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  Most popular articles (Since March 31, 2016)

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Case Series- Case Report

October 2016, 4(3):73-104
  2,924 213 -
Editor's Message
Jyoti Dabholkar
October 2016, 4(3):0-0
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Clinical Research

October 2016, 4(3):21-72
  2,320 203 -
A retrospective analysis of 200 axillary route thyroidectomy cases
Padmakumar Ramakrishnapillai, Madhukara Pai, Mary Varghese, Farish Shams, PG Shaji, TS Anithadevi, Subin Thomas
July-December 2016, 4(2):75-79
Background: Thyroid disorders are common in women. The surgical solution available in most places is open thyroidectomy, which can ultimately lead to unsightly scar formation. This can be cosmetically unappealing, especially for women. The endoscopic thyroidectomy is a very good alternative to the traditional open thyroidectomy. It gives excellent cosmetic outcomes, especially when done with an axillary approach, without compromising safety. Methodology: This is a retrospective study conducted on 200 patients who underwent endoscopic thyroidectomy at Sunrise Group of Hospitals, Kochi and Dubai, from July 2013 to March 2016. The procedures performed were total thyroidectomy and hemithyroidectomy. The operation time, thyroid gland/nodule size, duration of hospital stay, and complications were considered for the outcome assessment. Results: A total of 200 endoscopic thyroidectomies were done. The mean age was 38 years, and the mean size of the thyroid was 9.19 ± 3.45 cm. The average time for hemithyroidectomy was 90 ± 12 min, and average time for total thyroidectomy was 150 ± 10 min. Forty-two patients underwent endoscopic hemithyroidectomy, whereas 158 patients underwent endoscopic total thyroidectomy. The histopathological reports revealed that there were 70 adenomas, 41 colloid nodules, 30 thyrotoxicosis, 27 thyroiditis, 26 carcinoma, and 6 Hurthle cell neoplasm cases. Complications, such as permanent hypoparathyroidism, nerve injury, and mortality, were not seen in the study population. Conclusion: Endoscopic thyroidectomy offers excellent cosmetic outcomes with no additional untoward effects. This procedure can be utilized for thyroids as large as 12 cm. All pathologies, including malignancies, can be safely dealt by expert endoscopic surgeon.
  2,169 138 -
A clinicopathological study of oral potentially malignant disorders
Subodh Hosagadde, Jyoti Dabholkar, Nitish Virmani
January-June 2016, 4(1):29-34
Introduction: Oral cancer is the leading cause of cancer in India accounting for approximately 40% of the cancer burden. A significant number of these are preceded by precancerous lesions and conditions, together referred to as potentially malignant disorders (PMDs). It is important to screen patients for these conditions as they allow physicians to intervene early for prevention as well as early diagnosis of oral cancer. Aims: To study the demographic profile, etiology, clinical profile, and histopathology of oral PMDs. Materials and Methods: Patient evaluation was done in the outpatient department of a tertiary referral center, and those who complained of oral mucosal lesions were examined between March 2011 and March 2012. They were evaluated and treated according to their diagnosis and were observed for 1½ years, with minimum of 4 follow-ups. Results: Of the 23,380 patients who attended the outpatient department between March 2011 and March 2012, 70 (0.29% incidence) patients had oral potentially malignant lesions. Age group most commonly affected was 21–30 years (28.57%). Males were affected more than females (m = 50; f = 20). Smokeless tobacco was the most common risk factor (58.57%). Among single site lesions, buccal mucosa was most commonly affected. Based on histopathology, “leukoplakia without atypia” was the most common lesion followed by oral submucous fibrosis. Conclusions: There is a change in the trend of the age distribution of the oral potentially malignant lesions with younger generation and females being involved more and also a definite relation between tobacco-related abuses and oral lesions.
  1,827 316 -
Evolving role of immunotherapy in head-and-neck cancers: A systemic review
Raajit Chanana, Vanita Noronha, Amit Joshi, Vijay Patil, Kumar Prabhash
January-June 2018, 6(1):2-11
Head-and-neck squamous cell cancers (HNSCCs) are one of the most common cancers worldwide and account for more than half million new cases and 380,000 deaths per year. A large number of patients are diagnosed with locally advanced disease and require multimodal treatment approaches. Despite advances in radiation and surgical techniques and the use of chemotherapy and monoclonal antibodies in advanced disease, more than half of all patients recur. Tumor cells from various solid malignancies, including HNSCC, over-express PD-LI to habituate the immune checkpoint pathways to evade immune surveillance. In this review, we summarize the current literature on immunotherapeutic options that are available for HNSCC patients.
