Perineural Invasion of Superior and Inferior Laryngeal Nerves in Advanced Stage Squamous Cell Carcinoma of the Larynx: A Case Series and Review.

Objective: To evaluate bilateral superior and recurrent laryngeal nerves for tumor spread in patients of advanced-stage laryngeal carcinoma undergoing surgical resection. Methods: A prospective study was conducted including biopsy-proven cases of laryngeal squamous cell carcinoma (SCC) that were planned for total laryngectomy. Patients with metachronous or synchronous SCC were excluded from the study. All patients underwent total laryngectomy, where both superior and recurrent laryngeal nerves were harvested along with the specimen, and the proximal ends of the nerves were marked for reference. Perineural invasion (PNI) was assessed in nerves within the tumor and in bilateral extra-laryngeal nerves. Results: The study included 22 patients with a mean age of 58 years. Intra-tumoral PNI was found in 7 of the 22 cases (32%). The free nerve margins of superior and recurrent laryngeal nerves, which were examined from proximal to distal orientation, showed no tumor infiltration in any of the cases. Conclusion: Perineural invasion of minor nerves constitutes a major pathway of spread. On the contrary, invasion of superior or recurrent laryngeal nerves does not constitute a route for tumor spread. Hence, there is no need to extend the surgical boundary for total laryngectomy to include these major nerves separately.

Prospective Analysis of the Chronology of Smell and Taste Dysfunction in COVID-19 Positive ENT Doctors.

Olfactory and gustatory dysfunction has been reported as an early presentation in COVID-19. We intent to analyze the chronological outline of these chemosensory disturbances in term of onset, progression and resolution in ENT doctors with COVID-19. In six symptomatic otolaryngologists who tested positive for SARS-CoV-2, detailed symptomatology of olfactory and gustatory dysfunction was collected prospectively on regular basis till a period of at least three months. Due to their awareness, sensitivity and reliability, even mild and transient relevant symptomatology could be recorded accurately. Olfactory and gustatory dysfunction was universally present in all the six otolaryngologists. The onset of the symptoms was in first week and resolved completely within 4 weeks in four of them. In two doctors the recovery of olfactory dysfunction to near normal level was delayed and prolonged over 2 and 3 months. The pattern of involvement of basic tastes like sweet, salt, sour and bitter as well as food temperature and texture etc. pointed towards involvement of the gustatory mucosa with non-uniform involvement of the papilla and taste receptors. One of the doctors also experienced reappearance of parosmia and phantosmia in the 3rd month following complete disease resolution. Due to their expertise in the field of Otolaryngology, the recruited doctors represented the precise pattern of progression and resolution of olfactory and gustatory dysfunction in COVID-19. Larger studies are needed to validate our reported universal presence of these symptoms with complete recovery rate following disease resolution.

Head and Neck Surgery During COVID-19 Pandemic: Experience from a Tertiary Care in India.

Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of its close proximity to the mucosa of the upper aerodigestive tract. Retrospective review of all head and neck surgical procedures is undertaken during the pandemic from 23rd April 2020 to 30th September 2020. One hundred procedures were performed on 98 patients. COVID-19 status determined by SARS-Cov-2 RT-PCR at baseline was negative for 81, positive in 8 and unknown in 11. The RT-PCR negative subgroup included 40 diagnostic procedures and 41 ablative and or reconstructive procedures for head and neck neoplasms. None of the patients or health-care workers converted to COVID-19-positive status during the duration of the hospital stay. There were no cases with 30-day mortality. Clavien-Dindo grading for postoperative complications was as follows: 1-4, 2-12, 3a-2, 3b-1. Eleven patients with unknown COVID-19 status at baseline underwent emergency tracheostomy in a COVID-19 designated operating room for upper airway obstruction secondary to head and neck cancer. Of the 8 procedures conducted on known cases of COVID-19, 6 were tracheostomies performed for COVID-19 ARDS. The rest were maxillectomy for acute invasive mucormycosis and incision and drainage for parotid abscess. A matched-pair analysis was performed with similarly staged historical cohort operated during January to December 2016 to compare peri-operative complication rates (Clavien-Dindo Score). Incidence of complication with higher Clavien Dindo Score (>/=3a) was found to be lower in those patients operated during the pandemic (p=0.007). By meticulous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without jeopardising the risk of transmission of COVID-19 to the patients or health-care workers.