty this past September as a full-time faculty member at Children's Healthcare of Atlanta.  After graduating from Emory, Kara did a one year Pediatric Otolaryngology fellowship at Children's Hospital of Philadelphia (CHOP). Kara has an interest in airway reconstruction as well as general pediatric otolaryngology.

Our move to Emory Midtown two and a half years ago left Emory Hospital without a consistent Otolaryngology consultant.  Elizabeth Willingham, MD joined us as a Hospital Consultant at Emory University Hospital in October 2014.  Along with Sarah Wise, MD, Beth has established a busy and growing consult service at EUH.  Beth trained at Baylor College of Medicine in Houston, TX and comes to us most recently from private practice in Atlanta.

Carrie Flanagan, MD is our latest recruit at the Atlanta VA.  Carrie completed her residency at the University of MN and last year was the Emory Rhinology Fellow.   We created a new position at the Atlanta VAMC that enabled Carrie to vastly reduce wait times for our veterans in the clinic. She has been a great addition to our teaching program!

Jeanne Hatcher, MD joined the Emory Voice Center in mid-August 2014.  She comes to us from Wake Forest and a Fellowship at University of Texas at San Antonio.  Jeanne has a special interest in airway surgery, swallowing, and voice and adds her talents to the already robust Emory Voice Center.


Mihir Patel, MD is the latest addition to the Head and Neck service.  After a residency at University of North Carolina Medical Center, Chapel Hill, Mihir was a Head and Neck Fellow at the Hospital of the University of Pennsylvania.  Not surprisingly, in addition to his global head and neck expertise he has a special interest in transoral robotic surgery (TORS). 


After a long hiatus without senior leadership in our Pediatric Otolaryngology  Division, we are pleased to announce that Steve Goudy, MD will assume that role this March, 2015.  Steve comes to us from Vanderbilt where he is known not only as a superb clinician, but a well known researcher in maxillary development as it relates to the formation of clefts.  Steve will give great leadership to an already strong Pediatric Otolaryngology Group.



Bill Grist, MD has officially tendered his resignation, effective January 1, 2015.  Bill took a leave of absence after a severe bicycle accident in December 2012. He has had a long and illustrious career at Emory, first by doing his residency and then as a faculty member from 1981.  In his long career as a Head and Neck surgeon and Senior/Founding Member of The Emory Clinic, he has benefitted thousands of desperately ill patients and trained a legion of residents.  He leaves a huge legacy and reputation for the Department - one that it will be difficult for the rest of us to fill. 

Department Milestones:

Adam Klein, MD has received a second patent for instrumentation for laryngeal surgery.  This one is entitled "Phonomicrosurgical Arm Wrests."  

Esther Vivas, MD is now double boarded in both Otolaryngology - Head & Neck Surgery and Neurotology.  She also was just inducted into the American Neurotology Society. 

John DelGaudio, MD is now First Vice President of the American Rhinologic Society and will be President next year. John also is the first recipient of the Gerald Gussack Professorship in Otolaryngology.  Dr. Gussack was a young and vibrant member of the Department who tragically died of a brain tumor in 1997.  Dr. Gussack was known as an outstanding teacher and it is fitting that this honor be bestowed on John for his teaching and his outstanding work as Residency Director for the program. 


Best wishes to all for a great spring and summer!


Douglas E. Mattox, MD

Case Report 

Recurrent Polymorphous Low-grade Adenocarcinoma of the Tongue Base

by: J. Kenneth Byrd, MD

Assistant Professor

Department of Otolaryngology

Georgia Regents University



A 43 year-old African-American female presented to the Head and Neck Multidisciplinary Tumor Board with a recurrent base of tongue mass. Her history was notable for polymorphous low grade adenocarcinoma (PLGA) of the left tongue base, initially treated in 2009 with endoscopic resection. Due to the presence of positive margins, she received postoperative Cetuximab and radiation treatment. She required gastrostomy placement during adjuvant treatment, but subsequently returned to a normal diet with mild persistent dysphagia. In March 2014 the patient had a repeat PET/CT at the request of her oncologist, which demonstrated a 1-cm, FDG-avid mass in the left vallecula. Endoscopic biopsy revealed recurrent PLGA. She was then referred to our facility for further management. 

Figure 1

Contrasted CT demonstrated a persistent 9.6 x 7 mm enhancing lesion in the left tongue base near the vallecula (Figure 1) with no evidence of regional lymphadenopathy. There was no evidence of distant disease on PET/CT. The patient was clinically staged rT1N0M0. 


