Pub Date : 2023-01-01DOI: 10.4103/jhnps.jhnps_79_22
A. Yousuf, A. Shamim, Abdul Hannan, Kouser Sideeq, S. Qazi
Background: Thyroidectomy is the most commonly performed surgery worldwide for both benign and malignant lesions of thyroid. New surgical technologies have been introduced in thyroid surgery to achieve vessel sealing and hemostasis with an added advantage over conventional method. Aim: The primary aim of study was to compare the surgical outcome benefits of harmonic focus, LigaSure vessel sealer with conventional techniques of clamp and suture in thyroid surgeries. Objectives: The objectives of this study were to compare the three methods in terms of the overall time difference, the total blood loss in thyroid surgery, postoperative drainage output, and surgical complications. Methodology: The prospective study was conducted in Government Medical College, Anantnag, Kashmir, between 2020 June and May 2022, over a period of 2 years by the Department of ENT and HNS. A total of 84 patients who underwent thyroid surgeries (total/hemithyroidectomy) were divided into three groups: Group H (n = 28), Group L (n = 28), and Group C (n = 28). The patients were divided according to age, preoperative diagnosis (benign and malignant), and thyroid nodule size and stage of thyroid lesion to generate homogeneous groups. All cases were operated by the same surgeon to prevent surgical bias. Results: The three groups were homogeneous in terms of age, gender, clinical status, and pathology. In Group H and Group L, the mean operative time was 25–30 min shorter than Group C (P < 0.001). In Group H and Group L, the blood loss was significantly less as compared to Group C (P < 0.001). The comparison of pain score, postoperative drainage, complication rates as well as mean hospital stay was similar between the three groups (P = Statistically non significant). Conclusion: The use of surgical devices is as safe and effective for vessel dissection and hemostasis likewise conventional clamp suture technique. A significant reduction of the operative time and intraoperative blood loss was found with harmonic focus and LigaSure method compared to conventional method with comparable differences in postoperative complications, pain score, and drainage in all the three groups.
{"title":"Thyroid surgery outcome benefits with energy based devices over conventional technique: A comparative study","authors":"A. Yousuf, A. Shamim, Abdul Hannan, Kouser Sideeq, S. Qazi","doi":"10.4103/jhnps.jhnps_79_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_79_22","url":null,"abstract":"Background: Thyroidectomy is the most commonly performed surgery worldwide for both benign and malignant lesions of thyroid. New surgical technologies have been introduced in thyroid surgery to achieve vessel sealing and hemostasis with an added advantage over conventional method. Aim: The primary aim of study was to compare the surgical outcome benefits of harmonic focus, LigaSure vessel sealer with conventional techniques of clamp and suture in thyroid surgeries. Objectives: The objectives of this study were to compare the three methods in terms of the overall time difference, the total blood loss in thyroid surgery, postoperative drainage output, and surgical complications. Methodology: The prospective study was conducted in Government Medical College, Anantnag, Kashmir, between 2020 June and May 2022, over a period of 2 years by the Department of ENT and HNS. A total of 84 patients who underwent thyroid surgeries (total/hemithyroidectomy) were divided into three groups: Group H (n = 28), Group L (n = 28), and Group C (n = 28). The patients were divided according to age, preoperative diagnosis (benign and malignant), and thyroid nodule size and stage of thyroid lesion to generate homogeneous groups. All cases were operated by the same surgeon to prevent surgical bias. Results: The three groups were homogeneous in terms of age, gender, clinical status, and pathology. In Group H and Group L, the mean operative time was 25–30 min shorter than Group C (P < 0.001). In Group H and Group L, the blood loss was significantly less as compared to Group C (P < 0.001). The comparison of pain score, postoperative drainage, complication rates as well as mean hospital stay was similar between the three groups (P = Statistically non significant). Conclusion: The use of surgical devices is as safe and effective for vessel dissection and hemostasis likewise conventional clamp suture technique. A significant reduction of the operative time and intraoperative blood loss was found with harmonic focus and LigaSure method compared to conventional method with comparable differences in postoperative complications, pain score, and drainage in all the three groups.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48745102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/jhnps.jhnps_10_23
S. Rajan, Jacob Mathew, Pulak Tosh, Manu Sudevan
{"title":"Is awake videoscope-assisted bougie-guided intubation superior to fiberoptic intubation in patients with carcinoma larynx?","authors":"S. Rajan, Jacob Mathew, Pulak Tosh, Manu Sudevan","doi":"10.4103/jhnps.jhnps_10_23","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_10_23","url":null,"abstract":"","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44810231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_38_22
Shivani Sachdeva, Sanket Shinde, H. Saluja, V. Dehane
Background: Occlusion is dynamic and plays an important role in the functioning of the stomatognathic system. Disturbance in one of the components of the stomatognathic system may result in hypersensitivity of teeth, orofacial pain, migraine, and temporomandibular joint (TMJ) disorders. Coronoplasty performed using articulating paper is the conventional method for occlusal corrections. T-scan is a computerized occlusal analysis system that overcomes the limitations of articulating paper. Methods: Patients with Myofascial Pain Dysfunction Syndrome (MPDS) having dentinal hypersensitivity were taken into consideration. The joint vibratory analysis is performed using JVA device to rule out any TMJ disorders. T-scan-assisted coronoplasty is performed. The patient is asked to score for dentinal hypersensitivity on a visual analog scale pre- and postoperative. Results: Occlusion and disocclusion time are reduced along with hyperactivity of the muscles after T-scan-assisted coronoplasty. There is a reduction in dentinal hypersensitivity postoperative. Conclusion: T-scan quantifies the forces and hence proved a boon in the field of dentistry. The present case report highlights coronoplasty assisted with T-scan for diagnosis and treatment planning of hypersensitivity of teeth and hence it is the future of dentistry.
