Shunyu NB, Syiemlieh J. Prevalence of Head and Neck Cancer in the State of Meghalaya: Hospital-based Study. Int J Head and Neck Surg 2013;4(1):1-5.

Sinonasal cancers have variable biological behavior and outcomes. The physical proximity of several critical structures renders radiotherapy challenging for these cancers.

To report our early experience of helical tomotherapy (HT)-based image-guided intensity-modulated radiation therapy (IMRT) in midline sinonasal cancers.

Patients with midline sinonasal cancers were accrued on a prospective generic protocol of HT-based IMRT. HT plans were evaluated using standardized indices. All patients were followed up clinicoradiologically. Local control was defined as absence of failure (recurrence/ progression) in the tumor bed, whereas distant disease control was defined as absence of distant metastases. All time-to-event data was analyzed using Kaplan-Meier methods.

Ten patients with a median age of 42 years (range: 29-62 years) were included. HT was able to achieve excellent target volume coverage, good high-dose conformality with exquisite sparing of organs at risk. The acute toxicity of HT was generally mild and self-limiting. Seven patients experienced acute grade I-II ocular toxicity that responded to topical steroids, while one patient developed grade III conjunctivitis. The same patient later developed bilateral cataract necessitating extraction (late grade III ocular toxicity). No patient experienced dry-eye syndrome, corneal opacity or blindness. With a median follow-up of 27 months (interquartile range: 13-35 months), the 3-year Kaplan-Meier estimate of local progression-free survival, distant metastases-free survival, disease-free survival and overall survival was 59.3, 90, 53.3 and 90% respectively.

HT-based image-guided IMRT for midline sinonasal cancers achieves good high-dose conformality and is associated with mild, self-limiting acute ocular toxicity, minimal late morbidity with acceptable disease control.

Gupta T, Wadasadawala T, Phurailatpam R, Paul SN, Murthy V, Budrukkar A, Ghosh-Laskar S, Nair D, Pai P, Chaturvedi P, Agarwal JP. Early Clinical Outcomes in Midline Sinonasal Cancers treated with Helical Tomotherapy-based Image-guided Intensity-modulated Radiation Therapy. Int J Head and Neck Surg 2013;4(1): 6-12.

Tonsillectomy using local anesthesia (local tonsillectomy) is a safe and effective alternative to general anesthesia in the healthy cooperative teenage or adult patients. Blood loss, morbidity, complications and patient satisfaction were better in some studies with tonsillectomies done under general anesthesia.

Comparative case series analysis study of two groups of patients who underwent tonsillectomies under local and general anesthesia during the study period of 57 months from March 2007 to December 2011.

Overall 1,349 cases of tonsillectomies done for chronic tonsillitis were included under the study. Three hundred and sixty-seven cases operated under general anesthesia and 982 cases operated under local anesthesia were compared. The parameters compared were duration of surgery, blood loss and the mean pain visual analog score.

Significant difference in duration of surgery, blood loss during surgery and visual analog scale (VAS) pain scores were seen in the two groups with local anesthesia scoring over general anesthesia.

Tonsillectomy under local anesthesia is a good alternate for the procedure under general anesthesia with limited resources and in cooperative adults.

Naik SM, Naik SS, Ravishankara S, Appaji MK, Goutham MK, Devi NP, Mushannavar AS. Advantages of Tonsillectomy done under Local Anesthesia compared to General Anesthesia in Adults. Int J Head Neck Surg 2013;4(1):13-18.

To assess preoperative and postoperative shoulder function by electromyography (EMG) in spinal accessory nerve (SAN) sparing neck dissections in head and neck cancers.

A prospective study was done on 50 patients (51 shoulders) with histopathologically proven head and neck cancers with N0 or N1 neck who underwent nerve sparing neck dissections. Patients were assessed preoperatively and postoperatively at 3 weeks and 3 months by needle EMG and muscle strength tests of upper trapezius.

and interpretation: At 3 weeks postoperatively, 11 shoulders (39.3%) in FND group and four shoulders (33.3%) in modified radical neck dissection (MRND) group showed severely abnormal EMG, while in supraomohyoid neck dissection (SOHND) group only two (18.2%) shoulders showed severely abnormal EMG. All patients who underwent nerve sparing neck dissections showed improvement in at least one category on the second electromyogram at 3 months. This could be attributed to neuropraxia or transient devascularization of the accessory nerve. In our study, 11 patients in FND group showed severely abnormal EMG finding, but they did not have as great a degree of shoulder dysfunction as would be expected. This could be due to factors like preoperative condition of other synergistic shoulder girdle muscles, postoperative exercises, etc.

SAN injuries are common in all types of nerve sparing neck dissections requiring aggressive physiotherapy for an improved shoulder function. To conclude, in patients in whom it is oncologically sound, nerve sparing neck dissections offers significant benefit in terms of shoulder function.

Mohiyuddin A, Raj S, Merchant S, Oomen, Kottaram PJ. Electromyographic Assessment of Accessory Nerve Function Following Nerve Sparing Neck Dissection. Int J Head and Neck Surg 2013;4(1):19-23.

Acinic cell carcinoma (ACC) is a relatively rare and slowly growing tumor of the major salivary glands, usually arising from the parotid and rarely from the submandibular and sublingual salivary glands. ACC accounts for 3 to 4% of parotid tumors, 2 to 6% of all salivary gland tumors and 10 to 17% of all malignant salivary gland tumors.

A 40-year-old woman reported a slow growing mass in the oral cavity. The transoral aspiration biopsy was reported as pleomorphic adenoma arising from the minor salivary glands of the junctional zone of base of tongue. Rest of the neck examination was normal and magnetic resonance imaging (MRI) revealed the mass confined to the superficial layers of the tongue without invasion.

