International Journal of Head and Neck Surgery

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VOLUME 15 , ISSUE 1 ( January-March, 2024 ) > List of Articles

CASE REPORT

The Surgical Management of Oral Cancer in a Patient with Advanced Ankylosing Spondylitis: A Case Report

Harsha Kolgunda Nagappa Setty, Roshankumar Patil, Nikhil Patil, Bhagyashree Patil, Prashant E Moon

Keywords : Ankylosing spondylitis, Buccal mucosa, Case report, Cervical spine, Oral cancer, Surgical resection

Citation Information : Setty HK, Patil R, Patil N, Patil B, Moon PE. The Surgical Management of Oral Cancer in a Patient with Advanced Ankylosing Spondylitis: A Case Report. Int J Head Neck Surg 2024; 15 (1):21-28.

DOI: 10.5005/jp-journals-10001-1561

License: CC BY-NC 4.0

Published Online: 06-09-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Surgical management of oral cancer in a patient with severe comorbidities can pose many difficult challenges to the surgical team. A 48-year-old male patient who was suffering from long-standing, advanced ankylosing spondylitis (AS) presented with oral cancer. On evaluation, the tumor in the left buccal mucosa was found to be keratinizing squamous cell carcinoma of stage IVA [American Joint Committee on Cancer (AJCC)–tumor, node, metastasis (TNM) staging] and was planned for surgical resection. Due to AS, the patient's trunk and neck movements were severely restricted, along with trismus and restricted jaw movements. Surgical intervention under general anesthesia in such patients is associated with a substantial risk of spinal injury. The trismus and fixity of the neck rendered an exceedingly difficult surgical position for both the anesthesiologist and the head and neck surgeon. The anesthesiologist was successful in establishing a secured airway by performing awake bronchoscope-guided nasotracheal intubation. The neck of the patient had to be supported by pillows instead of a routine neck extension position used for neck dissections. Wide excision of the entire tumor with bite resection and left-sided modified neck dissection was conducted without any positional change of the neck. Reconstruction was conducted with the left anterolateral thigh flap. There were no surgery-related complications, and the healing of the surgical wounds was satisfactory. The patient was discharged from ward care after 8 days. The pathological staging was pT3N3b, and starting from the 5th week of postsurgery, the patient received adjuvant chemoradiation over 6 weeks. Despite many difficulties that were encountered during management, the patient was able to withstand and recover well. Ankylosing spondylitis (AS), as a comorbidity in head and neck cancer cases, can pose significant challenges to the surgical team. Although previous surgical experience and skills matter, good preoperative preparation and adapting the techniques to the needs of the patient will help in achieving surgical goals, prevent any complications, and ensure a good outcome for the patient.


