Prospective study of outcomes of surgically treated larynx and hypopharyngeal cancers.

OBJECTIVE: To determine the morbidity and survival of surgically treated locally advanced carcinoma larynx and hypopharynx in a tertiary referral center in South India, a prospective cohort study was carried out. MATERIALS AND METHODS: Patients who had undergone laryngectomy or laryngopharyngectomy from January, 2006 to January, 2011 at our institute were prospectively studied for factors affecting morbidity tumor recurrence and disease free survival (DFS). DFS was calculated for the whole group and for the larynx and hypopharynx cancer subgroups separately, using Kaplan Meir Method and the survival differences of the larynx and hypopharynx groups and between salvage and primary surgical cases were evaluated using the Cox's regression scale . RESULTS: A total of 154 patients with ages ranging from 23 to 78 (mean 56.3 + standard deviation 9.2) were studied, which included 145 males and 9 females. Pre-operative tracheostomy and previous radiotherapy were the most significant factors contributing to post-operative morbidity. Survival difference between the larynx and hypopharynx cancers was statistically significant and the DFS was significantly affected by primary site wound infection, primary site margin and node positivity. CONCLUSION: The results of laryngectomy can be optimized by "proper case selection and morbidity risk assessment".

Pre-operative prediction of a right non-recurrent laryngeal nerve by computed tomography.

OBJECTIVE: This paper reports a case of a non-recurrent laryngeal nerve which was accurately predicted pre-operatively using computed tomography. CASE REPORT: A 61-year-old man presented with papillary thyroid carcinoma with lymph node metastasis. Computed tomography scans of the neck and chest revealed an ill-defined, hypoattenuating nodule in the right lobe of the thyroid gland, with few upper paratracheal and prevascular nodes, and clear lung fields. The retro-oesophageal course of the right subclavian artery, which was arising from the distal portion of the arch of aorta, was also incidentally revealed in the computed tomography scan. A barium swallow further confirmed the presence of a retro-oesophageal subclavian artery. Total thyroidectomy was performed, with right neck dissection and central compartment clearance. This was carried out with the presence of a non-recurrent laryngeal nerve in mind, and the nerve was accurately localised and preserved. CONCLUSION: To our knowledge this is the first report in the world literature of accurate pre-operative incidental imaging of the right non-recurrent laryngeal nerve in a case of metastatic thyroid cancer, and the subsequent use of computed tomography to guide surgical navigation.

Combined fluphenazine and lidocaine for pain relief in head and neck cancers.

A successful method of treating intractable neoplastic pain in 12 cases is discussed. A completely new method was tried combining long-acting phenothiazine and lidocaine to achieve long-lasting pain relief. This combination gave pain relief which lasted for weeks. A possible explanation of the mechanism is offered.

Prolongation of action of local anaesthetic by a possible complexation: clinical trials.

Long lasting pain relief for patients of malignancy involving head, neck, face and patients of trigeminal neuralgia was sought by the use of lignocaine with addition of complexing agents. Five patients with severe intractable pain of malignancy involving the trigeminal (V cranial) nerve mainly the maxillary and mandibular divisions, two patients of trigeminal neuralgia with trigger zone in maxillary division were treated. Remarkable prolongation of action of pain relief up to 6 weeks could be achieved. The recurred pain was also of less severity especially radiation was less. An explanation of the possible mechanism is offered.