To identify whether the combination of Methoxyisobutylisonitrile (MIBI) and ultrasound scan (USS) in localizing the parathyroid gland preoperatively is more effective than either MIBI or USS alone.

Retrospective manual analysis of patients’ operative and medical notes was undertaken. Patients presenting with raised serum calcium and parathyroid hormone (PTH) between February 2009 and April 2012 (n = 76) were included in the study.

The sensitivity of localizing parathyroid adenomas via MIBI and USS with confirmation by histological evaluation of tissue following parathyroidectomy was assessed.

The combination of MIBI and USS provided a statistically significant improvement in preoperative localization of parathyroid adenoma over MIBI or USS alone (p = 0.033 and p = 0.043 respectively).

Ultrasound scan alone had a statistically much higher sensitivity to localize a parathyroid adenoma than MIBI and we therefore advise USS to be a first-line investigation with MIBI in reserve for when USS fails to identify an abnormality. However, the combination of both USS and MIBI provides a statistically improved preoperative visualization of parathyroid adenoma and thus reduces the risk of requiring further surgery.

Ridyard E. Preoperative Localization of Parathyroid Adenomas with Methoxyisobutylisonitrile and Ultrasonography: Are There Advantages of a Combined Approach? Int J Head Neck Surg 2015;6(2):45-48.

Head and neck synovial sarcoma (SS) amounts to 6.8% of all total body SS, with high incidences in the hypopharynx, postpharyngeal region and the parapharyngeal space. Also, incidences of SS in the tongue, soft palate, mandible, buccal mucosa, floor of the mouth, lungs, thymus, trunk and posterior peritoneum are reported.

We report a case of 12-year-old girl with swelling in the floor of the mouth for 2 months. The patient had difficulty in speech, tongue movements, poor oral hygiene due to food residue collecting around the tumor in the floor of the mouth. A smooth 4 × 4 cm globular mass arising from the floor of the mouth with the fine needle aspiration cytology (FNAC) as spindle cell neoplasm. Wide excision and immunohistology confirmed it as calcified synovial sarcoma, hence postoperative chemotherapy was given. There is no recurrence for the past 3 years.

Synovial sarcoma is a rare tumor in the oral cavity, which is slow growing and of variable aggressiveness. Immunohistological analysis confirming the diagnosis and wide surgical excision with adjuvant chemotherapy is the modality preferred in these cases. Recurrence is common in the first 2 years of therapy but can occur later also.

Nanjundappa A, Naik SM, Halkud R, Chavan P, Siddappa KT, Biswas S. Synovial Sarcoma of the Floor of the Mouth: A Rare Clinical Entity with Review of Literature. Int J Head Neck Surg 2015;6(2):49-52.

Controversy exists about the prognosis of squamous cell carcinoma of the tongue between young and older patients. Our objective was to evaluate age as a prognostic factor in oral tongue cancer.

A retrospective study was conducted by reviewing charts of 61 patients. They were divided into two age groups, below 40 years and above 40 years. Data regarding epidemiology pathology report, tumor differentiation, staging, treatment and outcome were obtained. The length of survival and disease recurrence was calculated and compared in this two age group. Statistical analysis was performed using student, t-test.

The result showed no significant difference in prognosis, tumor differentiation or staging related to age in oral tongue cancer.

Although age is not a significant prognostic factor in oral tongue cancer, the disease etiology is likely different, we recommend prompt and aggressive treatment of young patients.

Al-Qahtani K, Brousseau V, Islam T. prognosis of patients less than 40 Years of Age with Squamous Cell Cancer of the Oral Tongue. Int J Head Neck Surg 2015;6(2): 53-56.

Noncutaneous cancers of the head and neck occasionally metastasize to skin. We present a case series of patients with skin metastases from non-cutaneous malignancies of the head and neck. A literature review is presented to assess the morphology, pattern of distribution, and morbidity of skin metastases.

Relevant cases were identified by a dermatopathologist and cases were reviewed. A literature search yielded 94 cases which were also included.

The most common primary site, histology, and location of spread was the thyroid gland (42%), squamous cell carcinoma (42%), and scalp (25%) respectively. Skin metastases typically present as a discrete nodules, but the distribution varies. Metastases to skin can occasionally be a patients presenting complaint, but irrespective of timing of presentation portend a poor prognosis.

Skin metastases are clinically rare, and when present typically herald a poor overall prognosis. Information regarding their distribution and clinical presentation is of importance to the surgeon and oncologist.

Emanuel H, Emanuel P. Cutaneous Metastasis of Head and Neck Malignancy. Int J Head Neck Surg 2015;6(2):57-63.

Oral carcinoma prevalence is high in Kolar owing to tobacco chewing habit. The patients may have premalignant lesions all over oral cavity (field cancerization) making it difficult to select ideal biopsy site. 5-aminolevulinic acid (5-ALA) induced fluorescence helps to demarcate lesions beyond visible margin and helps to choose biopsy site.

To perform separate biopsies from the visible and fluorescent margins of malignant/premalignant lesions of oral cavity following staining with 5- ALA and determine if microscopic tumor extends beyond visible margin.

Our study included 50 patients with oral carcinoma/ premalignant lesions. Biopsies were taken from visible and fluorescence margins following incubation period of 3 hours post rinsing with 5-ALA solution. Specimens subjected to histopathological examination for detection of malignant cells. Usefulness of 5-ALA was documented by evaluating sensitivity, specificity, positive and negative predictive values and diagnostic accuracy.

