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   Table of Contents - Current issue
July-December 2021
Volume 9 | Issue 2
Page Nos. 67-166

Online since Friday, December 17, 2021

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Head and neck oncology practise in the post-COVID era p. 67
Prathamesh S Pai
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Differentiated thyroid cancer: Then and now. A personal perspective Highly accessed article p. 69
Anita M Borges
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Small round cells in sinonasal tract: Pathologists approach for the “blues” p. 73
Hiran Kattilaparambil Ravindran
The sinonasal cavities host a wide variety of undifferentiated malignancies with round cell morphology. The differential diagnosis is difficult for a practicing surgical pathologist, especially on very small sample, sometimes with artifactual changes. The correct classification is clinically relevant as it has implications on the management. Further, newer entities are added as we expand our understanding in these tumors. The aim of this review is to provide a comprehensive review of the variety of tumors we encounter, try for a broader classification based on histological hints as well as with an initial panel of immunohistochemistry. The further classification as individual entities is also described with their characterizing features, with a special reference to the ancillary testing to give a more objective picture. Overall, prognosis and general approach for managing the specific entity are also addressed in a nutshell.
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Sutureless technique for thyroidectomy: Systematic review of literature p. 80
Nitin Khunteta, Jaspreet Singh Badwal
The purpose of the present systematic review is to compare the outcomes and complications of two techniques of thyroidectomy: the surgical technique for thyroidectomy performed by a sealing device (LigaSure small jaw) versus conventional clamp-and-tie technique (CAT). Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, and Scopus. One-hundred and five articles provided information in relation to outcomes of thyroidectomy performed with the use of sealing device versus that performed using traditional CAT technique. Of these, 27 articles were selected for final inclusion. A thorough review of available literature shows that sealing device provides better results in terms of intraoperative and postoperative blood loss, postoperative drain volume, incidence of transient or permanent palsy of recurrent laryngeal nerve and external branch of superior laryngeal nerve, postoperative transient or permanent hypocalcemia, and length of hospital stay.
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Epithelial dysplasia as a predictor of malignant transformation in oral potentially malignant disorders: The concepts, controversies, and challenges p. 88
Mahija Janardhanan, Rakesh Suresh, Vindhya Savithri, Thara Aravind, Mridula Mohan, KR Biniraj
Oral potentially malignant disorders (OMPDs) are a group of precursor lesions with varied clinical manifestations which exhibit an increased risk of malignant transformation. Early diagnosis and prevention of oral cancer now focuses more on the early recognition of OPMDs and assessment of their risk of malignant transformation. Although epithelial dysplasia is being widely used as a yardstick to assess the malignant potential of OMPDs, the interobserver variability and lack of reproducibility observed in the interpretations had made their efficacy as a predictor of malignant transformation highly questionable. The aim of this paper is to discuss the concept, controversies, and challenges involved in the utility of epithelial dysplasia as a predictor of malignant transformation.
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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and updates in bethesda system for thyroid fine-needle aspiration cytology: An overview p. 94
Ajit Nambiar
Thyroid cancer incidence rising in the community has been a matter of concern. The possibility of a certain category of papillary carcinoma, namely the encapsulated follicular variant contributing to this rise needed a thorough look in. Scientific evidence has led to this category to be taken out from the malignant categorization even though the entity has the presence of the typical papillary nuclei. A new well-defined indolent category of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been defined with both inclusion and exclusion criteria. This has led to some disruption in the risk of malignancy assessments in the Bethesda system of thyroid fine-needle aspiration cytology. Importantly, cytology is limited in distinguishing the invasive from encapsulated follicular variants of papillary thyroid carcinomas. The new Bethesda system provides for a descriptive footnote in the category 4–6 on the need to consider the indolent counterpart NIFTP. Furthermore, category 3, atypia of undetermined significance (AUS)/follicular lesion of undetermined significance is well defined with an explanation for the reason behind using this terminology as this is a heterogeneous category. The NIFTP group is associated with RAS mutations unlike the BRAF mutations in the classical papillary carcinomas.
