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Oral squamous cell cancers involving the masticatory space are staged as unresectable cancers and their treatment is difficult. Curative treatment with extensive surgery followed by adjuvant therapy is one of the treatment options. In this retrospective study, the survival of 123 patients (93 with T4a cancers, 30 with T4b cancers), treated during the period August 2009 to August 2015, was evaluated. The majority had bucco-alveolar cancers (62.6%), were male (61.8%), and were tobacco users (76.4%). The select group of T4b oral cancer patients were treated with surgery, which included infratemporal fossa clearance in all 30 patients, followed by adjuvant therapy. The masseter was the most commonly involved masticatory muscle, and 24 patients had fewer than three involved structures. Free margins were obtained in 90.2% of cases; 41.5% of cases were node-positive. One hundred and four patients (84.6%) completed adjuvant treatment. The median follow-up was 42 months. For node-negative patients with T4a and T4b cancers, the 5-year overall survival was 59% and 50.2%, respectively (P= 0.62), and 5-year disease-free survival was 64.6% and 53.5%, respectively (P= 0.01). In conclusion, the select group of patients with T4b oral cancers and less than three masticatory space structures involved had comparable outcomes to those with T4a cancers after treatment with surgery and adjuvant radiotherapy.

Background: Microvascular flap reconstruction (MFR) of medium–large tongue defects following ablative surgery is the standard of care. The decision for MFR is often made prior to surgery or intraoperatively depending on the extent of the defect and the volume of remnant tongue. However, there exists no objective technique to predict this requirement preoperatively. This knowledge is crucial for counseling and planning. We aimed to identify an objective magnetic resonance imaging (MRI) measurement tool to predict the need for MFR of tongue tumors. Materials and Methods: This was a retrospective analysis of patients undergoing surgery (with or without reconstruction) for squamous cell carcinoma of the tongue. Patients had a preoperative MRI as part of their assessment. As per our institution protocol, the decision for the requirement of MFR was made by a consensus of two experienced reconstructive surgeons intraoperatively. This decision was correlated with the ratio of tumor volume to the total tongue volume (tv) as observed in the MRI. Results: A total of 47 patients were identified. Twenty-eight patients underwent reconstruction, while 19 did not. The ratio of tumor thickness to tongue thickness (Tt/tt) was calculated, and a cutoff of >0.395 (sensitivity 89.3% and specificity 89.5%) was found to significantly correlate with the decision for MFR (P < 0.001). The volume of a tumor to total tv ratio was calculated from the data of 22 cases, and a cutoff of >4.2 (sensitivity 83.3 and specificity 90) was found to be correlated significantly with the decision for MFR (P < 0.001). Conclusion: Tt/tt ratio is a useful tool to determine the need for MFR of tongue tumor excision defects in the preoperative setting and can help guide counseling.

BACKGROUND To validate the newly proposed American Joint Committee on Cancer (AJCC) eighth edition staging in early T1 and T2 oral cavity cancers and its effect in predicting tumour control. METHODS Retrospective analysis of treatment outcomes of 441 T1 to T2 oral squamous cell carcinoma (OSCC). Overall survival (OS), disease-specific survival (DSS), and tumour control were calculated and compared between the AJCC 7 and 8 staging systems. RESULTS The 5-year OS was 78% and 61% for T1 and T2 tumours, respetively (P

Background The purpose of this study was to determine the factors affecting local control in patients with T1N0 squamous cell carcinoma (SCC) of the tongue. Methods We conducted a retrospective analysis of 144 patients with pT1N0 SCC of the tongue who underwent wide excision and neck dissection without adjuvant therapy. Results The adverse pathological features associated with local control were least margin 5 mm (P = .004), infiltrative margin (P = .403), depth >4 mm (P = .136), lymphovascular invasion (P = .301), and perineural invasion (P = .342). We derived a scoring system of 10 points based on the hazard ratio for local failure; those with scores >5 points had a 5-year local control of Conclusion This study suggests patients having a margin of 5 mm need revision, however, if they do not have additional adverse pathological features (score ≤4), local control is 88% at 5 years, and they may be observed. Those who have margins over 5 mm with a total score >5 may still benefit from adjuvant therapy. Those with margins over 5 mm have improved local control (P = .029).

The objective of this study is to analyze the morbidity of selective neck dissection (SND) in oral cavity squamous cell carcinoma (OCSCC). This is a cross-sectional study of 106 consecutive patients with T1 and T2 (AJCC seventh edition) stage cancers. Morbidity in terms of scar characteristics, cervical lymphedema, sensation, shoulder dysfunction, and smile asymmetry were analyzed. Scar outcomes were inferior in terms of poor complexion in 15 patients (14.2%), poor texture in 25 patients (23.6%), limited skin movement in 9 patients (8.5%), soft tissue deficit in 13 patients (12.3%), and lymphedema in 14 patients (13.2%). Smile asymmetry was seen in 29.2%. Shoulder dysfunction was seen in 7.5%. Patients who received adjuvant treatment had significant scar issues (p = 0.001), lymphedema (p

