International Journal of Head and Neck Surgery

Register      Login

Table of Content

2011 | January-April | Volume 2 | Issue 1

Total Views


Jatin P Shah


[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:1] [Pages No:0 - 0]

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



Naik Balachandra Ramachandra

Clinicopathological Study of Ameloblastomas: Case Study in Tribal Areas

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:1 - 4]

   DOI: 10.5005/jp-journals-10001-1039  |  Open Access |  How to cite  | 


During the period of 10 years, we have received 19 ameloblastoma specimens for opinion. The purpose of this report is that many studies on ameloblastoma were published from western countries, but not a single study from this region, which is an area of tribal people. Hence, this study is taken up to analyze for various parameters, and to compared with the western countries studies and also to inform the new and rare findings which is not yet published that is, the malignant ameloblastoma metastasis in soft tissue with intercellular bridges. Specimens were processed for macroscopic and microscopic analysis by routine methods. Majority of analysis were similar to the western countries studies. Malignant ameloblastoma metastasis in soft tissue gave us surprise. Ameloblastoma in tribal people did not have differences with western countries, but we got a new thing which enriches the behavior of malignant ameloblastoma.



Sudhir Naik, Sarika S Naik

An Overview of 22 Thyroglossal Cysts Managed in KVG Medical College

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:5] [Pages No:5 - 9]

   DOI: 10.5005/jp-journals-10001-1040  |  Open Access |  How to cite  | 



Successful treatment of a thyroglossal duct cyst requires surgical extirpation of the cyst with its tract through the tongue base. Incomplete removal results in cyst recurrence, which is the most significant common complications of surgery. The Sistrunk's procedure increases the chances of complete removal of all affected tissue.


KVG Medical College, Department of ENT, Head and Neck Surgery.


A total of 22 cases of thyroglossal cysts (primary and secondary) operated were included in our study.


Recurrence was seen in two out of the 22 cases operated after one year of follow-up, and all the recurrences were seen in the secondary cysts.


Sistrunk's operation is the treatment of choice for primary thyroglossal cysts. Secondary cysts should be treated with removal of core of tongue base muscle and foramen cecum mucosa along with hyoid and scarred cyst excision.



Anatoly F Romanchishen, OV Lisovsky, KV Vabalayte

Choice of the Optimal Volume of Surgery for Patients with Sporadic Medullary Thyroid Cancer

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:5] [Pages No:11 - 15]

   DOI: 10.5005/jp-journals-10001-1041  |  Open Access |  How to cite  | 



Influence of lymphatic metastases at immediate and follow-up results of patients’ surgical treatment is controversial, especially for sporadic medullary thyroid carcinoma (SMTC).


A total of 3330 thyroid cancer patients were operated on (1973-2009), among them 226 (6.8%) were medullary thyroid cancer (MTC) patients. In 11 observations, MTC appeared as a part of MEN syndrome. Sporadic character of disease was confirmed in 215 (95.1%) cases. There were 140 (80.8%) females and 33 (19.2%) males (4.2:1.0) with average age 48.6 ± 2.7. Long-term results (1-40 yrs) were investigated in 173 (94.2%) cases. All SMTC patients were divided in to three groups. Group 1 made of 80 (46.2%) T1- 3N0M0, Group 2 of 47 (27.3%) T1-3N1a-bM0, Group 3 of 46 (26.6%) T4N1a-bM0 patients.


Group1: Organ-sparing operations were carried out in 59 (73.7%), thyroidectomies in 21 (26.3%) patients. Multicentric tumor growth (MTG) was observed in 19.1%: in T1 cases - 5.7%, T2 - 20.5%, T3 - 46.7%. All patients underwent ipsilateral prophylactic central neck dissection (CND). Average period of postoperative observation (APPO), 12.0 ± 1.7. 5 years survival rate made 98.4%, 10-91.7%. Local relapse of MTC was found in one patient (in contralateral thyroid lobe).

Group 2: Organ-sparing operations were carried out in 20 (42.6%), thyroidectomies—27 (57.4%) with curative central or central and lateral lymphadenectomy (LAE). MTG took place in 47.2%. Six group metastases only (T1a) were found in 38.9% and CND was performed. In other cases (61.1%), CND, lateral and mediastinal (8.3%) LAE were performed. APPO correspondent to 10.8 + 2.1 years. Repeated LAE because lymphatic metastases were carry out in 15 (31.9%) patients through 7.2 ± 2.4 years in average after initial operations. Tumor relapses were not found in thyroid remnant. Five-year survival rate made 89.2%, 10-67.8%.

