Pub Date : 2021-01-01DOI: 10.4103/jhnps.jhnps_22_21
V. Manju, A. Babu, V. Krishnapriya, J. Chandrashekar
Context: Three-dimensional printing technologies have been used recently for patients with maxillofacial deformities who seek esthetic prosthesis. The aim of the present study was to assess the accuracy, surface texture, marginal adaptation, patient satisfaction, and ease of fabrication of silicone auricular prostheses fabricated by the rapid prototyping technology (RPT) when compared to the conventional method (CM). Materials and Methods: A pilot study was conducted on five patients who had partial auriculectomy defects. Ear prostheses fabricated by CM and RPT were compared. RPT include the fabrication of prostheses by the duplication of polymer model fabrication or by injecting silicone to mold obtained by Vacuum casting method (VCM). The prostheses were evaluated by 15 randomly allotted trained independent observers based on the Likert Scale. The patients performed a self-rating assessment followed by a report from the clinician and technician. Statistical Analysis: The scores for each of the dimension were analyzed using the ANOVA. The cost, time, and quantity of silicone material were expressed in means for three fabrication methods. Results: Prostheses fabricated by RPT yielded superior scores in terms of accuracy, texture, and marginal fit; the vacuum casted prostheses being more precise. The patient perspective was in favor of RPT though not significant statistically. Time for fabrication and number of patient visits were less for rapid prototyping methods than CM. Conclusion: The present study demonstrated the potential benefits of digital method in the fabrication of auricular prosthesis using RPT in the field of maxillofacial rehabilitation.
{"title":"Rapid prototyping technology for silicone auricular prosthesis fabrication: A pilot study","authors":"V. Manju, A. Babu, V. Krishnapriya, J. Chandrashekar","doi":"10.4103/jhnps.jhnps_22_21","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_22_21","url":null,"abstract":"Context: Three-dimensional printing technologies have been used recently for patients with maxillofacial deformities who seek esthetic prosthesis. The aim of the present study was to assess the accuracy, surface texture, marginal adaptation, patient satisfaction, and ease of fabrication of silicone auricular prostheses fabricated by the rapid prototyping technology (RPT) when compared to the conventional method (CM). Materials and Methods: A pilot study was conducted on five patients who had partial auriculectomy defects. Ear prostheses fabricated by CM and RPT were compared. RPT include the fabrication of prostheses by the duplication of polymer model fabrication or by injecting silicone to mold obtained by Vacuum casting method (VCM). The prostheses were evaluated by 15 randomly allotted trained independent observers based on the Likert Scale. The patients performed a self-rating assessment followed by a report from the clinician and technician. Statistical Analysis: The scores for each of the dimension were analyzed using the ANOVA. The cost, time, and quantity of silicone material were expressed in means for three fabrication methods. Results: Prostheses fabricated by RPT yielded superior scores in terms of accuracy, texture, and marginal fit; the vacuum casted prostheses being more precise. The patient perspective was in favor of RPT though not significant statistically. Time for fabrication and number of patient visits were less for rapid prototyping methods than CM. Conclusion: The present study demonstrated the potential benefits of digital method in the fabrication of auricular prosthesis using RPT in the field of maxillofacial rehabilitation.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46676341","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_42_20
J. Bakshi, A. Dash, N. Panda, A. Bal, D. Chatterjee, S. Patro
Basaloid squamous cell carcinoma (BSCC) of the head and neck is a distinctive variant of squamous cell carcinoma known for its basaloid appearance and aggressive behavior. Being a rare variant, clear evidence is lacking for the management and outcome of the lesion. In this observational study, we have tried to evaluate the clinical, radiological, and histopathological characteristics along with the management and treatment outcome of ten patients diagnosed with having BSCC of the head and neck who were diagnosed and treated at our hospital.
