International Journal of Head and Neck Surgery

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2023 | January-March | Volume 14 | Issue 1

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Christopher de Souza

Electronic Cigarettes

[Year:2023] [Month:January-March] [Volume:14] [Number:1] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/ijhns-14-1-iv  |  Open Access | 



Suman Kharkwal, Sushanta Sarkar, Anbin TM Boban, Onkar Kaur, Anand K Verma

Clinical Profile and Management of Oral Cancer; Is Tobacco Ban the Need of the Hour? An ESIC Tertiary Care Hospital Experience

[Year:2023] [Month:January-March] [Volume:14] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Buccal mucosa, Demographic, Locally advanced, Oral cancer, Tobacco use

   DOI: 10.5005/jp-journals-10001-1545  |  Open Access |  How to cite  | 


Background: Oral cancer is the commonest cancer of males in India, and tobacco use is its most common modifiable risk factor. The study was conducted to provide the demographic profile and management outcomes of oral cancer in an exclusive labor-class population in an Employees, State Insurance Corporation (ESIC) Hospital, catering specifically to labor-class insured patients of low-income groups. Materials and methods: Data of patients presenting to the Surgical Oncology outpatient department (OPD), ESIC Basaidarapur, from the period January 2019 to May 2022 with cancer of the oral cavity were maintained prospectively in our computer database, and a retrospective analysis was done. Results: A total of 40 patients who presented in Surgical Oncology OPD with cancer of the oral cavity were included in the study. The most common age group affected was the 5th decade, and 52.4% of the patients belonged to the age group of 31–50 years of age. Gender preponderance stands at 5:1, in favor of males. Around 85.7% of the patients had a history of tobacco use. The most common subsite involved was the buccal mucosa (38.1%), followed by the tongue (26.2%), and lip (14.3%). About 76.2% of patients underwent upfront surgery, while 23.8% of patients received induction chemotherapy (ICT) before surgery. There were no postoperative (post-op) complications in 85.7% of the cases. Surgical site infection developed in 9.5% of the cases, while parotid fistula was seen in 4.5% of the cases. None of the cases showed submandibular gland involvement. The median lymph node harvest was 27 nodes. Lymphovascular invasion was seen in 46.1% of the cases. Perineural invasion was seen in 19.2% of the cases. Bone was involved in two out of the 40 cases (5%). As per the final histopathological examination (HPE) report, eight cases belonged to pT1 stage (20%), 17 cases to pT2 stage (42.5%), five cases to pT3 stage (12.5%), and five cases belonged to pT4 stage (12.5%). No residual tumor was found in three cases (7.5%). In 35% of cases, lymph nodes were found to be involved in the final HPE report. A positive margin was identified in only one out of the 40 cases. During follow-up, six out of the 40 cases presented with locoregional recurrence. Conclusion: Despite having a well-streamlined healthcare system for our insured patients, most presented with locally advanced stages, emphasizing the need for screening and awareness programs. Tobacco use was the single most modifiable risk factor in our study, highlighting the need for tobacco cessation programs and serious thinking for tobacco ban.



Shiv Kumar, Nishant Singh Gill, Resuciannie

Lemierre's Syndrome: A Retrospective Case Series

[Year:2023] [Month:January-March] [Volume:14] [Number:1] [Pages:3] [Pages No:6 - 8]

Keywords: Hematogenous spread, Internal jugular vein, Internal jugular vein thrombosis, Neck infection, Neck swelling, Septicemia, Tenderness, Thrombophlebitis