{"title":"Diagnostic tool in treatment planning of dentinal hypersensitivity: T-scan the unheeded newer dimension","authors":"Shivani Sachdeva, Sanket Shinde, H. Saluja, V. Dehane","doi":"10.4103/jhnps.jhnps_38_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_38_22","url":null,"abstract":"Background: Occlusion is dynamic and plays an important role in the functioning of the stomatognathic system. Disturbance in one of the components of the stomatognathic system may result in hypersensitivity of teeth, orofacial pain, migraine, and temporomandibular joint (TMJ) disorders. Coronoplasty performed using articulating paper is the conventional method for occlusal corrections. T-scan is a computerized occlusal analysis system that overcomes the limitations of articulating paper. Methods: Patients with Myofascial Pain Dysfunction Syndrome (MPDS) having dentinal hypersensitivity were taken into consideration. The joint vibratory analysis is performed using JVA device to rule out any TMJ disorders. T-scan-assisted coronoplasty is performed. The patient is asked to score for dentinal hypersensitivity on a visual analog scale pre- and postoperative. Results: Occlusion and disocclusion time are reduced along with hyperactivity of the muscles after T-scan-assisted coronoplasty. There is a reduction in dentinal hypersensitivity postoperative. Conclusion: T-scan quantifies the forces and hence proved a boon in the field of dentistry. The present case report highlights coronoplasty assisted with T-scan for diagnosis and treatment planning of hypersensitivity of teeth and hence it is the future of dentistry.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48560458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_60_22
R. Wani, S. Dar, N. Shah, I. Haq, Suraya Gani
Background: An association exists between obstructive sleep apnea (OSA) and bipolar disorder (BD). The prevalence of OSA in BD has significantly increased during the past two decades. We aimed to assess the prevalence of risk for OSA in BD. Materials and Methods: This was a hospital-based, cross-sectional, case–control study. Out of 218 participants enrolled in the study, 109 had BD and 109 were recruited for comparison in the control group. All the participants were asked to complete the Berlin Questionnaire, a self-assessment tool to establish the risk for OSA. Results: About two-thirds of the patients with BD were found to be at risk for OSA as compared to the 19.27% of prevalence in the control group. Patients of BD at high risk for OSA were males, had significantly higher body mass index (BMI), with comorbid physical illnesses, and in those who were on a combination of valproate and lithium in comparison to valproate alone. Conclusion: Patients with BD had significantly higher BMI in comparison to controls. In comparison to controls, significant higher percentage of patients with BD had higher risk for OSA in comparison to healthy controls. Our finding of over half of patients being in the high-risk range should be sufficient to sensitize clinicians and raise awareness concerning OSA in BD.