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Effectiveness of school-based oral health education in influencing oral health among school children-systematic review and meta-analysis p. 100
P Arathi Menon, Sahana Shivakumar, Garima Bhambani, Tarun Pratap Singh, Anshika Khare, Anuja Pathak
Oral health education (OHE) is considered an effective method to prevent oral diseases. Various studies have been conducted to assess the effectiveness of OHE among school children, and the most desirable person to render the same still remains a question. The aim of the review was to evaluate the effectiveness of OHE rendered by qualified dentists and school teachers in school children in improving oral hygiene and dental caries. Controlled trials with OHE as intervention for not more than 2 years among 4–15 years of age assessing either Sillnes and Loe Plaque index, Loe and Sillness Gingival index, and Decayed, Missing, Filled Teeth (DMFT)/ Decayed, Missing, Filled teeth Surface (DMFS) were included. Studies extracted from various databases were subjected to quantitative and qualitative analysis. The findings from the selected five studies were subjected to quantitative analysis using Review Manager 5.4 version using random effect models. Results showed that OHE provided by school teachers are as effective as those rendered by qualified dentists in improving plaque index (P = 0.81), gingival index (P = 0.55), and caries status (P = 0.77) in school children. OHE is an effective method for reduction of plaque accumulation and improving gingival health though not as effective in reducing dental caries. Improvement in oral hygiene and caries status through OHE is possible irrespective of the person rendering.
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“Race for SARS-CoV2 vaccine:” The propitious oral route p. 108
Areeba Shahid, Neeta Misra, Shivakumar Ganiga Channaiah, Sumalatha Masineni Narayanappa
In today's pandemic era, the public is eyeing eminent scientists to develop a successful vaccine against the highly contagious SARS-CoV2 infection, commonly known as COVID-19. It will be a relief to the overwhelmed medical fraternity. The oral cavity can be a great medium to deliver needle-free vaccination, which is psychologically beneficial to the general public. It is the most exigent vaccination method and still lacks protocols to investigate the efficacy of these systems. However, oral vaccination seems promising, offers several benefits at the societal level, is economically beneficial and hints at the possibility of rendering both cellular and antibody-mediated immunity. Here, this review article gives an overall view of oral vaccination, its challenges, and possibilities, with a focus on vaccine development against SARS-CoV2, administered via the oral route.
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Sulcus preservation to improve functional outcomes in compartmental tongue resection: A technique and case series p. 114
Bhanu Prakash Bylapudi, Akshay Kudpaje, Prasanna Hegde, Shalini Thakur, Vishal US Rao, Carsten E Palme
The primary aim of surgery in tongue cancers is tumor ablation with clear margins. Apart from tumor clearance, it is equally important to incorporate a technique that can improve the functional outcomes. It is a well-known fact that compartmental surgery has evolved as a propitious approach for early tongue and floor of mouth cancers. To overcome the functional deficits, we propose a technique of tongue reconstruction in cases where attached and reflected gingiva could be preserved when the tumor is not involving the floor of the mouth. We present a case series of three patients with our initial functional results in which this modified approach was performed. The parachute technique of flap inset maintained adequate sulcus. Regular sessions of speech and swallowing assessments were done and functional outcomes in these patients were assessed and compared with three other patients who underwent compartmental resection of tongue followed by interdental flap inset. Incorporation of a simple sulcus preservation technique by parachuting the remnant natural attached gingival mucosa after compartmental resection showed superior functional outcomes. It was also observed that the overall efficiency of chewing and clearance of food from oral cavity was better with this proposed technique as the lateral gutter was well maintained. The results of this study could help clinicians to provide a better functional outcome to the patients by this technique.
