To evaluate the effectiveness of transoral endoscopic laser surgery in the treatment of early laryngeal cancers in comparison to external radiotherapy.

Method: The patients included in the study were those who reported to the ENT department of a tertiary care hospital with early malignant lesions of the larynx.

Our study revealed a local recurrence rate of 15% in the radiotherapy arm but only 10% in the CO₂ laser arm; however, this difference was not statistically significant. The only parameter in the analysis of voice which showed a statistically significant difference between the two arms was roughness which was better in the radiotherapy arm at 6 months. The major complication following transoral CO₂ laser surgery was persistent hoarseness which was seen in six patients and it resolved completely on continuation of conservative measures. Severe laryngeal edema following treatment was seen in two patients. Statistically significant difference was noted in patient acceptability in favor of CO₂ laser.

Endoscopic CO₂ laser surgery in early laryngeal cancer leads to similar control of the disease as with the traditional methods, with better patient acceptability, low morbidity and good functional results.

The changes in lipid profile have long been associated with cancer because lipids play a key role in maintenance of cell integrity. Lipids are the major cell membrane components essential for various biological functions including cell growth and division of normal and malignant tissues. Lower blood lipids have been associated with the etiology of breast and colorectal cancer, and relation has also been reported between low cholesterol and increased risk of cancer occurrence and mortality.

The present study was designed to evaluate the serum lipid profile in patients with oral precancerous lesion/condition and squamous cell carcinoma to see whether there are any alterations in the lipid levels during the pathogenesis of these lesions and also to evaluate significance of lipid profile as biochemical marker, if any.

Pyriform sinus fistula belongs to the rarest group of cervical fistulae accounting for 3 to 10% of all branchial anomalies.¹ The first clinical and embryological studies were described in the early seventies by Sandborn and Tucker, but embryological knowledge in this field remains incomplete. Children and adults usually complaint of painful neck swelling accompanied by fever that is preceded by upper respiratory infection, otalgia and odynophagia. Neonates and infants may have respiratory distress, sometimes with stridor, due to tracheal compression by the abscess.^1,5,6 However, the most common mode of presentation is the recurrent episodes of acute thyroiditis. Eighty percent of patients with recurrent acute suppurative thyroiditis due to persistent pyriform sinus fistula present during the first decade of life. Making the distinction between third and fourth arch fistulas is difficult on clinical grounds alone and hence they are often collectively termed pyriform sinus fistula. Owing to the rarity of the condition and varied clinical presentation, diagnosis and ultimate management is often delayed leading to undue morbidity to the patient and professional frustration for the treating surgeon. We, hereby, present a case series of three classical cases of complete pyriform sinus fistulas with review of available literature in an attempt to clarify issues regarding presentation, diagnosis and management of this condition.

Given the high probability of cure, the aims of treatment are cure, laryngeal preservation and good voice quality while making effective use of available resources. In this study we analyze locoregional control (LRC) and survival following hypofractionated radiotherapy in early stage glottic squamous cell carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Center.

Between October 2003 and June 2009, 87 patients with early glottic squamous cell carcinoma were treated with hypofractionated radiotherapy. All patients were included in the study (M: 94%; F:6%). Median age was 60 years (range: 21-81 years). Sixty-six percent of patients were smokers. AJCC stage was T1 in 95% and T2 in 5% of the patients. Radiotherapy dose was 55 Gy in 20 fractions over 4 weeks. All patients were treated on cobalt-60. Median radiotherapy treatment time was 28 days (range: 23-35 days).

The LRC rate after primary radiotherapy at 5 years was 91% (95% CI: 88-94%). The 5 years overall and disease-specific survival was 86% (95% CI: 81 and 91%) and 97% (CI 95%: 95 and 99%) respectively. Patients with T1a and T1b disease had LRC rates of 95 and 88% (p = 0.32). The LRC rates for patients with and without anterior commissure involvement at 5 years were 80 and 96% (p = 0.02) respectively.

Hypofractionated radiotherapy 55 Gy in 20 fractions is comparable to conventional fractionation schedules in terms of locoregional control and survival while offering potential for optimizing resources usage.

To report a rare case of spindle cell sarcoma of submandibular salivary gland, with intraoral extension with pathological dilemma.

A 40-year-old male presented with swelling and pain in right submandibular area since 1 year. Right submandibular gland excision with intraoral mass excision was done with reconstruction of floor of mouth. Postoperative histopathology was suggestive of low-grade malignant tumor with differential diagnosis of acinic cell tumor, vascular tumor and myoepithelial tumor. The immunohistochemistry report revealed spindle cell sarcoma with high degree of vascularity. Based on this report postoperative radiotherapy was planned.

