Validation of an Intelligibility Assessment Tool in an Indian Language for Perceptual Speech Analysis in Oral Cancer Patients.

This study aimed to develop a speech intelligibility tool in Malayalam, an Indian language, based on the perceptual analysis. The tool had components of vowel, consonant, word, passage, and overall intelligibility. After face and content validation, a sample of 30 consecutive oral cancer patients underwent preliminary testing for internal consistency, inter- and intra-rater reliability, concurrent, and known-group validity. Subsequent validation was done in 80 T1-T4 patients from two centers. The scale had a high level of internal consistency; the Cronbach's alpha was 0.847 and good intra-rater and inter-rater agreement amongst all raters. There was a strong correlation between the Malayalam and the English passage. Pearson correlation coefficient of 0.646 proved concurrent validity. On known-group and subsequent validation, the tool showed expected differences between the treatment groups. The speech tool proved to be reliable and valid for perceptual evaluation of speech intelligibility in oral cancer patients.

Mandibular peripheral primitive neuroectodermal tumor: a rare case report with review of literature.

Primitive neuroectodermal tumor (PNET) is a high grade malignant neoplasm of small round cell tumor family, commonly affecting children and young adults. Peripheral primitive neuroectodermal tumor (pPNET) is a predominately neural, nonepithelial malignancy seen outside the nervous system that can arise in any place throughout the body including the diverse tissues of the head and neck. The diagnosis of PNET is confounded by its clinical and histopathological similarity to Ewing's sarcoma of the bone and has seldom been reported in the literature. The paucity of literature pertaining to the successful diagnosis and management of this lesion mandates its documentation and discussion. This article describes a case of an 11-year-old boy with an aggressive pPNET of the mandible. The clinical and radiographic presentations of this rare entity along with a detailed review on the current management modalities have been discussed.

Free tensor fascia lata-iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect.

Reconstruction of maxillectomy with extensive orbital rim and floor excision defects is a challenging problem. The goal of reconstruction here is to provide adequate orbital support to prevent enophthalmos and diplopia as well as obturation of the palatal defect. The existing methods of the reconstruction fail to simultaneously address these 2 goals of reconstruction. A new method of reconstruction of these defects using tensor fascia lata-iliac crest flap was used in 7 cases of cancers of the maxilla, which necessitated extensive resection of the orbital floor along with the maxillectomy. The flap was raised as a muscle and bone flap in 5 cases and in 2, a skin paddle was included. The immediate and delayed outcome at 6-month follow-up was analyzed. The functional outcome with regards to the ocular position and function, palatal obturation, speech, and swallowing were recorded. The bone viability at 6 months was assessed by computed tomography scan. The flap was successful in all the 7 cases. The delayed outcome assessment showed that the orbital support was excellent with no diplopia in all the cases. The palatal defect could be covered successfully in all the cases, resulting in normal speech and swallowing. The computed tomography scan showed excellent integration of the bone. The free tensor fascia lata-iliac crest flap is a reliable and safe method of reconstruction of the orbitomaxillary defects, addressing the issues of both orbital support and palatal obturation.

Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome.

The purpose of this study was to report the effectiveness of the lateral arm free flap (LAFF) in the reconstruction of oral tongue defects, the subsite in which it may have advantage over the other donor sites. This is a retrospective analysis of 48 consecutive cases of LAFF used for the reconstruction of partial glossectomy defects for squamous cell carcinoma of the oral tongue. Primary defect and donor-site morbidity and the functional and aesthetic outcomes were assessed in 37 evaluable patients, with a minimum of 6 months follow-up. Patient-reported Visual Analog Scale score from 0 (minimum satisfaction) to 10 (maximum satisfaction) was used to evaluate the aesthetic outcome. The follow-up was for 6 to 52 months (mean, 24 months). The flap was successful in 45 (93.8%) patients. The commonest observed donor-site morbidity was a broad scar, but it did not cause much patient dissatisfaction because it could be covered with appropriate dressing. Speech was normal or near-normal in all patients. Poor functional outcome was associated with adjuvant postoperative radiotherapy. The visual analog scale score for the aesthetic satisfaction (mean [standard deviation]) was 6.58 (1.82) for primary site and 7.13 (1.99) for the donor site. LAFF is an excellent option for the reconstruction of partial glossectomy defects of oral tongue without significant involvement of the floor of mouth and base of tongue.