{"title":"Basaloid squamous cell carcinoma of the head and neck: Our experience","authors":"J. Bakshi, A. Dash, N. Panda, A. Bal, D. Chatterjee, S. Patro","doi":"10.4103/jhnps.jhnps_42_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_42_20","url":null,"abstract":"Basaloid squamous cell carcinoma (BSCC) of the head and neck is a distinctive variant of squamous cell carcinoma known for its basaloid appearance and aggressive behavior. Being a rare variant, clear evidence is lacking for the management and outcome of the lesion. In this observational study, we have tried to evaluate the clinical, radiological, and histopathological characteristics along with the management and treatment outcome of ten patients diagnosed with having BSCC of the head and neck who were diagnosed and treated at our hospital.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49315462","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_20_20
B. Varghese, K. Rajan
Squamous Cell Cancer (SCC) of the tongue is generally known for its overall aggressive behavior. However, there are subsets within this group of cancers that behave differently in its clinical presentation, course, and outcome, and the insights into this are being elucidated with more and more accuracy. It is intriguing to note that some of these cancers present with aggressive primary with the late appearance of lymph nodes, whereas others in the opposite end of the spectrum would show up with very small primary and massive nodes. Knowledge of these variations in presentation and its clinicopathological correlation is essential to plan treatment strategies. Presented here is a case of a 49 year male with no habits, who had a diagnosis of tongue cancer but defaulted treatment and reported after eight years. Surprisingly he had no significant progression of lesion giving room for curative treatment. Besides giving an insight into the unique tumor biology, a possible link to health planning, and economics from a public health perspective is discussed.
{"title":"Squamous Cell Carcinoma of the Tongue Remaining Indolent for 8-Years","authors":"B. Varghese, K. Rajan","doi":"10.4103/jhnps.jhnps_20_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_20_20","url":null,"abstract":"Squamous Cell Cancer (SCC) of the tongue is generally known for its overall aggressive behavior. However, there are subsets within this group of cancers that behave differently in its clinical presentation, course, and outcome, and the insights into this are being elucidated with more and more accuracy. It is intriguing to note that some of these cancers present with aggressive primary with the late appearance of lymph nodes, whereas others in the opposite end of the spectrum would show up with very small primary and massive nodes. Knowledge of these variations in presentation and its clinicopathological correlation is essential to plan treatment strategies. Presented here is a case of a 49 year male with no habits, who had a diagnosis of tongue cancer but defaulted treatment and reported after eight years. Surprisingly he had no significant progression of lesion giving room for curative treatment. Besides giving an insight into the unique tumor biology, a possible link to health planning, and economics from a public health perspective is discussed.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47771429","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_32_20
Mash Hamid, A. Jabir, A. Fathi, Arwa Mohieeldin, M. Hamid
Background: Maxillofacial trauma has the potential to cause disfigurement and loss of function. It can be fatal by causing severe bleeding or interference with the airway. Objectives: The objectives of this study were to assess the etiology, site, timing, age, and gender predilection of maxillofacial trauma in a sample of Sudanese patients. Materials and Methods: This was a prospective descriptive-analytical hospital-based study. The records of 96 trauma patients who attended Khartoum Dental Teaching Hospital from February to April 2017 were investigated for the following information: the etiology of the trauma, site of the fracture, time of the injury as well as the patients’ age and gender. Data were analyzed using the Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY USA). Results: During the study period, 96 patients with 204 fractures were treated. 82.3% of the patients were males. The age group between 13 and 23 years showed the highest rate of incidence of maxillofacial trauma. The most common cause of the trauma was assault (36.5%) in males and falls in females (47.1%). Dentoalveolar fractures were the most common site of fractures (25.6%) followed by condylar fractures (14%). The majority of the injuries (34.4%) took place during the day between 1 pm and 6 pm. Conclusions: Causes and patterns of maxillofacial trauma vary greatly from one region to another. This can remarkably aid in raising public awareness and establishing specific prevention and treatment programs.
