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The anomalous position of nonrecurrent laryngeal nerve (NRLN) predisposes it to injury during thyroid surgery. The presence of right aberrant subclavian artery is a strong indicator of having an NRLN. Here, we are presenting a case report of an NRLN and role of imaging in its prediction.

Objective: Verrucous lesions of the oral cavity can be of varied histopathology. The present study evaluates the clinico-pathological features of verrucous lesions of the oral cavity and analyzes the treatment outcomes. Materials and Methods: This is a retrospective study of 15 consecutive patients who presented with verrucous lesions of the oral cavity, during the 5-year period from January 2006 to December 2010. Demographic, clinico-pathological features, treatment details, and outcomes were analyzed. Results: Fifteen patients with verrucous lesions of the oral cavity were treated with surgery as the primary modality. The mean age was 62.8 years (range 35-85 years). Wide excision of the primary lesion with adequate mucosal and soft-tissue margins was carried out. Free-flap reconstruction was done in eight patients. All patients remain loco-regionally controlled with good functional speech and swallowing outcome. Conclusions: Verrucous lesions of the oral cavity are a distinct clinical entity with varied histopathology. A surgical excision with wide margins and appropriate reconstruction is necessary to optimize the disease and functional outcome.

Objectives: After resection of the tumors of oral cavity adjacent to the mandible, it is a common situation that the whole of one side of the gingival mucosal segment has to be stripped off the mandible to get an adequate margin. When a cutaneous flap is used for reconstruction, it has to be hitched to the teeth to get a watertight seal. We describe a technique to hitch the flap to the adjacent teeth in such an instance. Materials and Methods: The technique was applied in 10 patients with oral cancer, resected, and reconstructed with cutaneous flaps. Results: The technique was found to be effective in all 10 patients. Adequate seal was obtained in all patients. Oral diet was started within 7 days. Conclusion: An effective and simple technique to approximate a cutaneous flap to the teeth-bearing mandible, when all the mucosa is removed as part of oncological resection, is reported.

Approximately 50% of head and neck cancer survivors experience dysphagia and related morbidity. Intensity-modulated radiation therapy (IMRT) is increasingly used to treat oropharyngeal cancers with excellent oncologic outcomes, but few studies have compared it with conventional 3-dimensional conformal radiation therapy (3D-CRT) to determine whether it can decrease treatment-related toxic and adverse effects.To determine whether IMRT improves percutaneous endoscopic gastrostomy (PEG) tube and treatment-related toxicity outcomes compared with 3D-CRT in patients with oropharyngeal squamous cell carcinoma.Retrospective review of 159 patients with oropharyngeal primary tumors with no history of chemotherapy, radiation therapy, or surgery of the head and neck who underwent definitive treatment with radiotherapy for oropharyngeal squamous cell carcinoma at the Hollings Cancer Center outpatient clinic, Medical University of South Carolina, from 2000 to 2009.Doses of 70 Gy in 35 daily fractions of radiotherapy delivered via IMRT or 3D-CRT.Primary end points included PEG tube dependence 1 year after radiotherapy start, weight loss during treatment, and change in Eastern Cooperative Oncology Group performance status. Secondary end points included overall and disease-free survival, disease recurrence, and toxic effect profiles.The IMRT group (n = 103) had a significantly lower rate of PEG tube dependence 1 year after treatment initiation than the 3D-CRT group (n = 56) for all patients (P = .02) and for those with advanced T stage (P = .01) and a shorter time to PEG tube removal (P .001). Acute grade 3 or greater toxic effects to skin and mucous membranes occurred less frequently in the IMRT group (P = .02 and P .001, respectively). The 2 groups did not differ significantly in weight loss, treatment failure (hazard ratio, 0.82 [95% CI, 0.47-1.41]), overall survival (P = .45), or disease-free survival (P = .26).The use of IMRT significantly improves PEG tube and toxicity-related outcomes compared with 3D-CRT in the treatment of oropharyngeal primary cancers. Given the association between mucosal toxic effects, PEG tube dependence, and dysphagia, these findings may be an indication of improved swallowing outcomes with IMRT.

Nodal metastasis from oral tongue squamous cell carcinoma follows a predictable pattern. Isolated level IV involvement, termed skip metastases, is described. This study attempts to identify the incidence of skip metastasis.Case series with chart review.Tertiary academic hospital.Fifty-two consecutive patients with T1 to T4 N0 stage who underwent excision of the primary tumor with neck dissection (levels I-IV).Retrospective study. The incidence of isolated level III or IV involvement pathologically and isolated nodal recurrence in levels III and IV was analyzed.Pathologically, isolated level III involvement occurred in 2 (3.8%) patients. Isolated level IV occurred in 1 (1.9%) patient. Mean follow-up was 24 months. Two patients had recurrence in the primary site; 1 had recurrence in neck level II. None had recurrence in level III or IV.Skip metastasis is rare in T1 and T2 oral tongue squamous cell carcinoma. Inclusion of level IV is not mandatory in selective neck dissection for clinically and radiologically negative neck disease in early tumors (T1 and T2).

