Most Downloaded Articles

   
 
REVIEW ARTICLE
Mina N Le, Erica Lee, Bhuvanesh Singh

The Evolution of Staging of Cutaneous Squamous, Cell Carcinomas: A Structured Review

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:57-63][No of Hits : 2439]


ABSTRACT

Among non-melanoma skin cancers, cutaneous squamous cell carcinoma entails the highest morbidity and mortality, and yet there is little guidance on how to identify the subset of cutaneous squamous cell carcinomas that behave aggressively. The staging of non-melanoma skin cancers is meant to provide this guidance, by dividing patients into groups for which survival differs between groups, is similar within each group, and consistently decreases with each increasing stage group. In the present review, we explore the history of how the staging of nonmelanoma skin cancers, focusing on cutaneous squamous cell carcinomas, has evolved over time. We describe the common criticisms leveled at the American Joint Committee on Cancer (AJCC) staging rubric. We discuss alternative staging systems that have recently been proposed, and how they have stood up to validation. Finally, we preview the AJCC staging changes that will go into effect next year and lay out some future directions for the improvement of skin cancer staging.

Keywords: Cutaneous squamous cell carcinoma, Non-melanoma skin cancer, Prognostic factors, TNM staging.

How to cite this article: Le MN, Lee E, Singh B. The Evolution of Staging of Cutaneous Squamous Cell Carcinomas: A Structured Review. Int J Head Neck Surg 2017;8(2):57-63.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Natalya Chernichenko

Critical Update on Malignant Salivary Gland Neoplasms

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:71-75][No of Hits : 1417]


ABSTRACT

Salivary gland neoplasms are relatively rare tumors with a wide range of biologic behavior. Early low-grade malignancies could be adequately treated with surgery alone, while larger locally advanced tumors will require adjuvant radiation therapy. The role of chemotherapy remains palliative. The goal of this article is to provide a critical review of recent literature on diagnosis and management of salivary neoplasms.

Keywords: Head and neck cancer, Perineural invasion, Salivary neoplasm.

How to cite this article: Chernichenko N. Critical Update on Malignant Salivary Gland Neoplasms. Int J Head Neck Surg 2017;8(2):71-75.

Source of support: Nil

Conflict of interest: None


 
LITERATURE REVIEW
Bahbak Shariat-Madar, Jeffrey C Liu

Role of Depth of Invasion in Evaluation and Management of Early-stage Oral Cavity Squamous Cell Carcinoma

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:84-88][No of Hits : 868]


ABSTRACT

Aim: To evaluate the existing body of literature and impact of depth of invasion (DOI) in early-stage oral cavity squamous cell carcinoma (OCSCC) and its role in predicting occult cervical lymph node metastases.

Background: The prognosis for early-stage T1 to T2 disease OCSCC is relatively poor compared with other mucosal subsites within the head and neck. Primary tumor DOI can help prognosticate high-risk tumors for additional treatment.

Review results: There are unequivocal management implications in the literature demonstrating a role for elective neck dissection in early-stage OCSCC based on DOI. Following appropriate patient selection, there may be a role for sentinel lymph node biopsy in regional lymph node staging in earlystage OCSCC.

Conclusion: There are a multitude of studies demonstrating novel strategies to appropriately treat early-stage OCSCC, which are increasingly becoming standard of care. These strategies are altering the overall and disease-free survival of early-stage OCSCC. Despite advances, locoregional recurrence remains a challenge in this disease.

Clinical significance: Herein, the authors highlight a number of advances in the management of early-stage OCSCC as described in the literature, which are having an impact on disease-free and overall survival.

Keywords: Carcinoma, Cavity, Cell, Cervical, Depth, Invasion, Lymphatic, Metastases, Oral, Squamous.

How to cite this article: Shariat-Madar B, Liu JC. Role of Depth of Invasion in Evaluation and Management of Early-stage Oral Cavity Squamous Cell Carcinoma. Int J Head Neck Surg 2017;8(2):84-88.

