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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Background: We know from the existing literature that perineural invasion (PNI), lymphovascular invasion , and depth of invasion (DOI) are important prognostic factor that influence locoregional control in oral squamous cell carcinoma (OSCC). However, there is a lack of robust data in literature to recommend adjuvant treatment when one or more of these soft adverse factors are present in early stage OSCC. Patients and Methods: All treatment naïve, early OSCC who received definitive treatment in the form of surgery in the institute between March 2010 and December 2013. The clinical and demographic details, histopathological features, and follow-up details were collected. Factors influencing the recurrence-free survival (RFS), including the soft adverse factors, were analyzed. Results: Of the 332 OSCC patients, 70 patients satisfied the eligibility criteria and were included in the study. Majority of them were men (54%), with a mean age of 59 years. All of them underwent surgery and a few received adjuvant treatment (n = 9). PNI was seen in 9% (n = 6) of the cases, median DOI was 6 mm, lymphovascular emboli was seen in only one patients. PNI was the only soft adverse factor, which influenced the RFS on univariate and multivariate analysis. Conclusion: In the present study, PNI seems to be an important soft adverse factor, which influences the RFS. Adding adjuvant radiotherapy may benefit these patients. Prospective studies are needed to further evaluate the need for adjuvant treatment in presence of soft adverse factors, especially PNI, in early OSCC to prevent recurrence.

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Introduction: Oral squamous cell carcinoma (SCC) is the most frequent head and neck cancer. The metastatic dissemination of these tumours usually occurs through the lymphatic system. The presence of occult lymph node metastasis is the most important prognostic factor. The high incidence of occult lymph nodal metastasis is a strong argument for the indication of elective neck dissection. However, there is a high percentage of patients who do not have metastasis in the pathological exam (pN0). Taking a homogenous group of patients all of whom received primary surgical treatment, at the same institution without prior radiotherapy or chemotherapy, applying stringent patient selection criteria, and standard pathological evaluation methods across the group, this study aims to establish predictors of cervical node metastasis in squamous carcinomas of the oral tongue. Result: During the study period, a total of 112 patients (98 males and 14 females; Mean age 49.7 years (range 15-70)) underwent resection of the primary tumor with SOND for N0 lymph node status of neck. A total of 1489 lymph nodes were analyzed in this study. Occult metastasis was found in 26 patients (23.2%). T-stage 4 was found to be a statistically significant predictor of occult lymph node metastasis in a cN0 neck. (95% CI, p-value 0.02). There was no correlation between gender, tumor thickness, and tumor differentiation and occurrence of occult metastasis. Discussion: Controversy exists over management of the neck in patients with cN0 oral SCC. As is evident there is no consistent statistically significant factor that can be attributed as a predictor of occult metastasis in head and neck cancer of the oral cavity. The search to identify reliable and accurate predictor(s) of occult metastases, or approaches to the management of patients with cN0 oral SCC, must continue. In absence of such predictors, keeping the high incidence of occult metastasis in mind, we recommend END in all cases of N0 OSCC.

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Introduction: Eagle's syndrome (ES) is defined as the elongation of styloid process or the calcification of the stylohyoid ligament causing clinical manifestations such as throat pain, odynophagia, dysphagia, headache, and irradiation of pain into the ear and neck pain. The clinician misses the diagnosis due to nonspecific clinical presentations. Objective: To study detail clinical profile and management of the patients with ES in a tertiary care teaching hospital of eastern India. Materials and Methods: Twenty-one patients with ES were included in our study. Diagnosis of the ES was based on clinical presentations and three-dimensional computed tomography (3D CT scan). All were treated through transoral approach under general anesthesia. Results: 3D CT is very useful for preoperative estimation of the styloid process length. There were no postoperative complications encountered. Chief symptoms of the patients were regressed after surgery. Conclusion: Clinical presentations and three dimensional CT are important for exact diagnosis of ES. The transoral approach is a safe and definitive treatment of ES.

