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  Citation statistics : Table of Contents
   2016| January-June  | Volume 4 | Issue 1  
    Online since May 23, 2016

 
 
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ORIGINAL ARTICLES
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
DOI:10.4103/2347-8128.182854  
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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EDITORIAL
Editorial
Jyoti Dabholkar
January-June 2016, 4(1):1-1
DOI:10.4103/2347-8128.182848  
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GUEST EDITORIAL
You can do it!
Madan Laxman Kapre
January-June 2016, 4(1):2-3
DOI:10.4103/2347-8128.182847  
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ORIGINAL ARTICLES
Laser-assisted posterior cordotomy for bilateral vocal fold paralysis: Our experience
Nitish Virmani, Jyoti Dabholkar
January-June 2016, 4(1):23-28
DOI:10.4103/2347-8128.182852  
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.
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A clinicopathological study of oral potentially malignant disorders
Subodh Hosagadde, Jyoti Dabholkar, Nitish Virmani
January-June 2016, 4(1):29-34
DOI:10.4103/2347-8128.182853  
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.
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Narrow band imaging during transoral laser surgery for premalignant and early malignant glottic lesions
Rakesh Srivastava
January-June 2016, 4(1):35-37
DOI:10.4103/2347-8128.182849  
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.
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Stage change from clinical N0 to pathological N+ neck: A retrospective analysis of 169 patients
Digpal Dharkar, Mohammad Akheel, Tushar Phulambrikar, Sonia Moses
January-June 2016, 4(1):38-41
DOI:10.4103/2347-8128.182850  
Aim: To find the incidence of upstaging from clinical N0 to pathological N+ in our study. Materials and Methods: This retrospective analysis of 169 patients was performed from January 1, 2015, to December 31, 2015. Out of these 169 patients, 97 were operated. Histopathological records of 87 patients were available and hence, included in this study. Rest of the patients were excluded from the study. Results: In these 87 operated patients, 26 patients had upstaging of the disease based on nodal status histopathologically. Out of these 26 patients, 11 patients had clinically N0 necks; however, due to their T size, elective radical neck dissections were performed. Histopathological reports show pathologically N-positive neck with their stage to get upgraded from N0 to N+ which had a direct influence on postoperative treatment management of the patients influencing the prognosis. Tongue cancers were upstaged more with 46.15% compared to other sites followed by buccal mucosa cancers with 38.45%. Conclusion: Pathologic lymph node staging, based on a staging or elective radical neck dissection, should be considered for patients treated for squamous cell carcinoma of oral cavity to identify high-risk patients who may benefit from postoperative adjuvant therapy such as radiation/chemotherapy. Prospective studies in large numbers are still essential to validate these findings before pathologic lymph node staging is also included in standard tumor node metastasis staging criteria.
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REVIEW ARTICLES
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
DOI:10.4103/2347-8128.182855  
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.
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Laryngeal transplant: The future?
Varun Jitendra Dave
January-June 2016, 4(1):12-15
DOI:10.4103/2347-8128.182851  
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.
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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
DOI:10.4103/2347-8128.182856  
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.
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