Though the incidence of anaplastic thyroid cancer (ATC) is minimal amongst thyroid cancers, the outcomes have remained dismal. As significant advances have happened after the 2012 guidelines, American Thyroid Association (ATA)-is a leading body, has recently released updated evidence-based guidelines of ATC in 2021. A need to interpret this guideline in the Indian context was perceived. The 2021 ATC guidelines by ATA, with relevant literature, were reviewed. The recommendations for specific subcategories were compiled. Relevant information pertaining to the Indian scenario was discussed with specific subcategories with Indian evidence. Future direction observations were shared. ATA has provided practical and updated guidelines for ATC. There are some region-specific considerations in the implementation of recommendations. A well-organized research approach and resource allocation are required to optimize ATC management in India.

The complex anatomy and exposure to various potential carcinogens lead to the development of tumors and tumor-like pathologies of the nose and paranasal sinuses. Delays in the diagnosis of sinonasal masses are common, leading to significant morbidity and mortality. Often the radiologist is the first person to recognize a neoplasm in a suspected inflammatory condition. Computed tomography and magnetic resonance imaging play a synergistic role in the assessment of pathologies in the sinonasal region, and their importance has become increasingly prevalent in the current scenario of coronavirus disease 2019 associated mucormycosis. Besides, imaging is essential for mapping the exact extent of the pathology and delineating vascular supply of hypervascular masses, thus facilitating the operating surgeon and interventional radiologist in management. The cases presented in this article have been accrued over the past three decades and analyzed as a retrospective observational study, with clinical, radiological, and pathological data having been extracted from the existing database in the institution. We present the imaging spectrum of sinonasal masses in the pediatric and adult population, highlight the key radiological features of the common pathologies and discuss an imaging template for reporting these masses, with special focus on the surgically relevant points to be included in the report. The educational goal of this review is to explore a meticulous and systematic imaging approach toward soft tissue lesions in the sinonasal region, which would enable the radiologist to reach a diagnosis or point toward the possible etiology and nature of the lesions.

Background: Tumor invasion into the orbit by carcinoma is well known and its negative impact on the survival and quality of life has been discussed in the literature. Methods: This article is a narrative review on the preservation of eye in the management of cancers of the nose and paranasal region. Conclusions: The clinical features and modern imaging can help in preoperative planning, aided by the intraoperative assessment in decision-making to preserve the eye or not. Unlike in the past, when even orbital periosteum involvement was considered for orbital sacrifice, more conservative approach has been advocated in recent years in view of anatomic, radiological, and histological studies. Limited involvement of the periorbita or even the small part of intraorbital fat may still be considered for the preservation of the eye in selected patients with frozen section control and without affecting the oncologic outcome.

Papillary carcinoma thyroid is a very common malignancy of the thyroid having a very good overall prognosis. Among the subtypes of this tumor certain histological subtypes identified are more aggressive than the ones with classic histology. The purpose of this review is to stratify the prognosis concerning papillary thyroid carcinoma patients with different histopathological patterns, their features of identification, and molecular differences. This is a narrative review of various published articles including meta-analysis results. This does not contain any studies with human participants by the author. A general outline of each subtype with histologic descriptions, relevant differential diagnosis, immunohistochemical as well as ancillary studies is discussed in this article. The rarity of the aggressive subtypes of papillary carcinoma and poor understanding of tumor biology can lead to inadequate treatment, and hence, the correct diagnosis is very important, and equally important is the awareness of these entities among the treating physicians.

Facial nerve (FN) anatomy is an enigma and its knowledge helps in safe and adequate parotidectomy without compromising the nerve. A review of the literature was done by searching the databases in PubMed, Embase, Scopus, and Google Scholar using the keywords “Parotid,” “FNT,” “Anatomy,” “Surgery,” and “Parotidectomy” and retrieving about 433 manuscripts fulfilling our requirements. FNT anatomy has been described in detail dividing the extracranial FNT under “Exit,” “Trunk,” “Pes Anserinus,” “Divisions,” “Branches,” “Communications,” “Relationships,” and “Termination.” Normal anatomy and variations including classification of the variation have been done. Knowledge of FNT anatomy helps in performing a safe parotidectomy. It is possible to preempt the course of the nerve and dissect the gland in a precise and rapid fashion, especially in surgery for a recurrence.

