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   2017| January-June  | Volume 5 | Issue 1  
    Online since July 27, 2017

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Transoral surgery in early-stage laryngeal cancer
Somiah Siddiq, Vinidh Paleri
January-June 2017, 5(1):3-12
Single modality treatment is advocated for early laryngeal cancer, providing superior functional outcome and crucially options for further treatment in the event of local tumor recurrence. Options include surgery (mainly in the form of endolaryngeal techniques) or radiotherapy. With no prospective direct randomized controlled trials available, the choice of treatment following multidisciplinary discussion rests on a combination of tumor, patient and local expertise factors, with ultimately patient choice taking precedence. However, recently published data support the case for primary surgery on the basis of both organ preservation and health economics in early laryngeal cancer. We present an evidence-based review of the current literature in the management of primary and recurrent early laryngeal cancer.
  5,909 634 1
A rare case of synovial sarcoma of the neck with review of literature
Jyoti Dabholkar, Ameya Bihani
January-June 2017, 5(1):34-37
Synovial sarcoma (SS) is a malignant tumor of pluripotent/undifferentiated cells. Only 3% of all SSs are found in the neck. We present a case of a 16-year-old male presenting neck swelling for 6 months which was diagnosed as biphasic SS of the neck on fine-needle aspiration cytology. Complete surgical resection with lateral partial pharyngectomy was done followed by postoperative radiotherapy. We also present the recent reviews on diagnosis and management on SS of head and neck.
  5,059 355 -
Ectopic undescended left parathyroid adenoma: Diagnosed on ultrasound
Alka Ashmita Singhal, Sanjay Saran Baijal, Deepak Sarin, Sowrabh Kumar Arora, Ambrish Mithal, Shafi M Khuchay
January-June 2017, 5(1):44-47
We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at the angle of jaw which was diagnosed primarily on high-resolution color Doppler ultrasound imaging at our institution, followed by Sestamibi and computed tomography-single photon emission computed tomography (CT-SPECT) and surgery. A 41-year-old female having endometrial hyperplasia and planned for TAH + BSO. Her routine preoperative investigations showed serum calcium to be 13.0 mg/dL. Serum parathyroid hormone (PTH) was 914.6 pg/mL and 25–OH Vitamin D 8.0 g/mL. Ultrasound neck with color Doppler localized an ectopic undescended left parathyroid adenoma located high in the neck just adjacent to the left submandibular gland. Sestamibi was suggestive of the left ectopic undescended parathyroid adenoma (below the pole of the left submandibular gland), confirmed further on CT-SPECT. The patient was operated and a 30 mm × 23 mm × 10 mm sized parathyroid adenoma was removed and confirmed on histopathology. A dedicated high-resolution color Doppler ultrasound has a great potential to localize the parathyroid nodules in all cases of raised serum PTH and must be utilized in all cases along with other imaging modalities.
  4,177 397 -
Is human papilloma virus positivity in oropharyngeal cancers a game changer in Indian subcontinent?
Jyoti Dabholkar
January-June 2017, 5(1):1-2
  3,704 530 -
A novel technique for surgery of extracranial schwannoma to preserve neurological function
Jyoti Dabholkar, Ameya Bihani
January-June 2017, 5(1):31-33
Schwannomas are benign encapsulated tumor arising from Schwann cells of the nerve sheath. Large schwannomas of the neck present as neck mass and arise from major nerve such as vagus and cervical sympathetic chain. Surgical excision is the standard of management of such tumors but result in permanent nerve damage. Here, we present a case of 35-year-old female with schwannoma arising from vagus nerve with the intact neurological function of the nerve. We removed the tumor by intracapsular dissection, leaving behind the capsule, preserving the function of the nerve.