Source of support: Nil

Conflict of interest: None


 
INVITED REVIEW
C Fitzgerald, James Paul O'Neill

High-risk Cutaneous Squamous Cell Carcinoma

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:37-44][No of Hits : 755]


ABSTRACT

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer worldwide. Cutaneous squamous cell carcinoma can potentially be treated fully with minimal morbidity when detected early; however, certain subtypes of cSCC have been shown to confer a poorer prognosis for patients. In these high-risk tumors, increased incidence of recurrence, as well as metastasis to local lymph nodes and distant sites, is seen as a result of certain patient characteristics and pathological features. While guidelines regarding the management of high-risk cSCC have been produced, no clear consensus management or prognostic algorithms exist. In this review, we discuss current definitions of high-risk cSCC, recommendations regarding the management of cSCC, and current guidelines.

Keywords: Clinical guidelines, High-risk, Oncology, Squamous cell carcinoma.

How to cite this article: Fitzgerald C, O'Neill JP. High-risk Cutaneous Squamous Cell Carcinoma. Int J Head Neck Surg 2017;8(2):37-44.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Evangelia Katsoulakis, Natalya Chernichenko, David Schreiber

Proton Therapy in the Treatment of Head and Neck Cancer

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:45-48][No of Hits : 752]


ABSTRACT

Aim: To examine the value of proton therapy in relation to other treatment modalities in head and neck cancer.

Review: Proton therapy has evolved into more sophisticated and costly intensity-modulated proton therapy and has resulted in even greater dose reduction to normal critical structures at risk as compared with photon therapy. Early clinical studies in head and neck cancers, especially for tumors of the skull base and paranasal sinuses, suggest that proton therapy is excellent in terms of local control and is comparable to intensity-modulated radiation therapy photons but with lower rates of morbidity.

Results: There are many potential advantages to radiation therapy with protons. While there are many single institution studies examining the added value of protons to photon therapy, the value of proton therapy must be examined in prospective randomized clinical studies and across many subsites of head and neck cancer. Additional evidence is necessary to guide efficient clinical practice, patient selection, and tumors that are most likely to benefit from this treatment modality and justify proton therapy use given its significant cost.

Keywords: Head and neck cancer, Proton therapy, Radiation therapy.

How to cite this article: Katsoulakis E, Chernichenko N, Schreiber D. Proton Therapy in the Treatment of Head and Neck Cancer. Int J Head Neck Surg 2017;8(2):45-48.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Joshua D Smith, Kayte Spector-Bagdady, Andrew G Shuman

Head and Neck Cancer Research Ethics: A Primer.

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:49-56][No of Hits : 601]


ABSTRACT

The rapidly evolving landscape of clinical research in head and neck cancer promises scientific discovery that will benefit patients and stand to improve the human condition for years to come. However, it is imperative that the head and neck oncology research community remains cognizant of the ethical conundrums posed by novel clinical investigation and respects and honors the primacy of the patients and participants upon whom such discoveries depend. It is as vital as ever to revisit the ethical debates of the past, the novel issues of the present, and potential ethical concerns of the future, to ensure research subject protection and respect evolves at the same pace as the research enterprise itself. Herein, we review the basic ethical principles required of human subjects research, the regulatory landscape, and selected emerging debates with relevant examples for head and neck providers and researchers.

Keywords: Clinical research, Head & neck cancer, IRBs, Research eithics.

How to cite this article: Smith JD, Spector-Bagdady K, Shuman AG. Head and Neck Cancer Research Ethics: A Primer. Int J Head Neck Surg 2017;8(2):49-56.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Christopher Thompson, Iain J Nixon

Our Understanding of Well-differentiated Thyroid Cancer

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:64-70][No of Hits : 593]


ABSTRACT

Through significant contributions to our understanding of risk factors, prognostic indicators and management of welldifferentiated thyroid cancer (WDTC), Prof Jatin Shah has contributed much to the field of thyroid cancer in recent times. Many of the guidelines used in WDTC management today are a testament to his less-aggressive, dedicated and individualised approach. This article seeks to both review the current understanding of WDTC and to outline these contributions in a special issue dedicated to the career of Prof Shah.

