International Journal of Head and Neck Surgery

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2010 | May-August | Volume 1 | Issue 2

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Chris de Souza


[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijhns-1-2-v  |  Open Access |  How to cite  | 



Sonal Vahanwala, Sandeep Pagare

Strategies in Management of Oral Mucositis

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:7] [Pages No:61 - 67]

   DOI: 10.5005/jp-journals-10001-1012  |  Open Access |  How to cite  | 


Oral mucositis is a clinically important and sometimes dose-limiting complication of Cancer Therapy. Mucositis lesions are painful, affect nutrition, quality of life and often hampers continuity of the treatment modality. The pathogenesis of oral mucositis is multifactorial and complex. This is a review paper which discusses various aspects a clinician should know in management of mucositis.



Josena K Stephen, Kang Mei Chen, Veena Shah, Vanessa G Schweitzer, Glendon Gardner, Michael S Benninger, Maria J Worsham

Consistent DNA Hypermethylation Patterns in Laryngeal Papillomas

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:9] [Pages No:69 - 77]

   DOI: 10.5005/jp-journals-10001-1013  |  Open Access |  How to cite  | 



This study examined the contribution of promoter hypermethylation to the pathogenesis of respiratory papillomatosis (RP), including recurrences (RRP) and progression to squamous cell carcinoma (SSC).

Materials and methods

A retrospective cohort of 25 laryngeal papilloma cases included 21 RRP, two of which progressed to SCC. Aberrant methylation status was determined using the multigene (22 tumor suppressor genes) methylation-specific multiplex ligationdependent probe amplification assay and confirmed using methylation specific PCR.


Twenty genes had altered DNA methylation in 22 of 25 cases. Aberrant methylation of CDKN2B and TIMP3 was most frequent. Promoter hypermethylation of BRCA2, APC, CDKN2A and CDKN2B was detected in 2 RRP cases with subsequent progression to SCC. Of the 25 cases, 22 were positive for HPV-6, 2 for HPV-11 and 1 for HPV-16 and 33.


Consistent aberrant methylation of multiple tumor suppressor genes contributes to the pathogenesis of laryngeal papillomas. Persistent aberrant DNA methylation events in 2 RRP cases that progressed to cancer indicate an epigenetic monoclonal progression continuum to SCC.



Gady Har-El, Edward D McCoul, Krishnamurthi Sundaram

Predictors of Gastrostomy Placement and Dependence in Oropharyngeal Cancer Patients Treated with Chemoradiotherapy

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:7] [Pages No:79 - 85]

   DOI: 10.5005/jp-journals-10001-1014  |  Open Access |  How to cite  | 



Treatment of oropharyngeal cancer (OPC) with primary chemoradiotherapy (CRT) may necessitate placement of a gastrostomy tube (GT). We sought to identify factors that may predict GT placement and dependence.

Materials and methods

A retrospective review of 61 consecutive patients receiving primary CRT for OPC over a 10-year period at a tertiary referral center. Patients with prior head and neck malignancy, distant metastasis, incomplete treatment course, or inadequate follow-up were excluded. Forty-four patients were included for analysis.


Sixty-one percent of tumors were located in the tonsil and 62% were stage IV disease at presentation. Complete response to CRT occurred in 36 patients, among whom GT placement was more likely when weight loss occurred before the start of CRT than after CRT (p = 0.028). Continued GT dependence was more likely in patients with GT placement after the start of CRT (p = 0.019). Multivariate analysis showed significant associations of GT placement with post-treatment dysphagia and mucositis. Advanced tumor stage was a significant predictor of GT dependence.


Prophylactic GT placement may be advisable in patients receiving CRT for OPC who have pretreatment weight loss. Conversely, GT may be withheld from asymptomatic patients.



Anatoly F Romanchishen

Modifications of Thyroid Cancer Surgical Diagnosis and Treatment: 33 Years of Experience at Saint-Petersburg Center of Endocrine Surgery and Oncology

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:6] [Pages No:87 - 92]

   DOI: 10.5005/jp-journals-10001-1015  |  Open Access |  How to cite  | 


Objective identification of recurrences and application of radioactive iodine for the treatment of cancers of the thyroid have now been available in Russia over the last 10 years. This has improved results of the treatment of thyroid cancers. Central neck dissection has also been crucial in the treatment of cancer of the thyroid.



Prathamesh S Pai

Treatment Intensification in the ‘High-risk’ Individual

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:93 - 96]

   DOI: 10.5005/jp-journals-10001-1016  |  Open Access |  How to cite  | 


The high-risk individual merits treatment intensification. However, there are concerns with CERT. More supportive care is necessary as toxicity is higher. Treatment related death is a reality. Hence before we set out to prescribe concurrent chemoradiation we would need to stratify them according to the risk factors, their performance status and bear in mind the costs involved in intensive support during treatment.

Apart from chemoradiation we need to explore emerging treatment strategies such as fractionated radiation therapy, and targeted therapies such as epidermal growth factor receptor blockade which might offer better if not similar results but with lesser toxicity.