Group 3: MTG was observed in 64.3%. Central compartment group lymphatic metastases were revealed in 93.3%, in 2 to 5 groups – 86.7%, in mediastinum – 38.5%, distant metastases – in 22.0%. Combined operations were performed in 58.9%, palliative in 45 (26.6 %) cases. Operations were completed by tracheostomy in 38.4%. Adjuvant therapy (X-ray, chemotherapy) was applied in 28.9%. Postoperative lethality made 6.5%. APPO corresponded to 3.3 ± 0.8 (1-10 yrs). During first year, eight patients have died. Five-year survival rate made 32.4%.


Detection of regional metastases of SMTC during the first patient presentation significantly worsen survival rate. Early diagnosis of SMTC by calcitonin level detection is the best way to improve results of treatment. Organ-sparing thyroidectomies with mandatory ipsilateral prophylactics CND are justified only at T1N0M0 sporadic MTC.



Madhumati Singh, Anjan Shah, Shouvik Chowdhury

Versatile Grafts and Flaps in Reconstruction of Oral and Maxillofacial Postsurgical Defects

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:9] [Pages No:17 - 25]

   DOI: 10.5005/jp-journals-10001-1042  |  Open Access |  How to cite  | 


Ablative surgery for head and neck tumors is associated with significant disfigurement and loss of function. The main aim of the surgeon is to provide functional ability and esthetics of the patient. Type and extent of tissue loss from surgery relates to loss of soft tissue and bone. Reconstructions of jaw and mouth defects represent a challenge to the surgeon and are most commonly indicated in patients with oral squamous cell carcinoma.4 Primary closure and the restoration of form, cosmetics and function are the goals of reconstructive surgery. Various techniques have been practiced, including grafts, local flaps, regional flaps and free vascularized flaps even with diverse options, each one has its inherent advantages and shortcomings.

This article highlights our experiences with various reconstructive options, best possible reconstructive method to be followed to minimize morbidity of the patient.



SS Pagare, Sukhjinder Kaur Khosa


[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:6] [Pages No:27 - 32]

   DOI: 10.5005/jp-journals-10001-1043  |  Open Access |  How to cite  | 


Osteoradionecrosis (ORN) is a major complication of surgery or trauma in previously irradiated bone. This condition is often painful, debilitating and may result in significant bone loss. ORN of the mandible is the commonest site in patients who receive radiotherapy for head and neck cancer because of the relatively poor vascularization in this area. Risk factors include the total radiation dose, modality of treatment, fraction size and dose rate, oral hygiene, timing of tooth extractions as well as the continued use of tobacco and alcohol. Conversely, steroid use before or after radiation may have a protective effect related to the inhibition of the initial inflammatory phase of ORN. The management of this side effect is difficult and can result in bone or soft tissue loss, affecting the quality of life. The recommended treatment guidelines are irrigation, antibiotics, hyperbaric oxygen therapy and surgical techniques, including hemimandibulectomy and graft placements.



Sudhir V Nair

Epidermal Growth Factor Receptor and the Squamous Cell Carcinoma of the Head and Neck

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:33 - 36]

   DOI: 10.5005/jp-journals-10001-1044  |  Open Access |  How to cite  | 


Epidermal growth factor receptor (EGFR) is over expressed in 80 to 90% of squamous cell carcinomas of the head and neck (HNSCC) and plays a role in its pathogenesis and clinical course. Several EGFR-targeted therapies have therefore been developed and tried in clinical trials in the past decade resulting in the approval of cetuximab, an EGFR monoclonal antibody as a treatment agent for HNSCC by US FDA. Even though, EGFR monotherapy so far does not have a significant effect, cetuximab in combination with radiotherapy has enhanced the overall effect of radiotherapy in these patients without enhancing significantly the overall toxicity. Hence, understanding the mechanisms of resistance and exploring new combination treatments with EGFR targeting agents are important.



Tejpal Gupta, Rahul Krishnatry, Ankita A Nachankar, Jai Prakash Agarwal

Oral Radiation Mucositis: A Short Review

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:7] [Pages No:37 - 43]

   DOI: 10.5005/jp-journals-10001-1045  |  Open Access |  How to cite  | 


Oral radiation mucositis is one of the debilitating and dose-limiting acute toxicity during (chemo) radiation or for HNC having a major impact on the patient daily functioning, well-being and quality of life. The unplanned interruption of treatment secondary to mucositis may compromise the treatment and the outcomes if not adequately addressed. Recently, the integrated pathophysiological mechanism of radiation injury has been proposed, aiding development of certain targeted therapies for the prevention and treatment of oral mucositis. Although there are currently no approved agents or strategies that can reliably prevent or treat oral mucositis, there are several agents are under investigation and development. This is an exciting juncture in the development of drugs and drug delivery agents for radiation oral mucositis. This review is to have a peep into currently available options at present to optimally know when these agents can be used and what should be the direction of future research to maximize the therapeutic benefit.



