An Insight into Survivin in Relevance to Hematological, Biochemical and Genetic Characteristics in Tobacco Chewers with Oral Squamous Cell Carcinoma.

BACKGROUND: Survivin is an inhibitor of apoptosis protein (IAP), encoded by the Baculoviral IAP Repeat Containing 5 (BIRC5) gene located on q arm (25.3) on chromosome 17. It is expressed in various human cancers and involved in tumor resistance to radiation and chemotherapy. The genetic analysis of the BIRC5 gene and its protein survivin levels in buccal tissue related to oral squamous cell carcinoma (OSCC) in South Indian tobacco chewers has not been studied. Hence, the study was designed to quantify survivin in buccal tissue and its association with pretreatment hematological parameters and to analyze the BIRC5 gene sequence. METHOD: In a single centric case control study, buccal tissue survivin levels were measured by ELISA. A total of 189 study subjects were categorized into Group 1 (n = 63) habitual tobacco chewers with OSCC, Group 2 (n = 63) habitual tobacco chewers without OSCC, and Group 3 (n = 63) healthy subjects as control. Retrospective hematological data were collected from Group 1 subjects and statistically analyzed. The BIRC5 gene was sequenced and data were analyzed using a bioinformatics tool. RESULTS: Survivin protein mean ± SD in Group 1 was (1670.9 ± 796.21 pg/mL), in Group 2 it was (1096.02 ± 346.17 pg/mL), and in Group 3 it was (397.5 ± 96.1 pg/mL) with significance (p < 0.001). Survivin levels showed significance with cut-off levels of absolute monocyte count (AMC), neutrophil/lymphocyte ratio (NLR), and lymphocyte/monocyte ratio (LMR) at (p = 0.001). The unique variants found only in OSCC patients were T → G in the promoter region, G → C in exon 3, C → A, A → G, G → T, T → G, A → C, G → A in exon 4, C → A, G → T, G → C in the exon 5 region. CONCLUSIONS: The tissue survivin level increased in OSCC patients compared to controls; pretreatment AMC, LMR, and NLR may serve as add-on markers along with survivin to measure the progression of OSCC. Unique mutations in the promoter and exons 3-5 were observed in sequence analysis and were associated with survivin concentrations.

Comparison of Visor Access Approach with Lower LIP Split Approach in Resection of Oral Cancers.

Purpose: There is high prevalance of oral cancers particularly buccal mucosa and lower gingivobuccal sulcus in our region. These can be approached by both Lower lip split and by Visor approach. Anteriorly placed oral cancers can be resected by visor approach, retaining oral competence and lower lip vascularity. Visor approach is challenging in locally advanced oral cancers requiring reconstruction. We compared outcome of resection of lateralized oral cancers by lower lip split approach and visor approach with regard to duration of surgery, adequacy of exposure of tumour, access for reconstruction, resection margins and complications. Methodology: 66 Patients with T2 & T3 staged oral squamous cancers were randomized into two groups. Following neck dissection, Group A underwent composite resection by lower lip split, and Group B by visor approach. Variables mentioned above were compared between two groups. Results: This study included patients with T2(58%)and T3 (42%) oral cancers. Except 3 patients in Group B, adequacy of exposure was similar in both groups. Operating time was longer in Group B. Close margins anteriorly were more frequent in Group A. Axial flaps(98.5% ) and radial forearm free flaps(1.5%) were used for reconstruction. Suturing bulky flaps was difficult in Group B( 9.1%).Most common complication in both groups was orocutaneous fistula. Conclusion: Adequacy of exposure, resected margins, surgical outcome with regards to healing and complications were similar between lower lip split and visor approach in oral cancers. Visor approach for resection of oral cancers is preferred option in tumours close to oral commissure.

Outcome of Submucosal Inferior Turbinoplasty in Perennial Allergic Rhinitis.