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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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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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Gingivobuccal cancer (GBC) is the most common oral cavity cancer (OCC). Its incidence is increasing with increased use of tobacco and areca nut chewing in third world countries especially the Indian subcontinent. It comprises buccal mucosa, gingivobuccal sulcus, alveolus and retromolar area cancers. OCCs comprise 12% of all male cancers in India, 40% of these are GBCs. Certain precancerous conditions and lesions such as submucous fibrosis, leukoplakia and erythroplakia are known. In special situations such as trismus, examination and early detection becomes difficult. Computed tomography scan is an investigation of choice. Tumor node metastasis staging gives adequate information for treatment selection and prognosis. Surgery remains the mainstay of curative treatment. Due to its unique proximity to mandible and posteriorly infratemporal fossa, extent of surgery remains critical to provide cure with satisfactory functional and esthetic outcomes. Marginal mandibulectomy has consistently provided these results in carefully selected patients. More advanced cancers need segmental or hemimandibulectomy and appropriate reconstruction-preferably free microvascular bone and soft-tissue transfer. Radiotherapy is used in adjuvant setting to reduce locoregional recurrences. It can also be used as palliative modality in advance cases. The role of chemotherapy is investigational; however, criteria have been defined for its use concurrent with radiation in adjuvant postoperative settings in high-risk patients. Cure rates are as high as 85% in early stages and as low as 0%–20% in advance stages. Follow-up strategy is aimed at detection of locoregional failure initially and prevention and management of second cancers.

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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.

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Carcinoma cuniculatum is a distinct but rare subtype of squamous cell carcinoma, often creating a diagnostic dilemma. Although it is associated with a good prognosis, it is locally aggressive and requires complete treatment. Distinguishing it from similar conditions is crucial to its management. We present our experience of two cases of carcinoma cuniculatum of the oral cavity and a review of literature.

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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.

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Carotid body tumors are rare neuroendocrine tumors derived from the extra-adrenal paraganglioma of the autonomic nervous system. Very few cases have been reported in literature in the pediatric age group <14 years of age. We present our experience in managing a Shamblin III carotid body tumor in a 13-year-old boy who underwent an unsuccessful attempt at excision at another hospital. Surgical excision of the tumor along with ligation of the internal carotid artery was done without any postoperative neurological sequel. The tumor on the contralateral side was being managed conservatively with serial follow-up.

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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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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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Objective: The purpose of this study was to review the incidence and characteristics of maxillofacial fractures in Loni (rural population) and compare them with the existing literature. Materials and Methods: A retrospective study of patients' records and radiographs was reviewed during the 10-year period between 2007 and 2017. Statistical analysis was carried out according to age, gender, cause of accident, and fracture site. Results: A total of 1943 cases with 2470 injuries were reviewed during the 10-year period. The age of patients ranged from 0 to 70 years. The ratio of men to women was 3.5:1. Most fractures were caused by road traffic accident (44.12%), followed by fall (26.76%), assault (25.06%), and animal injuries (4.06%). The prevalent anatomic regions of isolated fractures were the mandible (50.64%), followed by Zygomatic complex (ZMC) (9.26%), Le Fort II (4.07%), Le Fort I (3.50%), orbital floor (3.07%), Le Fort III (2.23%), dentoalveolar (1.39%), zygomatic arch (1.13%), and nasal bone (0.77%). In combination fractures, the most common were the midface combinations (12.55%), followed by mandibular and midface combinations (6.13%), mandibular combination fractures (3.25%), and midface and frontal bone fractures (1.444%). Conclusion: The findings of this study compared with similar studies reported in literature support the view that the cause and incidence of maxillofacial injuries vary from one country to another. Animal injury was one of the causes for maxillofacial trauma because of rural location of our center.

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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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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.

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Intrathyroidal parathyroid (IP) adenoma as a cause of primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localization and differentiating it from a thyroid nodule. We report here three distinct cases of PHPT where preoperative imaging findings were compared with surgical and histopathological findings. Case 1 was a typical true IP adenoma, as diagnosed by preoperative sestamibi and ultrasound, and confirmed at surgery and subsequent histopathology. Case 2 was diagnosed by sestamibi and ultrasound as bilateral lower pole IP adenomas which turned out to be thyroid nodules at surgery. Postsurgery, the serum PTH levels dropped only partially and PHPT persisted. Revision surgery was performed, and a right inferior parathyroid adenoma was removed, after which PTH was normalized. Case 3 had a preoperative sestamibi diagnosis of left inferior parathyroid. Preoperative ultrasound suggested a left thyroid nodule/IP along with an associated contralateral right inferior parathyroid nodule. Surgery and subsequent histopathology confirmed left follicular adenoma and right inferior parathyroid adenoma. We discuss the limitations of preoperative imaging modalities in these cases along with their learning outcomes. It is very essential that all the involved clinicians, radiologists, and surgeons are well aware of the diagnostic features and pitfalls associated with IPs so as to enable a correct diagnosis and appropriate surgical or medical management.

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