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Malignant proliferating trichilemmal tumor in neck: A rare clinical presentation and review of 50 cases from literature p. 119
K U Raghavendra Prasad, A T Fida Harish
Background: Proliferating trichilemmal tumor is a rare cutaneous neoplasm derived from the outer root sheath of the hair follicle which usually presents as a solitary lesion, in fourth to eighth decades of life, and has a predilection for women. The scalp is the most common site of occurrence of this tumor. Malignant proliferating trichilemmal tumor (MPTT) invades surrounding tissues or metastasizes with features of cellular pleomorphism and nuclear atypia. Local recurrences have been occurred in about 3.7%–6.6%. Complete surgical excision with a margin of normal tissue is the standard treatment. Aim: To present a rare case of MPTT over the upper part of the neck which presented to our ENT department and to review about 50 cases of this entity in terms of age, sex, location, treatment, and outcome. Methods: The detailed description of the case of MPTT presented over the upper part of the neck to our ENT department will be given. Literature was reviewed for similar cases of this entity and was studied in terms of age, sex, location of tumor, treatment, and outcome. Results: Out of the 50 cases reviewed, majority of the patients were females, between the age group 40 and 80 years. The scalp was the common site of tumor. All the cases were treated surgically. Conclusion: MPTT is a rare neoplasm which carries a diagnostic dilemma and is often confused with squamous cell carcinoma. Wide excision of MPTT with an adequate clearance margin is the treatment of choice.
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Hemostatic and hemodynamic effects of topical administration versus intranasal injection of adrenaline during endoscopic sinus surgery: A prospective observational study p. 123
Muhammed Rasheed, Vinod Felix, Veerasigamani Narendrakumar
Aim: The study intents to compare the hemostatic and hemodynamic effects of topical application versus intranasal injection of adrenaline during endoscopic sinus surgery (ESS) under general anesthesia (GA). Materials and Methods: This is a tertiary hospital-based, 1-year prospective observational study in fifty adults, within the age group of 18–70 years of both sexes with bilateral similar sinonasal pathology, who underwent ESS under GA. Intraoperative hemostatic and hemodynamic parameters following topical application and intranasal injection of adrenaline were analyzed. Results: It was found that Fromme–Boezaart grading for hemostasis did not show any statistically significant difference (P > 0.05) between topical versus injection adrenaline. Out of fifty patients, 74% showed <10-ml difference in blood loss and only 6% of the study population showed more than 20-ml difference in blood loss. The heart rate and mean arterial pressure were found to be increased following intranasal injection of adrenaline (P < 0.001). Six percent of the study population developed electrocardiogram variation in the form of sinus tachycardia following local infiltration of adrenaline. Conclusions: Topical application of 1:2000 dilution of adrenaline gives similar hemostatic effects compared to intranasal infiltration of 1:100,000 dilution of adrenaline during ESS, and thus, we can avoid the systemic adverse events such as tachycardia, arrhythmia, and mean arterial pressure changes due to adrenaline infiltration.
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The cephalometric norms of afro-arab population p. 128
Muathe Abdulghani Younso, Amal Hussein Abuaffan
Objectives: We aimed to determine the skeletal and dental cephalometric norms for Sudanese adults. Materials and Methods: A total of 106 lateral cephalograms (51 males and 55 females) aged 18–25 years with Class I occlusion and well-balanced profile were enrolled in this study. Twenty-seven variables were analyzed digitally by VistaDent software according to the McNamara, Tweed, and Jarabak analysis. Results: A statistically significant difference between genders was found in the skeletal variables (sella-nasion-B point angle, A point-nasion-B point angle, facial plane angle, Y-axis, mandibular to anterior cranial base angle, mandibular to Frankfort horizontal plane angle, mandibular to maxillary plane angle, anterior cranial base length, posterior facial height, anterior facial height, lower anterior facial height, effective maxillary length, effective mandibular length, and maxilla-mandibular difference) and dental variables (maxillary incisor to anterior cranial base angle, mandibular incisor to Frankfort horizontal plane angle, and lower incisor edge to A point-pogonion line distance). Skeletally, Sudanese males had more prognathic maxilla and more prominent chin. The males had longer midfacial lengths and mandibular lengths. Sudanese adults had a tendency toward bimaxillary protrusion with slight dental proclination than Arab, and less protrusion compared with African or African American populations. Conclusion: The results give a better insight for proper diagnosis and treatment planning for Sudanese orthodontic and orthognathic patients.