Pharmacotherapy forms mainstay of treatment for allergic rhinitis, and has adverse effects associated with it. Topical steroid therapy is the preferred medication and considered best for long term prophylaxis but with limited compliance. Submucosal turbinoplasty reduces the duration of treatment in comparison to topical steroid which has to be taken daily for a long time. The aim was to evaluate the outcome of submucosal inferior turbinoplasty in patients with perennial allergic rhinitis. A prospective interventional study was performed on 35 patients diagnosed with perennial allergic rhinitis, diagnosed as per ARIA criteria from July 2016 to July 2018. The severity of the disease was assessed using mini RQLQ scoring system. The patients were then subjected to bilateral submucosal inferior turbinoplasty under endoscopic guidance under local anesthesia. 50% significant improvement (p value < 0.05) seen in symptoms were need to blow nose, sneezing, nasal obstruction, nasal discharge, watery eyes, need to rub eye, regular house work, recreational activities, sore eyes, tiredness, irritability and thirst. 100% improvement (p value < 0.05) seen in symptoms were sleep, need to blow nose, sneezing, nasal discharge, watery eyes, need to rub eye, recreational activities and irritability. Nasal obstruction was not severe in 17 (48.5%) patients giving a very good symptom relief and improving quality of life. This is due to reduction in the erectile tissue and roominess in the nasal cavity. All patients with allergic rhinitis with associated hypertrophied turbinates should invariably be given option of inferior turbinoplasty along with proper counselling regarding its advantages and disadvantages.

Tracheo-esophageal Puncture Revisited.

This study aims to propose a novel surgical technique to rehabilitate patients with long term complication of trachea-esophageal puncture and stomal stenosis. Ours is retrospective study. Ten patients with tracheo-esophageal puncture who developed long term complications and who failed conservative management were included in our study. Majority of our patients were males within the age group of 50-70 years of age. Most of our patients had received adjuvant radiotherapy (8/10). All patients had multiple change of prosthesis. Nine patients suffered from multiple complications of TEP. Most common complication was that of progressive thinning of trachea-esophageal wall. All the patients who underwent this procedure healed well without any major complications. Long term trachea-esophageal puncture may undergo significant modification in terms of position and size. This technique gives a satisfactory and viable method of excising the altered anatomy and establishes speech & swallowing in such patients who fail conservative management.

Cellular Concentration of Survivin and Caspase 3 in Habitual Tobacco Chewers with and without Oral Squamous Cell Carcinoma in South Indian Rural Population-A Case Control Study.

Background: There is paucity of data on tissue levels of Survivin and Caspase 3 in south Indian tobacco chewers with oral Squamous cell carcinoma (OSCC). Oral cancer is a rapidly growing, highly prevalent head and neck malignancy; it involves a mucosal epithelium of a buccal cavity exposed to tobacco and other carcinogens. The basis of the survival of a tumor cell or transformed normal cell into a neoplastic cell is by the suppression of apoptosis regulation. Recently, researchers have focused on Survivin, an inhibitor of apoptosis family of proteins (IAP), involved in apoptosis regulation in cancer cells targeting the executioner Caspase 3. The current study aims to quantify the cellular levels of Survivin and Caspase 3 in tobacco chewers with OSCC and in habitual tobacco chewers without OSCC, in comparison to controls. Methods: A single centric case control study included 186 study subjects, categorized into: Group I (n = 63), habitual tobacco chewers with OSCC; Group 2 (n = 63), habitual tobacco chewers without OSCC; and Group 3 (n = 63), the controls. Resected tumor tissue from Group 1 and buccal cell samples from Groups 2 and 3 were collected into phosphate buffer saline (PBS) and assayed for Survivin and Caspase 3 levels by the ELISA sandwich method. Results: The mean ± SD of the Survivin protein in Group 1 was (1670.9 ± 796.21 pg/mL); in Group 2, it was (1096.02 ± 346.17 pg/mL); and in Group 3, it was (397.5 ± 96.1 pg/mL) with a significance of p < 0.001. Similarly, the level of Caspase 3 in Group 1 was (7.48 ± 2.67 ng/mL); in Group 2, it was (8.85 ± 2.41 ng/mL); and in Group 3, it was (2.27 ± 2.24 ng/mL) with a significance of p < 0.001. Conclusion: The progressive transformation of buccal cells to neoplastic cells is evident; in the case of OSCC, this indicates that the over-expression of Survivin compared to Caspase 3 confirms the suppression and dysregulation of apoptosis.

Significance of platelet parameters in squamous cell carcinoma of oral cavity - A case-control study.

