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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 6 | Issue 2
Page Nos. 63-99

Online since Monday, January 14, 2019

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GUEST EDITORIAL  

Strategies to improve oral cancer outcome in high-prevalent, low-resource setting p. 63
Moni Abraham Kuriakose
DOI:10.4103/jhnps.jhnps_42_18  
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ORIGINAL ARTICLES Top

Predictors of postoperative pneumonia in patients undergoing oral cancer resections and its management p. 69
Ridhi Sood, Jerry Paul, Sunil Rajan, Sobha Subramanian, Deepak Balasubramanian, Sivakumar Vidhyadharan, Krishnakumar Thankappan, Subramania Iyer
DOI:10.4103/jhnps.jhnps_41_18  
Background: Head-and-neck resections carry a major risk of postoperative pulmonary complications. It adds to morbidity and mortality, adversely affects recovery, and contributes to financial burden. The objective of this study is to find out the incidence of pneumonia and the utility of our institution protocol in the prevention of postoperative pneumonia (POP). Materials and Methods: Retrospective study including patients undergoing oral cavity resection at the tertiary hospital from August 2017 to July 2018. The patients were analyzed in terms of demographic profile, operative findings, and postoperative course. Diagnosis of pneumonia was established by intensivist based on symptoms and signs. Results: Incidence of pneumonia was 5.79% (15 out of 239). Average age of patients with pneumonia was 64.8 years and 60% were male. All had multiple comorbidities. Average preoperative serum albumin was 3.49. POP was seen commonly in patients who had composite resections involving alveolar arch and tongue (26.67%). Majority had reconstruction in the form of free flap (46.6%) with fibula flap being most common. Average intraoperative time was 10.5 h. The most common isolate was Pseudomonas aeruginosa (40%), followed by Klebsiella pneumonia (33.3%). About 26% were multidrug-resistant strains. Average hospital stay was found to be 30.6 days in patients of pneumonia. Conclusions: Data from our cohort indicated a much lower incidence compared to published literature. We attribute this to our routine practice of intensive care unit care in the immediate postoperative setting with a nursing care ratio of 1:1, postoperative early mobilization, frequent tracheal toileting, chest physiotherapy, early diagnosis of pneumonia, and prompt initiation of treatment.
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The pattern of psychiatric comorbidities in globus: A cross-sectional study from a tertiary care hospital in Kashmir, North India p. 73
Zaid Ahmad Wani, Shabir Ahmad Dar, Deeba Nazir, Aaliya Khanam, Shazia Kousar
DOI:10.4103/jhnps.jhnps_32_18  
Background and Aims: Globus is the physical sensation of a lump in the throat presenting as difficulty in swallowing. Since there is a paucity of literature regarding the psychiatric comorbidity in globus, we aimed to study the psychiatric comorbidities in these patients visiting a tertiary care center in Kashmir. Materials and Methods: It was a noncontrolled, noninterventional, cross-sectional, hospital-based study carried out from August 2014 to July 2015 among the patients with a diagnosis of globus. Patients were selected from the outpatient unit, visiting the Institute of Mental Health and Neurosciences Kashmir. About 51 patients with globus who fulfilled the inclusion criteria and gave written informed consent were selected as study cases. For diagnosing psychiatric comorbidities, we used the Mini-International Neuropsychiatric Interview. Results: The mean age of our cases was 39.58 years. Females outnumbered males in cases by a ratio of 3:1 approximately. Psychiatric disorders were seen in 70.588% of globus patients. Major psychiatric disorders seen in our patients were major depressive episode (23.53%) and generalized anxiety disorders (11.76%). Conclusions: Majority of patients with globus who present to a tertiary care center have comorbid psychiatric disorders. We need to screen these patients for such comorbidities and develop a holistic approach for better outcome in such cases.
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Recurrence pattern of glottic cancer patients treated by laser cordectomy: Intent to treat analysis p. 78
Sajith Babu Thavarool, Amit Tyagi, KN Harsha, Bhushan Kathuria, Nagendra Kadappa, Sithara Aravind, KM Aswathi, Sangeetha Nayanar, Satheesan Balasubramaniam
DOI:10.4103/jhnps.jhnps_38_18  
Introduction: Organ preservation treatment for glottic cancers is done with radiotherapy and conservation surgery like laser surgery. Voice outcome and oncological outcome have been found to be equal in both in early cancers. Methodology: A retrospective study with the intent to treat analysis was done to find the feasibility of laser treatment in early glottic cancers during August 2013–2016 at a single center. Results: There were 39 patients with laser cordectomy, of which 29 had malignancy and 10 had dysplasia. Type I to V cordectomies were as per the extension of lesion with frozen control. Four patients had close margin and four had involved margin and seven of these had radiotherapy. Eight had recurrence, of which six were treated with laser, two with radiotherapy. The second recurrence was seen in three of which one had laser surgery, one had open partial laryngectomy, and one had total laryngectomy with radiotherapy. Five-year overall survival was 90% and higher stages were found to have more recurrence (P = 0.05). Conclusion: Laser cordectomy is a feasible option for treatment with favorable oncological outcome in early glottic cancers. Higher stages (T2 and T3) have higher recurrence with laser surgery alone.
