Journal of Head & Neck Physicians and Surgeons最新文献

{"title":"Microvascular reconstruction for tumors of the head and neck in the pediatric population","authors":"D. Balasubramanian, N. Subramaniam, Janarthanan Ramu, R. Sood, Mohit Sharma, Jimmy Mathew, Krishnakumar Thankappan, Pramod Subhash, A. Krishnadas, S. Iyer","doi":"10.4103/jhnps.jhnps_37_19","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_37_19","url":null,"abstract":"Introduction: Microsurgical tissue transfer in the pediatric population is challenging for several reasons– small vessel diameter, flap size, difficulties with postoperative flap monitoring, and difficulty in anticipating tissue growth and remodeling. In addition, head-and-neck reconstruction is uniquely difficult due to the functional deficits after ablative surgery. We present our series of microvascular reconstruction for tumors of the head and neck in the pediatric population. Materials and Methods: Retrospective review of microvascular reconstruction performed in our institution for benign and malignant tumors of the head and neck for patients aged <10 years of age between 2004 and 2016. Demographic and treatment details were analyzed, and descriptive statistics were performed. Results: The flaps used for reconstruction were anterolateral thigh flap (n = 5), fibula free flap (n = 4), scapular free flap (n = 2), radial forearm free flap (n = 1), and sixth rib with serratus anterior and latissimus dorsi (growth center transfer) (n = 1). Rapid prototyping models and inverse planning were used for bony reconstruction in seven cases. The flap success rate was 100%. The average operating time was 130 min. There were no major intraoperative or postoperative complications. Conclusion: Microvascular reconstruction for head-and-neck tumors in the pediatric age group is safe and is associated with good functional and esthetic outcomes. The anterolateral thigh flap and the fibula flap are the flaps of choice in a majority of cases. Preoperative planning, especially in complex bony reconstruction, is important to maximize outcomes and minimize the operative time. Multidisciplinary care is essential to ensure rapid rehabilitation in the postoperative period.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42295736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant cervico-pectoral schwannoma","authors":"S. Sharma, K. Thakur, P. Sagar, Dhananjay Kumar","doi":"10.4103/jhnps.jhnps_12_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_12_20","url":null,"abstract":"Benign tumors of brachial plexus (BP) are relatively rare. However, these tumors pose a surgical challenge due to their origin in an anatomically complex region containing neurovascular tissue nexus. We describe a case of giant BP schwannoma involving the right neck and supraclavicular fossa extending to the right pectoral region without any associated neurological deficit.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46006883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of tumor-to-tongue thickness ratio to predict the need for microvascular flap reconstruction following glossectomy in carcinoma tongue","authors":"A. Anand, D. Balasubramanian, Sandhya C Jayasankaran, K. Milind, Samskruthi P. Murthy, N. Subramaniam, R. Bhaskaran, Jimmy Mathew, Mohit Sharma, Krishnakumar Thankappan, S. Iyer","doi":"10.4103/jhnps.jhnps_5_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_5_20","url":null,"abstract":"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.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44425688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction in head and neck cancer surgery: The ways we came through and the path ahead","authors":"S. Iyer","doi":"10.4103/jhnps.jhnps_24_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_24_20","url":null,"abstract":"","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42792548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of incidental pulmonary nodules in head-and-neck squamous cell cancer patients treated with curative intent","authors":"D. Tani, R. Ladwa, Wen Xu, Z. Lwin, K. Steinke, Brett G M Hughes","doi":"10.4103/jhnps.jhnps_39_19","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_39_19","url":null,"abstract":"Introduction: Incidental pulmonary nodule(s) (IPNs) are a common finding during staging imaging for the head-and-neck squamous cell cancers (HNSCC) treated with curative intent. Currently, the incidence of metastasis or synchronous malignancies and outcomes for IPN in this population is unknown. Methods: All cases (n = 2489) reviewed at a tertiary Australian Institution's head and neck (H and N) multidisciplinary meeting, from January 2010 to December 2014, were included. Of these patients, 310 (12.5%) had an HNSCC with an IPN that had been detected during staging imaging. These patients were also to undergo treatment by curative intent. Clinicopathological characteristics, the incidence of malignancy, progression-free survival, and overall survival (OS) were collected retrospectively over 5 years. Results: The median age of patients with an IPN was 66 (range 25–95) years. Tissue diagnosis of IPN was attempted in 46 (14.8%) patients due to radiological suspicion of malignancy. Malignancy was confirmed in 33 (11.0%) patients. From these, 33 patients, 11 (30.3%) had histological diagnoses of nonsquamous cell lung cancers and hence are not due to metastatic spread from a primary HNSCC. Age, gender, previous malignancies, smoking status, p16 status, stage, or primary site did not predict for malignancy. The incidence of pulmonary metastasis in patients who did not undergo tissue biopsy due to low clinical and radiological suspicion of malignancy (n = 244) occurred in 10 patients (4.1%). At the time of analysis, 91 (29.4%) patients had died, and tumor recurrence had occurred in 82 (26.5%) patients. The mean OS was 48 months (95% confidence interval: 44–51). OS was significantly associated with greater age (hazards ratio [HR] 1.04, P < 0.001); immunosuppression (HR 2.15, P = 0.013); and biopsy being attempted (HR 1.78, P = 0.013). There was no biopsy related mortality. Discussion: Detection of an IPN in patients undergoing workup for H and N cancer is common. The risk of malignancy in these IPNs however, is low. We did not identify any clinicopathological parameters to predict malignancy in this setting. Advanced age, current smoking status, and history of immunosuppression predict for poor outcomes. Further work is being undertaken to analyze radiological features that may predict malignancy in an IPN found during the radiological staging of HNSCC.