Transverse Cervical Artery Based Free Flap in Reconstruction of a Tongue Defect: A Case Report.

In the era of reconstructive surgery, new and revolutionary options are being explored in oro-facial defect reconstruction. As free flaps are presently front runners for reconstruction of defects resulting from resection of benign and malignant lesions, there is a need for devising newer options to serve the need of covering defects following oncological resection. The availability of promising pedicles in the supraclavicular region makes it a potential donor site for harvesting regional flaps, and going forward, free flaps. Transverse cervical artery flap has been a useful regional flap for head and neck reconstruction but there are limited literature pertaining to transverse cervical artery free flap. We report a case of successful reconstruction of tongue defect with transverse cervical artery free flap.

Intra-operative interstitial brachytherapy in a novel infra-zygomatic approach for partially resectable head and neck cancers around the base of skull: A technical note.

Purpose: To report an intra-operative catheter insertion technique into the base of skull tumor bed following surgical resection for maxillary tumors. Material and methods: A 42-year-old male patient diagnosed with carcinoma of the maxilla was treated with neoadjuvant chemotherapy followed by chemo-radiation using external beam technique combined with brachytherapy boost to post-operative bed. Brachytherapy was delivered via intra-operative catheter placement at the base of skull to residual disease, which was surgically unresectable. Initially, catheters were placed cranio-caudally. This was later changed into an infra-zygomatic approach to improve planning and dose coverage. High-risk clinical tumor volume (CTV) was generated with a 3 mm margin to residual gross tumor. Planning was done using Varian Eclipse brachytherapy planning system, and an optimal plan was generated. Conclusions: An innovative, beneficial, and safe brachytherapy approach is necessary in a difficult and critical area, such as the base of skull. Our novel method of implant insertion through infra-zygomatic approach resulted in a safe and successful procedure.

A Rare Case of Laryngeal Hamartoma.

Hamartoma presenting in the larynx is a rare entity. The common presentation of such a lesion may include stridor, hoarseness of voice, choking sensation, dyspnea and in children, failure to thrive. It is a benign lesion and can be confused with other benign lesions like lipoma, fibroma, chondromas etc. Pathologically it consists of a mesodermal compartment and a granular compartment. Hamartomas mainly occur  in pediatric age group. When it occurs  in adults, males are more commonly affected than females. With  very few cases reported so far, we present a case of laryngeal hamartoma presenting in a lady with progressive hoarseness of voice as a presenting feature.

Intra Parotid Facial Nerve Neurofibroma: A Rare Case Report.

Primary solitary neurofibromas of facial nerve in the parotid are rare. We present a case of solitary neurofibroma of facial nerve within parotid gland in a 38 year old gentleman who presented with left sided painful preauricular swelling of 3 months duration with normal facial nerve function.Computed tomography (CT) revealed a well marginated solid mass within superficial lobe of left parotid gland showing mild enhancement. The mass could not be delineated from peripheral buccal branch of facial nerve during surgery and histopathology revealed a neurofibroma.

Recurrent Bleeding Neck Mass: a Case Report.

An adult male presented to us with a recurrent, large bleeding tumour in the neck. We describe our approach to the patient, whose tumour was labelled as an atypical glomus on final histopathology. They are relatively uncommon in the head neck, and this case report with literature review is expected to add to our knowledge.

Oral histoplasmosis masquerading as oral cancer in HIV-infected patient: A case report.

Histoplasmosis is an endemic mycoses caused by Histoplasma capsulatum with endemicity around midwestern United States and central America. The endemicity of histoplasmosis in India is not clearly known. Histoplasmosis, especially oral histoplasmosis, is now increasingly being reported from India. We report here a culture-confirmed and sequence confirmed, oral histoplasmosis in a HIV seropositive individual who was referred to our regional cancer centre with a suspicion of oral cancer.

The utility of second look microlaryngoscopy after trans oral laser resection of laryngeal cancer.

In the past few decades more and more number of tumors of the glottis and supraglottis are been treated with single stage transoral laser microsurgery (TOLS). TOLS for the treatment of glottic and supraglottic carcinoma with anterior commissure (A-com) and/paraglottic space involvement is associated with a high rate of recurrence. We prospectively evaluated the outcomes of laser microsurgery and the impact of second look operation in these patients. Twenty-three patients with glottic and supraglottic carcinoma underwent transoral laser micro resection of the lesions. Subsequently five patients underwent second look microlaryngeal evaluation 6-8 months later for non-satisfactory healing, poor voice, and or suspicion of recurrent disease. Patients with A-com involvement and or paraglottic space involvement were followed up longitudinally for the effectiveness and timing of second look microsurgery. After initial transoral laser micro resection, all patients achieved microscopically clear resection margins. At second look microlaryngeal evaluation, local recurrence was found in four of 23 patients. Of these, two patients were salvaged by second look surgery and are disease free, whereas in two others, the larynx had to be subjected to open surgical intervention. One of two had extensive local recurrent tumor and underwent total laryngectomy with neck dissection followed by post-operative radiotherapy. Tracheohyoidopexy was done with successful functional and oncologic outcome for another patient who had local recurrence for the third time. Only the patient who underwent total laryngectomy with neck dissection was subjected to adjuvant post-operative radiotherapy. Finally, larynx was saved in 21 out of 23 patients.

Vocal cord paralysis after percutaneous embolization of a vagal paraganglioma--the role of intraoperative nerve monitoring.

The value of preoperative embolization is well established in the management of paragangliomas. Percutaneous direct intratumoral embolization has been described as a safe and effective technique to achieve devascularization of these tumors, thereby reducing intraoperative blood loss. However, the present article presents a case in which a patient developed vocal cord palsy after percutaneous embolization of a vagal paraganglioma. In view of the present findings, the possibility of intraoperative nerve monitoring needs to be explored to ensure safety of this procedure.