Head and Neck Surgery at Cleveland Clinic in Florida

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology - head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I'm joined by Dr. Ashley Mays, an otolaryngologist-head and neck surgeon. She is a specialist in head and neck cancer and reconstructive surgery at the Cleveland Clinic Indian River Hospital in Florida. Dr. Mays, welcome to Head and Neck Innovations.

Ashley Mays: Thank you. I appreciate the invitation.

Paul Bryson: Well, it's great to have you here and I understand you're going to be able to share with us some of the significant work that you're doing in Florida to really put forward a complex program for patients with head and neck cancer. But I wanted to start just have you share some background on yourself for our listeners, where you're from, where you trained, and how you came to Cleveland Clinic.

Ashley Mays: Sure. So I'm from Western North Carolina. I grew up on a big cattle ranch in a very small town in western North Carolina. So I did my ENT residency training at Wake Forest University, which was just about an hour down the road, and then ended up going to MD Anderson Cancer Center in Houston, Texas where I did the combined head and neck surgical oncology fellowship with the plastic surgery microsurgery fellowship. So I spent several years there and then ultimately went and joined the faculty of LSU, Louisiana State University, after that and was there for about five years before I joined Cleveland Clinic Florida about two and a half years ago. So I have some personal interest in program development and protocolization of surgical subspecialties as well as quality. And so I was really looking for an opportunity to build a program and try to achieve the same level of efficiency and safety and quality as it relates to head and neck cancer as we've all come to expect from major academic centers. So like I said, I've been in Florida for about two and a half years now.

Paul Bryson: Well, I just wanted to congratulate you on that, and as you're our first guest from Cleveland Clinic Florida on the podcast. And so just give our listeners some understanding of the head and neck surgery footprint in the region and how you've come to grow and develop the program down there. And I understand you have a partner as well, Dr. [Brian] Burkey is an old colleague of mine and a friend. Yeah. So just tell me a little bit more about the Florida space.

Ashley Mays: So the Florida market is a little bit different. So it's a regional practice, so there's five individual hospitals spread across a location called the Treasure Coast, which is along the east coast of Florida. And so the hospital system spans from around the Fort Lauderdale area north to the town that I live in, which is Vero Beach. So that's a fairly long corridor of patients that historically were underserved, right? Because the largest medical centers before the Cleveland Clinic arrived would've been Miami, which is a three hour drive, or Tampa, which is a three hour drive or north is Gainesville or Jacksonville. And so a very underserved population. So within the Cleveland Clinic Florida, most of the providers at this point are head and neck. We do have a comprehensive otolaryngologist, but in general, all the providers tend to operate in that head and neck and reconstruction realm.

And so my local partner is Dr. Burkey, as you mentioned, but down in our west and Fort Lauderdale location, there's two head and neck micro-trained providers there as well. So we cover a great geography area. So while we are not opposed to recruitment of other subspecialties, I think the niche that we found in Florida is that one of the great needs is certainly head and neck. It's Florida, so people love the sun, and so there's no lacking complex skin cancer cases and certainly all the reconstructions that go with it, but then of course, bread and butter head and neck as well. We're treating very complicated oral cavity oropharynx and salivary and endocrine disease as well. We don't have any endocrine surgeons within the Cleveland Clinic Florida system, so our service line provides all of that as well.

Paul Bryson: Yeah, it sounds like a great opportunity and the patients are really fortunate to have somebody with your expertise in their region. Right? Driving three plus hours is a real barrier to care. I mean, particularly for post-op care and surveillance.

Ashley Mays: Absolutely. Yeah, we were seeing, honestly, it's an observation. Many people with surgically resectable tumors were being offered non-surgical treatment, radiation primarily for something that could have been resected because people didn't know where to go or they couldn't go to a surgeon. It just wasn't accessible. And so we certainly felt welcomed by the community and can sense the great need for our subspecialty.

Paul Bryson: As you've grown this practice and built out this service line, maybe for folks in the area that are listening or interested patients, what can they expect if they make a referral to you? Maybe for the listener who's not as familiar with head and neck oncologic surgery and reconstruction, what does that patient experience possibly look like?

Ashley Mays: Sure. We have a goal of based on referral, getting people in within a relatively short period, making that first initial visit within 10 days of the referral being placed. And so you can expect an evaluation by someone fellowship trained in head and neck oncology surgery. And then if certainly any reconstructive surgery would be required. We have, again, multiple fellowship trained reconstruction and microsurgery colleagues that can take care of them. So albeit it is technically a community program, we do not have residents and fellows in Cleveland Clinic, Florida. The complexity and quality of the clinical care that you would be provided should be the same, and that's certainly the goal. And it's certainly been a big part of the quality push that I've tried to initiate when I came. So we're doing research to that regard as well. It's a big goal to try to provide the same experience as you would get at a Cleveland Clinic main campus, for instance.

Paul Bryson: Well, that's great to hear. Right, we talk about, we try to live that “one Cleveland Clinic” motto. I've read that in that regard. Can you speak to some of the virtual surgical planning, computer aided planning and things that you do for complex reconstruction? And also maybe it's related but not totally, but have you been successful in sort of establishing that tumor board model that many of us are familiar with?