The infrahyoid flap (IHF) is a myocutaneous pedicled flap which is mostly supplied by the superior thyroid vessels through the infrahyoid muscles perforators. The flap is thin and it could be transferred as a pedicle of superior thyroid artery along with the vein for the reconstruction of medium-sized defects of head and neck surgeries. The added advantage of this flap is that it is pliable and provides a skin island which is approximately seven by four centimeters from the central part of the anterior neck. The best substitute for reconstruction of oral defects is IHF. It can be carried out for the moderate defects of mouth along with that of pharynx carcinomas. The flap can be either unilateral or bilateral superior thyroid pedicle flaps but the main limitations are restricted arc of rotation and small flap volume. The IHF is contraindicated in cases with prior irradiation as well as cases of neck metastasis. The flap is most trusted and can be easily yielded during dissections of the head and neck; oncologically, it is safe and it carries least morbidity of the donor site.

Evidence-based decision-making (EBDM) entails the explicit, conscientious, and prudent evaluation of the best available information in making medical decisions. The process of EBDM involves learning the latest approaches and gaining new skills such as how to ask excellent clinical questions, carrying out a computerized search, critically evaluating the evidence, utilizing the findings in clinical settings, and analyzing the process. This method acknowledges that it is difficult for the practitioners to be totally up to date on all illnesses, treatments, materials, or products accessible. As a result, EBDM provides a method for filling in these knowledge gaps to give the best possible care. The basic goal of evidence-based practice is to improve health-care quality. It assists to arrive at a clinical decision on the basis of the latest and advanced research and the best possible evidence. Facilitating EBDM that leads to better patient outcomes, smarter research planning, better products, and improved policy formulation is critical and timely. This article gives an insight into EBDM and various levels of evidence.

Musculoskeletal disorders (MSDs) are the most common occupational illnesses in the world. Dental professionals are more prone to injuries and pain in their muscles, tendons, nerves, and joints, which are known as MSDs. Prolonged static postures, repeated actions, workplace designs, poor alignment, genetic predisposition, mental stress, physical conditioning, age, and nonwork activities are all factors that might contribute to musculoskeletal pain (MSP). This systematic review and meta-analysis was based on Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and the articles were retrieved from the search engines such as PubMed, Google Scholar, and Web of Science after fulfilling the eligibility criteria. After screening, a final of ten articles were included in the final analysis. This systematic and meta-analysis follows the PRISMA checklist. Medcalc software was used in order to find the significance of the prevalence of lower back pain, followed by neck pain, upper back pain, shoulder pain, and hand and wrist pain in dental practitioners. Significant differences were considered at P < 0.05. A total of ten studies were included, of which six studies met the criteria for the meta-analysis. The prevalence rates of musculoskeletal diseases were high. The lower back was the region most affected (47.753%, 95% confidence interval [CI]: 45.007–50.509), followed by the upper back body region (44.167%, 95% CI: 41.300–47.063%), neck pain (41.633%, 95% CI: 39.066%–44.234%), shoulder pain (33.608%, 95% CI: 31.222%–36.058% and 18.656%), and hand/wrist pain (95% CI: 16.359%–21.128%). Work-related MSP is the major health problem among dental professionals. Working posture of dental professionals is important and has been identified as a major risk factor for the development of work-related MSDs. A proper ergonomic design and posture can reduce the MSP. Therefore, further research is needed on possible ergonomics needed for preventing MSDs.