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48369471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical excision with the negative margins offers best cure rates for ameloblastoma: A case series and review of literature","authors":"H. Singhavi, A. Pai, M. Mair, S. Nair, D. Nair, P. Chaturvedi","doi":"10.4103/jhnps.jhnps_1_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_1_20","url":null,"abstract":"Objectives: The purpose of the study was to report a case series of ameloblastoma treated by radical approach with a negative margin. Study Design: The clinical, demographic, and the histopathological data of 24 biopsy-proven ameloblastoma were obtained and analyzed retrospectively from the electronic medical records. Statistical analysis was done using the software SPSS 20.0. Disease-free survival was calculated using Kaplan–Meier analysis. Results: The mean age of the patients in the study group was 46.6 (range, 17–69) years with male to female ratio of 1.18:1. The most common site of origin was mandible (75%). There was a significant positive linear correlation between size and age of the patients with a correlation coefficient of 0.85 (P = 0.042). Patients having multicystic ameloblastoma had a significantly higher age of presentation and larger size than unicystic ameloblastoma (P < 0.05). The mean distance of the closest mucosal/bony cut margin from the lesion was 6 mm (range 1–45 mm). All patients were alive, and 95.8% of the patients were disease free at a mean follow-up of 48 months. Conclusion: We recommend appropriate radical treatment for most of the patients of ameloblastoma with a negative margin except for small unicystic ameloblastoma. Thus, it is time to revisit the concept of conservative procedures in the management of ameloblastoma.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47728694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low survival of advanced laryngeal cancers: Time to change the treatment regime?","authors":"S. Vijay, S. Thavarool, S. Manu, N. George, R. Nair","doi":"10.4103/jhnps.jhnps_30_19","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_30_19","url":null,"abstract":"Background: This study aimed to detect the survival outcome of patients who underwent primary laryngectomy in comparison to the salvage total laryngectomy at our institution. Methodology: A retrospective analysis of patients who underwent laryngectomy in our institution from 2009 to 2016 either as primary surgery or as salvage surgery was done. Results: Fifty-four patients were assessed in the current study. Primary laryngectomy was done in 33 (60.4%) patients and savage laryngectomy in 21 (39.6%) patients. The common complication following laryngectomy was wound infection (68.5%) followed by pharyngocutaneous fistula (29.6%). The five year disease free survival in primary and salvage laryngectomy patients were 46% and 32 % respectively. DFS showed a decreasing trend with increase in T-stage and also node positivity. The overall survival (5 years) was found to be 52% for primary laryngectomy cases and 37% for salvage cases. Conclusion: Salvage laryngectomy was found to have higher incidence of postoperative complications. The overall survival and DFS was found to be lesser for salvage cases than primary laryngectomy. T- and N-stage have an important role in determining survival. The survival of advanced laryngeal cancers is dismal with surgery and radiotherapy.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45010010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An update on medullary carcinoma thyroid","authors":"M. Raam, A. Cherian, M. Paul, D. Abraham","doi":"10.4103/jhnps.jhnps_4_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_4_20","url":null,"abstract":"Medullary thyroid carcinoma is a rare neuroendocrine tumor arising from parafollicular cells of the thyroid gland. It occurs in both hereditary and sporadic forms which are associated with the gain of function mutations in rearranged during transfection proto-oncogene on chromosome 10q11.2. There are various syndromic and sporadic clinical presentations, and the understanding of the molecular pathophysiology and its genotype–phenotype correlation has led to mutation-based risk stratification and guidelines for evaluation and management. The authors present a current review of the literature with regard to pathophysiology, molecular basis, clinical presentation along with genotype–phenotype correlation and guidelines for evaluation and management.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44960443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular melanoma: A rare entity","authors":"R. Nagarkar, Sirshendu Roy, A. Wagh, Gauri Kokane, A. Adhav, Samadhan Pawar","doi":"10.4103/jhnps.jhnps_26_17","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_26_17","url":null,"abstract":"Malignant melanoma of eyeball is a rare entity. The overall incidence of malignant melanoma is 3%–7% per year worldwide. Early detection and meticulous treatment planning and its execution are challenge to surgeons. A 38-year-old male presented with loss of visionin one eye, and after investigating, it turned out to be malignant melanoma of the eyeball. He was treated surgically by enucleation of the eyeball followed by prosthetic rehabilitation.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44416293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lemierre's syndrome: A calamitous complication of oropharyngeal infection","authors":"Roopesh Yarappa, Sakshi Gagneja, S. Acharya, Shreya Gattani","doi":"10.4103/jhnps.jhnps_33_19","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_33_19","url":null,"abstract":"Lemierre's syndrome is an infectious thrombophlebitis of internal jugular vein (IJV) which occurs rarely, as a complication of oropharyngeal infection. We report an unusual case of a 36-year-old healthy female who presented with high-grade fever with chills, sore throat, and diffuse swelling of the neck on the right side. Examination revealed pharyngitis with swelling on the neck on the right side with palpable submental and submandibular lymph nodes bilaterally. Local site ultrasonography revealed thrombosed right IJV with subcentimetric regional lymph nodal enlargement. She was started on prophylactic intravenous antibiotics and anticoagulants, awaiting blood culture report. A detailed workup was done to rule out occult malignancy, and autoimmune as well as thrombotic screening was also negative. The etiological agent could not be identified as blood cultures were negative; she had already received antibiotics prior to admission. She responded to treatment, and there were no metastatic complications. Though the syndrome is rare, it has severe manifestations and mortality can be reduced, if timely diagnosed and managed.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44314335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}