Incidence of metastasis to level V lymph nodes in clinically positive necks among Sri Lankan patients with oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) remains the most common cancer among males in Sri Lanka. Metastasis to neck is a crucial prognostic factor. A modified radical/radical neck dissection including levels I -V, was performed in patients with OSCC who had a clinically positive neck (cN+). Currently, evidence suggests that sparing level V in a cN+ may be justified due to less chance of metastasis in early stages of the disease. To the best of our knowledge, the incidence of metastasis to level V in patients with cN+s has not been previously investigated in a Sri Lankan context. We aimed to determine level V lymph node metastasis and related clinicopathological indicators in cN+s in patients with OSCC. A multicentre retrospective study investigated postoperative biopsy reports of 187 patients for five years. OSCC patients with cN+s who underwent neck dissections of levels I-V were included. Only 6.4% of patients had histopathologically positive level V lymph nodes. A total of 127 lymph nodes were harvested from level V of those who showed level V positivity and out of them 68 were positive with a third of cases showing extranodal extension (ENE). The buccal mucosa (n=4) and lateral aspect of the anterior two thirds of the tongue (n=4) were the common primary sites for level V metastasis. In patients who showed positivity in levels III and IV, a considerably higher probability of level V nodes being positive was seen, which was statistically significant (p = 0.0001). We have concluded that the routine performance of a modified radical/radical neck dissection for cN+s should be stopped, as the incidence of Level V positivity is significantly low. Assessing the cN+ for N stage, status of levels III and IV, pattern of invasion, differentiation, and the site may be used instead as predictors for level V positivity.

Oropharyngeal epignathus with partial facial duplication: report of a rare case.

Foetal oral teratoma or epignathus is a rare benign condition that originates in the oropharyngeal region. The term 'teratoma' refers to a mass composed of poorly organized tissues derived from each of the three germ layers. Epignathus may occur when one twin ceases development during gestation and becomes vestigial to the fully formed dominant twin. The reported incidence of epignathus is approximately 1:35,000 to 1:200,000 live births. A unique case of partial facial duplication with gross histological and radiological evidence of partial duplication of the facial elements and organs is presented herein. The affected newborn baby underwent urgent surgery due to breathing difficulties. The mass was excised successfully and the infant made an uneventful recovery. The resected specimen included two developing faces, each composed of a developing mandible and maxilla with developing tooth buds. Tissues from all three germ layers were present. In such cases, the treatment option is exclusively surgical, and complete resection is curative in most cases during the early neonatal period.

Improvement of quality of speech in patients with velo-pharyngeal insufficiency corrected using a buccinator myomucosal flap.

INTRODUCTION: Oro-facial clefts involving the palate is the commonest structural defect causing velopharyngeal insufficiency (VPI) and poor intelli gibility of speech. Proper repair of the soft palateis a surgical challenge. Posterior-based buccinator myomucosal flap (BMF) is used to lengthen the soft palate of patients who undergo primary palatoplasty at Teaching Hospital, Karapitiya (THK). BMF is a good choice for the repair of medium sized mucosal defects in the oral cavity since it has appropriate thickness, contains mucous membrane with mucous glands and has a rich blood supply. Objectives To assess improvement in quality of speech after soft palate repair using BMF in patients with previously corrected cleft pate. METHODS: Thirty four patients (M:F-1:1) who had undergone palatal lengthening using BMF procedure for correction of VPI for speech improvement at Teaching Hospital, Karapitiya from 2010 to 2012, were assessed before and one year after surgery for quality of speech. RESULTS: All patients below 8 years showed significant reduction of hypernasality (p<0.05), whereas only 60% of patients above 8 years showed reduction after the surgery. All patients showed reduction in nasal air emission and in consonant production error at least by one consonant. The group below 8 years showed more improvement in speech quality after surgery. CONCLUSIONS: Palatal lengthening using BMF procedure is a good treatment option for correction of VPI.

A retrospective analysis to determine factors contributing to the survival of patients with oral squamous cell carcinoma.

The clinical outcome of patients with OSCC is assessed based on TNM system and currently it is the most reliable indicator on which therapeutic decisions are made. The patients with advanced disease are managed with combined treatment modalities. The aim of this retrospective study was to identify the factors which influence survival of patients with OSCC in Sri Lanka. Four hundred and thirty patients who have been managed surgically using either (1) local excision, (2) local excision+supraomohyoid neck dissection, (3) local excision+modified radical neck dissection, (4) local excision+radical neck dissection, (5) local excision+contra-lateral neck dissection depending on TNM stage, with or without post-operative radiotherapy. Patients with incompletely excised tumours showed statistically significant poor survival which improved with radiotherapy (stage II P=0.002, stage III P=0.017). With reference to TNM stage IV tumours, the patients who had received surgical option 4, showed poor survival compared to surgical options 2, 3, and 5 (P=0.001). However, within the group of patients who had received surgical option 4, those who had nodal metastasis showed poorer survival compared to patients without nodal metastasis. In addition, survival improved in patients who had been treated with surgical option 4, with radiotherapy. Furthermore, margin status was also found to significantly influence the survival of patients with TNM stage IV tumours (P=0.003). The main factors that had significant impact on the survival were TNM stage, nodal metastasis and the state of excision margins.

Mid-maxillary distraction osteogenesis of cleft patients using a special custom-made tooth-borne device.

A relatively new approach to maxillary advancement by maxillary distraction using a combined surgical and modified orthodontic technique is described. This protocol and the technique have been used for the past 3 years (2006 to 2009) on more than 60 patients, aged between 14-29 years. Distraction of between 7 and 18 mm has been achieved, creating class 1 or mild class 2 arch relationships in cleft lip and cleft palate patients who had class 3 arch relationship compounded by significant maxillary retrusion. The technique is simple, inexpensive and less time consuming.