To retrospectively review the outcomes of adjuvant postoperative radiotherapy (PORT) following surgery in patients with advanced hypopharyngeal cancer treated at an academic tertiary referral center.

Data of patients treated with curative intent in a single radiotherapy unit over a 15-year period (1990-2004) with upfront surgery followed by PORT was retrieved from an electronic database. Local control (LC), locoregional control (LRC) and disease-free survival (DFS) were considered as outcome measures.

The study dataset constituted 159 patients with a median age of 55 years (range 30-79 years). Patients underwent either radical surgery (total laryngectomy with or without pharyngectomy) or voice-conserving surgery. All patients underwent appropriate comprehensive neck dissection. The median radiotherapy dose was 60 Gy (inter-quartile range 50-60 Gy). With a mean follow-up of 21 months (inter-quartile range 6-29 months), the 3-year LC, LRC, and DFS was 87.8%, 70.3% and 62.2% respectively. Cut margin negativity and pyriform sinus subsite predicted for improved LRC and DFS on univariate analysis. Cut margin status was the only independent predictor of outcome on multivariate analysis.

Hypopharyngeal cancer characterized by advanced disease at presentation. Definitive surgery (either voice-conserving or radical) followed by adjuvant radiotherapy provides good LRC and DFS and continues to remain a valid upfront treatment option for advanced hypopharyngeal cancer. Cut margin status and primary subsite are important determinants of outcome.

Establishment and maintenance of safe access is crucial for long-term enteral nutrition in patients with head-neck and esophagogastric cancers. Tube enterostomies such as gastrostomy and jejunostomy are being increasingly used with wider use of chemoradiation and adjuvant therapy following surgery. This article reviews the currently available enteral access techniques by the open and percutaneous route and their indications, safety, effectiveness and role in modern oncological practice.

A lesser known reason of epidemic proportion of oral cancer in India is the rampant use of Areca nut chewing. Just like tobacco, areca nut or betel nut is a psychostimulant, an addictive substance and a carcinogen. The cancer causing properties of areca nut have been well-reported in animal, human and epidemiologic studies. The World Health Organization and International Agency for Research on cancer classified areca nut as a Group 1 human carcinogens with sufficient evidence of increased risk of submucus fibrosis (precancerous oral lesion) and cancers of the oral cavity, pharynx, and esophagus. This was based upon several studies from India, Bangladesh, Pakistan and Taiwan. Cancers caused by betel nut chewing also shows a strong dose–response relationship for frequency and duration of chewing. It is postulated that areca nut-specific N-nitroso compounds converted from alkaloids are responsible for oral and pharyngeal cancer. There are several other reports that have linked areca nut chewing (with or without tobacco) with hepatocellular carcinoma, cholangiocarcinoma, cancers of the larynx, stomach, lung and cervix in humans.

Rare case of intracapsular carcinoma ex pleomorphic adenoma in the buccal space with focus on its appropriate management.

Case report with review of current literature on buccal space lesions and intracapsular carcinoma ex pleomorphic adenoma.

Although salivary gland tumors are common, intracapsular carcinoma ex pleomorphic adenoma is a rare entity especially within the buccal space with no similar case report in the current literature.

Our case is unusual due to its unusual presentation in the buccal space and pathological features. This case report also highlights issues regarding its appropriate management.

We report a case of nonsyndromic type of multiple basal cell carcinoma associated purely with actinic keratoses. A 69-year-old Indian male had suffered from multiple, variable-sized papules and nodules on the face, neck and chest for 13 years previous to treatment. He had no history of arsenic intake, irradiation, herb medication, or exposure to chemical warfare gases. Family histories for basal cell carcinoma and xeroderma pigmentosum were negative. Classical features of Gorlin's syndrome were conspicuous by their absence. Histopathologically, the tumors revealed typical findings of basal cell carcinoma arising from actinic keratoses. The case in point is a very rare and unique case in itself as being nonsyndromic, nonhereditary and occurring in the absence of various other environmental conditions as already mentioned in literature.

Solitary fibrous tumors (SFT) rarely occur in the neck region and can be easily mistaken for more common tumors if the index of suspicion is not high. They are characterized by remarkable histologic variability. However, immunopositivity for CD34 and Bcl2 with immunonegativity for other markers aid in establishing the diagnosis. Distinction from the other common benign entities is essential, as SFT are tumors of low grade aggressiveness and unpredictable biologic behavior. Complete resection is the key feature determining outcome.

Osteoradionecrosis (ORN) of the mandible is a well acknowledged entity following radiotherapy for oral cancers. Mandibular surgery prior to radiotherapy adds an additional risk factor for osteoradionecrosis. Management of these cases poses various hurdles including added morbidity, additional cost for treatment of ORN and suboptimal dose delivery to the tumor bed. This case reports elaborates the issues related to mandibular surgery in patients requiring adjuvant radiotherapy, precautions to be taken and the management of ORN in a postsurgical setting.

Medulloepithelioma is rare intraocular tumor seen predominantly in children, and arising mainly from undifferentiated nonpigmented epithelium of the ciliary body.

We present a typical neglected case of malignant nonteratoid medulloepithelioma of the eye with extensive metastases to the facial soft tissue parotid and cervical lymph nodes.

An aggressive surgical approach with orbital exenteration and comprehensive disease clearance with total parotidectomy and neck dissection augmented by postoperative radiotherapy was utilized after initial unsuccessful chemotherapy.

The present case highlights the natural history of untreated medulloepithelioma of the eye. Colossal growth at the primary site with extensive regional lymph node metastases develops without distant metastases. Complete surgical excision supplemented with postoperative radiotherapy should be considered even in the setting of advanced locoregional disease.

Epidermal inclusion cyst is a relatively common condition usually associated with trauma, with characteristic presentation, and seen in the extremities. However, it is an uncommon entity in the head and neck region.

The purpose of this paper is to report the unusual presentation of epidermal inclusion cyst in the maxilla without any definitive history of trauma and to review the concerned English language literature.

In the absence of any definitive history of trauma, only a thorough clinical examination along with characteristic radiological imaging and histopathological findings will help in diagnosing epidermal inclusion cyst.

Carcinoma of the larynx is uncommon in children 15 years of age or younger. Because of low index of suspicion, the diagnosis of childhood laryngeal carcinoma is often delayed. Other factors contributing to its delayed diagnosis are the similarity of its early symptoms to those of other benign, common childhood conditions and the relative difficulty encountered during pediatric laryngeal examination. Treatment of pediatric laryngeal cancers is challenging, because no guidelines are available.

We believe that every single case of childhood laryngeal cancer should be reported, because of paucity of literature on this childhood entity, it is limited only to case reports and reviews. This makes treatment options and outcomes difficult to interpret.

We propose a simple clinical sign that is seen in certain patients with bulky nodal metastases. The fundamental basis of this sign is the direct infiltration of platysma by the nodal mass causing contracture of the muscle fibers of platysma called “Platysma sign”. The exact definition of this sign is “ puckering of the platysma and the overlying skin like an inverted Japanese fan”. This puckering always happens below the level of nodes and finishes at the level of the clavicle. This clinical sign can serve as an instant reminder to the clinician and avoid oversight of the skin/platysma infiltration. Assessment of the integrity of the neck skin overlying a large neck nodes must be undertaken while examining a head and neck cancer patient with bulky neck metastasis. Infiltration of platysma or the skin is an important finding in the staging and treatment of the neck disease.