Oral cavity cancer (OCC) treatment is associated with functional defects, morbidity, and significant chances of recurrence. Functional defect in terms of restriction of movement, reduced mouth opening, dysphagia, difficulty in speech results in poor quality of life (QoL). However, with timely physiotherapy majority of the functional loss can be rehabilitated. Training of physiotherapy needs to be started from preoperative time period setting up the mindset for postoperative rehabilitation. Literature lacks the robust data on the effects of physiotherapy for each step of cancer management (pretreatment, perioperative, and postoperative stage). In this systematic narrative review, we lay down the available evidence through extensive search of the available literature on the role of timely physical therapy in improving QoL in oral submucous fibrosis, preoperative and perioperative setting in OCC patients. The reviewed articles also shed light on perioperative role of physiotherapy in tracheostomy care, chest physiotherapy, prevention of deep vein thrombosis, speech, swallowing function, neck, shoulder movement, donor site hand, and leg mobility is highlighted. The review also highlights post-treatment management of trismus, dysphagia, lymphedema, and its recent advances.

Objective: To evaluate and compare the reliability, reproducibility, and speed of two cephalometric tracing methods computer-aided cephalometric tracing and manual tracing. Materials and Methods: This was an analytical, cross-sectional study. One hundred and three pretreatment cephalometric radiographs were randomly selected from the orthodontics department of a public university. Twelve cephalometric landmarks were identified, and fifteen measurements were calculated both manually and digitally using Vistadent OC software. The reliability of measurements was assessed for each method by applying the intraclass correlation coefficient (ICC). Paired t-test was used to compare the measurements' reproducibility and time difference between the two methods. Results: All angular and linear measurements for both the methods showed a range of moderate correlation (0.8 ≥ ICC ≥0.5) to strong correlation (ICC ≥0.8) except for L1-MAD, which displayed a poor correlation for both manual and digital tracing, (ICC = 0.36 and 0.33, respectively), as well as digital tracing of interincisal angle (ICC = 0.36). No statistically significant differences between the two methods were observed for all angular and linear measurements except upper anterior facial height (UAFH) and lower anterior facial height (P = 0.000). There was a statistically significant time difference between the two techniques (P = 0.000). The mean tracing time of the operator for single tracing was 18.02 min for manual tracing and 8.85 min when using the Vistadent program. Conclusion: Cephalometric measurements in conventional manual and digital cephalometric analysis are highly reliable. Although the reproducibility of some measurements between two methods showed statistically significant differences, most differences were considered minimal and clinically acceptable. Computer-assisted cephalometric analysis proved to be more time-efficient.

Introduction: Free radial artery forearm flap is a feasible reconstructive option for small defects in the head and neck. However, one of the major drawbacks is covering of the donor site with split-thickness graft, which leads to donor site morbidity, in terms of compromised cosmesis. An alternative strategy to close this defect primarily, utilizing native skin, can be helpful to mitigate this issue. Materials and Methods: We have described a technique of primary closure of donor site defect of the radial forearm flap using a transposition flap in 24 patients. The principle used is to transpose the ulnar skin flap which derives its blood supply from the perforators of the ulnar artery. The efficacy and complications were recorded and described. Results: We were able to close defects of up to 8 cm × 5 cm using this technique. No major complications were reported in any patients. Seven (29.1%) patients had small areas of necrosis at the tri-pointer area and skin edge. All of them healed using conservative measures by secondary intention except one case which required a secondary skin grafting procedure. Hypertrophic scarring was seen in three patients. Conclusions: This technique has many advantages over traditional skin grafting such as improved cosmesis, avoidance of a secondary donor site, and skin graft-associated complications. Further studies to prove the efficacy of this technique with objective function evaluation over a larger cohort are desirable.