  3,504 278 -
Head and neck cancers: Regional trends in Kashmir
Shahid Rasool, Tahir Hussain, Rafiq Ahmad Pampori, Suhail Amin Patigaroo
January-June 2017, 5(1):13-16
Background: The current study is a prospective study conducted in the department of otorhinolaryngology Government Medical College and associated Hospitals Srinagar, Jammu and Kashmir for 1½ year. The aim of the study was to study the loco-regional pattern of head and neck cancers (HNCs) in our society which is different from the rest of the country with its unique environment, different sociocultural habits and customs. Material and Methods: All patients of HNCs who reported to our department were enrolled in the study. Metastatic carcinomas to head and neck from other sites and carcinoma with unknown primary were excluded from the study. Results: A total of 99 cases of HNCs were received at our tertiary care institute. The most common tumor encountered was thyroid cancer. The most common thyroid cancer was papillary carcinoma of thyroid, constituting 35% of total HNCs. Thyroid cancers were followed by head and neck squamous cell cancers (HNSCCs). Seventy percent of thyroid cancer patients presented with symptoms of neck swelling while as only 35% had lymph node metastasis, all of papillary thyroid cancer type. The majority of thyroid cancers (86%) belonged to stage 1st irrespective of cancer type (43/50), six patients (12%) were stage 2nd, and only one patient (2%) had stage 3rd. There was no stage 4th tumor in any patient with thyroid cancer. Squamous cell carcinoma of larynx (20.40%) was most common HNSCC. It was observed that the most of the patients of HNSCC had advanced stages of disease at presentation, with almost 60% of patients having T3-T4 stage and more than half of patients (53.84%) had palpable neck nodes. Conclusion: The study pointed out about the influence of environmental factors, local customs, and cultural habits on the nature and type of cancers and thus different cancer incidences and prevalences in different geographical areas.
  3,354 324 -
Bisphosphonate related osteonecrosis of jaw: A case report
Waquar Ahmed, Geeti Vajdi Mitra, Sushmitha Rajmohan, Tejas Motiwale, Vinod Andhare
January-June 2017, 5(1):41-43
Bisphonates are used widely to treat osteoporosis, hyperglycemia of malignancy, bone metastasis of solid tumors. However a relationship has been reported between the use of bisphosphonates and osteonecrosis of jaw. Clinical presentation of bisphosphonates related osteonecrosis of jaw (BRONJ) includes gingival ulceration with exposed necrotic bone in the oral cavity involving either maxilla or mandible that has persisted for 6-8 weeks. And in severe cases it may cause spontaneous pain, tooth mobility, pathological fracture. Though treatment recommendation's exists, no definitive standard of care has been established for BRONJ and surgery was previously reported as capable of exacerbating bone exposure. The present study shows a case report of patient of BRONJ treated as conservatively as possible. Patient was managed with observation, oral antibacterial rinse, analgesics for pain control. After follow up of 18 months, healing of the lesion was achieved and patient became symptom free.
  3,257 330 1
Transoral laser surgery for supraglottic squamous cancers
Sultan Pradhan, Rishav Garg, Anjoo Chaudhary, Marzee Mehta, Rajan Kannan
January-June 2017, 5(1):23-26
Objective: The objective of the study was to evaluate the oncological and functional results of transoral CO2laser microsurgery (TLM). Study Design: This is a retrospective study of squamous cancers of the supraglottis treated with transoral CO2laser resection. Materials and Methods: Between May 1997 and April 2014, 131 cases of T1/T2/T3squamous cancer of the supraglottis/hypopharynx with freely mobile vocal cords and no gross invasion of the laryngeal spaces, were resected transorally with the CO2laser. Results: Oncologically, resections performed under the magnification of the operating microscope are safe and yield high local control rates ranging from 79% to 85% for supraglottic cancer. For salvage of local recurrences following TLM, a full range of treatment options remains available including re-use of TLM. Of the 29 recurrences, 9 were salvaged with repeat TLM, 4 with radiotherapy, and 6 with total laryngectomy. In supraglottic cancer, management of neck is very important. Twenty patients with the clinically “N+” neck at presentation, underwent neck dissection at the same time of TLM or after an interval of 4–5 days. For the 111 “N0” cases, the neck was treated only if and when metastasis manifested at followup. Thus, nine patients underwent neck dissection for regional recurrence at followup. The neck was also treated in the local/locoregional recurrences salvaged either with radiotherapy or total laryngectomy. There were two cases of advanced regional recurrences that could only be offered palliative care.