  1,741 392 -
A century of progress in head and neck cancer
Jatin P Shah
July-December 2016, 4(2):50-58
  1,753 319 -
Changing trends in antibiotic prophylaxis in head and neck surgery: Is short-term prophylaxis feasible?
Naresh K Panda, Muhammed Shafi, Sourabha K Patro, Jaimanti Bakshi, Roshan Kumar Verma
January-June 2016, 4(1):42-48
Background: The duration and dosage of prophylactic antibiotics vary substantially among surgeons. This study explored the outcome and efficiency of short-term antibiotic prophylaxis in head and neck procedures. Methods: One hundred and forty-three patients undergoing various head and neck surgical procedures were included. They were categorized into two groups, clean (Group C) and clean-contaminated (Group CC). They received short-term prophylaxis with intravenous (IV) antibiotics. Group C patients received single dose IV antibiotic at induction and Group CC received antibiotic for 3 days. The scoring methods such as American Society of Anesthesiologist (ASA) score, National Nosocomial Infections Surveillance (NNIS) score, and additional treatment, discharge, erythema, purulent discharge, separation of deep tissue, isolation of bacteria and stay (ASEPSIS) were used. Scoring methods were used to analyze the risk factors and complications up to a period of 4 weeks postoperatively. Results: There were 83 patients in Group C and 60 patients in Group CC. Parameters such as body weight, body mass index (BMI), biochemical and hematological parameters along with surgical details, and postoperative wound assessment were analyzed. A significant association of surgical site infection (SSI) with BMI, anemia, hypoalbuminemia, and tobacco usage was noted along with a high incidence of SSI in surgical procedures involving the larynx. There was no significant relationship with ASA score and NNIS score. Conclusion: Short-term antibiotic prophylaxis in clean and clean-contaminated cases is feasible and effective as long-term prophylaxis. Correction of anemia, hypoalbuminemia, weight reduction, and avoidance of tobacco can prevent SSIs.
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The journey of ultrasound-based thyroid nodule risk stratification scoring systems: Do all roads lead to Thyroid Imaging, Reporting and Data System (TIRADS)?
Abhishek Mahajan, Tanvi Vaidya, Richa Vaish, Nilesh Sable
July-December 2017, 5(2):57-65
A number of qualitative and quantitative ultrasound (US) risk stratification systems for thyroid nodules are being used all over the world, new ones are being devised but so far, no consensus on a single system has emerged. Efforts by the worldwide medical community involved in the management of thyroid nodules are converging toward US risk stratification systems, which could provide a high-sensitivity and high-negative predictive value (NPV) for the diagnosis of clinically significant thyroid carcinomas. In this article, we review the fascinating journey of thyroid US-based thyroid imaging reporting and data system (TIRADS), the changing trends in TIRADS and emerging stratification systems to assess the risk of malignancy. Our recommendation is to develop a comprehensive system of risk stratification which incorporates clinically relevant as well as radiological risk factors and aims to accurately predict the risk of malignancy and oncologic outcome for each patient.
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Laser-assisted posterior cordotomy for bilateral vocal fold paralysis: Our experience
Nitish Virmani, Jyoti Dabholkar
January-June 2016, 4(1):23-28
Introduction: Bilateral vocal fold paralysis (BVFP) is a relatively uncommon cause of respiratory distress. The goals of surgical treatment are an improvement in airway size by enlarging the glottis, thus, eliminating the need for tracheostomy, while at the same time avoiding a breathy voice and aspiration. Striking this balance is extremely important. Unilateral laser-assisted posterior cordotomy provides sufficient airway at posterior glottis while preserving phonatory and protective functions of the larynx. Aims: To evaluate long-term acoustic, aerodynamic and functional results of laser-assisted unilateral posterior cordotomy in BVFP. Materials and Methods: The prospective study includes seven patients of BVFP who underwent unilateral laser-assisted posterior cordotomy. Surgical success was evaluated regarding decannulation rate, time to decannulation and need for the second procedure. Voice assessment was done using voice handicap index (VHI), grade, roughness, breathiness, asthenia, strain and measurement of maximum phonation time (MPT). Effect of deglutition was assessed by the presence or absence and duration of aspiration. Observations and Results: Of seven patients, four had been tracheostomized at some time during their treatment. They were successfully decannulated within an average of 1 week after the surgery. The postoperative respiratory function was adequate for more than routine activity in all patients. None of the patients required a second procedure. VHI values demonstrated that while four patients had no/mild degree of voice handicap, two had moderate and one had a severe degree of handicap. While five patients had a normal MPT, two had a reduced MPT. Perceptual rating by a speech pathologist revealed that while two patients had mild dysphonia, four had moderate dysphonia. None of the patients complained of aspiration postoperatively. Conclusion: Unilateral CO2laser posterior cordotomy is a simple, safe and short surgical technique that creates a satisfactory glottic airway to improve respiration while avoiding aspiration and having minimal to the mild effect on the voice.