{"title":"Pattern and Etiology of Maxillofacial Trauma among Sudanese Population","authors":"Mash Hamid, A. Jabir, A. Fathi, Arwa Mohieeldin, M. Hamid","doi":"10.4103/jhnps.jhnps_32_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_32_20","url":null,"abstract":"Background: Maxillofacial trauma has the potential to cause disfigurement and loss of function. It can be fatal by causing severe bleeding or interference with the airway. Objectives: The objectives of this study were to assess the etiology, site, timing, age, and gender predilection of maxillofacial trauma in a sample of Sudanese patients. Materials and Methods: This was a prospective descriptive-analytical hospital-based study. The records of 96 trauma patients who attended Khartoum Dental Teaching Hospital from February to April 2017 were investigated for the following information: the etiology of the trauma, site of the fracture, time of the injury as well as the patients’ age and gender. Data were analyzed using the Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY USA). Results: During the study period, 96 patients with 204 fractures were treated. 82.3% of the patients were males. The age group between 13 and 23 years showed the highest rate of incidence of maxillofacial trauma. The most common cause of the trauma was assault (36.5%) in males and falls in females (47.1%). Dentoalveolar fractures were the most common site of fractures (25.6%) followed by condylar fractures (14%). The majority of the injuries (34.4%) took place during the day between 1 pm and 6 pm. Conclusions: Causes and patterns of maxillofacial trauma vary greatly from one region to another. This can remarkably aid in raising public awareness and establishing specific prevention and treatment programs.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45310076","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_29_20
Vishal Gupta
Human papilloma virus (HPV) is now attributable to most of the oropharyngeal squamous cell cancers (OPSCCs) occurring in western world. The HPV-associated OPSCC effect younger, otherwise healthy population and is typically associated with better outcome. Traditional treatment strategies, while successful, are associated with significant long-term morbidity and poorer quality of life. This has led to various trials and investigations to de-escalate the treatment in this patient population while maintaining excellent outcome. The objective of this review is to discuss various de-escalation strategies and trials.
{"title":"De-escalation Strategies in Human Papilloma Virus-Positive Oropharyngeal Cancer","authors":"Vishal Gupta","doi":"10.4103/jhnps.jhnps_29_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_29_20","url":null,"abstract":"Human papilloma virus (HPV) is now attributable to most of the oropharyngeal squamous cell cancers (OPSCCs) occurring in western world. The HPV-associated OPSCC effect younger, otherwise healthy population and is typically associated with better outcome. Traditional treatment strategies, while successful, are associated with significant long-term morbidity and poorer quality of life. This has led to various trials and investigations to de-escalate the treatment in this patient population while maintaining excellent outcome. The objective of this review is to discuss various de-escalation strategies and trials.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47174758","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_40_20
R. Yadav, A. Malik, Rajni Prasad
Purpose: To evaluate the diagnostic accuracy of sonography including Doppler and sonoelastography in differentiation between reactive and metastatic cervical lymphadenopathy. Materials and Methods: A cross-sectional study was undertaken with 50 study participants after defined inclusion and exclusion criteria as per the study needs and imaging limitations. Sonographic and sonoelastographic examination was done by two examiners and diagnosis was reached in consensus. Sonographic features assessed were size, short/long axis ratio, presence or absence of echogenic hilum, intra-nodal necrosis including pattern of vascularity. With ultrasonoelastography, color-coded elastograms and strain ratio (SR) were evaluated. Then, the accuracy of individual sonographic and sonoelastographic parameters as well as combined sonographic and sonoelastographic evaluation were evaluated against histopathological examination diagnosis. Cutoff for all the combined evaluation was determined from the receiver operating characteristic curve. Results: Sensitivity of individual sonographic parameters ranged from 81% to 96.3%, whereas specificity was from 50% to 96.3%. Maximum accuracy of 94.3% was obtained with intra-nodal necrosis and echogenic hilum individually. Color-coded elastograms with pattern >3 suggesting metastatic showed sensitivity of 100% but specificity of 75%. Maximum accuracy was achieved by SR >1.99 with 96.3% sensitivity and 93.02% specificity. Combined ultrasonography evaluation had sensitivity of 70.4% and specificity of 87.5%, whereas combined sonographic plus elastographic evaluation increased sensitivity and specificity to 92.6% and 100%, respectively. Conclusion: Combined sonographic and sonoelastographic assessment is better than individual assessment; hence, elastographic findings complement sonographic assessment and further increases the diagnostic confidence.