  3,168 294 -
Clinical presentation and outcome of surgical management of primary hyperparathyroidism: A single center-based case series in Egypt
Hebatallah Gamal El Din Mohamed Mahmoud
January-June 2017, 5(1):17-22
Introduction: Primary hyperparathyroidism is an asymptomatic disease in the Western world detected during routine laboratory investigations.The differential diagnosis and the management of primary hyperparathyroidism presenting with more severe symptoms like Skeletal manifestations present a challenge to the surgeon from similar presenting conditions like bone metastases and bone tumors. Objectives: To describe the presentation and the management of primary hyperparathyroidism in the context of limited resources and the challenges faced with the differential diagnosis, especially with the dominance of the skeletal manifestations of the disease. Patients and Methods: Patients presenting with primary hyperparathyroidism during the period from 2010 to 2014 in the National Cancer Institute in Egypt were included in the study. Data were retrieved retrospectively from the files (demographic, pathological, preoperative investigations, surgical approaches, and outcome). Results: In this study, 23 patients were included with an age range of 12–69 years, skeletal manifestations predominated the presentation of the primary hyperparathyroidism in 66.6%, and unilateral neck exploration was the main surgical approach done in 70.8%. The 1-year overall survival is 100% and 1-year relapse-free survival is 92.9%; 17 cases (73.92%) were cured and 6 cases (26.08%) had persistent hyperparathyroidism. Conclusion: The skeletal manifestations predominates primary hyperparathyroidism presentation in this study. The clinician should be aware of the bony manifestations mimicking bone tumors and metastatic tumors to the bone. Calcium and parathyroid hormone levels should be done first before attempting excision of the tumor, especially if it involves the maxilla or mandible. Surgery is curative for symptomatic cases in different age groups with low incidence of complications, recurrence, and persistence of the disease.
  3,101 305 -
Practical tips to reduce complication rate in thyroidectomy
Claudio Cernea, Lenine G Brandão, Flávio C Hojaij, Dorival De Carlucci, Felipe Vanderlei, Renato Gotoda, Ana K Leite, Marco A V Kulcsar, Leandro L Matos, Rogério A Dedivitis, Vergilius J F Araújo-Filho, Marcos R Tavares
January-June 2017, 5(1):27-30
Introduction: Thyroid cancer is the most frequent endocrine neoplasm, and its incidence has been consistently rising during the last decades. Surgical treatment is the choice, but the complications can be truly devastating. Methods: The objective of this article is to present some practical tips to reduce the complication rate in thyroid surgery. Results: The more frequent complications during a thyroidectomy are mentioned, as well as practical tips to try to prevent them: acute airway compression, nerve injuries (both inferior laryngeal and external branch of the superior laryngeal nerves), and hypoparathyroidism. Conclusion: The prevention of complications during a thyroidectomy is imperative. The only way that the surgeon can assure the safety is to strictly adhere to technical principles, with diligent hemostasis, thorough anatomical knowledge, and gentle handling of the anatomic structures adjacent to the thyroid gland.
  3,014 324 -
Angioleiomyoma in deep neck space: A rare case report
Santhosh Kumar Nochikattil, Bipin T Varghese, Anitha M Francis, Shaji Thomas
January-June 2017, 5(1):38-40
Angioleiomyoma is a benign, slow-growing soft tissue tumor originating from vascular smooth muscles. Angioleiomyoma in head and neck region is extremely rare, and when it is present, it is more commonly seen in the auricle, nasal cavity, lip, and buccal mucosa. We present a case of asymptomatic angioleiomyoma involving parapharyngeal and prevertebral space.
  3,043 286 -