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Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes p. 82
Deepak Balasubramanian, Narayana Subramaniam, Sherry Peter, Latha Rao, Pramod Subhash, Arjun Krishnadas, V Manju, Janarthanan Ramu, Jimmy Mathew, Mohit Sharma, Krishnakumar Thankappan, Subramania Iyer
DOI:10.4103/jhnps.jhnps_39_18  
Introduction: Ameloblastomas are benign but aggressive odontogenic tumors with have a high propensity for bony destruction. They require to be excised completely to avoid local recurrence, and these resections involve significant functional and esthetic disturbances. With the advent of microvascular reconstruction, they can be excised, and defects are reconstructed with preservation of form and function. This paper presents our experience with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas, and to describe the planning, resection, microvascular reconstruction, and rehabilitation of these patients. Materials and Methods: A retrospective review of records for patients treated with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas at Amrita Institute of Medical Sciences Kochi between 2003 and 2015 was performed. Clinical and pathological features were described, and a literature review was performed. Results: A total of 48 patients were identified with equal sex distribution and mean age at presentation of 35 (range 16–71) years. Half of these patients had primary lesions, and the remaining half had the recurrent disease (range 1–4 previous surgeries). Forty patients (83%) had mandibular lesions and the remaining had the maxillary disease. All patients had wide excision with a gross bony margin of 1 cm and reconstruction with microvascular flaps (fibula free flap = 41, distal circumflex iliac artery flap = 3 and scapular free flap = 2, anterolateral thigh flap = 1 and radial forearm free flap = 1). Mean tumor size was 4.73 (2–14) cm. At a median follow-up of 21 months, all patients were free of recurrence. Successful dental rehabilitation was achieved in 40 patients (83%). Conclusion: This approach leads to results in excellent local control, functional, and esthetic outcomes. Although managing these patients is challenging, multidisciplinary expertise and planning are crucial for successful management.
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Oral cancer in the young with no tobacco exposure: A distinct epidemiological subset? p. 86
Narayana Subramaniam, Deepak Balasubramanian, Samskruthi Murthy, Sivakumar Vidhyadharan, Krishnakumar Thankappan, Subramania Iyer
DOI:10.4103/2347-8128.208524  
Objectives: To describe oral squamous cell carcinoma (OSCC) in the young (<45 years) with no tobacco exposure and identify the determinants of locoregional control and survival. Materials and Methods: This is a retrospective analysis of 82 young patients of OSCC with no tobacco exposure treated with surgery and adjuvant therapy. Survival analysis was performed, and determinants of control and survival were identified by Cox proportional hazards regression model. Results: Overall 67% were male, and the median age was 40 years. Survival was excellent: for Stages I, II, III, and IV, 5-year overall survival was 97%, 95%, 75%, and 64% and disease-free survival (DFS) was 84%, 79%, 57%, and 59%, respectively. On multivariable analysis, perineural invasion (PNI) predicted DFS and local and distant control. Conclusion: This cohort had excellent survival when treated appropriately with adjuvant therapy. PNI may represent the need for treatment escalation. Further study is required to identify if this is a biologically distinct cohort.
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CASE REPORTS Top

Spontaneous regression of supraglottic squamous cell carcinoma: A clinical case report p. 93
Vikram M Bhardwaj, Pooja Kataria Jain
DOI:10.4103/jhnps.jhnps_23_16  
Spontaneous regression of histologically proven squamous cell carcinoma is extremely rare. We present the case of a 66-year-old male with histologically proven squamous cell carcinoma of the larynx which regressed spontaneously without any treatment. The patient is alive and healthy 3 years after the diagnosis. The exact mechanisms of spontaneous regression remain elusive although spontaneous regression is not the natural course of squamous cell carcinoma and the disease may recur in time and space.
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Intrathyroidal branchial cleft cyst p. 97
Satvinder Singh Bakshi, Roopa Urs
DOI:10.4103/jhnps.jhnps_3_18  
Branchial cleft cysts are common in the neck, but those occurring within the thyroid gland are very rare; we report the occurrence of intrathyroidal branchial cleft cyst. A 42-year-old female presented with a slowly progressive enlargement of her left lobe of the thyroid gland, she subsequently underwent a hemithyroidectomy. The postoperative biopsy was reported as intrathyroidal branchial cleft cyst.
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