PV Dhond, Rajesh Yadav, Mudit Mittal, Shashi Kant

Symptoms of Oral Submucosal Fibrosis: Our Experience with Intralesional Injection Treatment

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:45 - 48]

   DOI: 10.5005/jp-journals-10001-1046  |  Open Access |  How to cite  | 



This study evaluates the symptoms and effects of peroral intralesional injections in relieving the symptoms of oral submucosal fibrosis (OSMF) in our clinical settings.

Study design

Retrospective clinical review at a primary care hospital of 32 patients with extensive OSMF who underwent peroral intralesional injections of steroid, hyaluronidase, placentrex and lignocaine performed in office setting.


The main symptoms were change in color of buccal mucosa, trismus, burning mouth, vesicles in oral cavity. All patients experienced considerable improvement in their symptoms over a duration of 2 to 6 weeks.


Though, a large number of Indian population is suffering and seeking treatment for OSMF, unfortunately not much has been done in this area. It is difficult to find studies on peroral intralesional injection technique. When there is lack of reliable evidence of oral submucosal fibrosis treatment, the old technique of peroral intralesion shots of steroid, hyaluronidase, placentrex in lignocaine is safe and effective in resolving the symptoms associated with OSMF. The therapy is very cost effective and also reduces the need of surgery.



Rohan R Walvekar, Brad LeBert, Sean R Weiss, Jonas T Johnson

Retroauricular Hairline Approach for Excision of Second Branchial Cleft Cysts

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:49 - 52]

   DOI: 10.5005/jp-journals-10001-1047  |  Open Access |  How to cite  | 



To report our preliminary experience with a retroauricular hairline incision (RAHI) for excision of second branchial cleft cysts (SBCC) and to present a relevant literature review.

Study design

Retrospective case series.


A retrospective chart review was conducted of two consecutive patients diagnosed with SBCC who underwent surgical removal via a RAHI. Relevant demographic, clinicopathological and radiological data were recorded. A web-based search was conducted to identify relevant scientific literature on “retroauricular hairline incision/approach” in order to present a systematic review of current literature.


In both cases, the SBCC (6.0 and 3.8 cm) could be safely excised without major complications. One patient developed a temporary hypoesthesia of earlobe. None of the patients had a postoperative infection, hematoma, spillage of cyst fluid or necrosis of the skin flap. All patients were satisfied with the cosmetic outcome of the procedure (100%). The incisions healed well without any evidence of hair loss or keloid formation.


In conclusion, the RAHI offers an excellent surgical outcome and superior cosmetic result with no proven increased risks to the patients who require surgical excision of a benign SBCC.



Vijay Palwe, Kaustav Talpatra, Umesh Mahantshetty, Seethalaxmi Viswanathan

Metastatic Implantation of Head and Neck Squamous Cell Cancer at PEG Tube Site Exit— An Unusual Relapse Site: A Case Report and Review of Literature

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:53 - 56]

   DOI: 10.5005/jp-journals-10001-1048  |  Open Access |  How to cite  | 



The placement of percutaneous endoscopic gastrostomy (PEG) tubes is a common procedure in patients with head and neck cancer who require adequate nutrition because of the inability to swallow before or after surgery and adjuvant therapies. A potential complication of percutaneous endoscopic gastrostomy tubes is the metastatic spread from the original head and neck tumor to the gastrostomy site.


This is a case of a 55-year-old male with a (cT4N3M0) stage IV squamous cell carcinoma of the oropharynx who underwent percutaneous endoscopic gastrostomy tube placement prior to commencement of definitive chemoradiation therapy and 7 months thereafter developed metastatic spread to the gastrostomy site. Tumor was treated with radiation therapy. A review of the published literature regarding the subject is done. The pull-through method of gastrostomy tube placement had been used in our patient as well as in the majority of the other cases reviewed in the literature.


There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. The direct implantation of tumor through instrumentation is the most likely explanation for metastasis; however, hematogenous seeding is also a possibility. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk.



Siddharth Gupta, C Anand Kumar, Namita Raghav

Polymorphous Low-grade Adenocarcinoma of the Palate: Report of a Case and Review of Literature

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:57 - 60]

   DOI: 10.5005/jp-journals-10001-1049  |  Open Access |  How to cite  | 


Polymorphous low-grade adenocarcinoma (PLGA) is a malignancy arising predominantly from minor salivary glands. PLGAs account for 10% of all tumors and 25% of all malignancies of the minor salivary glands. It has been frequently described as occurring in hard or soft palate minor salivary glands; some cases being described in the tongue and in major salivary glands. We report a case of PLGA of the palate extending into the maxillary sinus and nasal cavity diagnosed on the basis of histopathology and treated by subtotal maxillectomy. The review of literature concerning clinical, histological and immunohistochemical features, as well as the proper management concerning this tumor is included.