The tumor was resected transorally with adequate margins. The tumor histology was typical of ACC with the margins free and wide on all the sides. The patient was kept on monthly follow-up where palpable nodes developed during the course of 6 months. The neck was addressed with supraomohyoid dissection and followed up without irradiation.

ACC is a low-grade malignant salivary neoplasm rarely diagnosed in minor salivary glands of the oral cavity. The overall prognosis after surgical resection depends on the extent of lesion and the adequacy of the initial resection. Hence, keeping in mind the malignant potential of the disease careful long-term follow-up is advised.

Naik SM, Kudpaje A, Gupta S, Nanjundappa A, Halkud R, Prashanth V, Biswas S. Acinic Cell Carcinoma of the Minor Salivary Glands of the Tongue: A Case Study with Review of Literature. Int J Head and Neck Surg 2013; 4(1):24-28.

Head and neck cancer in India has distinct demographic profile, risks factors, food habits, and personal and family history. They are emerging as major public health problems in India, which are lifestyle related, have a lengthy latent period and need dedicated infrastructure and human resource for treatment. Need based and coordinated research for understanding the threats to the nation from chronic diseases such as head and neck cancers and ways to defy such threats will assume increasing importance.

Overall, 57.5% of global head and neck cancers occur in Asia especially in India. Head and neck cancers in India accounted for 30% of all cancers. In India, 60 to 80% of patients present with advanced disease as compared to 40% in developed countries. A slow decline in the incidence of most of head and neck cancers has been documented in India.

The problem of managing head and neck cancers in India is somewhat different, as compared to the west. The major shortcoming is to cope up, with the loss to follow-up, which makes the task of conducting and reporting the end results of clinical trials awfully difficult.

The highest priority for cancer control should be given to the burden of head and neck cancer in India. The emphasis should be on preventing the onset and detecting the disease at an early stage. In developing countries like India, implementing cancer control activities has to be prioritized, making optimal use of limited resources to deliver the utmost benefit to the largest number of people.

Kulkarni MR. Head and Neck Cancer Burden in India. Int J Head and Neck Surg 2013;4(1):29-35.

Ocular myiasis or ophthalmomyiasis means the infestation of the eye on a background of foul smelling skin infection or advanced case of skin cancers. Older people, immunocompromised patients with orbital carcinomas, diabetics and patients on immunosuppressive therapy, poor environmental sanitation and personal hygiene are prone for this infestation.

A 72-year-old female reported to us with extensive myiasis of the right eye. Lesion of 4 × 4 cm at the medial canthus and the right maxillary region with the right nasal dorsum was infested with maggots. All the larvae were removed with forceps and the wound debrided.

The larvae were present for a week and on healing the wound was evaluated with computed tomographic (CT) scan paranasal sinuses with axial and coronal section. As no bony erosion and intracranial extension was noted hence considering the age and diabetic status surgery was not contemplated and the lesion was irradiated.

Ocular myiasis is a rare disease, accompanied by marked inflammatory reactions and secondary bacterial infections with massive destruction and life-threatening consequences, such as intracranial invasion. Prompt management with debridement and radical antibacterial therapy is essential.

Naik SM, Nanjundappa A, Halkud R, Gupta S. Advanced Case of Invasive Basal Cell Carcinoma with Extensive Ocular Myiasis. Int J Head and Neck Surg 2013;4(1):36-40.

Abu-Ghanem S, Zilker V, Trejo L, Fliss DM. Classic Lipoma of the Palatine Tonsil: Case Report and Review of the Literature. Int J Head and Neck Surg 2013;4(1):41-43.

Pascual-Gallego M, Moreno-Gutierrez A, Gutierrez-Gonzalez R, Rodriguez-Boto G. Metastatic Nasopharyngeal Carcinoma Simulating a Schwannoma of the Vagus Nerve. Int J Head and Neck Surg 2013;4(1):44-46.

Manekar VS. Regional Grafts for Closure of Postsurgical Defect in Anterior Maxilla: Versatility of Chin Graft and Local Rotational Flap. Int J Head and Neck Surg 2013;4(1):47-50.

Khosa SK, Nayak CD, Vahanwala S, Pagare SS. An Ambiguous Growth in Floor of the Mouth. Int J Head and Neck Surg 2013;4(1):51-54.

Kumar S, Agarwal SP, Kumari M. Cysticercosis Neck: A Rare Presentation. Int J Head and Neck Surg 2013;4(1):55-56.

To describe an unusual presentation of myxoid liposarcoma of oropharynx and a brief review of literature.

Liposarcomas of head and neck are very rare. Its treatment and prognosis mainly depends on the site and the histologic pattern of the tumor.

The present case report describes a 65-year-old male with complaints of dysphagia, dyspnea, and a peculiar complaint of mass in the throat which turned out to be a low-grade myxoid liposarcoma arising from right lateral wall of oropharynx extending intraluminal in the esophagus, compressing posterior wall of trachea. The mass was successfully excised surgically and postoperative period was uneventful and patient was asymptomatic 4 months after surgery.

Myxoid liposarcoma is a rare tumor in head and neck and surgical excision with adequate margin is the treatment of choice.

Mohiyuddin A, Raj S, Merchant S, Arun P. Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx. Int J Head and Neck Surg 2013;4(1):57-58.

Tubachi JB, Balasubramanian K, Mewa J, Pradhan S. Management of Postoperative, High Output Salivary Fistulas in Head and Neck Surgeries. Int J Head and Neck Surg 2013;4(1):59-60.