{"title":"Role of sonoelastography beyond sonography for differentiation between reactive and metastatic lymphadenopathy","authors":"R. Yadav, A. Malik, Rajni Prasad","doi":"10.4103/jhnps.jhnps_40_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_40_20","url":null,"abstract":"Purpose: To evaluate the diagnostic accuracy of sonography including Doppler and sonoelastography in differentiation between reactive and metastatic cervical lymphadenopathy. Materials and Methods: A cross-sectional study was undertaken with 50 study participants after defined inclusion and exclusion criteria as per the study needs and imaging limitations. Sonographic and sonoelastographic examination was done by two examiners and diagnosis was reached in consensus. Sonographic features assessed were size, short/long axis ratio, presence or absence of echogenic hilum, intra-nodal necrosis including pattern of vascularity. With ultrasonoelastography, color-coded elastograms and strain ratio (SR) were evaluated. Then, the accuracy of individual sonographic and sonoelastographic parameters as well as combined sonographic and sonoelastographic evaluation were evaluated against histopathological examination diagnosis. Cutoff for all the combined evaluation was determined from the receiver operating characteristic curve. Results: Sensitivity of individual sonographic parameters ranged from 81% to 96.3%, whereas specificity was from 50% to 96.3%. Maximum accuracy of 94.3% was obtained with intra-nodal necrosis and echogenic hilum individually. Color-coded elastograms with pattern >3 suggesting metastatic showed sensitivity of 100% but specificity of 75%. Maximum accuracy was achieved by SR >1.99 with 96.3% sensitivity and 93.02% specificity. Combined ultrasonography evaluation had sensitivity of 70.4% and specificity of 87.5%, whereas combined sonographic plus elastographic evaluation increased sensitivity and specificity to 92.6% and 100%, respectively. Conclusion: Combined sonographic and sonoelastographic assessment is better than individual assessment; hence, elastographic findings complement sonographic assessment and further increases the diagnostic confidence.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41336316","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_45_20
A. Vedhapoodi, V. Mariappan, S. Narayanan, S. Siddique, Venugopal Kumar
Aim of the Study: The aim is to study the incidence and grade of Zuckerkandl’s tubercle (ZT) and the course of recurrent laryngeal nerve (RLN) with respect to the grade of ZT. Settings and Design: A prospective observational anatomical study. Materials and Methods: The relationship of ZT to RLN was studied, and the size of the ZT was measured and graded according to Pelizzo’s grading system in all cases of routine thyroidectomy in 36 patients (45 sides) from December 2018 to November 2019. Results: ZT was present in 32 (71.11%) of the sides, more commonly on the right side in 24 (88.89%) with a P value of 0.001. Among the total thyroidectomy, bilateral ZT was present in 7 cases (77.78%). In the 45 sides Grade 0 was noted in 13/45 (28.89%), Grade I 14/45 (31.11%), Grade II 9/45 (20%), and Grade III 9/45 (20%) with a P value of 0.001. ZT more than 0 but less than 1 cm was the most common occurrence (Grade I and II). In the 32 sides which had ZT, 23/32 (71.88%) were Type A (posterior) and 9/32 (28.12%) were type D (lateral) with a P value of 0.01. Conclusions: The identification and meticulous dissection of ZT ensures completeness of thyroidectomy. As the size of the ZT increases, the nerve often runs posterior and medial to surface of ZT. The site of ZT can be considered an eloquent area in thyroid surgery as it lies in proximity to the RLN and superior parathyroid gland.
