Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection.

BACKGROUND: Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. METHODS: This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. RESULTS: From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). CONCLUSION: Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

Laser-assisted management of a symptomatic anterior pharyngeal diverticulum.

BACKGROUND: Dysphagia is a relatively common symptom following laryngectomy. An anterior pharyngeal diverticulum is a rare cause of post-laryngectomy dysphagia. However, it is often an incidental finding on rigid telescopic examination. METHODS AND RESULTS: This article describes two patients with a symptomatic anterior pharyngeal diverticulum. They were treated by transoral micro-endoscopic potassium titanyl phosphate 532 nm laser assisted resection. Both patients could take feeds orally after the procedure without any difficulty. One patient died one and a half years after the procedure because of secondary lung cancer. The other patient died after three years as a result of regional recurrence. The patients were able to swallow during their survival period post treatment. CONCLUSION: Laser-assisted micro-endoscopic resection is a relatively safe, quick and effective procedure for the management of anterior pharyngeal diverticulum.

KTP Laser in Laryngeal Amyloidosis: Five Cases with Review of Literature.

To study the clinical presentation and review the options in the management of laryngeal amyloidosis. To study the efficacy of KTP 532 laser in the excision of laryngeal amyloidosis. Study was conducted in our department in a tertiary care hospital between Jan 2001 and Feb 2010. We report five patients who presented with hoarseness of voice and localized laryngeal lesions. The biopsy proven laryngeal amyloidosis lesions were excised microendoscopically using KTP 532 laser in three patients and other two patients were kept only on follow-up as they refused further surgery. The patients were evaluated for systemic amyloidosis. The average duration of follow up was 2.6 years (3 months 6 years). All the five patients in our study were asymptomatic with no evidence of recurrence at their last follow up. In our small case series, KTP 532 laser excision of the laryngeal amyloidosis had a favorable outcome. Long term follow up is required to rule out recurrence and systemic involvement.

Customised acrylic nasal stents following recanalisation of modified Young's procedure.

INTRODUCTION: Maintaining the patency of the nasal vestibule following recanalisation of a modified Young's procedure can be a difficult task, as restenosis is quite common. MATERIALS AND METHODS: Sixteen patients underwent recanalisation of a modified Young's procedure, between January 2005 and December 2007, in the ENT--head and neck surgery department of a tertiary centre. Three different stent types were used following recanalisation: silicone suction tube tips, dental wax plate stents and customised acrylic stents. RESULTS: The silicone suction tube stents prevented restenosis. They were visible in the post-operative period, and there appeared to be some blunting of the nasal valve region, with no functional impairment. Dental wax plates had a high rate of restenosis and were uncomfortable and unsightly. The customised acrylic stents were more acceptable in the post-operative period, and enabled nasal valve angulation to be maintained. CONCLUSION: The customised acrylic stent described was a superior alternative to such stenting methods as repeated packing, silicone suction tubes and dental wax plates, following recanalisation of a modified Young's procedure.

Role of KTP-532 laser in management of oral submucous fibrosis.

INTRODUCTION: Oral submucous fibrosis is a chronic disease characterised by progressive inability to open the mouth. Various treatment modalities are available for its management, but these have largely been ineffective. MATERIALS AND METHODS: Nine cases of oral submucous fibrosis underwent a release procedure using a KTP-532 laser, from March 2005 to January 2006, within the ENT-head and neck surgery department of a tertiary centre. RESULTS: Pre- and post-operative mouth-opening was compared using the Wilcoxon signed rank test, and a significant difference observed (Z = -2.690, p = 0.007). Follow up over an average period of 12 months showed encouraging results. CONCLUSION: This preliminary study indicated that adequate release of oral submucous fibrosis can be achieved by using a KTP-532 laser release procedure, with minimal morbidity and satisfactory results. These promising results should encourage more widespread use of this technique in the management of this condition.

Endonasal endoscopic dacryocystorhinostomy: our experience.