According to literature, spindle cell sarcoma of submandibular salivary gland has not been reported yet. This case is presented for its uniqueness of its site, extension and histopathological dilemma.

Tracheal cast formation postlaryngectomy is common in patients with dry, inspissated secretions, more so in dry weather, but is rarely large enough to cause significant respiratory distress. Our patient had significantly large tracheal casts to cause respiratory distress even with a widely patent tracheostoma.

We report a rare case of lateral skull base hamartoma. The diagnostic dilemma, the therapeutic challenge and the importance of interdisciplinary approach to decrease the morbidity has been discussed.

We report a rare case of a 48-year-old male with swelling over the left side of face and cheek for a duration of 12 years, who presented to us only for his cosmetic deformity and no functional impairment, after a thorough clinical examination and series of invasive and noninvasive investigations, was diagnosed to have a rare tumor hamartoma of skull base and face. A complete surgical excision without morbidity was made possible only by a multidisciplinary team approach. The investigation and surgical approach to reduce per operative morbidity has been discussed. Microscopic examination of the excised specimen with special staining techniques was conclusive for hamartoma. Patient has been on a regular follow-up for the last 2 years with no evidence of recurrence and functional compromise.

The rarity of the tumor, the difficulty in diagnosis, management and prognosis of hamartoma have been discussed.

Hamartoma of the infratemporal fossa is a rare tumor and those originating in this surgically challenging site are even rarer. Further their close proximity to vital structures in head and neck poses a formidable challenge in their diagnosis and surgical management to achieve a good cosmetic and functional result.

We present two cases of adenoid cystic carcinoma arising from the nasal septum. The first patient was previously untreated. The second patient had been operated outside with a presumed diagnosis of a benign lesion. We excised both the lesions with wide margins as is advisable for this histology. The histopathology examination in the first case showed adenoid cystic carcinoma with no high-risk features. In the second case, the histopathology revealed no residual malignancy. Adjuvant treatment was, therefore, not given to either patient. The postoperative appearance in both cases was good. They have been disease free on follow-up.

Sialolithiasis is the most common disease of salivary glands. Commonly, sialoliths measure from 5 to 10 mm in size and stones over 10 mm can be reported as sialoliths of unusual size. Giant sialoliths measuring more than 35 mm are extremely rare, with only around 17 cases published in the literature. We report an asymptomatic case of a sialolith in the submandibular duct measuring 62 × 20 mm and weighing 40 gm, highlighting the management aspects and also review the literature.

A vallecular cyst although rare but well-documented clinical entity. This case report presents a case of vallecular cyst in a 26-year-old male patient who presented to us with history of spontaneous onset hemoptysis for 9 days along with voice change and dysphagia for 15 days.

Plummer-Vinson syndrome also known as sideropenic dysphagia is a disease characterized by chronic iron-deficiency anemia, dysphagia and esophageal web. It commonly affects white female in the 4th to 7th decade. Most of the dysphagia and iron deficiency can be treated by iron supplementation and rarely web dilatation is needed.

Department of ENT, Head and Neck Surgery and Anesthesia, KVG Medical College, Sullia, Karnataka, India.

A 36-year-old female with dysphagia of 10 months and iron-deficiency anemia with a small upper esophageal web seen on upper GI endoscopy and barium swallow.

Conservative line of management with blood transfusion and dilatation of the web with cuffed endotracheal tube.

A good symptomatic and radiological improvement was seen after blood transfusion and web dilatation with cuffed endotracheal tube.

Cuffed endotracheal tube dilatation is a better way of managing upper esophageal webs with minimal complications under general anesthesia.

Ocular melanoma in the pediatric population is extremely rare, and the congenital variety is even rarer. We present a case of a 3-year-old female child presenting with a congenital ocular melanoma with no preexisting conditions, managed by surgical removal of the affected eye followed by postoperative radiotherapy. We also discuss the various features of the condition reviewing the literature.

Intramuscular hemangiomas are rare benign congenital neoplasms of vascular origin. They account for less than 1% of all hemangiomas and less than 20% of these are found in head and neck and present in 2nd and 3rd decade. The masseter is the most frequently involved site in the head and neck. Because of their infrequency, deep location and unfamiliar presentation, these lesions are seldom correctly diagnosed clinically and usually present as facial swelling causing facial asymmetry. A case of intramuscular hemangioma occurring in masseter muscle of an 8-year-old girl is presented here. Ultrasonography, color Doppler and Gd-enhanced MRI were performed and a presumptive diagnosis of hemangioma was considered which was subsequently confirmed by excision biopsy.