Prabha S Yadav, Quazi G Ahmad, Vinay K Shankhdhar, GI Nambi

A Simple Technique to Prevent External Jugular Vein Compression after Microanastomosis

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:2] [Pages No:97 - 98]

   DOI: 10.5005/jp-journals-10001-1017  |  Open Access |  How to cite  | 


External jugular vein (EJV) is one of the most commonly used veins for microanastomosis in head and reconstruction. Being in the subcutaneous plane, the EJV is prone for compression from both external and internal factors after mobilization for anastomosis. To prevent this, we describe a technique where a trench is created in the sternomastoid muscle in which the EJV is placed safely and prevented from compression.



Duncan F Hanby, Andrew McWhorter, Eric Wallace, Eugene A Woltering, Anthony Harton, Kerri B Santiago, Daniel W Nuss, Rohan R Walvekar

Nonsinonasal Neuroendocrine Carcinoma of the Head and Neck: Case Series and Review of Literature

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:99 - 102]

   DOI: 10.5005/jp-journals-10001-1018  |  Open Access |  How to cite  | 



To describe three patients with nonsinonasal neuroendocrine carcinoma (NSNEC) of the head and neck and present a systematic review of literature.

Study design

Retrospective chart review


Three patients with pathologically proven NSNEC of the head-neck who presented to our institution were identified. Relevant demographic, clinic-pathological, and radiological data was recorded. A web-based search was conducted to identify relevant scientific literature on “neuroendocrine carcinoma (NEC) of the head and neck” and a systematic review of literature is presented.


Two female and one male patient aged 44 to 66 years presented to our service with NEC of the supraglottis (2/3), and of the thymus (1/3). Diagnosis was confirmed with immunohistochemical staining such as Ki-67, synaptophysin, chromogranin, and also with octreotide scanning. The first case, a T4bN0M0 large cell NEC of the thymus with tracheal invasion received conservative airway management and emergent radiotherapy. The second case, moderately differentiated NEC of the supraglottis was managed with a laser supraglottic laryngectomy followed by adjuvant treatment. The third case, a laryngeal NEC was treated with chemoradiotherapy.


NSNEC of the head and neck are extremely rare tumors with variability in clinical presentation that present challenges in diagnosis and treatment planning. Consideration of the histological subtype and staining characteristics of the individual tumor, accurate diagnosis, and classification of the tumor is vital in order to tailor therapeutic intervention.



Dror M Allon, Shlomo Calderon, Ilana Kaplan

Intraosseous Compound-type Dermoid Cyst of the Jaw

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:103 - 106]

   DOI: 10.5005/jp-journals-10001-1019  |  Open Access |  How to cite  | 


Dermoid cysts within the maxillofacial skeleton are extremely rare, with only 13 cases in the literature. The present report describes a new long-standing intraosseous DC and reviews the literature.

A 69-year-old female presented with an expansile mandibular lesion, presenting a large radiolucency with the second and third molars impacted and displaced to the inferior mandibular border. Microscopic examination showed an intraosseous DC, lined by stratified keratinizing epithelium, with multiple aggregates of sebaceous cells and well formed sebaceous glands. Impaction of both second and third molars is an indication of initial development before the physiologic eruption time at approximately age 12. Thus, this presents an extremely longstanding intraosseous DC of at least 45 years duration. Analysis of the literature indicates that in comparison with the more common odontogenic keratocyst, intraosseous DC seems to have a very slow growth rate, and an indolent behavior.



Ilana Kaplan, Zoe Nicolaou-Ioannou

Nonresolving Osteomyelitis of the Maxilla and Maxillary Sinus after Long-term Use of Oral Bisphosphonates

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:107 - 110]

   DOI: 10.5005/jp-journals-10001-1020  |  Open Access |  How to cite  | 


Case history

A 64-year-old woman had been treated with oral BP since 1991 for arthritic pain and osteoporosis. There were no other medical problems, no other medications used, she did not smoke nor drink alcohol.

In 2005, the left maxillary molars had been extracted. The extraction site failed to heal, but she continued to use BP. Eighteen months later she presented with swelling and pain, suppuration and an area of 2 x 1 cm of exposed necrotic bone in the left posterior maxilla and oroantral fistula (OAF).

Panoramic radiograph showed partial opacification of the maxillary sinus, unhealed extraction site, and sclerosis of adjacent maxillary alveolus. Histopathological analysis diagnosed osteomyelitis associated with actinomycosis, consistent with BRONJ.


BP was discontinued, followed by 7 months of PO antibiotics and iodoform gauze packs. The wound seemed to be completely closed but within 2 months signs and symptoms and OAF recurred. Treatment continued with antibiotics daily rinses and weekly irrigation with Chlorhexidine 2%, and several repeated sequesterctomies, however, the patient still had pain. A course of 30 hyperbaric oxygen treatment was administered. Three years from onset symptoms improved, and sequstered bone is no longer visible. However, the OAF is still present, requiring irrigations, and the radiographs still present bony abnormality.

An unusually severe BRONJ of 3 years duration associated with 15 years oral BP use is presented.