   DOI: 10.5005/jp-journals-10001-1543  |  Open Access |  How to cite  | 


Introduction: Lemierre's syndrome is a rare and less commonly occurring clinical condition that generally relates to the septic thrombophlebitis of the internal jugular vein. Common bacteria causing infection are Streptococci followed by Staphylococci and Klebsiella. The major proportion of cases that come to light are due to deep neck space infections that ultimately leads to thrombotic involvement of IJV, accounts for majority of the cases. The other causes include complications of chronic suppurative otitis media and thrombosis occurring in deep veins. Since the internal jugular vein is involved the infection can also undergo hematogenous spread. The infection generally spreads to spleen, liver, kidney, heart and brain. Lemierre's syndrome can be diagnosed on the basis of clinical symptoms, multitude of blood series and imaging. Since it is an infectious condition the treatment involves systemic antibiotic therapy and early administration of broad spectrum antibiotics in high dose become necessary for prevention of complications and systemic spread of infection. We are presenting a case series of 5 cases over a period of six years from November 2015 to November 2021. Materials and methods: This case series focused on the cases of Lemierre's syndrome that presented in the MBS Hospital, Kota over a course of 2 years from November 2019 to November 2021. The cases that were encountered were admitted, diagnosed and treated uneventfully. The investigations that the patients underwent were: blood cultures, chest skiagrams, contrast-enhanced computed tomography (CECT), skiagrams of mastoid bone, throat cultures and thorough clinical and ENT examination. Results: The observation and analysis of all the 5 recorded cases reveals that 2 cases of Lemierre's syndrome were having deep neck space infection as a causative factor in development of the disease and the other 2 cases were due to complications of chronic suppurative otitis media and the last remaining case had deep venous thrombosis as a causative factor for involvement of IJV and development of Lemierre's syndrome. Early administration of broad spectrum antibiotics is absolutely necessary on suspicion of Lemierre's syndrome so as to prevent adverse clinical outcome.



Sujata Sarkar, Ritesh Sharma, Roopesh R Yotham, Irfan Bashir, Nitin K Dumeer, Anshul Bhatnagar, Priyanka Sinha, Mohamed Sheedh

A Rare Case of Malignant Peripheral Nerve Sheath Tumor in Neck and Role of VMAT Radiotherapy

[Year:2023] [Month:January-March] [Volume:14] [Number:1] [Pages:4] [Pages No:9 - 12]

Keywords: Malignant peripheral nerve sheath tumor, Neck, NF-1, Sarcoma, Volumetric modulated arc technique radiotherapy

   DOI: 10.5005/jp-journals-10001-1544  |  Open Access |  How to cite  | 


Introduction: Malignant peripheral nerve sheath tumor (MPNST) is a rare variety of sarcoma. Its presentation is different from usual sarcomas in early presentation, aggressive behavior, high recurrence and poor prognosis. They are usually found in pelvis and extremities. Neck is an extremely rare site. About 50% cases are found in patients of nerofibromatosis type 1 (NF-1). In absence of NF-1 or any evidence of its association with nerve sheath or neurofibroma, visualization of ultrastructure features of Schwann cells in electron microscopy forms the basis of diagnosis, as S100 is weakly present in <50% cases. Case summary: Here, we are reporting a rare case of MPNST in right side of neck in a in a 36-year-old male with NF-1. Discussion: In literature, role of radiotherapy in MPNST has been described in general with other sarcomas. Our aim is to describe clinicopathological features and treatment with volumetric modulated arc technique (VMAT) radiotherapy in MPNST of neck.



H Shilpa, Amrita Suzanne Mathew

A Case of Temporal Bone Erosion: Our Diagnostic Dilemma

[Year:2023] [Month:January-March] [Volume:14] [Number:1] [Pages:3] [Pages No:13 - 15]

Keywords: Acquired cholesteatoma, Cholesterol granuloma, Temporal bone

   DOI: 10.5005/jp-journals-10001-1548  |  Open Access |  How to cite  | 


Background: Cholesteatoma is a sac containing keratin debris surrounded by keratinized squamous epithelium with bone-eroding properties. Secondary cholesteatoma is the commonest type of cholesteatoma. Middle ear cleft cholesterol granulomas (CG) usually present with middle ear effusion and features of diffuse mastoid disease. Hemorrhage, drainage obstruction, and impaired ventilation precipitate CG formation. The latter two factors also contribute to the pathogenesis of chronic otitis media (COM) and cholesteatoma, often leading to their coexistence. CGs are rarely aggressive and are encased by thick fibrous tissue with bone-eroding capabilities. However, differentiation of a cholesteatoma from a CG based on computerized tomography (CT) is difficult and necessitates magnetic resonance imaging. Case description: We report a rare case of a secondary cholesteatoma with a coexistent erosive tympanomastoid CG causing erosion of the basal turn of the cochlea but with an intact scutum, thereby presenting a diagnostic challenge. Conclusion: Evidence of bone erosion on a computerized tomogram in patients with COM does not indicate the mere presence of a cholesteatoma. A differential diagnosis which includes other erosive conditions such as glomus tympanicum, CG, etc., which can coexist with a cholesteatoma, should be considered and investigated accordingly in order to plan its surgical treatment.


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