Preliminary Analysis of CyberKnife Stereotactic Radiotherapy for Primary and Recurrent Head and Neck Cancers: A Delicate Balance
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:5] [Pages No:43 - 47]
Keywords: CyberKnife, Radiosurgery, Recurrent head and neck cancer, Survival
DOI: 10.5005/jp-journals-10001-1425 | Open Access | How to cite |
Introduction: This is a preliminary analysis of CyberKnife (CK) stereotactic body radiotherapy (SBRT) among the Indian head and neck cancer (HNC) population. Forty-one patients (27 recurrent and 14 primary) were selected and grouped into group I (re-irradiation = 26) and group II [recurrent RT naïve or CK boost after volumetric modulated arc therapy (VMAT)/intensity-modulated radiotherapy (IMRT) = 15]. Histological types included squamous cell carcinoma (38) and adenoid cystic carcinoma (3). Materials and methods: Univariate and multivariate analyses for disease-free survival (DFS) and overall survival (OS) were performed using disease group, median tumor volume, median tumor size, positron emission tomography (PET)-CT median SUVmax, and post-CK response category. Kaplan–Meier survival and Cox proportional ratios were used using SPSS version 19.0. Results: After a median follow-up of 25 months (range: 0–39 months), all patients combined the 2 years OS and DFS were 92 and 45%, respectively. The median OS and DFS were 25 and 10 months among the cohort. Group I had II years OS and DFS of 85 and 25%, respectively, whereas group II had 2 years OS and DFS 98 and 45%, respectively. Till the last follow-up, 33 patients were alive and 5 were lost to follow-up. Eight patients in group I and only one patient in group II had disease progression. Eleven patients in group I and 12 patients in group II had partial to complete response. The median tumor volume was 29.8 cm3 and was found to be a strong statistically significant factor for DFS in univariate (p = 0.007) analysis. Treatment was well tolerated with only three-grade IV toxicities. Conclusion: CyberKnife SBRT is an attractive option for both recurrent and primary HNC. A delicate balance needs to be maintained between disease control and major adverse events.
Clinical Outcomes in Partial Cricotracheal Resection and Anastomosis in Subglottic and Upper Tracheal Stenosis: A 10-year Institutional Study
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:48 - 50]
Keywords: Partial cricotracheal resection and anastomosis, Subglottic stenosis, Tracheal stenosis
DOI: 10.5005/jp-journals-10001-1416 | Open Access | How to cite |
Aim and objective: The study aimed to review the clinical and surgical outcomes of partial cricotracheal resection (PCTR) and anastomosis in the management of laryngotracheal stenosis (LTS). Materials and methods: The study used a retrospective analysis of adult patients managed in a University Hospital who underwent PCTR and anastomosis from 2007 to 2017. Results: During the 10 years, 53 patients were diagnosed with cricotracheal or tracheal stenosis. Prolonged orotracheal intubation and blunt trauma were the leading causes of upper LTS. The stenosis were classified as per Myer-Cotton classification. Thirty-seven were chosen for surgical intervention. Of the patients who underwent surgical intervention, PCTR was done in 33, resection and anastomosis in 3 and 1 underwent balloon dilatation. Tube displacement and surgical emphysema were the most common complication seen postoperatively. Ninety-seven percent of the patients who underwent surgery were successfully decannulated. Conclusion: Partial cricotracheal resection is an established surgical procedure with low morbidity and mortality. Risk factors for increased morbidity include diabetes mellitus (DM), lengthy resection, and children. Rib autograft was found to be ideal for reconstruction. Prompt observation and intervention of morbidity is the key to good clinical outcomes.
Comprehensive Evaluation of the Surgical OSAS: In Office and DISE
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:7] [Pages No:51 - 57]
Keywords: Drug-induced sleep endoscopy, Lingual tonsils, Obstructive sleep apnea, OSAS, Palate, Tongue, Tonsils
DOI: 10.5005/jp-journals-10001-1417 | Open Access | How to cite |
Obstructive sleep apnea is a multifactorial disease whose prevalence is increasing over the years. Due to different mechanism, the upper airway (UA) collapses during sleep. The ENT is the specialty that plays an important role in the exploration of the UA and also in the treatment of OSA, because the UA is our domain and in our hands is the ability to explore and to treat the disease. Nevertheless, the exploration of the UA in an obstructive sleep apnea syndrome (OSAS) patient is not the same as the exploration of other pathologies, one has to pay attention to small details that are not important in everyday exploration but in OSAS can change the treatment plan. In this article, the most important tips of the UA exploration awake and sleep will be discussed to provide a guide that can help the ENT to choose the best treatment for every patient.
Genomics Testing in Head and Neck Cancers: Is there a Benefit?