{"title":"Risk for obstructive sleep apnea in patients with bipolar disorder, prevalence from Kashmir","authors":"R. Wani, S. Dar, N. Shah, I. Haq, Suraya Gani","doi":"10.4103/jhnps.jhnps_60_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_60_22","url":null,"abstract":"Background: An association exists between obstructive sleep apnea (OSA) and bipolar disorder (BD). The prevalence of OSA in BD has significantly increased during the past two decades. We aimed to assess the prevalence of risk for OSA in BD. Materials and Methods: This was a hospital-based, cross-sectional, case–control study. Out of 218 participants enrolled in the study, 109 had BD and 109 were recruited for comparison in the control group. All the participants were asked to complete the Berlin Questionnaire, a self-assessment tool to establish the risk for OSA. Results: About two-thirds of the patients with BD were found to be at risk for OSA as compared to the 19.27% of prevalence in the control group. Patients of BD at high risk for OSA were males, had significantly higher body mass index (BMI), with comorbid physical illnesses, and in those who were on a combination of valproate and lithium in comparison to valproate alone. Conclusion: Patients with BD had significantly higher BMI in comparison to controls. In comparison to controls, significant higher percentage of patients with BD had higher risk for OSA in comparison to healthy controls. Our finding of over half of patients being in the high-risk range should be sufficient to sensitize clinicians and raise awareness concerning OSA in BD.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45058027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_81_22
Krishnakumar Thankappan
{"title":"Artificial intelligence and machine learning in head and neck oncology","authors":"Krishnakumar Thankappan","doi":"10.4103/jhnps.jhnps_81_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_81_22","url":null,"abstract":"","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44758615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_34_22
M. Shabani, H. Modir, F. Barsari
Purpose: The present evidence-based clinical study addressed the therapeutic effectiveness of lidocaine-remifentanil intravenous infusion versus gargle on attenuation of hemodynamic responses and prevention of sore throat and cough after endotracheal extubation. Materials and Methods: In a double-blind clinical trial whereby 76 cases receiving endotracheal intubation under general anesthesia were classified into two intervention groups being treated with lidocaine-remifentanil mixture administered by either intravenous infusion or gargle using balanced block randomization. Hemodynamic parameters including heart rate and blood pressure during surgery and in recovery every 15 min and respiratory symptoms such as cough, hoarseness, and sore throat during recovery and at certain postoperative time points of 2, 4, 8, 12, and 24 h were gathered. Pain score was measured by a Visual Analog Scale. Statistical analysis was conducted using the software SPSS v22 by Chi-square and independent t-test. Results: No statistically significant observed intergroup in terms of oxygen saturation, heart rate, mean blood pressure, need for analgesic medication, duration of surgery, and the incidence of cough and hoarseness (P > 0.05), but not in pain score in recovery and eight postoperative hours. While the intergroup difference was found at other times, the intravenous infusion group was associated with less pain score, compared to the gargling group (P > 0.05). Conclusion: A reduction in sore throat observed in subjects receiving an intravenous infusion compared to those receiving the gargling intervention during recovery and 8 h after surgery. We have convincing evidence to support the superiority of intravenous therapy comprising of lidocaine and remifentanil; however, larger sample size is needed to establish whether or not the interventions are effective.
{"title":"The comparative effect of lidocaine-remifentanil intravenous infusion and gargle on hemodynamic responses and sore throat and cough after endotracheal extubation: A randomized clinical trial","authors":"M. Shabani, H. Modir, F. Barsari","doi":"10.4103/jhnps.jhnps_34_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_34_22","url":null,"abstract":"Purpose: The present evidence-based clinical study addressed the therapeutic effectiveness of lidocaine-remifentanil intravenous infusion versus gargle on attenuation of hemodynamic responses and prevention of sore throat and cough after endotracheal extubation. Materials and Methods: In a double-blind clinical trial whereby 76 cases receiving endotracheal intubation under general anesthesia were classified into two intervention groups being treated with lidocaine-remifentanil mixture administered by either intravenous infusion or gargle using balanced block randomization. Hemodynamic parameters including heart rate and blood pressure during surgery and in recovery every 15 min and respiratory symptoms such as cough, hoarseness, and sore throat during recovery and at certain postoperative time points of 