RESUMO
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.
Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Humanos , Incidência , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Esvaziamento Cervical , Estadiamento de Neoplasias , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e PescoçoAssuntos
Anestesia Dentária , Dente Molar/cirurgia , Anestesia Local , Anestésicos Locais , Carticaína , Método Duplo-Cego , LidocaínaRESUMO
Zygomycosis is a rare fungal infection usually found in immunocompromised patients. It is a rapidly progressing infection with a high mortality rate. Our report describes an unusual case of rhinofacial zygomycosis due to Cunninghamella sp. in an immunocompetent patient, who presented with a slowly progressive swelling of the left cheek. An interrupted course of amphotericin B treatment caused regression of the lesion. Drug therapy was abandoned due to impairment of renal function. The patient was clinically and radiologically disease free for 2 years following cessation of therapy.