PV Dhond, Mudit Mittal, Rajesh Yadav, Shashikant Mhashal, Nirav Mody, Pratima Markar

Glomus Tumor Nose in a 6 Years Old Girl: A Rare Presentation

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:2] [Pages No:111 - 112]

   DOI: 10.5005/jp-journals-10001-1021  |  Open Access |  How to cite  | 


Glomus tumors are relatively rare tumors of head and neck region. These tumors occur in infants and in the elderly, but usually occurs in 5th and 6th decades.1 Here we are reporting a rare case of glomus tumor presenting on the dorsum of nose of a six years old girl which was surgically removed successfully.



Arpit Sharma, Shawn T Joseph, Rahul C Gupta

Endoscopic Removal of Sharp Foreign Bodies in Neck Using Image Intensified Television

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:113 - 116]

   DOI: 10.5005/jp-journals-10001-1022  |  Open Access |  How to cite  | 


Foreign body impaction in the neck poses life-threatening problems when it is deep and close to vital structures. We report two cases of sharp metallic foreign body impaction in the neck – one of them in the prevertebral space and the other in the intervertebral disk space. A neck exploration and surgical removal of these foreign bodies, as is usually practised in most centers, would have been life-threatening and associated with high morbidity. We removed these foreign bodies using rigid endoscope under image intensified television (IITV) guidance. The patients could be discharged the same day. We suggest that endoscopic removal under IITV fluoroscopy system should be the method of choice in the removal of foreign bodies located in these sites. We also propose a classification of neck into vertical segments which would be useful in the management decision of these cases.



Arvind Krishnamurthy, KT Siddappa

Papillary Thyroid Carcinoma with Malignant Pleural Effusion: Dilemma of Etiology

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:3] [Pages No:117 - 119]

   DOI: 10.5005/jp-journals-10001-1023  |  Open Access |  How to cite  | 


Papillary carcinomas of thyroid generally have an indolent course with metastatic disease in less than 5% of patients. Common sites of distant metastasis include lung and bone. A presentation with malignant pleural effusion is exceedingly rare with only a handful of cases reported in literature. We present a case and discuss the treatment of a patient presenting of papillary thyroid cancer with a relapse of the disease in the pleural cavity. There are no standard treatment recommendations in this setting in view of paucity of published data from literature.



Baldev Singh, Prahlad Duggal, Ruchika Grover

Fibrous Dysplasia of the Temporal Bone

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:121 - 124]

   DOI: 10.5005/jp-journals-10001-1024  |  Open Access |  How to cite  | 


We report a case of monostotic fibrous dysplasia of temporal bone in a 15-year-old male which presented with mass in the temporomastoid region. There was no associated complaint and patient came only for cosmetic correction of the asymmetry of skull. Conductive hearing loss was an incidental finding on audiogram. Computed tomography showed increased bone thickness with ground glass appearance. Shaded surface display of the skull was used in assessing the external bony deformity. Patient was operated for contouring of the bone and canalplasty which improved the cosmetic appearance as well as corrected the hearing loss thereby avoiding an extensive surgery. Patient is under regular follow-up with good cosmetic and functional results. This case highlights the importance of conservative surgery and regular follow-up in selective cases of temporal bone fibrous dysplasia along with use of shaded surface display for planning the correction of external deformity.



Vikram Kulkarni, Vidisha Athanikar, Trupti Katti

Large Angioleiomyoma on the Face

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:3] [Pages No:125 - 127]

   DOI: 10.5005/jp-journals-10001-1025  |  Open Access |  How to cite  | 



To report a rare case of angioleiomyoma with regard to size, type (variant) and location.

Case report

45 years old male presented with painless swelling on the right side of the face since 2 years. On examination, the swelling was 4 cm × 3 cm in size, firm in consistency with well-defined margins. It was not adhering to overlying skin and underlying structures. The swelling was excised and sent for histopathological diagnosis. It was reported as solid variant of angioleiomyoma based on microscopic features.


According to the world literature, large angioleiomyoma on face is rare or not reported yet (usually less than 2 cm) and location (usually externar ear, tip of nose, lip). This case is presented for its uniqueness in size —large (4 cm x 3 cm); painlessness; variant; and location.



Arvind Krishnamurthy, KT Siddappa, Shirley Sundersingh, Satish Srinivas

Esophageal Metastasis from Carcinoma Thyroid

[Year:2010] [Month:May-August] [Volume:1] [Number:2] [Pages:3] [Pages No:129 - 131]

   DOI: 10.5005/jp-journals-10001-1026  |  Open Access |  How to cite  | 


The incidence of hematogenous spread at the time of presentation of well-differentiated thyroid carcinoma is the range of 4 to 15%. Distant metastases in the most common cause of death from well-differentiated thyroid cancers. About 5% of papillary carcinoma and 25% of follicular carcinoma develop distant metastases. Distant metastases occur largely in the lungs and to a lesser extent in the bones, brain and soft tissues. We report and discuss the management of an elderly gentleman with papillary carcinoma thyroid metastatic to the esophagus on follow-up. Only one similar published report is described which was from a follicular carcinoma thyroid. Our case of a papillary carcinoma thyroid metastatic to the esophagus seems to be the first if its kind.


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