Keywords: Lymph nodes, Risk stratification, Thyroidectomy, Well-differentiated thyroid cancer.

How to cite this article: Thompson C, Nixon IJ. Our Understanding of Well-differentiated Thyroid Cancer. Int J Head Neck Surg 2017;8(2):64-70.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ashwin A Jaiswal, Bikram K Behera, Ravindranath Membally, Manoj K Mohanty

Congenital Midline Cervical Cleft: A Case Report with Review of Literature

[Year:2017] [Month:January-March] [Volumn:8 ] [Number:1] [Pages:36] [Pages No:25-30][No of Hits : 579]


Abstract

Aim: To highlight a rare case of a congenital midline cervical cleft (CMCC) in context with embryological theories/hypothesis, presentation, and management along with review of literature.

Introduction: Congenital midline cervical cleft is a rare but interesting anterior neck anomaly with controversial theories/ hypothesis regarding its embryogenesis.

Case report: We describe here a classical case of midline cervical cleft that presented at birth with a cephalocaudal orientation, extending from the level below the hyoid bone to the suprasternal notch with a length of 3 cm and width of 0.5 cm. At 6 months of age, the lesion was excised and closure was done by multiple Z-plasty, with satisfactory results.

Discussion: Although the diagnosis is clinical, it is frequently misdiagnosed. The associated clinical features could include thyroglossal duct cysts, cleft lip/mandible/sternum, cervical contractures, mandibular spurs, microgenia, and/or bronchogenic cysts. If it is not treated at an early age, it can result in complications like webbing of the neck, dental malocclusion, and restricted neck movements.

Conclusion: Earliest recognition of CMCC and proper intervention can provide better esthetic and functional prognosis.

Clinical significance: A correct earlier recognition of the lesion and appropriate surgical management are key to avoid longterm complications.

Keywords: Branchial arches, Congenital midline cervical cleft, Thyroglossal duct cysts, Z-plasty.

How to cite this article: Jaiswal AA, Behera BK, Membally R, Mohanty MK. Congenital Midline Cervical Cleft: A Case Report with Review of Literature. Int J Head Neck Surg 2017;8(1):25-30.

Source of support: Nil

Conflict of interest: None


 
ORIGINCAL ARTICLE
Praveen D Shivanandappa, Veena P Doddamane, KS Munish, BS Yogeesha, AM Shivakumar

A Clinical Approach to the Parapharyngeal Space

[Year:2017] [Month:January-March] [Volumn:8 ] [Number:1] [Pages:36] [Pages No:1-4][No of Hits : 564]


Abstract

Aim: To present the clinicopathological profile, surgical management, and the outcome of parapharyngeal space (PPS) neoplasms in 14 patients.

Materials and methods: This is a retrospective review of the clinical records of 14 patients treated for PPS tumors. The age of patients ranged from 24 to 54 years, with female to male ratio of 1.3:1. The commonest clinical presentation was a slowgrowing, painless neck swelling. The preoperative protocol was based on: (1) imaging study to establish site, size, and anatomical relationships. (2) Fine-needle aspiration cytology (FNAC) was performed to determine the nature of the mass. Details of the management, morbidity, and outcome of these patients are presented.

Results: A total of 85.7% of the PPS neoplasms were benign and 14.2% were malignant. Majority of the benign tumors were of neurogenic origin. The histocytopathology confirmed 12 (85.7%) of these diagnoses (2 patients were with ""nondiagnostic"" result). The positive predictive value of the FNAC was 83.3% for benign tumors and 100% for malignant tumors. In 6 patients (60%), a transcervical surgery was performed. Three patients (30%) underwent transparotid–transcervical surgery for a pleomorphic adenoma of the deep lobe of the parotid gland in the prestyloid space and transcervical–transmandibular approach was taken in 1 case (10%). Postoperative complications occurred in 3 out of 10 patients (33.3%).

