This is a randomized case-control study to know the efficacy of postoperative pain relief with transdermal diclofenac patch 200 mg and comparison with injection diclofenac sodium 75 mg.

A total of 100 patients with head and neck cancer were included in the study and were randomly divided into two groups (A and B). Anesthetic procedure was standardized. A transdermal diclofenac diethylamine patch of 200 mg was applied to group A, just before the skin closure. And in group B, injection diclofenac was given 8 hourly. In group A, injection diclofenac was given on an as-needed basis whenever patient had visual analog scale (VAS) of pain > 5. Visual analog scale at 2nd, 4th, 8th, 12th, and 24th hour postoperatively was recorded for 5 days. Injection diclofenac needed in groups A and B was recorded for five postoperative days and the mean number of injections of diclofenac per patient per day needed in both groups was calculated.

In group A, we needed only 0.96 injections (diclofenac 75 mg)/patient on the first day and no injection was needed further, while in group B, we had to use three injections/day/ patient. Visual analog scale and pain relief were more steady and better in group A as compared with group B.

Transdermal patch of diclofenac diethylamine 200 mg is very effective in providing postoperative analgesia and is better than intravenous injection diclofenac 75 mg.

Singh SP, Jain DK, Das S, Jain S. A Prospective Case-control Study on the Comparison of Postoperative Pain Relief with Transdermal Diclofenac Patch and Injection Diclofenac. Int J Head Neck Surg 2015;6(4):129-133.

Depressed skull fracture is a very serious type of trauma occurring in 11% of severe head injuries, and there is a consistent association between the presence of cranial fracture and higher incidence of intracranial lesions, neurological deficit, and poor outcome. Depressed cranial fractures have to be treated aggressively because of their association with infection and late epilepsy.

To study the clinical profile and surgical outcome of patients with depressed cranial fractures.

A case series study of 44 patients with depressed fracture was conducted in a tertiary care hospital setting at the Department of Neurosurgery, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, during the period from June 2013 to January 2015. Among the selected patients, the clinical profile, radiological profile, and surgical interventions were undertaken and the outcomes were noted. Appropriate descriptive statistics were used to analyze the findings and to draw inferences.

There were 30 males and 14 females. The mean age of the patients was 26.95 ± 14.87 years (6–65 years). The common cause of depressed fracture was road traffic accident (45%) and assault (40.9%); 63% of them had compound type and half of the fractures were located in the frontal region. Common associated injuries were extradural hematoma (50%) followed by dural tear (27.3%). Common complications were wound infection (9.1%) and cerebrospinal fluid leak (9.1%).

The management of depressed fractures should be individualized depending on factors like the degree of depression, communication with the exterior, neurological deficit and presence of associated injuries.

Sidram V, Kumar PCC, Raghavendra B. A Prospective Study of Spectrum of Depressed Fractures

Bhattacharjee A, Uddin S, Prakash R, Rathor A, Kalita S. Diagnostic and Management Challenges in Mikulicz Syndrome. Int J Head Neck Surg 2015;6(4): 139-145.

As congenital anomalies of the thyroid are rare and the pathology associated with it warranting total thyroidectomies is still rare, so the inadvertent parathyroidectomies are rarely reported. Unilateral or bilateral hypoplasia or agenesis of one or both thyroid lobes, with or without isthmic agenesis, is a rare developmental anomaly. Meticulous subcapsular dissection with preserving the vascular twigs to the parathyroid is very important in avoiding complications.

We report two cases of thyroid hemiagenesis in our medical college institution over a period of 10 years. Both were females in the 6th decade with swelling in the neck. One had a right-sided swelling and the second had a left-sided swelling, both measuring about 5 ⨯ 5 cm.

So the total thyroidectomy surgery in hemiagenesis cases poses a risk to the parathyroids as the altered anatomy. So the time-tested technique of subcapsular dissection and meticulous preservation of the multiple vasculature of the parathyroids in the fascial compartment provides better results with least morbidity.

Naik SM, Halkud R, Chavan P, Appaji M, Sathya P, Bhat SR, Deekshith RM. Importance of Preserving Parathyroids in Surgery for Hemiagenesis of Thyroid: Analysis with Review of Literature. Int J Head Neck Surg 2015;6(4):146-148.