Introduction: The prevalence of thyroid diseases is enormous in general population of India and more common in women than men. Although the World Health Organization assessment status has classified India as having optimal iodine nutrition in 2004, hypothyroidism still contributes significantly to burden of thyroid disorders in India. The prevalence of thyroid diseases varies according to different geographical areas, age, and sex. The aim of this study is to determine the pattern of thyroid lesions in surgically resected specimens in urban industrial area and to study their histomorphological features. Materials and Methods: The 430 patients in whom partial or complete surgical resection of thyroid was done were included in the study. The histomorphological features were studied in detail and correlated with clinical findings. Results: The majority of thyroid specimens (90.71%) were total thyroidectomies. More than half, i.e., 54.65% (n = 235) of the thyroidectomies were done in 3^rd and 4^th decade. The 85.11% (n = 366) were female patients. The multinodular goiter was the commonest etiology (n = 341) for thyroidectomy. The follicular adenoma (n = 25) and the papillary thyroid carcinoma (n = 20) were common neoplastic lesion. Conclusion: The thyroid lesions in females more often require surgical intervention as compared to males. The 31–50 years is the most common age group who require surgical intervention. The substantial number of younger females in the age group of 16–30 years requires surgical intervention. The multinodular goiter due to iodine deficiency appears to be most common cause of thyroidectomy. The early diagnosis and proper therapy is the key for reducing the thyroidectomies in younger females.

Introduction: 12.2% of the Indian have a palpable thyroid nodule, but only 5% of these are malignant. The rest of the patients do not need to undergo surgery, unless clinically indicated for other reasons. Fine needle aspiration cytology (FNA) from the thyroid gland is the most commonly performed screening investigation to determine whether a patient needs surgery or not. The sensitivity, specificity and accuracy of FNA should therefore, be audited in every Institute from their own data. Materials and Methods: A retrospective analysis of the case records of all patients of thyroid nodules who underwent surgery at our hospital between September 2019 and September 2021 was undertaken. Clinical, demographic details as well as correlation between the nonguided FNA report and the final histopathology was done. The sensitivity, specificity, positive and negative predictive value as well as accuracy of FNA was calculated. Results: The sensitivity of FNA for malignancy was 73.1% and the specificity was 89.3%. The positive predictive value was 85.7% and the negative predictive value was 79.2%. The accuracy of nonguided FNA was 81.8%. Conclusions: Though there were no inadequate smears, the high false negative rate and the lower accuracy point toward the need to use ultra-sonography guidance in selected cases to overcome the pitfalls of nonguided FNAs.

Introduction: The purpose of this study was to evaluate the diagnostic accuracy of sonography including Doppler and sonoelastography in differentiation between metastatic and tuberculous cervical lymphadenopathy. Materials and Methods: This single-center observational study was undertaken with 86 study subjects after defined inclusion and exclusion criteria as per study needs and imaging limitations. Sonographic and sonoelastographic examinations were done by two examiners, and the diagnosis was reached in consensus. Sonographic features assessed were size, short/long axis ratio, the presence or absence of echogenic hilum, and intranodal necrosis including pattern of vascularity. With ultrasonoelastography, color-coded elastograms and strain ratio (SR) were evaluated. Then, the accuracy of individual sonographic and sonoelastographic parameters as well as combined sonographic and sonoelastographic evaluation was evaluated against HPE diagnosis. Cutoff for all the combined evaluations was determined from receiver observing curve. Results: Out of 127 nodes examined, 100 were tuberculous and 27 were metastatic on histopathology. Among all ultrasound features, intranodal necrosis showed maximum sensitivity, i.e., 39% and specificity 96%. SR had highest sensitivity (95.6%) and specificity (96.3%) among all US and elastographic parameters. Conclusion: Sonoelastographic assessment has good diagnostic accuracy for differentiation between metastatic and tuberculous cervical lymphadenopathy and adds to sonographic assessment, thereby further increasing the diagnostic confidence.