OBJECTIVES: To study the outcome of endonasal endoscopic dacryocystorhinostomy (DCR) with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. To determine the duration of the surgical procedure of DCR, influence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases. METHODS: Combined retrospective and prospective study in our tertiary referral center. 24 patients with chronic dacryocystitis underwent 25 standard endonasal endoscopic DCR procedures, 10 with and 15 without mucosal flap preservation. 6 of these had concomitant sinonasal diseases for which they underwent septoplasty or functional endoscopic sinus surgery (FESS) or both, simultaneously or as staged procedures. Relief from epiphora and patency of the nasolacrimal fistula was assessed by nasal endoscopy and syringing of the lacrimal apparatus at 1 week, 3 weeks and 3 months postoperatively. RESULTS: Out of 18 patients who underwent only DCR, 17 patients (94.44%) had complete relief from epiphora. Out of 6 patients who underwent 7 DCRs with concomitant sinonasal surgery, 5 patients (85.71%) had complete relief from epiphora. Overall 23 out of 25 DCRs (92%) had complete relief. In 15 of the 25 procedures, mucosal flap was excised completely. In remaining 10 procedures, flap was trimmed, repositioned to cover exposed bone around the newly created nasolacrimal fistula. In either situation, only one patient each had partial block of the nasolacrimal fistula. Average duration of the surgical procedure of DCR was 18 min. CONCLUSION: Endonasal endoscopic DCR is a viable alternative to external DCR, co-existing sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate (92%) with less complications.

Conidiobolus coronata granuloma of left inferior turbinate: a rare presentation.

OBJECTIVE: To report a rare genus of a fungal family commonly affecting the sinonasal region, which presented as a fungal granuloma of the inferior turbinate in an immunocompetent host. Such a case has not previously been reported. CASE REPORT: A 49-year-old man presented with nasal conidiobolus limited to the left inferior turbinate, despite pre-operative fungal culture and tissue biopsy being negative for any fungal growth. On computed tomography scanning of the paranasal sinuses, and peri-operatively, the left inferior turbinate was seen to be enlarged and a bony, cartilaginous spur was found to impinge deep into the inferior turbinate. The spur may have caused microtrauma suitable for spore implantation, leading to fungal granuloma development. This unusual presentation highlights the fact that excision biopsy is diagnostic and therapeutic in such cases. CONCLUSION: Conidiobolus coronata of the inferior turbinate is rare. Such a fungal granuloma may be large enough to be confused with a benign or malignant lesion of the nasal cavity.

Hyalinizing clear cell carcinoma of the base of tongue.

Hyalinizing clear cell carcinoma is a rare, low-grade neoplasm of the minor salivary glands. It is composed exclusively of epithelial cells with optically clear cytoplasm. There are only a few isolated cases reported in the literature involving the base of tongue. The treatment of choice is wide excision and selective neck dissection, with or without radiotherapy. The prognosis of these tumours is good. A 57-year-old male patient presented with a lesion in the base of tongue, which was well enhanced on contrast computerized tomography scan. Once confirmed by biopsy, the hyalinizing clear cell carcinoma was resected via a transcervical approach. The patient underwent postoperative radiotherapy. There was no evidence of locoregional recurrence or distant metastasis at 18 months of follow up.

Role of three-dimensional computed tomography reconstruction in the management of elongated styloid process: a preliminary study.

Elongated styloid process is a relatively common cause of facial and neck pain, but it is often misdiagnosed due to its varied clinical presentation. Since an elongated styloid process is often confirmed by radiological means, it would be helpful to find a more accurate mode of depicting the styloid process. In this prospective study, 39 cases were evaluated. A three-dimensional computed tomography (3D CT) reconstruction of the styloid process was performed in 18 cases. In these patients, we compared the length and medial angulation of the symptomatic styloid process as viewed on an orthopantomogram and a 3D CT reconstruction. It was noted that a 3D CT reconstruction was more accurate in depicting the styloid process. This investigation can be considered as the 'gold standard' in the radiological diagnosis of an elongated styloid process.

Sphenochoanal polyp with heterotopic glial tissue.

An isolated polyp arising from the sphenoid sinus is rare. Due to the presence of important structures adjacent to the sphenoid sinus, a proper pre-operative radiological and nasal endoscopic evaluation is mandatory, along with a neurological and ophthalmological assessment. We report the case of a 23-year-old man with a sphenochoanal polyp with heterotopic glial tissue in the stroma. A Medline search did not reveal any previously reported cases of glial tissue in the sphenoid sinus presenting as a sphenochoanal polyp.

Oncocytic variant of a ductal retention cyst in the interarytenoid region.

Laryngeal cysts are a mixed group of benign lesions that have been classified as per their site of origin and histopathology. We report a case of an interarytenoid cyst in a 56 year old male with hyperparathyroidism. The cyst was resected under an operating microscope using KTP532 laser. It was reported on histopathology as an oncocytic variant of a ductal retention cyst.

Metastatic renal cell carcinoma presenting with epistaxis.

