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Elective neck dissection (END) is preferred in all treatment naïve patients with invasive oral squamous cell carcinoma (OSCC), including the early stage, node negative cases (T1/T2 N0). Usually the conventional horizontal neck crease incision leads to a faintly visible scar in the neck. However sometimes, the neck scar is hypertrophic and is highly unaesthetic and psychologically distressing to the patient. Retro-auricular hairline approach has been popularized in the Robot assisted neck dissections (RoAND), to avoid easily visible scar in neck crease. We have been using the retro-auricular incision for selective neck dissection in early invasive OSCCs using an assembly of customized retractors as an open approach with only occasional use of endoscopes. This approach to the neck surgery is oncologically safe, reproducible and economical. It is cosmetically superior as the scar of neck dissection is in a less conspicuous area of the face, hidden behind the ear and in the hairline.
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Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Toma de Decisiones Clínicas , Manejo de la Enfermedad , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Disección del Cuello/instrumentación , Disección del Cuello/normas , Metástasis de la Neoplasia , Estadificación de Neoplasias , Cuidados Posoperatorios , Complicaciones PosoperatoriasRESUMEN
OBJECTIVE: Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of areca nut, and is mainly seen in the parts of Southeast Asia and the Indian subcontinent. We hypothesized that oral cancers occurring in presence of OSMF are clinicopathologically a distinct entity. STUDY DESIGN: We analyzed 289 treatment naïve patients of oral cancer. They were followed up for a median of 44 months. Association of presence of OSMF with other histopathological factors was done using the χ2 test. Kaplan-Meier analysis was used for survival analysis. RESULTS: Oral squamous cell carcinoma along with OSMF was seen more often in younger patients (P < .001) and males (P < .007), and had a lower T-stage (P < .002) and N-stage (P < .000). These were thinner (P < .002), less infiltrative (P < .04) tumors and required adjuvant therapy less frequently (P < .017). The mean disease specific survival, overall for those with and without OSMF was 58.8 and 48.6 months (P < .002), and specifically for stages III and IV was 49.4 and 38.5 months, respectively (P < .053). CONCLUSIONS: Oral squamous cell carcinomas associated with OSMF are associated with good clinicopathologic profile and have better prognosis and oncological outcomes.
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Carcinoma de Células Escamosas/patología , Neoplasias de la Boca/patología , Fibrosis de la Submucosa Bucal/patología , Lesiones Precancerosas/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Areca , Carcinoma de Células Escamosas/cirugía , Transformación Celular Neoplásica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Estadificación de Neoplasias , Fibrosis de la Submucosa Bucal/etiología , Fibrosis de la Submucosa Bucal/cirugía , Lesiones Precancerosas/etiología , Lesiones Precancerosas/cirugía , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
INTRODUCTION: Oral squamous cell carcinoma (OSCC) are amongst commonest cancer in the Indian sub-continent. After treatment, these patients require frequent followup to look for recurrences/second primary. Mouth Self Examination (MSE) has a great potential in all levels of prevention of oral cancer. However, the compliance to self-examination has been reported as poor. Mobile phone is a cheap and effective way to reach out to people. Short Message Service (SMS) is extremely popular can be a very effective motivational and interactive tool in health care setting. METHODOLOGY: We aimed to identify in adequately treated OSCC patients, the influence of health provider initiated SMS on the compliance to the MSE and to establish the efficacy of MSE by comparing patients' MSE interpretation via replies to the SMS with that of the experts' opinion on clinical examination status during follow up. CONCLUSION: We conclude that MSE can be very useful in adequately treated OSCC patients for evaluating disease status. All treated OSCC patients must be adequately educated for MSE as an integral part of treatment & follow-up protocol by the health provider facility. Health provider generated SMS reminders do improve motivation and compliance towards MSE but don't seem to reduce dropouts in follow up for large and diverse population like that in India.
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BACKGROUND: The cost-effectiveness of the frozen section for assessment of margin in head and neck squamous cell carcinoma (HNSCC) is still contentious. The purpose of this study was to evaluate whether gross examination of margin is an alternative to frozen section. METHODS: It was a prospective observational study in 145 consecutive patients undergoing surgery for HNSCC. Surgical margins were first assessed by the surgeons with a metallic scale. All specimens were then examined using frozen section and permanent section. RESULTS: Overall, 83% of inadequate margins were detected by frozen section. The chances of inadequate margin were very low if gross surgical margin were 7 mm or more. Gross examination alone (with 7 mm as cutoff) predicted 88% of the inadequate surgical margin. There was no difference in precision of frozen section vis-à-vis gross examination with 7 mm cut off (p ≤ .8). CONCLUSION: Achievement of 7 mm surgical margin measured by a surgeon obviates the need for frozen section.