  1,692 152 -
Basic Science Research

October 2016, 4(3):1-4
  1,005 827 -
Molecular biology of head and neck cancers
Deepa Philip, Vanita Noronha, Amit Joshi, Vijay Patil, Anant Ramaswamy, Anuradha Chougule, Kumar Prabhash
January-June 2016, 4(1):16-22
Head and Neck cancers constitute a real challenge for oncologists across the globe, with one person dying every hour of every day. It can distort and disfigure the face, strip away the voice and rob one of his basic abilities to eat, drink and swallow. The psychosocial impact can be extremely devastating. From previously being considered a homogenous entity, it is now a well recognized fact that Head and Neck cancer is rightly called “Head and neck cancers” in view of their genetic and molecular heterogeneity despite sharing histological and etiological homogeneity. The present review discusses recent insights as well as established principles of the molecular biology of Head and Neck Cancers.
  1,526 306 -
Chemoprevention in head and neck cancer
Joydeep Ghosh, Anant Ramamswamy, Vijay Patil, Amit Joshi, Vanita Noronha, Kumar Prabhash
January-June 2016, 4(1):4-11
Head and neck cancer comprises of a large section of our malignancies. The locations of the organs allows us to have an early diagnosis, and consequently, early treatment. However, even with the best possible treatment, the outcomes are quite dismal in many cases. So , newer strategies targeting prevention of the development of head and neck cancers are required. Epidemiological studies have given us a fair idea about the role of environmental factors as well as many precancerous lesions that predate the development of invasive cancers. There has been multiple efforts the decipher the pathways leading to the evolution of normal tissue to premalignant lesions to invasive carcinomas. Also, there have been many attempts to halt the process at various stages to prevent the development of the final step. This review focuses on the risk factors in brief, the pathways as well as biomarkers, and the agents that have been tested for prevention of head and neck malignancies.
  1,583 208 -
Medullary carcinoma of thyroid: Case report and a review of literature
Ratna Priya, Nitish Virmani, Jyoti P Dabholkar
July-December 2016, 4(2):80-84
Medullary thyroid carcinoma (MTC) constitutes around 5% of all thyroid cancers. It accounts for as much as 13% of all thyroid cancer-related deaths. MTC usually arises from parafollicular C-cells that normally secrete a number of peptide hormones such as calcitonin, serotonin, and vasoactive intestinal peptide; thus, it is widely accepted as a neuroendocrine tumor. Both sporadic and familial forms are seen, the sporadic form being responsible for 70% of the cases and familial form for 10-20% of the cases. Here, we present a case report of two patients with sporadic MTC. The first patient underwent total thyroidectomy with central compartment neck dissection and right lateral neck dissection, and also in the second patient, total thyroidectomy with central compartment neck dissection was done. Final histopathology came out to be medullary carcinoma of the thyroid. Postoperative serum calcitonin at 2 months following the surgery came out to be normal. Both the patients are on regular follow-up, and there has been no recurrence. Genetic screening and the evaluation of familial syndromes should always be considered in preoperative work-up in MTC patients. Early diagnosis offers a higher likelihood of cure and long-term survival. Total thyroidectomy plus central compartment neck dissection is the mainstay of treatment. All patients must be kept on regular follow-up to avoid recurrence.
  1,607 163 -
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.
  1,471 218 -
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.
  1,544 92 -
Clinical Audit

October 2016, 4(3):5-20
  1,335 199 -
Is human papilloma virus positivity in oropharyngeal cancers a game changer in Indian subcontinent?
Jyoti Dabholkar
January-June 2017, 5(1):1-2
  1,360 156 -
Laryngeal transplant: The future?
Varun Jitendra Dave
January-June 2016, 4(1):12-15
There is very less literature about laryngeal transplant, particularly in India. In the past, laryngeal transplant along with other “nonvital” organ transplant had been considered unethical as the risks associated with chronic immunosuppression outweighed the gains of the transplanted organ. However, with the advent of newer immunomodulatory drugs and drug delivery systems, the risks of immunosuppression are considerably low. This has prompted the growth and expansion of nonvital organ transplant which was evident by the first hand transplant performed in India. In the following discussion, the success of the two laryngeal transplants performed till date and the need for optimism in this field is outlaid. This article is directed toward all the ear-nose-throat and head-neck surgeons who treat laryngeal cancer on a regular basis.