Ashutosh Chauhan, NC Chakarborty, Pramod Nath, Manomoy Ganguly

Primary Small Cell Carcinoma of Nasal Cavity Presenting as Unilateral Blindness

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:61 - 63]

   DOI: 10.5005/jp-journals-10001-1050  |  Open Access |  How to cite  | 


Primary sinonasal small cell carcinomas are extremely rare lesions. We present a case of 29-year-old male patient, who initially presented with recurrent right sided nasal obstruction and occasional epistaxis, but came to medical attention when he developed progressive deterioration of vision in ipsilateral eye. Radiological examination showed a tumor with epicenter in right nasal cavity with extensive local infiltration. The histopathology picture and immunohistochemistry profile of the tumor showed it to be a primary small cell neuroendocrine tumor. Extensive imaging studies revealed no other site of primary. He was treated with induction chemotherapy followed by concomitant chemoradiotherapy. Complete clinical response was seen and the patient has been disease free since last 20 months. The report discusses the diagnostic criteria which differentiates this extremely rare but aggressive tumor from a much more common and more indolent tumor, esthesioneuroblastoma.



Rao Vishal, Purushottam Chavan, KS Raghavendra, M Ashok Shenoy

Vocal Cord Paralysis Following Percutaneous Embolization of a Vagal Paraganglioma

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:2] [Pages No:65 - 66]

   DOI: 10.5005/jp-journals-10001-1051  |  Open Access |  How to cite  | 


Tumors of the head and neck region that frequently require embolization include meningiomas, paragangliomas and angiofibromas, owing to their rich vascularity. Serious complications following embolization are uncommon. We report an unusual case of vocal cord palsy following embolization.



Muttagi Sidramesh, Pankaj Chaturvedi

Spontaneous Small Bowel Perforations in Patients Receiving Radiotherapy or Chemotherapy for Advanced Head and Neck Cancer

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:2] [Pages No:67 - 68]

   DOI: 10.5005/jp-journals-10001-1052  |  Open Access |  How to cite  | 


Gastroduodenal perforations are known to occur due to various causes. However, such problems involving small bowel and manifesting spontaneously, especially in a head and neck cancer patient, undergoing chemoradiation has never been described in the literature. We report three cases of head and neck cancer that were undergoing treatment (one case curative and two cases palliative), during which small bowel perforation manifested requiring urgent surgical intervention. We seek to highlight this problem, so as to ascertain the possible mechanisms of its causation, identify a group of patients at risk, evolve possible preventive strategies and facilitate earlier diagnosis and treatment.



HP Singh, Sunil Kumar, Ambrish Kumar, SP Agarwal

Branchial Cyst: An Unusual Presentation as Intrathoracic Extension and Hoarseness of Voice

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:69 - 71]

   DOI: 10.5005/jp-journals-10001-1053  |  Open Access |  How to cite  | 


Branchial cleft cysts usually present as a unilateral, fluctuant soft tissue swelling that is localized deep to the anterior border of sternocleidomastoid in the lateral aspect of the neck. They are often noticed late in childhood or early adulthood. It is important that clinical diagnosis and, in some cases, appropriate imaging is performed, so that definitive treatment may be carried out. The authors present an unusual case of a 35-year-old man who presented with hoarseness of voice associated with a lateral neck mass that extended retrosternally.



GA Raviraj, Thomas Rony, GA Dhanraj, Vishal US Rao

Pediatric Infraorbital Nerve Schwannoma: A Rare Clinical Entity

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:73 - 75]

   DOI: 10.5005/jp-journals-10001-1054  |  Open Access |  How to cite  | 


This report elaborates a rare case of infraorbital nerve Schwannoma in an 8-year-old boy who presented with the recurrent progressively increasing swelling over the right cheek following initial treatment. The mass was excised surgically via a facial approach. Infraorbital nerve sheath tumors occurring in the pediatric age are rare and can be often mistaken for infectious causes in this age group. Surgery remains the mainstay of treatment in these tumors. Early diagnosis and prompt surgical treatment can serve to minimize the treatment related morbidity arising from multiple interventions while avoiding undue apprehension. Pediatric infraorbital schwannomas, although a rare entity, should be considered in the differential diagnosis of long standing pediatric facial swellings.


© Jaypee Brothers Medical Publishers (P) LTD.