Conclusion: The results of our study are in agreement with other studies reported in the literature and confirm the need to follow a careful preoperative diagnostic protocol that must take advantage of imaging studies (computed tomography, magnetic resonance imaging) and of cytology FNAC, in order to plan surgical treatment with a safe approach and that reduces complications, esthetic and functional damage, and the risk of recurrence.

Keywords: Parapharyngeal space, Poststyloid, Prestyloid, Tumor.

How to cite this article: Shivanandappa PD, Doddamane VP, Munish KS, Yogeesha BS, Shivakumar AM. A Clinical Approach to the Parapharyngeal Space. Int J Head Neck Surg 2017;8(1):1-4.

Source of support: Nil

Conflict of interest: None


 
ORIGINCAL ARTICLE
M Ambikavathy, S Kumar

Ludwig’s Angina: Report of 40 Cases and Review of Current Concepts in Emergency Management in a Rural Tertiary Facility Teaching Hospital.

[Year:2017] [Month:January-March] [Volumn:8 ] [Number:1] [Pages:36] [Pages No:11-14][No of Hits : 562]


Abstract

Objective: To review the current protocols and assess their efficacy in the emergency management of cases presenting with Ludwig’s angina.

Materials and methods: A retrospective study of patients diagnosed with Ludwig’s angina, admitted and treated in our institution between November 2007 and December 2012.

Results: There were 40 cases with 24 males (60%) and 16 females (40%), ages ranged between 16 and 80 years. Duration of symptoms was between 3 days and 2 weeks. The most common cause was dental infections seen in 23 cases (57.5%), one of them was a pregnant lady. Six were due to habitual tooth pricking with a broom stick (15%). In 3 patients it was due to submandibular duct stenosis secondary to calculi (7.5%). Five patients had diabetes as underlying disease (12.5%). Facial trauma contributed in 2 patients (5%) and in 1 patient it was due to carcinoma buccal mucosa (2.5%). All the patients were treated with systemic broad spectrum antibiotics, intravenous fluids, and analgesics. Twenty patients (50%) underwent tracheostomy with surgical decompression through small incisions under local/ general anesthesia. Ten patients (25%) were subjected to incision and drainage with subsequent removal of the diseased teeth. Ten patients (25%) were managed conservatively with antibiotics, analgesics, and under close supervision for airway compromise. There were no complications recorded and no mortality.

Conclusion: Ludwig’s angina is a life-threatening surgical emergency. Early diagnosis and immediate surgical intervention can save lives. The appropriate use of parenteral antibiotics complemented with airway protection and surgical decompression remains the standard treatment protocol in advanced cases of Ludwig’s angina.

Keywords: Ludwig’s angina, Management, Protocols, Tracheostomy.

How to cite this article: Ambikavathy M, Kumar S. Ludwig’s Angina: Report of 40 Cases and Review of Current Concepts in Emergency Management in a Rural Tertiary Facility Teaching Hospital. Int J Head Neck Surg 2017;8(1):11-14.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Ashok M Shenoy, Vikas Sharma, Purushottam Chavan, Rajshekar Halkud, Namrata Ranganath, Tanvir Pasha, Poornima Shenoy, B Ravikumar, Suma M Narayana, Muhammed I Sharif, CR Vijay

Transoral Laser Microsurgery vs Radiotherapy for Early Glottic Cancer: Study at Tertiary Care Center in India

[Year:2017] [Month:January-March] [Volumn:8 ] [Number:1] [Pages:36] [Pages No:15-20][No of Hits : 522]


Abstract

Aim: To compare laryngeal preservation rates, survival rates, and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT).

Materials and methods: A review of oncologic results was performed on a consecutive series of individuals with early-stage glottic carcinoma (T1 and T2) who were treated between 2011 and 2014 at Kidwai Memorial Institute of Oncology and had received either RT or TLM. Data were collected with a view to assess overall survival, disease-specific survival, laryngectomyfree survival, and laryngeal preservation rates. The Voice Handicap Index-30 (VHI-30) was used as the measure of voice quality after treatment.