  1,236 142 -
Organising Chairman's Message
Alok Thakar
October 2016, 4(3):0-0
  750 582 -
Evaluation of distant metastasis in treated thyroid cancers: Study of radioiodine scans in a tertiary care center
US Vishal Rao, Srinidhi Koya, Sataksi Chatterjee, Ashutosh A Patil, Ravi C Nayar, KG Kallur
July-December 2016, 4(2):59-62
The presence of distant metastases is one of the most important predictive factors of poor outcomes in thyroid cancer patients. Apart from distant metastasis, sex, age, histopathological subtypes, and completeness of surgical resection are the other prognostic indicators of survival. Our attempt in this study is to analyze the presence of distant metastasis in operated patients of thyroid malignancy and evaluate these prognostic indicators in the metastatic subgroup. Objective: The objective of this study was to retrospectively analyze the presence and extent of distant metastasis among treated thyroid cancer patients. Materials and Methods: The postoperative radioiodine scan reports of the patients who presented to Health Care Global Enterprises Ltd., Bengaluru over a period of 8 years (January 2008 to December 2015) were analyzed. Results: Sixty-six patients out of the 499 patients evaluated (13.22%) had distant metastasis. Most of the patients with distant metastasis were females, aged 45 years and above and had papillary carcinoma of thyroid. Percentage of skeletal and pulmonary metastasis was almost equal in the study group. Conclusion: The patterns of distant metastasis were similar to the trends in literature, except for increased incidence of skeletal metastasis, more so in a follicular subtype of papillary carcinomas.
  1,191 129 -
Journey so far and beyond
Jyoti Dabholkar
July-December 2017, 5(2):49-50
  915 382 -
Narrow band imaging during transoral laser surgery for premalignant and early malignant glottic lesions
Rakesh Srivastava
January-June 2016, 4(1):35-37
Introduction: NBI is relatively new optical image enhancement technology. The wavelength is centered on 415 (blue) & 540 nm (green). Blue and green light has different depth of penetration thus highlights mucosa and submucosa. Material and Methods: It is a retrospective study on 45 patients of early premalignant and malignant glottic cancers. Patient undergone preoperative, peroperative and postoperative white light and NBI endoscopy. NBI findings (using Ni etal classification) compared with the histopathological diagnosis. Results: The preoperative distribution of cases on the basis of T-staging using WL/NBI was mild-moderate dysplasia-15, Tis- 4, T1a-16, T1b-8, T2a-2. The peroperative distribution using the same tool changed the distribution with mild-moderate dysplasia-12,Tis-6, T1a-13, T1b-10, T2a-3, T2b-1. Conclusion: The upstaging of disease was noted in all stages of the T-disease using NBI. With the aid of angled telescope peroperatively mapping and staging of the disease is done. Thus it helps in better surgical dissection and results.
  1,176 115 -
Editor's message
Jyoti Dabholkar
July-December 2016, 4(2):49-49
  1,060 171 -
Patterns of failure and prognostic factors for radically treated patients of oropharyngeal cancers planned by two-dimensional radiotherapy: An audit from a regional cancer center
Pragyat Thakur, Bhavana Rai, Raviteja Miriyala, Sushmita Ghoshal
July-December 2016, 4(2):63-68
Objectives: To review the patterns of failure and analyze various prognostic factors influencing the outcomes of radically treated patients of oropharyngeal squamous cell cancer treated at our institute with two-dimensional planning (2D). Materials and Methods: Case records of 100 oropharyngeal squamous cell cancers, which were treated radically with radiation or concurrent chemoradiation to an equivalent dose of 66 Gy in conventional fractionation, in our department between 2011 and 2013 were retrospectively analyzed for locoregional control (LRC), progression-free survival (PFS), patterns of failure, and various prognostic factors. Results: Median age of presentation was 53 years, 95% being males. Ninety-three percent had a history of tobacco use. Base of tongue was the most common site in 63% of patients followed by tonsil in 26%. All patients were of Stage III and IV. Among these patients, 27% received concurrent chemoradiation while others received radical radiation. At a median follow-up of 28 months, 57% of the patients were disease free and the LRC was 60%. Among the recurrences, 17% had local failures while 23% had nodal failures as the first site of recurrence. There were no marginal failures. On multivariate analysis, stage of the disease was the single most important prognostic factor determining the PFS and LRC. Conclusion: Stage appears to be the most important prognostic factor affecting LRC and PFS. Absence of marginal failures in our study implies adequacy of coverage with 2D treatment planning while in-field failures mandate attempts to use increased dose, chemosensitizers or nodal dissection postradical radiation.
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