Management of oral cancer in late stages: a review.

Sixty cases of oral cancer (2 were of stage II and other 58 were of stage III and stage IV) were treated and observed over a period of 2 years. In patients of oral cancer with bone involvement and mobile cervical nodes (44 cases) local excision which included partial or hemimandibulectomy with radical neck node dissection was performed. Out of these 44 cases, 18 cases received radiotherapy pre-operatively and 26 cases postoperatively. Better results were observed in these cases. When the growth was inaccessible and/or nodes were fixed (13 cases) radiotherapy was found to be suitable. Fistula formation and reconstructive flap necrosis were common following surgery after radiotherapy. Combined modalities of treatment with pre- and postoperative radiotherapy and radical neck node dissection showed excellent results (86.4%) in majority of cases. The remaining one patient received chemotherapy and local excision was performed in 2 cases.

Evaluation of different surgical procedures in filarial lymphoedema of lower extremity.

Ninety-six cases of different stages of lymphoedema of inferior extremity were taken for study. Twenty-four patients with early lymphoedema (stage II) were subjected to lymphonodovenous shunt (LNVS) operation; 54 patients of late lymphoedema with skin changes (Stage IV) were subjected to Charles' operation and 18 patients with late lymphoedema without skin changes (stage III) were subjected either to Sistrunk's or Thompson's operation. All the results were studied, evaluated and compared. The cases subjected to LNVS operation had a rapid relief of lymphoedema in the early postoperative period followed by slow reduction. Patients subjected to Charles' operation had immediate volume and circumference reduction and take up of skin grafting was 84%. The cases subjected to Thompson's operation did not have satisfactory reduction in volume and circumference postoperatively. There were a few minor postoperative complications in all these procedure, infection being most notable in those who had undergone Charles' operation. It is concluded that while excisional surgery, such as Charles' operation becomes necessary for late stages of lymphoedema, which have progressed to elephantiasis, nodovenous shunt alone is sufficient to relieve early stages of lymphoedema due to filariasis.