Transmandibular approach for excision of maxillary sinus tumors extending to pterygopalatine and infratemporal fossae.

En bloc resection of maxillary sinus tumors that extend through the posterior wall necessitates resection of maxilla along with pterygopalatine and infratemporal fossae contents. This cannot be readily performed by conventional anterior maxillectomy approaches. The objective of this study is to evaluate the effectiveness of transmandibular approach for the excision of maxillary sinus tumors extending to pterygopalatine and infratemporal fossae. This is a retrospective review of 15 consecutive patients who underwent maxillectomy with transmandibular approach for tumors with posterior extension, between January 2004 and February 2008. The principal outcome parameter was the margin status on final histopathology report. In addition, evaluable patients were reviewed to assess the morbidity of the procedure using pre-defined parameters. All the patients had negative margins at the infratemporal fossa region. Varying degree of trismus was present in all patients. The cosmetic outcome of the procedure was excellent. Other anterior and transcranial approaches could be combined with this procedure when indicated. We conclude that transmandibular approach is an effective technique for resection of maxillary tumors with posterior extension to the pterygopalatine and infratemporal fossae. The procedure has acceptable morbidity and the aesthetic and functional results are satisfactory.

Comparison of quality of life in advanced laryngeal cancer patients after concurrent chemoradiotherapy vs total laryngectomy.

OBJECTIVE: To compare quality of life (QOL) of patients with advanced laryngeal cancers treated by total laryngectomy with those who received concurrent chemoradiotherapy. STUDY DESIGN: This is a cross-sectional study of the patients treated in our institution who have completed one year of follow-up and were disease-free at the time of evaluation. SUBJECTS AND METHOD: Forty patients treated for advanced cancer of the larynx (stage III/IV), either by concurrent chemoradiation (11) or total laryngectomy and postoperative radiation (29), have been included in this study. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4 questionnaire was used. RESULTS: Total scores for overall QOL are equal in both treatment groups (P = 0.69). Scores for individual components are similar in both treatment groups. However, dryness of mouth is significantly worse in the chemoradiotherapy group (P = 0.01) and ability to communicate with others is poorer in the laryngectomy group (P = 0.03). CONCLUSION: Long-term overall QOL remains similar in all the patients treated for advanced carcinoma of the larynx irrespective of treatment modality.

Increased plate and osteosynthesis related complications associated with postoperative concurrent chemoradiotherapy in oral cancer.

BACKGROUND: Plate osteosynthesis is a widely used technique in head and neck reconstructive surgery. The objective of this study was to determine whether postoperative chemoradiotherapy, which was recently introduced for high-risk head and neck cancer, affects plate and osteosynthesis related complications. METHODS: Fifty-two consecutive patients, who had undergone plate osteosynthesis for mandibular reconstruction between October 2003 and September 2006, were included in the study. The patients were divided into 3 groups: (1) surgery alone (n = 19), (2) surgery with postoperative radiotherapy (n = 14), and (3) surgery with concurrent chemoradiotherapy (n = 19). Outcome measures included any bone or plate related complications. RESULTS: The plate and osteosynthesis related complications occurred in 10.5% of patients in surgery-alone group, 28.6% in surgery with postoperative radiation group, and 63.2% in surgery with postoperative concurrent chemoradiotherapy group. The differences in the complication rates among these 3 groups were statistically significant (p = .003). In univariate analysis, postoperative radiation (p = .007) and concurrent chemotherapy (p = .003) were found to be significantly associated with complications. In multivariate analysis, only concurrent chemotherapy was found to be statistically significant (p = .002) with odds ratio of 7.72. CONCLUSION: Postoperative concurrent chemoradiotherapy significantly increases plate and osteosynthesis related complications in oral cancer.