This article aims to illustrate various applications of facial artery-based islanded myomucosal (iFAMM) and osseous/osteo-myomucosal flaps (iFOMM) in head and neck reconstruction. A retrospective analysis of 75 patients who underwent the reconstruction of various head and neck mucosal defects with iFAMM/iFOMM in a tertiary head and neck cancer department from May 2015 to May 2019 was performed. The patients had surgery for cancer, which involved the oral tongue, floor of mouth, oropharynx, lower alveolus, larynx, hypopharynx, cricopharynx and trachea. iFOMM was used in 3 patients. Functional and esthetic outcomes, short-term and long-term complications were analyzed. The flap was successful in 74 out of 75 patients. Speech was intelligible in almost all patients and majority of patients could take oral feeds without any restrictions. The esthesis of reconstruction was scored high with a mean visual analog scale score of 8.4. The most commonly observed complication was marginal mandibular paresis, which improved with time. Mouth opening was3 cm in 68/75 patients. Adjuvant radiation was a common factor in patients with3 cm mouth opening. Flap was sensate by 4 months in majority of patients. The reach, pliability, and esthetics of the flap combined with recoverable morbidity of donor site present in the facial artery-based flap as a good option in the reconstruction of various head and neck subsites. Reduced operative time, lesser complication rates, less financial burden, and simplicity of the procedure make it a cost-effective alternate solution for reconstruction.

Differentiated thyroid cancers (DTC) are seen with increasing incidence in clinical practice. These tumours have good prognosis and the extent of surgery can be tailored to the size and pathological characteristics of the lesion. Historically total thyroidectomy was the recommended procedure for tumours >1 cm; however, current recommendations suggest a more conservative approach. This review focuses on the evolution of the extent of surgery in differentiated thyroid cancer.

Thyroidectomy for thyroid cancers and central neck dissection are considered as independent predictors of postoperative hypocalcemia. Post-surgical hypocalcemia is the most common and often the most difficult long-term consequence of thyroid surgeries. Management of hypocalcemia is done with calcium supplementation, but there is no consensus on the timing and the amount of calcium supplementation.A retrospective study of all thyroid cancer patients who underwent total thyroidectomy at our Centre, from August 2009 to August 2017 was done to evaluate the prevalence of symptomatic hypocalcemia. The patients were grouped into two based on the early and late supplementation of calcium in the form of intravenous calcium gluconate and oral calcium with calcitriol.There were 133 patients of which 109 had papillary carcinoma, 11 had follicular, 3 had hurthle cell and 10 had medullary carcinoma. Of these, 49.6% underwent total thyroidectomy alone and the rest with neck dissection. 38 patients (28.6%) had a unilateral neck dissection and 16 patients (12%) had a bilateral neck dissection. 14 out of the 67 patients (20.9%) who underwent neck dissection developed symptomatic hypocalcaemia, in contrast to only 2 patients out of the 66 (3%) without neck dissection. 31.7% of lateral neck dissection and 7.7% of central compartment dissection had symptomatic hypocalcaemia (p value = 0.0053). 22.5% of patients whose parathyroid were not identified had more symptomatic hypocalcaemia than in whom at least one parathyroid gland was seen (p value=0.0004). Eleven out of 73 patients (15.1%) who were treated late with calcium and calcitriol, and one out of 60 (1.7%) who had early calcium supplementation developed symptoms (p value=0.0073).Central compartment and lateral neck dissection were significantly associated with higher incidence of symptomatic hypocalcemia. Early intervention with calcium supplementation reduced the symptoms of hypocalcemia. Identification and preservation of parathyroid glands significantly reduces the hypocalcemia.

To validate the newly proposed American Joint Committee on Cancer (AJCC) eighth edition staging in early T1 and T2 oral cavity cancers and its effect in predicting tumour control.Retrospective analysis of treatment outcomes of 441 T1 to T2 oral squamous cell carcinoma (OSCC). Overall survival (OS), disease-specific survival (DSS), and tumour control were calculated and compared between the AJCC 7 and 8 staging systems.The 5-year OS was 78% and 61% for T1 and T2 tumours, respetively (P 0.001) (AJCC 7) vs 87% and 67% (P 0.001) (AJCC 8). The 5-year DSS was 78% and 61% for T1 and T2, respectively (P 0.001) (AJCC 7) vs 89% and 71% (P 0.001) (AJCC 8). For stages I and II tumours the 5-year OS was 81% and 76%, respectively (P 0.302) (AJCC 7) vs 87% and 73% (P 0.017) (AJCC 8). The 5-year DSS was 83% and 82% (P 0.222) vs 89% and 77% (P 0.016). With the AJCC eighth edition the 5-year local, regional, and distant control rates for T1 vs T2 tumours were 85% vs 74% (P = 0.003), 95% vs 77% (P = 0.001), and 95% vs 80% (P = 0.014), respectively.The AJCC 8th staging system provided for more accurate prediction of OS, DSS, and disease control in early oral cavity cancers.