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Facial masks for COVID-19 pandemic an approach toward awareness among health practitioners p. 136
Shivani Sachdeva, Harish Saluja1, Amit Mani, Shubhangi Mani, Kirti Chawla, Syeda Nikhat Mohammadi
Objective: Coronavirus pandemic is a human respiratory disease caused by the severe acute respiratory syndrome (SARS-CoV-2). The objective of the present study was to evaluate the type of mask, frequency of change, difficulties in breathing, dryness of mouth, hazards, and treatment taken for skin allergies if any due to use of facial masks in the present Coronavirus pandemic. Materials and Methods: The present survey was carried on dental practitioners for evaluating knowledge and attitude among 1640 participants. The anonymous survey was carried among different groups of age, gender, and qualifications among dentists all around the globe. SPSS 23.0 statistical software was used for statistical analysis. GraphPad Prism 6 was used for statistical analysis and visualization using Chi-square test, one-way ANOVA and post hoc test. The validity of the questionnaire was pilot tested and measured. The Chron bach's alpha value was 0.71. Results: Among the participants 46.3% used respirators such as N95, filtering facepiece respirators 2, or the equivalent. Surgical masks were used by 43.9% and the remaining used cloth masks. When inter group comparison was done for different age groups, it was found that there was a statistically significant for the type of mask used. Sixty-six percent participants reported oral malodor after using the facial masks while dryness of the mouth was reported in 41.5 and 9.1% reported acne. Conclusion: The use of face masks has become mandatory ornament along with social distancing to avoid transmission. Hypercapnia and breathing difficulties reported were less. For treating the face after long use of facial mask many of the participants reported that no treatment was taken while, others hydrated the face frequently with water, moisturizer and very few used antifungal agent.
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Teleconsultation – the pandemic mantra or the new norm? p. 142
V Shwetha, S Sujatha, N Rakesh, T Pavan Kumar, P Vaishnavi, P Sreekanth
Background: December 2019 witnessed an outbreak of coronavirus disease. This disease soon intensified its spread as a pandemic engulfing the health and economic status of countries worldwide. The route of transmission of this virus is through droplet spread or contact with secretions or infected surfaces. The health-care professionals were the most vulnerable group for contracting and spreading the infection. The dental professionals who come in close contact with oral secretions during various operative procedures were also at high risk of contracting the infection. Governments across the globe issued a lockdown to curtail the spread of the infection. To render essential and emergency health services, teleconsultation provided a lot of assistance in health management. Methodology: A descriptive cross-sectional study utilizing a validated questionnaire survey was used to assess the perceptions of dental health professionals regarding the utility of teleconsultation during the pandemic. The survey also assessed the drawbacks of teleconsultation and its implications on practice in the near future. 504 dentists answered the questionnaire and descriptive statistical analyses were used to analyze the data. Results: The response rate was 63% (504 out of 800). 90.1% of the dentists felt that teleconsultation was definitely better than traditional care services during the pandemic. Majority (61.15%) of dentists felt that teleconsultation was extremely helpful during the pandemic period to manage patient-related queries and provided the satisfaction of discharging their duties toward the patient. They felt that teleconsultation services could be extended even beyond the pandemic period and could have promising implications in future. Conclusion: Teleconsultation proved to be a feasible alternative to in-person appointments during the pandemic and helped in reducing viral transmission and compliance with social distancing measures. It also holds promise for future implications in routine dental practice. With further improvements in technology and application of artificial intelligence in teleconsultation could improvise remote patient monitoring and diagnosis and treatment planning in the near future and prove us a useful tool.