{"title":"The incidence and grade of tubercle of zuckerkandl and its relationship to the course of recurrent laryngeal nerve in thyroid surgery","authors":"A. Vedhapoodi, V. Mariappan, S. Narayanan, S. Siddique, Venugopal Kumar","doi":"10.4103/jhnps.jhnps_45_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_45_20","url":null,"abstract":"Aim of the Study: The aim is to study the incidence and grade of Zuckerkandl’s tubercle (ZT) and the course of recurrent laryngeal nerve (RLN) with respect to the grade of ZT. Settings and Design: A prospective observational anatomical study. Materials and Methods: The relationship of ZT to RLN was studied, and the size of the ZT was measured and graded according to Pelizzo’s grading system in all cases of routine thyroidectomy in 36 patients (45 sides) from December 2018 to November 2019. Results: ZT was present in 32 (71.11%) of the sides, more commonly on the right side in 24 (88.89%) with a P value of 0.001. Among the total thyroidectomy, bilateral ZT was present in 7 cases (77.78%). In the 45 sides Grade 0 was noted in 13/45 (28.89%), Grade I 14/45 (31.11%), Grade II 9/45 (20%), and Grade III 9/45 (20%) with a P value of 0.001. ZT more than 0 but less than 1 cm was the most common occurrence (Grade I and II). In the 32 sides which had ZT, 23/32 (71.88%) were Type A (posterior) and 9/32 (28.12%) were type D (lateral) with a P value of 0.01. Conclusions: The identification and meticulous dissection of ZT ensures completeness of thyroidectomy. As the size of the ZT increases, the nerve often runs posterior and medial to surface of ZT. The site of ZT can be considered an eloquent area in thyroid surgery as it lies in proximity to the RLN and superior parathyroid gland.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43400642","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_30_20
K. Tae
Recently, many surgeons worldwide have adopted the transoral thyroidectomy approach owing to the associated advantages of less surgical morbidity, excellent cosmesis, and superior postoperative vocal outcomes. Specifically, transoral robotic thyroidectomy, in which a surgical robot is used, has been performed to hide or avoid visible neck scars and overcome the limitations associated with the endoscopic procedure. The transoral robotic thyroidectomy technique involves creation of three oral vestibular incisions and use of an additional axillary port, if indicated. Transoral robotic thyroidectomy is feasible and comparable to conventional transcervical thyroidectomy for highly selected patients. However, some unusual complications, such as CO2 embolism, mental nerve injury, surgical site infection, and skin burn and trauma, are noted. Appropriate patient selection is important for the safety and success of this surgery.
{"title":"Transoral Robotic Thyroid Surgery: Technical Considerations","authors":"K. Tae","doi":"10.4103/jhnps.jhnps_30_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_30_20","url":null,"abstract":"Recently, many surgeons worldwide have adopted the transoral thyroidectomy approach owing to the associated advantages of less surgical morbidity, excellent cosmesis, and superior postoperative vocal outcomes. Specifically, transoral robotic thyroidectomy, in which a surgical robot is used, has been performed to hide or avoid visible neck scars and overcome the limitations associated with the endoscopic procedure. The transoral robotic thyroidectomy technique involves creation of three oral vestibular incisions and use of an additional axillary port, if indicated. Transoral robotic thyroidectomy is feasible and comparable to conventional transcervical thyroidectomy for highly selected patients. However, some unusual complications, such as CO2 embolism, mental nerve injury, surgical site infection, and skin burn and trauma, are noted. Appropriate patient selection is important for the safety and success of this surgery.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42675778","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_41_20
M. Mohan, B. Naveen, S. Joseph, J. Tharayil
A late side effect of radiation for head and neck cancer that has a significant effect on quality of life is esophageal stricture. Many newer techniques of radiation have evolved, but esophageal stricture still remains a complication, especially in a concurrent chemoradiation setting. The treatment options in such conditions can be either invasive or noninvasive. We present a reconstructive option in the form of islanded facial artery myomucosal (iFAMM) flap which carries less donor site morbidity and also provides a mucosal lining. A patient with carcinoma hypopharynx reported with dysphagia following concurrent chemoradiation. The patient was evaluated clinically (video-laryngoscopy, esophago-gastro-duodenoscopy, and video-fluoroscopy) and radiologically and diagnosed as stricture cervical esophagus. The patient had undergone repeated noninvasive techniques of dilatation and failed. Stricture release and patch pharyngoplasty were done with iFAMM flap. Till the last follow-up of 1 year, the patient showed satisfactory deglutition with normal voice. iFAMM is a viable and esthetically appealing option for reconstruction of partial postradiation hypopharynx and cervical esophagus stricture of up to 6 cm in length that are not amenable to dilatation procedures.