Introduction: Tumor microenvironment plays an important role in cancer progression. Platelets are one of the components of the tumor environment shown to have a role in cancer survival and progression. Materials and Methods: Ninety-six cases of squamous cell carcinoma (SCC) cases of the oral cavity and 96 age/sex-matched healthy controls were considered for the study. Data regarding platelet count, platelet distribution width (PDW), mean platelet volume (MPV), Platelet-Large Cell Ratio (P-LCR), Plateletcrit (PCT), platelet/neutrophil ratio (PNR), platelet/lymphocyte ratio (PLR), and Platelet/Monocyte Ratio (PNR) from automated hematology analyzer records and clinicopathological data from the Department of Pathology were captured. These data were compared between cases and controls and also with tumor size, tumor grade, lymph node status, and tumour node metastasis (TNM) stage of cases. Results: Mean ± standard deviation for platelet count, PDW, MPV, P-LCR, PCT, PNR, PLR and PMR among cases were 315.03 ± 98.26, 10.94 ± 1.66, 9.91 ± 0.77, 23.52 ± 5.64, 0.31 ± 0.086, 62.55 ± 31.51, 149.34 ± 61.32, and 498.67 ± 194.91, respectively, and among controls were 287.88 ± 74.11, 10.84 ± 1.18, 9.89 ± 0.72, 23.45 ± 4.55, 0.29 ± 0.061, 60.27 ± 21.02, 138.71 ± 49.28, and 497.64 ± 172.28, respectively. The association between means of platelet count, PDW, P-LCR, and PCT among cases and controls were statistically significant (P = 0.020, 0.006, 0.030, and 0.000, respectively). No statistically significant association was found between means of platelet count, PDW, MPV, P-LCR, PCT, PNR, PLR, and PMR versus tumor size, lymph node status, and tumor grades. The association between the means of PCT/PMR and TNM Stages I and II were statistically significant (P = 0.029 and 0.016, respectively). Conclusions: Platelet count, morphology, and functions are altered in oral SCC. Platelet activation plays an important role in oral cancer. PCT and PMR can be used to predict the progress of oral SCC as a cost-effective inflammatory marker.

Role of turmeric extract in minimising mucositis in patients receiving radiotherapy for head and neck squamous cell cancer: a randomised, placebo-controlled trial.

OBJECTIVE: To determine the role of turmeric extract in reducing mucositis in patients undergoing radiotherapy for head and neck cancer. METHODS: Sixty-one patients who underwent radiotherapy were included in the study and randomised into groups A and B. Patients in group A received 500 mg of turmeric extract (BCM-95) thrice daily, while patients in group B received placebo until radiotherapy completion. All patients were assessed for oral mucositis on a weekly basis during treatment and two months post-treatment using the National Cancer Institute Common Terminology Criteria for Adverse Events and World Health Organization criteria. RESULTS: Both groups had a similar grade of mucositis in first two weeks of treatment. The severity of mucositis was progressive in the control group, with four patients developing grade 3 mucositis by week four. In group A, however, the majority of patients (73.3 per cent) had grade 1 mucositis after four weeks of treatment. The difference was statistically significant from the third week onwards (p < 0.001). CONCLUSION: Turmeric extract reduces the incidence and severity of radiation-induced mucositis, which can benefit patients undergoing radiation for head and neck cancer.

Evaluation of Mucociliary Activity in Maxillary Antra in Patients with Squamous Cell Carcinoma of Buccal Mucosa Undergoing Post Operative Radiotherapy.

A prospective longitudinal observational study was conducted on 24 patients of histopathologically confirmed squamous cell carcinoma of buccal mucosa upon whom bilateral 'middle meatal antrostomy was performed during the same sitting as the tumour resection with the main aim to assess the maxillary mucociliary clearance, pre-, during and post-irradiation; and compare the findings with the non-irradiated side in the same patient to avoid any confounding factors. All patients underwent methylene blue dye clearance and saccharine clearance tests before the commencement of radiation therapy, weekly during irradiation and again at first and sixth month of completion of irradiation. Pre-radiation there was statistically no difference (P > 0.05) in clearance times between both sides. But, there was a significant (P < 0.001) increase in saccharin and methylene blue clearance times on the irradiated side in comparison to contralateral non-irradiated side, during and post-radiation. It is concluded that external beam radiotherapy for oral cancers significantly affect ciliary activity in the adjacent maxillary antrum and has no effect on the opposite side. Recovery in mucociliary activity was not seen even after 6 months after radiation therapy.