Results: Two-year overall survival for TLM group was 93.8% and for RT group was 90.5%, p = 0.643. Disease-free survival (TLM = 90.6% vs RT = 76.2%) was not found to be significant (p-value = 0.104). Laryngeal preservation rate was 79.5% in TLM and 71.4% in RT group (p-value = 0.003). Laryngectomyfree survival was better in TLM (TLM = 96.9% vs RT = 76.2%, p = 0.003). Substage analysis showed equivalent voice for TLM (VHI = 6–12) and RT (VHI = 6–14) in T1a patients (p = 0.94), whereas voice outcome was better for RT in T1b (VHI = 10–16 for TLM vs VHI = 11–18 for RT, p = 0.044) and T2 (VHI = 21–29 for TLM vs VHI = 16–23 for RT, p = 0.002) stages.

Conclusion: Transoral laser microsurgery can be considered the treatment of choice for early glottic cancer in view of better laryngeal preservation rate and laryngectomy-free survival with added advantage of low treatment cost and shorter hospital stay compared with RT.

Clinical significance: Laryngeal cancers represent the most common malignancy of head and neck, with estimated worldwide incidence of 120,000 cases annually. Optimal treatment modality has generated significant controversy in literature. External beam RT, open partial laryngectomy, and TLM are various treatment options available. This study depicts TLM as a preferred modality for early glottic cancer.

Keywords: Glottic cancer, Laser, Radiotherapy.

How to cite this article: Shenoy AM, Sharma V, Chavan P, Halkud R, Ranganath N, Pasha T, Shenoy P, Ravikumar B, Narayana SM, Sharif MI, Vijay CR. Transoral Laser Microsurgery vs Radiotherapy for Early Glottic Cancer: Study at Tertiary Care Center in India. Int J Head Neck Surg 2017;8(1):15-20.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Volkert B Wreesmann

Role of Extracapsular Nodal Spread and Surgical Margin Status in defining High-risk Head and Neck Squamous Cell Carcinoma and its Treatment Intensity

[Year:2017] [Month:April-June] [Volumn:8 ] [Number:2] [Pages:51] [Pages No:76-83][No of Hits : 508]


ABSTRACT

High-risk head and neck squamous cell carcinoma (HNSCC) includes an ill-defined collection of tumors that share an extremely poor outcome after seemingly appropriate multimodality treatment. Accumulating evidence suggests that extracapsular nodal spread and suboptimal surgical margins may be markers of high-risk HNSCC, but their utility is limited by ambiguous pathological criteria and unsatisfactory establishment of independent prognostic value. Inaccurate definition of high-risk HNSCC continues to obscure the scientific basis of treatment intensification protocols that have been proposed for high-risk HNSCC. Recent studies propose a more objective definition of clinically relevant extracapsular nodal spread (ECS) and surgical margins, which may contribute to improved staging and treatment selection.

Keywords: Extracapsular nodal spread, Head and neck squamous cell carcinoma, Margins, Outcome, Treatment.

How to cite this article: Wreesmann VB. Role of Extracapsular Nodal Spread and Surgical Margin Status in defining High-risk Head and Neck Squamous Cell Carcinoma and its Treatment Intensity. Int J Head Neck Surg 2017;8(2):76-83.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Lee J Kaplowitz, Eric M Joseph

A Practical Approach for Learning Rhinoplasty Surgery

[Year:2016] [Month:January-March] [Volumn:7 ] [Number:1] [Pages:56] [Pages No:33-46][No of Hits : 3803]


ABSTRACT

Rhinoplasty surgery is a procedure well suited for otolaryngology residents to incorporate in their training and subsequent practices of medicine. We detail a practical approach for learning rhinoplasty which may commence during residency. The resident learns to conduct a proper consultation, preoperative evaluation, surgical procedure, and follow-up care for the prospective rhinoplasty patient. The history of rhinoplasty, and modern rhinoplasty techniques is discussed, and suggestions are made for residents to successfully incorporate learning rhinoplasty surgery during their otolaryngology training.