{"title":"A myomucosal reconstruction solution to stricture postradiation cervical esophagus","authors":"M. Mohan, B. Naveen, S. Joseph, J. Tharayil","doi":"10.4103/jhnps.jhnps_41_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_41_20","url":null,"abstract":"A late side effect of radiation for head and neck cancer that has a significant effect on quality of life is esophageal stricture. Many newer techniques of radiation have evolved, but esophageal stricture still remains a complication, especially in a concurrent chemoradiation setting. The treatment options in such conditions can be either invasive or noninvasive. We present a reconstructive option in the form of islanded facial artery myomucosal (iFAMM) flap which carries less donor site morbidity and also provides a mucosal lining. A patient with carcinoma hypopharynx reported with dysphagia following concurrent chemoradiation. The patient was evaluated clinically (video-laryngoscopy, esophago-gastro-duodenoscopy, and video-fluoroscopy) and radiologically and diagnosed as stricture cervical esophagus. The patient had undergone repeated noninvasive techniques of dilatation and failed. Stricture release and patch pharyngoplasty were done with iFAMM flap. Till the last follow-up of 1 year, the patient showed satisfactory deglutition with normal voice. iFAMM is a viable and esthetically appealing option for reconstruction of partial postradiation hypopharynx and cervical esophagus stricture of up to 6 cm in length that are not amenable to dilatation procedures.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47385514","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 : 2020-07-01DOI: 10.4103/jhnps.jhnps_14_20
M. Abdulla
A 55-year-old man presented with high-grade fever, nasal obstruction, and erythematous skin rash for 1 week. He had hypertension for 5 years, uncontrolled diabetes mellitus for 6 years, and bronchial asthma for the past 8 years. He was diagnosed to have eosinophilic granulomatosis with polyangiitis (EGPA) based on the clinical, laboratory, and histopathological findings. He was treated with prednisolone 1 mg/kg which was tapered over months. He had immediate relief for his nasal obstruction following steroids. Fever and skin rash subsided later. We present a patient with acute nasal obstruction during the vasculitic phase of EGPA. Nasal manifestations are usually seen during the early phase along with asthma long before the onset of vasculitic phase. Invasive fungal infections of the paranasal sinuses which can have similar presentations also should be ruled out by histopathology in such patients, especially when they are at risk. Awareness regarding such rare acute presentations of an uncommon vasculitis can avoid diagnostic dilemmas.
{"title":"Eosinophilic Granulomatosis with Polyangiitis Presenting as Acute Nasal Obstruction","authors":"M. Abdulla","doi":"10.4103/jhnps.jhnps_14_20","DOIUrl":"https://doi.org/10.4103/jhnps.jhnps_14_20","url":null,"abstract":"A 55-year-old man presented with high-grade fever, nasal obstruction, and erythematous skin rash for 1 week. He had hypertension for 5 years, uncontrolled diabetes mellitus for 6 years, and bronchial asthma for the past 8 years. He was diagnosed to have eosinophilic granulomatosis with polyangiitis (EGPA) based on the clinical, laboratory, and histopathological findings. He was treated with prednisolone 1 mg/kg which was tapered over months. He had immediate relief for his nasal obstruction following steroids. Fever and skin rash subsided later. We present a patient with acute nasal obstruction during the vasculitic phase of EGPA. Nasal manifestations are usually seen during the early phase along with asthma long before the onset of vasculitic phase. Invasive fungal infections of the paranasal sinuses which can have similar presentations also should be ruled out by histopathology in such patients, especially when they are at risk. Awareness regarding such rare acute presentations of an uncommon vasculitis can avoid diagnostic dilemmas.","PeriodicalId":41774,"journal":{"name":"Journal of Head & Neck Physicians and Surgeons","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43322177","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}
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