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:7] [Pages No:58 - 64]
Keywords: Actionable mutations, Cancer genomics, Head and neck cancers, Head and neck squamous cell carcinoma (HNSCC)
DOI: 10.5005/jp-journals-10001-1420 | Open Access | How to cite |
Introduction: Elucidation of the genomic basis of head and neck cancers (HNCs) may help in reducing cancer-related mortality and morbidity. This is because prognostication by predicting disease course and treatment response will help to individualize treatment protocols. Materials and methods: This prospective pilot study used a 48-gene mutation panel on tumor tissue samples obtained from 18 patients suffering from HNCs. The clinical significance of these mutations was analyzed in terms of treatment resistance, presence of distant metastasis, family history, and disease recurrence. Results: Two patients carried germline mutations, nine carried somatic mutations and seven samples had no mutation detected on the 48-gene panel. The genomic studies detected germline mutations in BRCA and AIP, and somatic mutations in TP53, phosphatase and tensin homolog (PTEN), RB1, STK11, GNA11, and HRAS. Conclusion: The study appears to validate early genomic testing of HNC cases to modify treatment protocols and offers more specific and personalized treatment options to patients. Clinical significance: The study demonstrates the potential benefit of integrating genomic data with clinical details to map out a tailored treatment plan to benefit individual patients.
Lhermitte–Duclos Disease: Case Report and Literature Review
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:6] [Pages No:65 - 70]
Keywords: Dysplastic gangliocytoma, Headache, Lhermitte–Duclos disease
DOI: 10.5005/jp-journals-10001-1424 | Open Access | How to cite |
Lhermitte–Duclos disease (LDD) is a neurological disorder caused by a hamartomatous lesion within the cerebellum. Clinically, LDD is often associated with symptoms of the space-occupying lesion due to increased intracranial pressure, hydrocephalus, and focal neurological deficit. This was a case of a 36-year-old woman who presented with progressive headache and difficulty in swallowing liquids. Magnetic resonance imaging demonstrated a right cerebellar mass lesion with the characteristic “tiger-striped appearance”. There was an inferior displacement of the right cerebellar tonsil. She underwent ventriculoperitoneal (VP) shunt and followed by partial resection of the tumor to decrease the mass effect. Her headache gradually improved and she was able to swallow liquids by the time of discharge.
Pathophysiology of Obstructive Sleep Apnea: The Role of Physiologic Phenotypes
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:71 - 73]
Keywords: Loop gain, Obstructive sleep apnea, Pharyngeal critical closing pressure, Phenotypes, Respiratory arousal responses, Sleep apnea, Upper airway control
DOI: 10.5005/jp-journals-10001-1428 | Open Access | How to cite |
Obstructive sleep apnea (OSA) is a common medical disorder of increasing interest in the medical community because of evidence that significant cardiovascular and neurocognitive defects occur when OSA is untreated or inadequately treated. Positive airway pressure (PAP) therapy remains the most effective and widely prescribed treatment for OSA. However, long-term adherence to PAP therapy has proven challenging. Alternative surgical and medical therapies are available, but an estimation of treatment efficacy based on clinical grounds has yielded inconsistent and largely disappointing results. The identification of a unique mechanism for OSA in a given clinical subject should prove useful in the selection of treatment alternatives to PAP. Until recently, personalizing treatment of OSA based on the determination of the mechanism of action was available only in experimental settings requiring invasive instrumentation. However, it is now possible to analyze clinical polysomnography data and identify the physiologic mechanism(s) or phenotype(s) of OSA in an individual case. The determination of physiologic phenotype offers the opportunity for personalized therapy. Additionally, physiologic phenotyping of OSA provides an opportunity to understand OSA mechanisms in specific subgroups, such as the elderly and the obese without OSA. In this manuscript, we introduce the reader to the concept and techniques of physiologic phenotyping of OSA and summarize the scientific data that physiologic phenotyping confers to understanding and treating OSA.
“Oh Granny, What Big Two Ears You've Got!” “All the Better to Hear You with, My Dear!” (Neuronal Circuit Recovery with a Cochlear Implant)
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:5] [Pages No:74 - 78]
Keywords: Binaural hearing, Cochlear implantation in unilateral deafness, Neuronal circuits in lateralization, Neuronal recovery with cochlear implantation, Sudden unilateral deafness and sound localization, Unilateral deafness in the blind, Unilateral hearing loss
DOI: 10.5005/jp-journals-10001-1407 | Open Access | How to cite |
Introduction: Having an auditory pattern of behavior based on two ears is essential for sound localization, quality of hearing, understanding in groups, and with ambient noise. Aims and objectives: Describe and discuss: (1) The consequences of unilateral deafness. (2) The gradual recovery of failing neuronal circuits when stimulated with a cochlear implant. (3) The case of a blind patient with sudden unilateral deafness who required cochlear implantation that is used as a common thread for the subject. Materials and methods: Forty-five-year-old blind woman with sudden unilateral deafness. With unilateral deafness, she could not localize the sound source in terms of side nor if the sound came from above/below, near/far, or from front/back. Her hearing in groups and with ambient noise deteriorated. As a result, she lost her autonomy and required and underwent cochlear implantation. Results: It took her 2 years to recover full sound localization, to be able to discriminate in groups, and to recover binaural fusion. Recovery was gradual. Her abilities to localize sound source in terms of side, of being near or far, or coming from above or below recovered separately, that is to say, at different periods of time. Conclusion: After losing functional neuronal circuits, early stimulation with a cochlear implant helped to fully recover these circuits. Neuronal circuits for sound localization for side, coming from above or below, near or far are seemingly different since they recovered at different times. Hearing with both ears is essential for sound localization, discrimination in groups and with ambient noise.