Microsurgical Anatomy of Stapedius Muscle: Anatomy Revisited, Redefined with Potential Impact in Surgeries.

Stapedius muscle even though being the smallest skeletal muscle in human body, it has a major role in otology. As many of the distinguished books in otology missed to explain much about stapedius muscle, and also considering the need for the anatomy based visit to this small muscle we felt it was important to have a exercise like this. In the dissection hall of our institution we dissected 32 cadaveric temporal bones and delineated stapedius muscle as a part of PG teaching programme to have a clear idea of the anatomy of stapedius muscle, its origin, attachment, extension, size (all dimensions). Length of the stapedius muscle varied between 9 and 11 mm. Stapedial tendon measured about 2 mm. The muscle had a classical sickle shape with tendon looking like the handle of the sickle. It has a bulky belly with a maximum breadth of 2-3 mm. It was found to be medial to midportion of vertical limb of facial nerve. All of our temporal bones measured size varied from 9 to 11 mm in length excluding stapedial tendon. Stapedial tendon measured almost 2 mm. Muscle is classical sickle shaped with tendon acting like the handle of the sickle. It has a bulky tummy which forms the maximum breadth of 1-3 mm. Why to have a clear idea about the anatomy of stapedius muscle is that, unless the anatomy is clear there is chance of confusing the muscle with that of facial nerve while doing facial nerve grafting and also while drilling for facial nerve decompression in experienced hands may get confused and decompress the muscle. Stapedius muscle said to be the smallest muscle in the body, but its not as small as its been described. Detailed awareness of the anatomy of stapedius muscle is needed so as to avoid confusion while facial nerve grafting and while drilling.

Novel association of oral squamous cell carcinoma with GSTP1 Arg187Trp gene polymorphism.

AIMS: Glutathione S-transferase subtype pi 1 (GSTP1) is an enzyme that is involved in the detoxification of carcinogenic substances. Arg187Trp is a functional polymorphism in the corresponding GSTP1 gene that reduces the enzymatic activity by 45%. We evaluated, for the first time, the association of Arg187Trp with the risk of oral squamous cell carcinoma and compared it with other established GSTP1 polymorphisms viz, Ile105Val and Ala114Val. MATERIALS AND METHODS: We carried out a 1:2 case-control study by recruiting 100 patients with oral squamous cell carcinoma and 200 age and gender-matched healthy individuals. Ile105Val, Ala114Val, and Arg187Trp polymorphisms were genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and their distribution in the study groups was compared by chi-squared test (Fisher's exact). RESULTS: The minor allele of Ala114Val and Arg187Trp were more common in patients than in controls. In contrast, the distribution of Ile105Val minor allele was similar in the two groups. The differential distribution was also significant at the level of genotypes. CONCLUSIONS: These results indicate that GSTP1 Arg187Trp is associated with the risk of developing oral squamous cell carcinoma. Our study underlines the importance of detoxification pathway in the risk of carcinogenesis.

Auditory function and quality of life in patients receiving cisplatin chemotherapy in head and neck cancer: A case series follow-up study.

BACKGROUND: Cisplatin is one of the anticancer drugs used for head and neck cancers. Although some studies have shown that cisplatin can cause ototoxicity, periodic audiometric assessments have not been extensively studied in the Indian rural population. Hence, this study has been undertaken to evaluate the effects of cisplatin on hearing. MATERIALS AND METHODS: Fifty-nine patients with squamous cell carcinomas of head and neck, who received cisplatin chemotherapy, were recruited. Serum creatinine, blood urea, serum proteins, and audiometry were assessed before and after the first, second, and third chemotherapy cycle. The cochleotoxic effect of cisplatin was assessed by pure tone audiometry. Hearing loss was graded accordingly. All patients were administered a quality of life questionnaire at baseline and at the end of the third cycle. RESULTS: Hearing loss was observed in 12 patients at speech frequencies and those at higher frequencies were 12 (4000 Hz), 18 (6000 Hz), and 28 (8000 Hz). The hearing loss was symmetrical, sensorineural, and showed a strong correlation with the low serum albumin levels at the end of the third cycle. Dizziness was seen in eight patients, at the end of the study. The commonly observed adverse effects were nausea, vomiting, hair loss, fatigue, and tinnitus. CONCLUSION: The studies have shown hearing loss in higher frequencies, but in our study, we have observed hearing loss at speech frequency in 22.2% of patients receiving cisplatin, who also had low serum albumin levels. Periodic audiometric monitoring and serum albumin level may be helpful to provide timely intervention to prevent further hearing loss and deterioration in the quality of life.