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  1. Sieper J, Braun J, Rudwaleit M, et al. Ankylosing spondylitis: an overview. Ann Rheum Dis 2002;61(suppl 3):iii8–iii18. DOI: 10.1136/ard.61.suppl_3.iii8
  2. Leone A, Marino M, Dell'Atti C, et al. Spinal fractures in patients with ankylosing spondylitis. Rheumatol Int 2016;36(10):1335–1346. DOI: 10.1007/s00296-016-3524-1
  3. Moll JM, Haslock I, Macrae IF, et al. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, intestinal arthropathies, and Behçet's syndrome. Medicine (Baltimore) 1974;53(5):343–364. DOI: 10.1097/00005792-197409000-00002
  4. Schlosstein L, Terasaki PI, Bluestone R, et al. High association of an HL-A antigen, W27, with ankylosing spondylitis. N Engl J Med 1973;288(14):704–706. DOI: 10.1056/NEJM197304052881403
  5. Mielants H, Veys EM, Joos R, et al. HLA antigens in seronegative spondyloarthropathies. Reactive arthritis and arthritis in ankylosing spondylitis: relation to gut inflammation. J Rheumatol 1987;14(3):466–471. PMID: 3498033.
  6. Brophy S, Pavy S, Lewis P, et al. Inflammatory eye, skin, and bowel disease in spondyloarthritis: genetic, phenotypic, and environmental factors. J Rheumatol 2001;28(12):2667–2673. PMID: 11764216.
  7. Rudwaleit M, Siegert S, Yin Z, et al. Low T cell production of TNFα and IFNγ in ankylosing spondylitis: its relation to HLA-B27 and influence of the TNF-308 gene polymorphism. Ann Rheum Dis 2001;60(1):36–42. DOI: 10.1136/ard.60.1.36
  8. Francois RJ, Gardner DL, Degrave EJ, et al. Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis. systematic study of specimens from patients and control subjects. Arthritis Rheum 2000;43(9):2011–2024. DOI: 10.1002/1529-0131(200009)43:9<2011::AID-ANR12>3.0.CO;2-Y
  9. Lories RJ, Derese I, Luyten FP. Modulation of bone morphogenetic protein signaling inhibits the onset and progression of ankylosing enthesitis. J Clin Invest 2005;115(6):1571–159. DOI: 10.1172/JCI23738
  10. Zink A, Braun J, Listing J, et al. Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. J Rheumatol 2000;27(3):613–622. PMID: 10743798.
  11. Mau W, Zeidler H, Mau R, et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. results of a 10-year follow-up. J Rheumatol 1988;15(7):1109–1114. PMID: 3262757.
  12. Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007; 369(9570):1379–1390. DOI: 10.1016/S0140-6736(07)60635-7
  13. Oostveen J, Prevo R, den Boer J, et al. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 1999;26(9):1953–1958. PMID: 10493676.
  14. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023;82(1):19–34. DOI: 10.1136/ard-2022-223296
  15. Bron JL, de Vries MK, Snieders MN, et al. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 2009;28(8):883–892. DOI: 10.1007/s10067-009-1151-x
  16. Lautermann D, Braun J. Ankylosing spondylitis-cardiac manifestations. Clin Exp Rheumatol 2002;20(6 suppl 28):S11–S15. PMID: 12463440.
  17. Franks AL, Slansky JE. Multiple associations between a broad spectrum of autoimmune diseases, chronic inflammatory diseases, and cancer. Anticancer Res 2012;32(4):1119–1136. PMID: 22493341.
  18. Deng C, Li W, Fei Y, et al. Risk of malignancy in ankylosing spondylitis: a systematic review and meta-analysis. Sci Rep 2016;6(1):32063. DOI: 10.1038/srep32063
  19. Sun LM, Muo CH, Liang JA, et al. Increased risk of cancer for patients with ankylosing spondylitis: a nationwide population-based retrospective cohort study. Scandinavian J Rheumatol 2014;43(4):301–306. DOI: 10.3109/03009742.2013.863969
  20. Chan TM, Luo SF, Yu KH, et al. Risk of cancer in patients with ankylosing spondylitis: a nationwide cohort study in Taiwan. Scand J Rheumatol 2021;50(2):132–138. DOI: 10.1080/03009742.2020.1804612
  21. Kelty E, Raymond W, Inderjeeth C, et al. Cancer diagnosis and mortality in patients with ankylosing spondylitis: a Western Australian retrospective cohort study. Int J Rheum Dis 2021;24(2):216–222. DOI: 10.1111/1756-185X.14036
  22. Dave N, Sharma RK. Temporomandibular joint ankylosis in a case of ankylosing spondylitis–anaesthetic management. Indian J Anaesth 2004;48(1):54–56. https://journals.lww.com/ijaweb/abstract/2004/48010/temporomandibular_joint_ankylosis_in_a_case_of.10.aspx
  23. Ruof J, Stucki G. Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review. J Rheumatol 1999;26(4):966–970. PMID: 10229429.
  24. Raghuram S, Bikram R, Arun S, et al. Laparoscopic nephrectomy in a patient with ankylosing spondylitis: surgical and anesthetic challenges. J Laparoendosc Adv Surg Tech 2007;17(2):223–225. DOI: 10.1089/lap.2006.0027
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