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Minor salivary gland neoplasm of the larynx: Our experience p. 147
Dipak Ranjan Nayak, R Balakrishnan, C Jalwa Ahmed
Introduction: Minor salivary gland neoplasm of larynx is a rare tumor of head and neck and account to around 1% of laryngeal cancers. This is a disease of middle age and affects subglottis mostly than other parts of the larynx. Preferred treatment is total laryngectomy (TL) due to high propensity for submucosal spread. In this case series, we discuss our experience in the management of salivary gland tumors of larynx. Methods: Retrospective analysis of five patients of salivary tumors of larynx treated at our institute for over 30 years. Results: Among the five patients, four had Adenoid cystic carcinoma (ACC) and one had clear cell carcinoma (CCC). Four ACC patients had the lesion in the subglottis and 3 underwent TL with chemoradiation and had no recurrence till latest review after 32 months of surgery. However, one patient who underwent chemoradiation alone had a persistent disease and is receiving palliative care. CCC patient had lesion in the glottis and underwent hemilaryngectomy and had no recurrence till 15 years following surgery. No locoregional metastasis identified, though one patient had lung metastasis. Discussion: ACC is the most common salivary tumor seen in the larynx. Literature had shown male predominance, however, our study had shown no sex predilection. In our study, patients who underwent TL with adjuvant chemoradiation showed no recurrence as compared to one patient who underwent chemoradiation alone and had disease progression. Conclusion: ACC is the most common salivary gland neoplasm of larynx and surgical treatment with chemoradiation seem to provide better outcome than chemoradiation alone.
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Carotid body tumor: Surgical management and complications p. 153
Ishwar Singh, Ravi Meher, Padam Singh Bhandari, Karandeep Singh
Introduction: Carotid body tumors (CBT) or paragangliomas account for approximately 3% of all paragangliomas occurring in the head-and-neck region. Delay in the surgical resection of tumors may be associated with high morbidity or mortality and risk of malignant transformation. Methodology: Three cases of CBTs were included in the study, out of which one case presented as bilateral neck swelling. All the patients were clinically and radiologically evaluated and taken up for surgical excision of the tumor. In case with bilateral tumor, a staged removal was planned. Results: Out of three patients, a female patient developed stroke postoperatively, she was managed and discharged in stable condition, and another male patient developed left vagal palsy. Conclusion: Excision of shambling Type III CBTs is difficult and one should know the collateral circulation of the tumor preoperatively. Bilateral CBT resection requires staging procedures to reduce the risk of cardiovascular and neurological issues.
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Pectoralis major myocutaneous flap in females: Report of the technique and literature review p. 159
Shreya Bhattacharya, Achyuth Panuganti, Krishnakumar Thankappan, Deepak Balasubramanian, Subramania Iyer
Background: Pectoralis major myocutaneous (PMMC) flap still finds a place in oral cancer reconstruction in certain settings such as salvage, free flap failure, and medically unfit patients. In females, raising a PMMC is considered challenging owing to its unreliability and donor site morbidity. We hereby report a literature review of the female PMMC and present our technique of the harvest to overcome these caveats. Patients and Methods: We followed our method of flap harvest in eight women. The lower neck flap and the upper chest flap are dissected and elevated in continuity. The skin paddle is placed completely in the infra-mammary crease, the dissection superior to the flap is done to raise the breast tissue off the PMMC, thus maintaining the integrity of breast tissue and incorporating the least amount of fat between the muscle and skin paddle. Results: The indications for the female PMMC were locally advanced primary in 2, surgical salvage in 2, free flap failure in 3, and medical comorbidity in 1 patient. Two patients had partial flap loss, one patient contracted a surgical site infection and another developed a seroma; all were managed conservatively. None had a complete flap loss. The mean duration of the hospital stay was 6 days. Conclusion: PMMC is still a viable reconstructive option in selected female patients. Our technique of flap harvest gives acceptable outcomes and retains the breast aesthetics.
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A middle ear paraganglioma masquerading as a facial nerve schwannoma p. 163
Reshma Raj, Naresh Panda, Ramya Rathore, Gyanranjan Nayak, Debajyoti Chatterjee
We report the rare case of a 36-year-old female with complaints of unilateral facial weakness and hearing loss with clinical, imaging, and intraoperative findings suggestive of facial nerve schwannoma, but the postoperative histopathology report was consistent with paraganglioma (PGL). After a primary excision, the patients developed recurrence and was accordingly managed by surgical excision again.
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