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Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Secciones por Congelación , Humanos , Periodo Intraoperatorio , Variaciones Dependientes del Observador , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
Ameloblastoma is a unique, histologically benign but aggressive neoplasm of the jaws, arising from odontogenic epithelium with potency to cause extensive destruction of jaw bones and infiltration into the surrounding tissues. Recurrences are common after incomplete treatment. Recurrences can occur at difficult sites such as temporal and infratemporal fossa, orbit, anterior cranial base, paranasal sinuses etc. Fine needle aspiration cytology or core biopsy of these recurrent lesions may be misleading. Clinical course and radiological features help immensely in these situations. Good communication between surgeon, radiologist, and pathologist is of paramount importance.
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OBJECTIVES: To evaluate the prognostic role of the lymph node ratio (LNR; ratio of total positive nodes to total dissected nodes) in oral squamous cell carcinoma (OSCC) as compared to pN staging with an aim to provide an optimal cut-off value. METHODS: 1,408 OSCC previously untreated patients who underwent treatment (surgery + neck dissection + adjuvant treatment). LNR sensitivity with respect to survival was calculated using receiver operating characteristic (ROC) curves and Cox regression method. LNR and TNM staging variables were subjected to multivariate analysis. RESULTS: LNR (0.088) showed significant association with survival outcomes. For patients with LNR ≤0.088, the OS, DFS, local control, regional control and distant metastasis rates were 64%, 70%, and 89%; for LNR >0.088 it was 22%, 19%, and 52%, respectively (P < 0.001). On multivariate analysis LNR of 0.088 was seen to be an independent prognostic factor for 5-year regional control (p, hazard ratio [95% confidence interval]; 0.044, 2.016 (1.019-3.990), DFS, 0.032, 1.858 (1.054-3.276), and OS, 0.040, 1.195 (1.033-1.144). On multivariate analysis LNR categorization showed a statistically significant [0.032, 1.858, (1.054-3.276)] advantage over pN staging [0.527, 1.208 (1.054-3.276)] in predicting survival. CONCLUSIONS: LNR is a better prognostic marker than the current N staging of TNM classification.
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Carcinoma de Células Escamosas/mortalidad , Ganglios Linfáticos/patología , Neoplasias de la Boca/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Femenino , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Estudios RetrospectivosRESUMEN
UNLABELLED: Inflammatory lesions, like periapical/odontogenic abscesses, are by far the most common pathologic condition of the jaws. Radiographically, these lesions commonly manifest as widening of periodontal ligament space, discontinuity of lamina dura and ill-defined periapical radiolucency. There are some rare disorders which could cause similar radiographic changes in the jaw bone. With careful scrutiny of periapical radiolucency, regular periodic follow-up radiographs and histo-pathologic examination, the periapical abscess or infection can be differentiated from rare fatal disorders. CLINICAL RELEVANCE: This paper highlights the need for vigilant examination of even the commonest, innocuous-appearing periapical changes which sometimes are produced by some rare fatal disorders.
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Enfermedades Mandibulares/diagnóstico , Neoplasias Mandibulares/diagnóstico , Osteosarcoma/diagnóstico , Absceso Periapical/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Granuloma/diagnóstico , Humanos , Úlceras Bucales/diagnóstico , Osteomielitis/diagnóstico , Resorción Radicular/diagnóstico , Alveolo Dental/patologíaRESUMEN
Voice rehabilitation in laryngectomized patients by tracheoesophageal puncture is a time tested technique. In some patients the tracheoesophageal puncture gets inordinately dilated leading to leakage around the prosthesis. Most of these fistulas are managed by a variety of conservative treatments like temporary removal of prosthesis, placement of silastic ring over the prosthesis, placement of nasogastric tube and airway protection by a cuffed tracheostomy tube. Intractable fistulas are tackled by surgical closure but are fraught with failures. We hereby suggest a novel temporary obturator that can be can be easily made at a very low cost in any hospital having prosthetic rehabilitation services and obviates the need for a tracheostomy tube, nasogastric tube and repeated hospital visits.
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BACKGROUND: Oral cancer is the most common cancer in Indian males and is the third most common cancer in Indian females. Tobacco, alcohol, areca nut, and human papillomavirus (HPV) are the common etiologic factors. Each of these agents follows a unique model of carcinogenesis that leads to a certain distinct presentation and behavior. For example, HPV is strongly associated with oropharyngeal cancers in younger age and is known to have a better outcome and specific histopathologic characteristics. A high incidence of oral submucous fibrosis (OSMF) is linked to areca nut (group 1 human carcinogen) chewing in the Indian subcontinent. METHODS: We prospectively studied 371 consecutive patients with proven squamous cell carcinoma of the oral cavity. Of these, 112 patients had oral cancer with OSMF and 259 had oral cancer without OSMF. All patients underwent standard management and their clinicopathologic findings were recorded. RESULTS: We found that patients of oral cancer with OSMF are younger males with better prognostic factors such as better grade of tumor differentiation, lesser incidence of nodal metastases, and extracapsular spread. This difference was maintained even after matching for stage. We also report that presence of OSMF is an independent factor influencing nodal metastases. CONCLUSIONS: Based on these findings we propose that oral cancers with OSMF constitute a clinicopathologically distinct disease. Since all patients with OSMF had chewed areca nut with or without smokeless tobacco, we believe that the differences in the 2 groups emanate from differential mechanisms of areca nut carcinogenesis.