Usefulness of supraclavicular flap in reconstruction following resection of oral cancer.

OBJECTIVE: To evaluate the usefulness of supraclavicular artery flap in reconstruction of defects following resection of buccal mucosa cancer. METHODS: Twenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients underwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depending on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute. RESULTS: Seven (28%) patients had complete necrosis of the flap. One patient had a local recurrence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the functional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58%), 3 patients had a good outcome score (13%), while 7 patients (28%) had flap necrosis. CONCLUSIONS: We find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preserving the external jugular vein and sacrificing supraclavicular nerves give good outcome.

GSTP1 c.341C>T gene polymorphism increases the risk of oral squamous cell carcinoma.

Glutathione S Transferases (GST) are anti-oxidant enzymes involved in detoxification of cellular and exogenous carcinogens and oxidative products of reactive oxygen species. Genetic polymorphisms can attenuate the detoxification capacity of GST and consequently increase the susceptibility to carcinogenesis. There are eight classes of GST enzymes of which pi subtype is the predominant form expressed in the oral mucosa. c.341C > T single nucleotide polymorphism (rs1138272) in GSTP1 gene, is a functional variation that reduces the enzymatic activity of GST pi. We carried out a 1:2 case-control study involving 270 individuals to determine the association of c.341C > T variation with the risk of oral squamous cell carcinoma. GSTP1 c.341C > T variation was genotyped by PCR-RFLP method. GST pi expression in the tumour sample was determined by immunohistochemistry. Tobacco consumption was the major risk factor among cancer patients. The odds ratio for the risk of oral squamous cell carcinoma in individuals with the minor allele was 4.5 (0.95 CI = 2.3-8.9; P = 0.000004). The genotype was found to follow dominant mode of inheritance (OR 4.4 [0.95 CI = 2.1-9.2]; P = 0.00006). Our results support the conclusion that c.341C > T variation in GSTP1 increases the risk of OSCC in patients habituated to tobacco consumption.

Nicotinic acetylcholine receptor gene polymorphism is not associated with tobacco-related oral squamous cell carcinoma.

BACKGROUND: Nicotinic acetylcholine receptor is implicated in carcinogenesis indirectly through increasing nicotine dependence and directly through its impact on cell-cycle regulation. Functional polymorphism in nicotinic acetylcholine receptor alpha-5 subunit gene (CHRNA5 c.1192G>A; rs16969968) is associated with nicotine dependence and risk of lung cancer. AIM: The aim of this study was to evaluate the association of CHRNA5 c.1192G>A polymorphism with the risk of oral squamous cell carcinoma (OSCC). SETTINGS AND DESIGN: This was a rural teaching hospital-based case-control study. MATERIALS AND METHODS: A total of 100 histopathologically confirmed cases of OSCC patients and 100 age- and gender-matched healthy individuals were genotyped for CHRNA5 c.1192G>A polymorphism by polymerase chain reaction-restriction fragment length polymorphism method. Allele and genotype frequencies among case and control groups were compared by Chi-squared test (Fisher's exact). RESULTS: The frequency of CHRNA5 c.1192A allele was 22% in OSCC patients and 26% in control individuals. The difference in the distribution of alleles and genotypes between case and control groups was not significant (P > 0.05). CONCLUSIONS: CHRNA5 c.1192G>A polymorphism is not associated with the risk of developing OSCC.

Parotid abscess in children - A tertiary rural hospital experience.