Keywords: Otolaryngology, Residency, Rhinoplasty.

How to cite this article: Kaplowitz LJ, Joseph EM. A Practical Approach for Learning Rhinoplasty Surgery. Int J Head Neck Surg 2016;7(1):33-46.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
John Nathan, Lynda Asadourian, Mark A Erlich

A Brief History of Local Anesthesia

[Year:2016] [Month:January-March] [Volumn:7 ] [Number:1] [Pages:56] [Pages No:29-32][No of Hits : 1473]


ABSTRACT

Mankind has, throughout its existence, been engaged in the quest to control the pain associated with disease and trauma. Evidence from over 4500 years ago demonstrates the Egyptians use of methods to compress peripheral nerves. Homer’s Iliad relates the use of herbal remedies for pain control. Other early writings describe the use of electricity generated by the Torpedo ray for pain control as well as cold water and ice for pain reduction. These techniques, in their various incarnations, comprised the main armamentarium of local pain control until the early 1800’s when the early framework for the hypodermic syringe emerged in America. Cocaine, noted for its stimulant effect as well as numbing properties, was first brought to Europe by Vespucci. The combination of a workable syringe and the purification of Cocaine by Niemann essentially gave birth to modern local anesthesia. Halsted would perform the first injections of cocaine via hypodermic syringe into a proximal nerve for distal pain control, introducing modern conduction local anesthesia. All that remained was the introduction of numerous blockers of nerve depolarization, combined with vasoconstrictors, to minimize systemic toxicity, and we arrive at the modern state of local anesthesia.

Keywords: Local anesthesia, Nerve depolarization, Pain control, Vasoconstriction.

How to cite this article: Nathan J, Asadourian L, Erlich MA. A Brief History of Local Anesthesia. Int J Head Neck Surg 2016; 7(1):29-32.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Payam Sajedi, Narendra Shet

Imaging of Pediatric Neck Masses

[Year:2016] [Month:April-June] [Volumn:7 ] [Number:2] [Pages:91] [Pages No:89-96][No of Hits : 1376]


ABSTRACT

Pediatric neck masses comprise a wide spectrum of entities, benign and malignant. The role of imaging is to characterize these lesions, in order to better determine which can be expectantly managed and which require immediate intervention. An important consideration in the pediatric population is ionizing radiation; while X-ray and CT can be useful, radiation can have harmful effects, particularly in children. In this article, we review imaging feature of common pediatric neck masses, with emphasis on radiation sparing modalities (ultrasound and MRI) when possible.

Keywords: Computed tomography, Magnetic resonance imaging, Neck mass, Pediatric, Ultrasound.

How to cite this article: Sajedi P, Shet N. Imaging of Pediatric Neck Masses. Int J Head Neck Surg 2016;7(2):89-96.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Jessica W Scordino, Frederick J Stucker

Management of the Crooked Nose

[Year:2016] [Month:July-September] [Volumn:7 ] [Number:3] [Pages:42] [Pages No:168-172][No of Hits : 1305]


ABSTRACT

Aim: To describe an approach for the diagnosis and management of patients presenting with crooked nose.

Background: Patients with crooked nose suffer from functional ailments, most significant nasal obstruction, as well as esthetic concerns which may impact their self-image as well as others’ perception of them. As such, management of the crooked nose is an especially challenging task in that it demands careful attention to both nasal function and appearance. There are a plethora of surgical techniques which may be utilized, and the surgeon’s approach must be tailored to each individual patient’s presentation.

Technique: Accurate diagnosis is imperative for a successful outcome and relies on a thorough history and careful physical examination. Surgical intervention may be addressed by either an endonasal or open approach based on the location and severity of the deformity. It is helpful to break down the nose in vertical thirds when planning your surgical approach. Different techniques are used to address the upper third