Ashley Mays: Yeah, so virtual surgical planning for the reconstructive surgeons in the world came about 10 years in the past where we could surgically model a planned resection and then surgically model how we would reconstruct them. And what that allows is precision which can manifest postoperatively with teeth lining up, making sure that the jaw is symmetric to what you would've had before surgery, but then ultimately also reducing operative times, ischemia times, which have long been found to improve postoperative outcomes. And so certainly it's something I'm in, I will tell you, I don't think it's necessary for every patient. It's a bit overkill for reconstructive surgeons that are well-trained and are confident and kind of understanding replicating native anatomy. Certainly people without teeth, if you're doing a jaw or a maxilla recon, those aren't the people that are going to benefit the most from that added technology and of course added expense.

But a younger patient, someone with teeth that added precision of just millimeters, making sure that that jaw sits just about as flush as possible with their opposing dentition can make all the difference in their quality of life. So I absolutely implore it in the appropriate clinical situation, but I just don't think it's necessary for every reconstruction that we do.

As far as tumor board, yes, we have a full-service tumor board. It's attended by us as surgeons, radiation, medical oncology, pathology, radiology, social work, our clerical staff. We've tried our very best to replicate any standard civilized advanced tumor board. It is so important, and particularly in a community setting where you can't always confirm that your ancillary providers have the same training as you. Dr. Burkey’s great training, I have great training. You can't always be certain that the med onc in the community is well-versed in head and neck cancer. So it becomes all the more critical that we are making very clear evidence-based recommendations during that meeting so that we can pass on those recommendations to the other providers and make sure that people are getting the standard of care treatment. So I totally agree. It was a big push when the program was initiated many years ago, even before I came, and it's only grown since then. Our volume is so high, we have to pick and choose cases. We can't present them all like most places, but it's a big part of our practice.

Paul Bryson: Oh, that's great to hear. Right, it's really a challenge I think sometimes even when you're at a big center to get everybody to meet and get on the same page. So I really commend you on standing that up and having it.

Ashley Mays: I think the community providers too appreciate it. Right? I think it gives them an added level of comfort that there's an actual official meeting of people with expertise. And we sometimes call into our Cleveland colleagues for pathology or med onc if there's a specific situation that we just want another opinion on. So it's very collaborative, so we're very proud of that.

Paul Bryson: Well, can you speak to any of the research or clinical trials that you and the team are participating in that you're excited about?

Ashley Mays: Yeah, so I'll tell you, when building this program, we don't have the same research infrastructure, and maybe similarly, we don't have the workforce. A lot of research is done by medical students or trainees. And so what I tried to start when I first came here, which is being built out is a database, is a way to log our cases. And so from that database, we are slowly starting to pull individual outcome measures. And so one of my pushes in program development was that I think all of our research at this point needs to be very outcome-based. We need to be looking at quality and safety measures, survival in the community setting, comparing it to that, that would be achieved elsewhere. And so that's what we've done and we're still working on it. It's creating databases of patients treated with each subtype and subsite, and then in using that data to test our own quality.

And that's a big part of my job. I run quality for all of Cleveland Clinic Florida and the surgical specialties. And that's a big push is that we must test our own quality. We must confirm that what we are doing is up to snuff. And so that is the majority of our clinical research. I'll tell you for otolaryngology-head and neck surgery, as far as clinical trials, as of right now, most of those would be done out of the Weston location. And we don't currently have any med onc based clinical trials for head and neck. And there's certainly plenty of other clinical trials for skin melanoma, things as such. But specific trials for head and neck, bread and butter, head and neck, we currently don't have any. So obviously something we're trying to build going forward, but just not right now.

Paul Bryson: Yeah, makes sense. It sounds like you have a lot going on, nonetheless. We will be looking forward to seeing how things evolve. And I just wanted to thank you again for your time. And as we wrap up, any final take home messages for our listeners? Anything you wanted to highlight?

Ashley Mays: Sure. Well, I think it's just pointing out that the Cleveland Clinic Florida practice is different, right? I mean, we are doing high-end advanced head and neck cancer and reconstructive surgery without the traditional model, and we're doing it in a community setting, but that doesn't take away from the expertise that we have. And so I would encourage referring providers that might hear this or patients that might hear this to feel very confident in reaching out to us and coming for a consult. And we have all the respect in the world for the programs near us, University of Miami and Moffitt and Mayo, Jacksonville, that have certainly been here longer. But we really take pride in what we've built and trying to do it as well, if not better, than the other competing regional programs. And so we try to get people in extremely quickly. We do not have long wait times, and that's by design. So if any referring provider or patient wants to be seen, just reach out to us and we'll get it done.

Paul Bryson: Well, for more information on otolaryngology-head and neck surgery at Cleveland Clinic in Florida, please visit clevelandclinicflorida.org/headandneck. That's clevelandclinicflorida.org/headandneck. And to speak with a specialist or submit a referral, contact our referring physician hotline by calling 833.733.3710. That's 833.733.3710. Dr. Mays, thanks for joining Head and Neck Innovations.

Ashley Mays: Thank you so much.

Paul Bryson: Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website clevelandclinic.org/podcasts. Or you can subscribe to the podcast on iTunes, Google Play, Spotify, BuzzSprout, or wherever you listen to podcasts. Don't forget, you can access realtime updates from Cleveland Clinic experts in otolaryngology – head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.