Introduction: Childhood dental caries can have a negative impact on the oral health of both children and their caregivers. The purpose of this research was to assess the severity of dental caries and other covariates such as age and gender and affected the oral health-related quality of life of preschool children and their parents. Materials and Methods: 1110 preschool children aged 4–6 years attending both public and private schools of Kanpur city were studied. dmft index was used for quantifying dental caries. Oral Health-related Quality of LifeScale (OHRQoL) questionnaire of Michigan OHRQoL–Child Version and parent version was used to assess OHRQoL. Chi-square test was run for analyzing the relationship of OHRQoL with dental caries, age and gender. P < 0.05 was considered to be statistically significant. Results: Children with higher caries experience reported with compromised OHRQoL in each domains of “Pain/discomfort,” “Temperomandibular joint disorders,” “Consequences of poor oral health” and “Psychological/Esthetic domain.” OHRQoL exhibiting no difference between males and females in each domains of “Pain/discomfort,” “Temperomandibular joint disorders,” “Consequences of poor oral health” and “Psychological/Esthetic domain.” The younger age Group i.e., 4 year old reported with worse OHRQoL as compared to 5-year-old and 6 year old in each domains of “Pain/discomfort,” “Temperomandibular joint disorders,” “Consequences of poor oral health” and “Psychological/Esthetic domain.” Parent's perception of OHRQoL was high when compared to their children's OHRQoL. Conclusion: In the sample of preschool children evaluated, the overall influence of dental caries prevalence on OHRQoL was rather significant. Longitudinal analyses should be used in future studies to measure risk markers.

Introduction: Follow-up care and monitoring of survivorship are key aspects of head and neck cancer management. The unprecedented COVID-19 pandemic has posed an unforeseen challenge before head and neck surgeons and has created an urgent need for deploying processes for triaging patients. This study evaluates the effectiveness of a 3-tiered protocol incorporating principles of “mhealth” proposed by WHO and telemedicine to monitor recurrence, maintain compliance, and address pressing issues in follow-up head and neck cancer patients. Materials and Methods: One hundred and one head and neck cancer patients who have undergone surgery and/or completed chemoradiation between the years 2015 and 2020 were selected. Details of patients who were on regular follow-up until March 2020 were obtained. A 3-tier screening protocol including a telephonic questionnaire, video consultation, and visit to primary care center was utilized to triage patients. Results: Fifty-seven percent of the patients did not require any intervention and were managed through video consultation with specialists. 38% of the patients needed a visit to a nearby health care worker or primary physician along with rehabilitation services. Only 5% of them needed a visit to a tertiary healthcare center for specialist care. The overall dropout from follow-up in this study was 19.8%. There was no significant difference of scores noted between oral cavity and nonoral cavity cancer groups (z = 1.17, P = 0.24, Mann–Whitney Test). Conclusion: The proposed 3-tier screening protocol using telemedicine is a feasible, cost-effective, and time-efficient tool to overcome the negative impact of COVID-19 on follow-up care.

Nasopharyngeal swab collection procedure has been used as a part of COVID-19 testing. Few cases of cerebrospinal fluid (CSF) leak following nasopharyngeal swab have been reported so far. Here, we report an interesting case of CSF leak following nasopharyngeal swab for COVID testing which we repaired using platelet-rich fibrin as an outpatient department procedure.

Microcephaly is a rare neurological condition, and it is characterized by a smaller head than other children of the same age and sex. Microcephaly with or without chorioretinopathy, lymphedema, or mental retardation (MLCRD) is a syndrome with a varying spectrum that occurs as a result of variants of KIF11 gene. A 3-year-old girl was presented to our clinic with microcephaly; she had no motor or growth retardation except microcephaly. After obtaining a normal karyotype and microarray result, Trusight One-Expanded Panel analysis showed NM_004523.4 (KIF11): c. 2409dupA (p. Leu804Thrfs Ter13) heterozygous pathogenic novel variant. Patients who have KIF11 mutation often also have different clinical features; in our case, the motor development is consistent with its peers and has a history of prenatal and postnatal microcephaly. Microcephaly can be caused by a variety of genetic mutations. In our case, firstly we identify the association of a novel de novo KIF11 gene duplication variant related to isolated microcephaly.