Fifty patients with age ranging from 33 to 78 years showed female predominance—4:1. Forty-seven patients noted fluorescence beyond visible margin. Tongue malignancies showed maximum extension. Diagnostic sensitivity with 5-ALA was 95.74% and specificity was 100%. Positive and negative predictive values were 100 and 60% respectively. 5-ALA's diagnostic accuracy was determined to be 96%.

Majority patients showed microscopic tumor extension beyond visible margin. 5-ALA staining helps in determining the true extent of lesion as Protoporphyrin IX accumulation in malignant cells shows fluorescence. This helps in guiding biopsies in field cancerization and adequate surgical tumor clearance thereby improving locoregional control.

Ramachandra M, Mohiyuddin SMA, Suresh TN, Sagayaraj A, Merchant S. Evaluating Usefulness of 5-Aminolevulinic Acid induced Fluorescence to guide Biopsy of Oral Cancers and Premalignant Lesions. Int J Head Neck Surg 2015;6(2):64-68.

Primary mucocutaneous tuberculosis of nose is extremely rare even in countries with high incidence of pulmonary tubercular disease. The clinicians fail to diagnose its symptoms as primary nasal tuberculosis and, therefore, its treatment is often delayed.

To elucidate the clinical features and discuss the diagnostic difficulties, management and outcome of primary mucocutaneous tuberculosis of nose.

A retrospective chart review of five cases of primary mucocutaneous tuberculosis of nose was done over a period of 10 years. The clinical and imaging data, treatments, and outcomes were analyzed in these patients.

Out of five patients of primary mucocutaneous tuberculosis of nose studied during a decade, four were females. The mean age at the time of diagnosis was 24.2 years (12–60 years). The most common presenting symptoms were progressive nasal obstruction, recurrent epistaxis, skin ulceration. All the patients had no signs of pulmonary tuberculosis. All patients had nasal endoscopic guided biopsy for the accurate diagnosis based on histopathology. Biopsy was positive in all the five cases confirming the diagnosis. All the five patients received antitubercular therapy for a period of 6 to 9 months. There was successful response to antitubercular drug treatment. The follow-up for 2 to 7 years showed no relapse, dissemination or death.

Primary nasal tuberculosis is a very rare disease. However, it is important to have a high index of suspicion for nasal tuberculosis in patients presenting with nasal obstruction, epistaxis and skin ulceration especially in countries with high prevalence of tuberculosis.

Gupta Y, Sinha R. Primary Mucocutaneous Tuberculosis of Nose: One Decade Study. Int J Head Neck Surg 2015;6(2):69-72.

Lymph node metastasis in squamous carcinoma of oral cavity carries poor prognosis. Majority of patients in our country present with locally advanced malignancy which has high incidence of micrometastasis. A comprehensive neck dissection in patients with N0 and N1 neck is overkill with resultant morbidity. Lymph node metastasis from oral cavity has predictable pattern. Supraomohyoid neck dissection (SOND) is a one stage treatment and staging procedure in patients with locally advanced oral cancer with N0 and N1 neck.

We are presenting a series of 117 patients with malignancy of oral cavity with N1 neck who underwent SOND, majority involved buccal mucosa. Among the 117 patients who were clinical N1 cases, 53 (45.3%) were found to have positive nodes on histopathology and 64 (54.7%) were false. Level I lymph node metastasis (77.3%) was seen in majority of the oral cancers. After mean follow-up of 30 months, 71 patients are alive and disease-free, twelve patients had local and six (5.1%) had nodal recurrences.

Supraomohyoid neck dissection in locally advanced oral malignancies with N1 neck, carries low morbidity and complications and is effective substitute for modified radical neck dissection in suitable cases. Postoperative radiotherapy improves the outcome.

Harshita TR, Mohiyuddin SMA, Sagayaraj A, Suresh TN, Merchant S. Effectiveness of Supraomohyoid Neck Dissection in Oral Cancers with N1 Neck. Int J Head Neck Surg 2015;6(2):73-75.

Kalra SK, Lathi AA, Lathi SA. A Com prehensive Review of Etiopathogenesis of Oral Submucous Fibrosis. Int J Head Neck Surg 2015;6(2):76-79.

Patel S, Sakthivel P, Singh I, Gulati A, Gupta D. Frequency of Skip Metastases in Oral Cancer: An Overview. Int J Head Neck Surg 2015;6(2):80-85.

Divya GM, Ramachandran K, Nampoothiri PM, Sunil Kumar KP. Four Cases of Cervical Sympathetic Chain Schwannoma and Review of Literature. Int J Head Neck Surg 2015;6(2):86-89.

Mahuvakar AD, Nabi SMAA, Gujrathi AB, Ambulgekar VK, Garud S, Khokle P. Cervical Thymic Cysts— Rare Abnormality: A Report of Two Cases. Int J Head Neck Surg 2015;6(2):90-92.

Shah PD, Mukherji S. The Softurator: When, Where and How We do It? Int J Head Neck Surg 2015; 6(2):93-95.

Mohiyuddin SMA, Deo RP, Jyothi DN, Kumar HML, Sagayaraj A. Ewing's Sarcoma of Maxilla: A Rare Presentation. Int J Head Neck Surg 2015;6(2):96-98.

Qadri S, Afroz N, Rabindranath D, Qadri S. Fibrosarcoma developing in the Parotid Gland: An Unusual Presentation. Int J Head Neck surg 2015;6(2):99-102.