She was taken to the operating room for trasoral robotic resection of the left tongue base and glossotonsillar sulcus. The Feyh-Kastenbauer (FK) retractor was used to expose and suspend the patient, with the Da Vinci robot (Sunnyvale, CA) docked at approximately 45 degrees to the head of bed. The 30-degree scope was used with a Maryland Retractor and monopolar cautery as dissecting instruments. Incisions were made anteriorly at the circumvallate papillae, medially at the midline, and laterally at the glossotonsillar sulcus. 

In Figure 2, the FK retractor (green arrow) retracts the oral tongue. The lateral cut has been made 1 cm away from the tumor (yellow asterisk); the epiglottis (black arrow) is retracted to visualize the vallecula.


The dissection was taken through the superior constrictor laterally and into the base of tongue musculature to ensure that an adequate cuff of deep tissue was removed. Inferiorly, the dissection extended into the vallecula with exposure of the pre-epiglottic fat. The left lingual artery was exposed with blunt dissection (Figure 3, yellow arrow) and cauterized with the bipolar to prevent bleeding. Circumferential frozen margins returned negative, and the procedure was terminated.

Figure 2
Figure 3

On final pathology, the tumor was 1 cm in size without perineural or lymphovascular invasion, and margins were negative. Figures 4 and 5 demonstrate the characteristic features of polymorphous low grade adenocarcinoma. Tumors appear well circumscribed, but with microscopically infiltrating borders. Cells are monomorphic in appearance with uniform ovoid or round nuclei and low mitotic rates1.


Due to previous radiation treatment and underlying dysphagia, the patient required swallowing therapy and supplemental nasogastric feeds for approximately two weeks. At last follow-up she was tolerating a full diet and was disease-free.

Figure 4
Figure 5


Polymorphous low grade adenocarcinoma, introduced as a distinct pathology by Evans and Batsakis in 1984, is the second most common malignancy arising in minor salivary glands2. The most common site of occurrence is the palate. Because its histologic patterns (solid, cribriform, and tubular) are similar in appearance to adenoid cystic carcinoma (ACC), evaluation by an experienced head and neck pathologist is crucial for correct diagnosis3.


Compared to adenoid cystic carcinoma, PLGA is less aggressive, but recurrence is common, particularly if incompletely excised. Although tumors show a high degree of neurotropism histologically, they do not follow the course of relentless perineural spread seen in ACC. Transformation to high-grade carcinoma has been reported, but is rare. Regional and distant disease are not typical of PLGA, but lymph node metastases may be more common from extrapalatal sites, including the base of tongue, and in tumors with a significant papillary component4,5.


Although recurrences may occur many years after initial treatment and long-term follow-up is recommended, overall survival is excellent, and surgery alone is indicated unless regional or distant disease is present. Radiation has not been shown to provide benefits in local control or survival for PLGA1,4. Treatment consists of complete removal of the primary tumor with an adequate margin, and treatment of the neck if clinically or radiographically positive. In this case, complete tumor resection was facilitated by the robotic approach, which allowed excellent binocular visualization through an angled scope, as well as bimanual dissection. Transoral laser microsurgery is an alternative technique that may also be successfully used for tongue base neoplasms.



1.         Castle JT, Thompson LD, Frommelt RA, Wenig BM, Kessler HP. Polymorphous low grade adenocarcinoma: a clinicopathologic study of 164 cases. Cancer. 1999;86(2):207-219.

2.         Evans HL, Batsakis JG. Polymorphous low-grade adenocarcinoma of minor salivary glands. A study of 14 cases of a distinctive neoplasm. Cancer. 1984;53(4):935-942.

3.         Darling MR, Schneider JW, Phillips VM. Polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma: a review and comparison of immunohistochemical markers. Oral oncology. 2002;38(7):641-645.

4.         Seethala RR, Johnson JT, Barnes EL, Myers EN. Polymorphous low-grade adenocarcinoma: the University of Pittsburgh experience. Archives of otolaryngology--head & neck surgery. 2010;136(4):385-392.

5.         Evans HL, Luna MA. Polymorphous low-grade adenocarcinoma: a study of 40 cases with long-term follow up and an evaluation of the importance of papillary areas. The American journal of surgical pathology. 2000;24(10):1319-1328.


The 2015 Annual Summer Meeting is being held at The Sonesta Resort in Hilton Head, SC. The meeting will be from Thursday, July 23 - Sunday, July 26 and will consist of panels and state-of-the-art lectures on Friday, Saturday, and Sunday mornings. Join us for the Saturday Night Beach dinner party. Two complimentary tickets to the dinner are included with registration. Additional tickets are available for purchase. Families and guests welcome!

Sonesta Resort is offering a group room rate. Please call reservations at 1-800-766-3782 and mention GSO 2015 Summer Meeting or the group booking code: 030GSOHNS 
You can make your reservations online through the following link: 

 More meeting information can be found at