UNLABELLED: Parotid abscess is a rare complication of acute parotitis in children. Acute parotitis occurs due to infection of intra-parotid or para-parotid lymph nodes or glandular parenchyma of the parotid gland which may progress to parotid abscess. OBJECTIVES: To document the causative organism, clinical behaviour and response to treatment in paediatric parotid abscess. MATERIALS AND METHODS: A retrospective study was done in our tertiary rural hospital from May 2007 to May 2015 to identify and analyse paediatric parotid abscess in 80 unilateral parotitis cases. RESULTS: 7 cases of parotid abscess were identified. 4 cases were diagnosed clinically and in 3 cases ultrasound was done showing heterogenous, hyperechoic, solid and cystic areas. In 2 patients, abscess was extending to the submandibular space. Incision and drainage was done in all patients. The most common bacteria was Methicillin Sensitive Staphylococcus aureus. Escherichia coli was reported in one patient, and was rare in parotid region. 2 patients had House Brackmann grade 2 marginal mandibular nerve palsy, and they recovered within 4½ months. CONCLUSION: Parotid abscess is an uncommon but life-threatening condition in paediatric age group. Poor orodental hygiene was most important predisposing factor. Abscess can be diagnosed clinically and ultrasound scan is also an important diagnostic tool. It is commonly caused by Gram positive cocci and responds well to incision and drainage followed by appropriate antibiotics. No fistula may result if treated early.

Evaluation of histomorphological and immunohistochemical parameters as biomarkers of cervical lymph node metastasis in squamous cell carcinoma of oral cavity: A retrospective study.

INTRODUCTION: Oral squamous cell carcinoma (OSCC) is seen worldwide but is more common in India. Lymph node (LN) metastasis has been shown to be the strongest prognostic factor in OSCC. Many histopathological and immunohistochemical markers have been studied to predict the LN metastasis. AIMS: To identify clinicopathological factors and immunohistochemical (IHC) biomarkers which predict cervical metastasis in OSCC patients. STUDY AND DESIGN: A total of 105 cases of OSCC were taken up for our study. Histopathological parameters such as tumor thickness, depth, degree of differentiation, pattern of invasion (POI), lymphovascular and neural invasion were assessed. IHC was done on all cases using antibodies against Ki-67, cyclin D, E-cadherin, p53, CD31 and each antibody was assessed according to the standard protocol. STATISTICAL ANALYSIS: To calculate the relation between clinical, histopathological parameter, IHC marker and the occurrence of LN metastasis, chi-square test was used. Variables were tested using multivariate logistic regression method to assess the predictive significance. RESULTS: Out of 105 cases studied, 29 cases showed LN metastasis. Maximum numbers of cases affected were females with involvement of buccal mucosa. We found significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression. In our study; tumor depth, thickness, extent of peritumoral lympho-plasmacytic infiltration, presence of eosinophils, tumor nest type, p53 and microvessel density (MVD) showed no significant correlation. CONCLUSION: Significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression was seen.

Island pectoralis major myocutaneous flap: an Indian perspective.

The aim of this study is to conceive a method of raising an island PMMC flap, so as to circumvent its drawbacks of bulk, flap length and the difficulty of developing this flap in female patients. And to consider island PMMC flap as a viable reconstructive option in head and neck surgeries, especially in peripheral centres. Ours is an experimental case series. The study was done at Sri Devaraj URS Medical college, Tamaka, Kolar. Between 2009 and 2010, head and neck reconstruction was performed using this method in 20 patients who had oral cancer (18), carcinoma supraglottis (1) and mucoepidermoid carcinoma parotid (1). The patients age ranged from 16 to 75 years, and there were 15 women and 5 men. Nineteen of our patients underwent primary surgery and one patient was operated for residual disease. In (16) patient, island pmmc flap was used for intra oral closure. In (4) patients the flap was spiraled for providing skin cover. Four patients developed complications. Three were minor complications of margin necrosis and wound dehiscence, which were managed conservatively. One patient developed orocutaneous fistula, which required secondary suturing. None of our patients had a total necrosis of the flap. Island PMMC flap is still a very useful and viable option for reconstruction in head and neck surgeries, especially in lateral gingivo buccal tumours and other head and neck tumours. In institutions where microvascular expertise is not available, island PMMC flap can be an alternative with results comparable to that of free tissue transfer.