2, 4, 8, 12, and 24 h were gathered. Pain score was measured by a Visual Analog Scale. Statistical analysis was conducted using the software SPSS v22 by Chi-square and independent t-test. Results: No statistically significant observed intergroup in terms of oxygen saturation, heart rate, mean blood pressure, need for analgesic medication, duration of surgery, and the incidence of cough and hoarseness (P > 0.05), but not in pain score in recovery and eight postoperative hours. While the intergroup difference was found at other times, the intravenous infusion group was associated with less pain score, compared to the gargling group (P > 0.05). Conclusion: A reduction in sore throat observed in subjects receiving an intravenous infusion compared to those receiving the gargling intervention during recovery and 8 h after surgery. We have convincing evidence to support the superiority of intravenous therapy comprising of lidocaine and remifentanil; however, larger sample size is needed to establish whether or not the interventions are effective.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48837512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_74_22
J. Paul, S. Rajan, N. Sasikumar, L. Kumar
{"title":"Nasal spur causing permanent damage to intubating video bronchoscope","authors":"J. Paul, S. Rajan, N. Sasikumar, L. Kumar","doi":"10.4103/jhnps.jhnps_74_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_74_22","url":null,"abstract":"","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48123890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_57_22
Bindu K. Vasu, S. Rajan, N. Sasikumar, S. Babu, Manu Sudevan, J. Paul
Background and Aims: Hypothyroidism is common following treatment of head-and-neck malignancy. We aimed to assess the incidence of hypothyroidism in patients posted for operations with a history of radical neck surgeries with or without adjuvant chemoradiotherapy, their requirement of induction agents, hemodynamic changes, and recovery time following general anesthesia. Methods: This was a prospective, nonrandomized single-arm study conducted in 100 patients aged 18–85 years, who were posted for surgery under general anesthesia after 3 months of radical neck surgery with or without adjuvant therapy. All patients received a standardized general anesthesia protocol. Patients were grouped into those having either hypothyroidism or those in the euthyroid state. Results: Seventy-two percent of patients had varying degrees of hypothyroidism. There was significant reduction in heart rate (HR) and mean arterial pressure (MAP) from preinduction values at 1, 3, 5, and 10 min after intubation in patients with hypothyroidism. The reduction in both HR and MAP was significantly pronounced throughout postintubation period in the hypothyroid patients as compared to the patients with normal thyroid function. The mean induction dose of propofol was significantly lesser for hypothyroid patients compared with euthyroid (0.85 ± 0.17 mg/kg vs. 1.62 ± 2.52 mg/kg), with prolonged recovery time. The incidence of hypotension was significantly high among the hypothyroid patients. Conclusion: The incidence of hypothyroidism in patients after radical neck surgery with or without adjuvant chemo-radiotherapy is as high as 72%. These patients required less anesthetic agents for the induction of general anesthesia and developed profound hypotension after induction which persisted after intubation and had a prolonged recovery time.
背景与目的:甲状腺功能减退是头颈部恶性肿瘤治疗后的常见症状。我们的目的是评估有根治性颈部手术史的患者甲状腺功能减退的发生率，是否有辅助放化疗，他们对诱导剂的需求，血流动力学的变化，以及全身麻醉后的恢复时间。方法:这是一项前瞻性、非随机单臂研究，对100例年龄在18-85岁的患者进行了研究，这些患者在接受或不接受辅助治疗的根治性颈部手术3个月后，在全身麻醉下进行手术。所有患者均接受标准化全身麻醉方案。患者被分为甲状腺功能减退和甲状腺功能正常两组。结果:72%的患者有不同程度的甲状腺功能减退。甲状腺功能减退患者插管后1、3、5和10分钟的心率(HR)和平均动脉压(MAP)较诱导前显著降低。与甲状腺功能正常的患者相比，甲状腺功能减退患者的HR和MAP在整个插管后期间均显著降低。甲状腺功能减退患者异丙酚的平均诱导剂量(0.85±0.17 mg/kg vs. 1.62±2.52 mg/kg)明显低于正常甲状腺功能减退患者，且恢复时间延长。甲状腺功能减退患者低血压发生率明显增高。结论:根治性颈部手术后伴或不伴放化疗患者甲状腺功能减退的发生率高达72%。这些患者在全麻诱导时所需麻醉剂较少，诱导后出现深度低血压，插管后持续存在，恢复时间较长。
{"title":"The staggering hypothyroidism in head-and-neck cancer patients after combined multimodality treatment: Dealing with the anesthetic dilemma","authors":"Bindu K. Vasu, S. Rajan, N. Sasikumar, S. Babu, Manu Sudevan, J. Paul","doi":"10.4103/jhnps.jhnps_57_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_57_22","url":null,"abstract":"Background and Aims: Hypothyroidism is common following treatment of head-and-neck malignancy. We aimed to assess the incidence of hypothyroidism in patients posted for operations with a history of radical neck surgeries with or without adjuvant chemoradiotherapy, their requirement of induction agents, hemodynamic changes, and recovery time following general anesthesia. Methods: This was a prospective, nonrandomized single-arm study conducted in 100 patients aged 18–85 years, who were posted for surgery under general anesthesia after 3 months of radical neck surgery with or without adjuvant therapy. All patients received a standardized general anesthesia protocol. Patients were grouped into those having either hypothyroidism or those in the euthyroid state. Results: Seventy-two percent of patients had