Renal cell carcinoma is a slow growing malignancy of the kidney that has a high propensity for metastasis. It is the most common metastasis reported in the paranasal sinuses. A fifty six year old male patient, an operated case of left renal cell carcinoma presented seven years later with epistaxis. Computerized tomography of the paranasal sinuses and of the abdomen showed a metastatic lesion involving the left nasosinus region and a lesion involving the right kidney with lung metastasis, respectively. Due to the poor prognosis palliative radiotherapy was given.

Schwannoma of the nose and paranasal sinuses.

Sckhwannoma is a benign tumor arising from the Schwann cells of nerve sheath.Through they arise more commonly in the head and neck than other regions, a through search in the liturature including medline revealed only about 47 reported cases of schwannoma in the paranasal sinuses of which the maxillary sinus involvement is more common. We report three cases of schwannoma arising from unusual sites in the paranasal sinuses with different modes of presttation each requiring a specific approach for surgical excision Transnasal endoscopic approach in combination with vonventional approaches is of immense value in the surgical management of these benign lessions of the paranasal sinuses.

Fourth branchial pouch sinus: a case report.

The fourth branchial pouch sinus is a very rare developmental anomaly; it usually presents as a recurring abscess in the left side of the neck. A high index of suspicion, combined with Barium swallow and computed tomography scan, aids in diagnosis. A case of branchial pouch anomaly is reported here for its rarity and late presentation. Complete excision of the entire epithelial tract combined with ipsilateral thyroid lobectomy remains the mainstay of management.

Osteolipoma of the skull base.

Although lipomas are the most common benign tumours of the head and neck, the involvement of the skull base is rare and it is also very rare for a lipoma to undergo osseous metaplasia to become an ossifying lipoma or osteolipoma. We present a case of a solitary osteolipoma involving the skull base in a 17-year-old girl. A few cases of osteolipoma involving the head and neck have been reported, but this may be the first reported case of a solitary osteolipoma involving the skull base with extension to the infratemporal fossa and parapharyngeal space. The computed tomography (CT) scan helped to clinch the diagnosis and the histopathology confirmed it. The clinical presentation, role of CT scan, surgical approach used, histological features and the review of literature are discussed.

Congenital cervical bronchogenic cyst.

A bronchogenic cyst is a rare developmental aberration that occurs in the paediatric age group. Over 50 cases of bronchogenic cysts have been reported in the literature. There is still a possibility of clinically misdiagnosing this condition as a more common congenital neck cyst like a branchial cyst. We report here the case of a 12-year-old female presenting with a neck swelling since birth who was diagnosed to have a bronchogenic cyst based on characteristic clinical and histopathological findings.

Results of KTP-532 laser and tendon preservation stapedotomy in otosclerosis-a preliminary report.

Tendon preservation stapedotomy with or without KTP-532 laser has been performed on 25 rases Jrom November 1998 to February 2000. A study of the symptoms, demographic profile, audiological impairment, surgical treatment and the resultant hearing improvement after 3 weeks and 6 weeks was done. KTP-532 laser assisted cruratamy and stapedotomy was found to be easier than the conventional method. Insertion of the prosthesis was also found to be much easier because of tendon preservation.

Solitary adult myofibroma of the pinna.

Solitary myofibroma is a recently described benign neoplasm of the skin or superficial soft tissue and it represents the adult counterpart of infantile myofibromatosis. This new clinicopathological entity is being recognized increasingly. A case of solitary myofibroma occurring in the pinna of a 50-year-old woman is presented. Such a lesion occurring in the pinna of an adult has not been reported in the literature.

Synovial sarcoma of the head and neck a report of 3 cases.

Synovial sarcoma is very rare and highly malignant tumour of the head and neck. Only 3 cases of synovial sarcoma have been treated 1980-1997 in Kasturba Medical College, Manipal. Treat-ment involved extensive surgical resection of the tumour (with neck dissection in two cases); and post- operative radiotherapy and chemotherapy in one case. Behaviour of the tumour was followed up till August 1997. It remains in our experience that synovial sarcoma, though a tumour or poor prognosis if treated by adequate tumour resection and adjunctive radiotherapy and chemotherapy, has good patient survival.

Endoscopic dacryocystorhinostomy and retrograde nasolacrimal duct dilatation with cannulation: our experience.

Endoscopic endonasal dacryocystorhinostomy [EDCR] is considered to be a superior alternative technique to the conventional external dacryocystorhinostomy [DCR], both in primary and secondary cases. It is of particular value in children and young adults as it avoids an external scar. Sixteen cases of chronic dacryo-cystitis were treated by the endoscopic technique, including 8 revision cases of failed external approach. In all cases except one, a patent nasolacrimal fistula was noted, with a success rate of 93.7%. The authors share their experience in EDCR and review the relevant literature.