Return of Sounds at almost 100 Years of Age: Which will be the Limit?
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:4] [Pages No:79 - 82]
Keywords: Aging and hearing loss, Anesthesia for the elderly, Cochlear implants in the elderly, Oldest person with cochlear implant
DOI: 10.5005/jp-journals-10001-1408 | Open Access | How to cite |
Introduction: Cochlear implant (IC) is the standard treatment for profound deafness in children and adults. In the elderly, this indication is becoming more common every day. Aims and objectives: To describe the medical and the surgical approaches to be considered while operating a cochlear implant in an elderly patient. Materials and methods (clinical case): An approach to cochlear implants in the elderly is described, using as a common thread, the case of a 98-year and 9-month-old woman with severe bilateral gradually progressive sensorineural hearing loss who did not benefit from her hearing aids. She underwent comprehensive multispecialty medical evaluation including otolaryngology neurology, cardiology, and anesthesiology. She underwent cochlear implantation under local anesthesia and sedation. Results: No intra- or postoperative complications occurred. Recovery was quick and she was discharged on the second postoperative day. The device was activated at 1 month post-surgery and all electrodes were active. Free field thresholds for pure tones were 25 dB HL PTA 4 and discrimination in silence with IC in left ear and hearing aid in right ear for sentences were 76% and for familiar words 100%. Conclusion: Cochlear implantation resulted in an adequate alternative for this elderly patient, possibly the oldest or one of the oldest implanted individuals in the world. Cochlear implantation should be considered a reasonable alternative for elderly patients with profound hearing loss. The surgical decision should focus more on the general health conditions than on the chronological age.
Recurrent Laryngeal Hamartoma—An Unusual Cause of Apneic Spells: Case Report and Review of Literature
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:83 - 85]
Keywords: Apnea, Hamartoma, Supraglottic mass
DOI: 10.5005/jp-journals-10001-1415 | Open Access | How to cite |
Hamartomas are focal congenital malformations consisting of a focus of mature locally derived tissues with abnormal histological architecture. Laryngeal hamartomas are extremely rare with even <50 cases as well documented and reported in Indian literatures till now. Common symptoms associated with laryngeal hamartomas are stridor, dyspnea, hoarseness, and dysphagia. After endoscopic and radiological examination, excision of mass under video-endoscopic guidance remains the mainstay of treatment with a very good prognosis.
Reverse Marginal Mandibulectomy for Submandibular Gland Tumor
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:86 - 88]
Keywords: Conservative mandibular resection, Reverse marginal mandibulectomy, Segmental resection, Submandibular gland
DOI: 10.5005/jp-journals-10001-1426 | Open Access | How to cite |
Segmental resection of mandible was a preferred approach in oral cancers with proximity to the bone, for adequate resection margins and fear of local recurrence as it was thought to spread via the periosteal lymphatics. However, with a better understanding of oral cancer spread, mandibular preserving strategies are being practiced in which only a portion of the mandible is excised with preservation of bony continuity. This improves overall functional and cosmetic outcomes. Conservative mandibular resections including the classical rim, reverse, sagittal, and oblique types have been described in contemporary literature. We report reverse marginal mandibulectomy in a case of submandibular gland tumor and review the clinical and pathological basis of the selection of cases suitable for mandibular preservation strategy.
An Interesting Case of Hodgkin's Lymphoma Presenting as Salivary Gland Tumor
[Year:2021] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:89 - 91]
Keywords: Hodgkin's lymphoma, Neck mass, Non-Hodgkin's lymphoma, Submandibular tumor
DOI: 10.5005/jp-journals-10001-1421 | Open Access | How to cite |
A lump in the neck is a common problem presenting to clinicians. In most individuals, the new lump in the neck is noticed casually by the patient himself or by others. This lump without any associated symptoms may be the only indicator of underlying malignancy in the adult population. Here, we report one such case of a vague neck lump turning out to be lymphocyte-rich classical Hodgkin's lymphoma (HL). Lymphocyte-rich classical Hodgkin's lymphoma (LRCHL) is considered a rare subtype of HL having a relatively good prognosis.