varying degrees of hypothyroidism. There was significant reduction in heart rate (HR) and mean arterial pressure (MAP) from preinduction values at 1, 3, 5, and 10 min after intubation in patients with hypothyroidism. The reduction in both HR and MAP was significantly pronounced throughout postintubation period in the hypothyroid patients as compared to the patients with normal thyroid function. The mean induction dose of propofol was significantly lesser for hypothyroid patients compared with euthyroid (0.85 ± 0.17 mg/kg vs. 1.62 ± 2.52 mg/kg), with prolonged recovery time. The incidence of hypotension was significantly high among the hypothyroid patients. Conclusion: The incidence of hypothyroidism in patients after radical neck surgery with or without adjuvant chemo-radiotherapy is as high as 72%. These patients required less anesthetic agents for the induction of general anesthesia and developed profound hypotension after induction which persisted after intubation and had a prolonged recovery time.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45007260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_46_22
A. Thaduri, A. Panuganti, D. Maharaj, Pallvi Kaul, K. Majumdar, S. Usmani, P. Garg
T4b oral cancers are considered unresectable tumors according to most of the standard treatment guidelines. However, from a head-and-neck surgeon's perspective number of factors has to be considered before labeling a T4b cancer as unresectable. This narrative review aims to emphasize various aspects of decision-making in treating a T4b oral cancer, in particular tumors involving infratemporal fossa (ITF). We conducted a literature search in PubMed for articles published between January 1990 and December 2021 using the following key terms: Oral cancer, advanced oral cancer, Head and Neck cancer, T4b oral cancer, ITF, and Compartment surgery. Then, some of these terms were used in combination for the search. Finally, a result was manually checked for relevant articles. A narrative review is presented from the surgeon's perspective in the management of T4b oral cancer.
{"title":"Approach to T4b oral cancers – A surgeon's perspective","authors":"A. Thaduri, A. Panuganti, D. Maharaj, Pallvi Kaul, K. Majumdar, S. Usmani, P. Garg","doi":"10.4103/jhnps.jhnps_46_22","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_46_22","url":null,"abstract":"T4b oral cancers are considered unresectable tumors according to most of the standard treatment guidelines. However, from a head-and-neck surgeon's perspective number of factors has to be considered before labeling a T4b cancer as unresectable. This narrative review aims to emphasize various aspects of decision-making in treating a T4b oral cancer, in particular tumors involving infratemporal fossa (ITF). We conducted a literature search in PubMed for articles published between January 1990 and December 2021 using the following key terms: Oral cancer, advanced oral cancer, Head and Neck cancer, T4b oral cancer, ITF, and Compartment surgery. Then, some of these terms were used in combination for the search. Finally, a result was manually checked for relevant articles. A narrative review is presented from the surgeon's perspective in the management of T4b oral cancer.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48782944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jhnps.jhnps_66_22
S. Gopal, S. Priyadharshini, V. Poongodi, B. Harsha Vardhan
Background: Oral cancer in India accounts for two-third of global incidence. Ninety percent are squamous cell type that are prone to neck lymph node metastasis. Computed tomography (CT) and magnetic resonance imaging (MRI) are common imaging methods used in our clinical practice for treatment planning, determine the prognosis and after treatment follow-up. Aim: The aim of this study was to assess the diagnostic efficacy of CT and MRI in detecting cervical lymph node metastasis among oral cancer patients in India using systematic review and meta-analysis. Methods: Literature search was conducted by manual search as well as in academic databases such as Scopus, PubMed, Medline, ScienceDirect, and Google Scholar from 2000 to 2021. Based on inclusion and exclusion criteria's, studies were analysed and tabulated. Qualitative assessment of included studies was done with QUADAS-2 which assessed the risk of bias. Further meta-analysis was done to know the efficacy of CT and MRI in identifying lymph node metastases. Results: A total of 14 studies including 516 participants were involved. With overall pooled sensitivity and specificity in the meta-analysis, CT showed a sensitivity of 92% and specificity of 70% and MRI had a sensitivity of 75% and specificity of 91%, which was identified in ROC curve in detecting the cervical lymph node metastasis. The diagnostic criteria for MRI and CT in identifying cervical lymph node metastasis includes key features like increases in size, round shape, structural changes, and extra nodal extension. Conclusion: CT has a good sensitivity and MRI has a good specificity, which are essential for selective neck dissection.
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