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Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Neoplasias de la Boca/patología , Fibrosis de la Submucosa Bucal/epidemiología , Fibrosis de la Submucosa Bucal/patología , Lesiones Precancerosas/patología , Adulto , Distribución por Edad , Carcinoma de Células Escamosas/etiología , Causalidad , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Mucosa Bucal/patología , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/etiología , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Fibrosis de la Submucosa Bucal/etiología , Lesiones Precancerosas/epidemiología , Pronóstico , Medición de Riesgo , Distribución por Sexo , Fumar/efectos adversos , Análisis de Supervivencia , Tabaco sin Humo/efectos adversos , Tabaco sin Humo/estadística & datos numéricosRESUMEN
Arecanut (AN) usage is widespread in Asian countries, especially India and Taiwan. The incidence of oral cancer is increasing day by day, but there is no exponential increase with tobacco usage. Especially in the country like Taiwan where betel quid mostly do not contain tobacco, AN can be correlated with the increased incidence of cancer. There are different studies in the literature about AN and oral cancer but none of them have concluded with the definite pathway for carcinogenesis. The present paper includes reviews of the literature for AN and oral cancer and summarizes the possible mechanisms associated with AN-induced carcinogenesis; and we have also tried to propose pathway of carcinogenesis.
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Mandibular metastasis due to thyroid carcinoma is not very frequent and the cases described in the literature are few. Due to its bloodstream dissemination, most of them are a consequence of the follicular variant of thyroid carcinomas. We are presenting a case in which the metastatic lesion of mandible was detected before diagnosis of primary malignancy.
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OBJECTIVE: The aims of this study are to evaluate the impact of frozen section in achieving adequate surgical margin and to study the accuracy of frozen section in detection of occult metastases. MATERIALS AND METHODS: This was a retrospective review of prospectively collected data of 877 patients with squamous cell carcinoma of the tongue who underwent surgery and intra-operative frozen section at our center from January 2007 to June 2010. RESULTS: Frozen section was found to have very high accuracy in assessment of margin as well nodal status. On frozen section, 2% of our patients had positive margins and 21% had close margins. Most of these underwent intra-operative revision and at final pathology, 1.2% patients had positive margins and 11% were close. Of the 651 supraomohyoid neck dissections performed, one third were found to have occult metastases on frozen section. Of those reported positive on frozen section, 68% got additional removal of level 4 ± 5. Interestingly, 11% of these additionally removed nodes harbored metastases at final pathology. However, 7% of the patients were wrongly declared negative on frozen section. Tumor thickness was predictor of margin positivity as well as occult metastases. Tumor volume did not correlate with occult metastases or margin status. CONCLUSIONS: Frozen section nearly halves the rates of positive margin and close margins which certainly translates into clinical benefits. The incidence of 11% positive nodes in the frozen section guided removal of lower levels is an important finding in our study that questions the ability of supraomohyoid neck dissection to completely eradicate the nodal burden in such patients.
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Carcinoma de Células Escamosas/diagnóstico , Metástasis Linfática/diagnóstico , Neoplasias de la Lengua/diagnóstico , Carcinoma de Células Escamosas/cirugía , Femenino , Secciones por Congelación , Humanos , Masculino , Persona de Mediana Edad , Disección del Cuello , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias de la Lengua/cirugíaRESUMEN
The aim of this research was to determine the pathologic invasion of the carotid sheath (CS) when found grossly uninvolved during surgery, in patients undergoing neck dissection for head and neck squamous cell carcinoma (HNSCC). A prospective study was undertaken in 70 consecutive patients with biopsy proven HNSCC, without prior history of any treatment, undergoing neck dissection, in whom the CS was found grossly uninvolved intra-operatively, were included. A total of 80 neck dissections were performed. Supra-omohyoid neck dissections for clinically N0 neck and appropriate modified radical neck dissections for clinically N+ neck were carried out. 129 CS were dissected separately and thoroughly examined by well trained head and neck pathologists for tumour infiltration and the presence of lymphatic tissue. On microscopic examination, 27 patients were N0 status and the remaining 43 (61.4%) had at least one metastatic lymph node (N+). None of 129 CS specimens show the presence of normal lymphatic tissue or metastatic tumour deposits. The authors think that avoiding resection of the CS in the absence of gross invasion by nodal disease is possible without jeopardising oncologic safety. A preserved CS might offer protection to the important neurovascular structures and reduce significant morbidity.