The American Joint Committee on Cancer (AJCC) 8

Reduced mobility of the mandible known as trismus is a phenomenon frequently seen in head and neck (H&N) cancer patients and patients with temporomandibular disorders [1–3]. Although numerous advancements have occurred in head and neck oncology practice during the past few decades, survival has not improved significantly. Currently, there is a need for clinical trials that focus not only on survival but also on the patient’s experience and health-related quality of life.

Any condition that causes dysphagia can directly reduce dietary intake and impair nutrition. The complex process that allows for the safe passage of masticated food boluses through the pharynx and esophagus for subsequent digestion and absorption can be disrupted by several pathologic phenomena caused by a disease or the toxic effects of the treatment for the disease. Moreover, malnutrition can worsen the dysphagia itself, leading to increased morbidity and mortality, thus causing a vicious cycle.

Leishmaniasis is rare in India except some endemic areas in Orissa, Bihar etc. Although cutaneous and mucocutaneous varieties exist, pure mucosal varieties have been reported very rarely and such an entity has been questioned. But since the spread of AIDS, lots of atypical presentations of various diseases have been reported .Here we report a case of a 27 year old 7 months pregnant female, from Gondia, Maharashtra came with presenting complaints of left buccal mucosal ulcer since 3 months and left sided neck swelling since 2 months. As a routine protocol we checked her serostatus before a biopsy and was found to be HIV ELISA positive. Reports of FNAC from lymph nodal swelling, punch biopsy from ulcerative lesion and cervical lymph node excision biopsy were all consistent with positive for amastigote forms of leishmaniasis. We treated her with inj. sodium stibogluconate and HAART with complete resolution of lesions and improvement in CD4 counts.

Introduction of nasal endoscope has revolutionized the field of rhinology. Endoscopic septoplasty is a minimally invasive technique that helps us to correct the deformity of the septum under excellent direct visualization using an endoscope. AIMS: Studied indication, technique result and complication of endoscopic septoplasty. METHODS AND MATERIAL: It was a prospective study carried out at our institute from August 2011 to December 2013 RESULTS: 57 patients having nasal obstruction were selected for the study. In present study 24(42.1%) patients had only cartilagenous deviation, 9(15.7%) patients had bony deviation, 15(26.3%) had both bony and cartilage deviation, while 12(21%) had spur and 5(8.7%) had caudal dislocation. Minor complications were seen during study, no major occurred during endoscopic septoplasty or post- operative period. In 40(70%) cases endoscopic septoplasty was performed as primary procedure and in 9(15.7%) cases performed as conjugation with FESS, also in 8(14%) patients septoplasty performed prior to endonasal DCR for good assess to lateral nasal. CONCLUSIONS: Endoscopic septoplasty is an effective technique that can be performed safely alone or in combination with endoscopic sinus surgery. It reduces the complication, hospital stay and has fast recovery of the patients postoperatively. It facilitates accurate identification of the pathology, and it is associated with significant reduction in patient's morbidity in the postoperative period.

Rosai-Dorfman disease is also known as sinus histiocytosis with massive lymphadenopathy (SHML) is a rare clinico-pathological condition. It is a benign condition which causes significant cervical lymphadenopathy in children and young adults. The clinical presentation varies from isolated nodal involvement to significant extranodal manifestations. The clinical features are usually mild, but rarely life-threatening complications can occur in some individuals depending on the site of involvement. Here, we present two cases of Rosai-Dorfman disease, both diagnosed on fine needle aspiration cytology (FNAC) and histopathology and responded well to steroids. One of the patients had extranodal site involvement in the form of bilateral nasal mass which is very rare. How to cite this article Ekhar VR, Shelkar RN, Rane S, Anand A, Lanjewar K, Jain SKT. Rosai-Dorfman Disease: A Rare Cause of Cervical Lymphadenopathy. Int J Head Neck Surg 2014;5(3): 152-154.

The American Joint Committee on Cancer (AJCC) 8th edition marks a paradigm shift in the staging of head-and-neck cancers. It introduces several novel considerations into the staging of head-and-neck cancer, with distinct therapeutic ramifications, to stage and prognosticate patients better. In oral cancer, it introduces the depth of invasion as a determinant of T-stage. The nodal staging recommendations have also upstaged extranodal extension, which has been shown to be a high-risk adverse feature associated with worse survival. In oropharyngeal cancer, human papillomavirus (HPV) expression of tumors has been used to reclassify tumors into two separate entities, with distinct staging systems. For HPV-positive tumors, nodal staging has been divided into clinical staging and pathological staging, for better prognostication of HPV-positive diseases treated with surgery. In carcinoma of unknown primaries with cervical nodal metastasis, immunohistochemical staining of nodal tissue for HPV and Epstein-Barr virus has been recommended in all cases. These recommendations are based on a high-quality evidence aimed at personalizing cancer therapy to optimize outcomes while minimizing morbidity. The new recommendations address many of the shortcomings of the previous editions. The practice of oncology in India, however, is markedly different from that in the Western world. Majority of these recommendations are universal; however, some are likely to have hurdles in implementation in India.