Background The purpose of this study was to analyze the oncologic and functional outcomes of the preserved eye in malignant sinonasal tumors with orbital involvement. Methods In a retrospective study of 19 consecutive patients who underwent craniofacial resection or maxillectomy with preservation of orbital contents and adjuvant radiotherapy, the oncological outcome in terms of local recurrence and survival was analyzed. The functional outcome in the preserved eye was analyzed for the cases that did not recur in the orbit. Results Nineteen patients were analyzed for their oncologic and functional outcomes. Fifteen patients underwent immediate reconstruction of the orbital support. Eight patients had local recurrences; 11 patients were disease free at the end of the follow-up. Squamous cell carcinoma has a high propensity for local recurrences (ie, 5 of 8 local recurrences were squamous cell carcinoma). Sixteen patients, in whom a satisfactory orbital tumor clearance was obtained, remained recurrence free in the orbit. All the preserved eyes retained adequate function after adjuvant radiotherapy. Conclusions Adequate local control with preserved visual function can be obtained with surgery and adjuvant radiation in appropriately selected malignant sinonasal tumors with orbital involvement. The preserved eye, if reconstructed appropriately, maintains good overall function with acceptable morbidity. © 2012 Wiley Periodicals, Inc. Head Neck 35: 1379–1384, 2013

Purpose To study the differential expression of Ceramide Synthase isoforms in oral mucosal dysplasia and its malignant transformation. Methods We identified 12 cases of oral mucosal dysplasia with subsequent malignant transformation from the College of Dental Medicine, Division of Oral Pathology Database at the Medical University of South Carolina. These were formalin fixed paraffin embedded (FFPE) biopsy specimens of dysplasia from one oral subsite at one time point and a matching specimen from the same subsite and same patient at a later time-point with frank invasive squamous cell carcinoma. We also identified 42 cases of alveolar ridge keratosis which were age and gender matched to our set of cases with malignant transformation. Two sections, 5 microns each from the FFPE blocks to extract RNA using the High Pure RNA FFPE micro-kit from Roche Applied Sciences (Catalog No. 04823125001), followed by reverse transcription and q-PCR using Ceramide Synthase (CerS) isoform 1, 4 and 6 probes. Results CerS 1 levels are higher in malignancy compared to the matched dysplasia samples whereas CerS 4 levels are lower in malignancy compared to the matched dysplasia samples. The levels of CerS6 are not significantly changed across the two sample sets. Conclusion Ceramide synthase isoforms play a role in malignant transformation of oral mucosal dysplasia however the mechanism needs to be further studied and understood. This could be a novel marker for early detection of potentially malignant lesions in the oral mucosa and may serve as a target for chemoprevention strategies in oral squamous cell carcinoma.

Purpose Mammary Analogue Secretory Carcinoma (MASC) is a newly characterized neoplastic process commonly misdiagnosed as Acinic Cell Carcinoma. Although well-characterized genetically, little information exists regarding the clinicopathologic factors affecting outcome in patients with this disease process. Acinic Cell Carcinoma is a rare entity, and clinicopathologic data has been elucidated from studies with relatively small patient populations. We aim to better understand the characteristics affecting outcome in Acinic Cell Carcinoma patients, and to compare these with patients that have been re-classified with MASC. Materials and Methods Twenty-one patients diagnosed with Acinic Cell Carcinoma were identified from the Medical University of South Carolina cancer registry. Pathological specimens from each patient were then analyzed using fluorescence in situ hybridization (FISH) to detect the ETV6-NRTK3 (12;15) (p13;q25) translocation, which is diagnostic of MASC. Furthermore, radiographic findings were also reviewed for each patient. Demographic information, primary site, presenting symptoms and tumor staging characteristics were obtained along with treatment, recurrence and outcome data for each identified case. Results All patients were treated with primary surgical excision, eleven of which also received adjuvant treatment. The average age at diagnosis was 50.4 years. Parotid glad was the most common site (95%), with one patient demonstrating disease in a minor salivary gland. The majority of patients were female (76%), and most patients were stage I (48%). However, 60% of male patients, and 19% of female patients demonstrated Stage IV disease. Eight patients from our cohort showed increased s100 reactivity, thus making them candidates for FISH analysis. At this point, one case of MASC has been identified with two more cases still to be analyzed. Our confirmed case of MASC was Stage I, which received only primary surgical treatment. Conclusions Although thought to be slightly more aggressive, MASC may have similar clinical outcomes compared to Acinic Cell Carcinoma.