To study the frequency of postoperative complications after thyroid surgery indicated for various benign and malignant lesions and to corroborate the results in relation to the extent of surgery and a clinical overview of evolution of thyroid surgery.

An analytical study was carried out at a tertiary care center over a period of 3 years from January 2011 to December 2013. Data were collected from 80 patients who underwent thyroidectomies for various thyroid diseases at this center.

Hemithyroidectomy, isthmusectomy, subtotal, neartotal, and total thyroidectomies were performed in 36 (45%), 6 (7.5%), 8 (10%), 10 (12.5%), and 20 (25%) cases respectively. The overall postoperative complication rate was 20%. Postoperative hypocalcemia and recurrent laryngeal nerve injury were the most common complications. Permanent hypocalcemia and permanent recurrent laryngeal nerve injury were observed in 3.75 and 2.5% of all operated cases respectively. The less common complications were wound hematoma, seroma formation, and superior laryngeal nerve injury. There was no mortality observed in our series.

The overall complication rate can be minimized by operating in a bloodless field, doing a meticulous dissection, and correctly identifying and preserving recurrent and superior laryngeal nerves along with parathyroid glands, if feasible.

Pandey AK, Maithani T, Agrahari A, Varma A, Bansal C, Bhardwaj A, Singh VP, Rathi S. Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery. Int J Head Neck Surg 2015;6(4):149-154.

Complex defects resulting from resection of buccolabial cancers are generally reconstructed with pedicled flaps or with free flaps, often resulting in suboptimal cosmesis and function.

A total of 11 patients with malignancies involving the oral commissure and lips were studied. Wide excision and reconstruction with local flaps was done. Posttreatment mouth opening, hair match, color match, vermilion match, resection margins, and disease control were documented.

Average interlabial mouth opening was 3.6 cm and interincisor 3.3 cm. Good hair and color match was seen in all patients. Vermilion match was achieved in all but three patients. Resection margins were wide in all. All but one patient (distant metastases of malignant melanoma) were disease free at the last follow-up.

Local flaps provide good cover for complex buccolabial defects, without affecting disease clearance. In view of definite advantages over distant and free flaps, they should regain their place in the head and neck surgeon's armamentarium.

Dravid C, Priya SR. Reconstruction of Complex Buccolabial Defects: Feasibility of Local Flaps with respect to Cosmetic and Functional Outcomes. Int J Head Neck Surg 2015;6(4):155-160.

To study the clinicopathological parameters associated with recurrence of oral squamous carcinoma and analyze the survival of patients managed in ENT and Head and Neck Surgery Department between January 2008 and December 2013.

Records of 178 cases were reviewed for clinical details, histopathological data, and follow-up status. Age, gender, addiction, subsite, T–N pathological staging, tumor thickness, margin status, grade of differentiation, lymphovascular permeation, perineural spread, and adjuvant therapy were analyzed.

The recurrence rate was 13.5%. The median follow-up for the entire cohort was 20 months. Twenty-four patients had locoregional recurrence: 9 (37.5%) local recurrence alone, 11 (45%) regional recurrence alone, and 4 (17.5%) had both local and regional recurrence. The average time to recur in case of negative margin was 12.1 months, for close margin was 11.9 months, and with positive margin was 4.1 months. Looking at all patterns of recurrence, 4/98 (4%) of cases with negative margins, 15/65 (23%) cases with close margins, and 5/15 (33.3%) of those with positive margins recurred. Out of 24 cases of recurrence, 22 were sent for salvage surgery and others for salvage chemoradiation therapy. The Kaplan– Meier method and log-rank tests showed that the 2- and 5-years survival rates were significantly lower in the recurrence group compared with nonrecurrence group (78 vs 94%, 37 vs 66%, p < 0.001). Locoregional recurrence is strongly correlated with margin status according to univariate and multivariate analysis.

Among all clinicopathological parameters, the status of the surgical margin is the most important prognosticator. Good local control is mandatory to ensure patient's survival. Adequate margins at initial resection for complete clearance without the need of revision should be pursued by every surgeon. Although it is in surgeon's control, the achievement can be limited by the aggressiveness of the disease.

The aim of this study was to ascertain the relation between surface electrical potential and the presence of cancer in the buccal mucosa and their correlation.

A device was designed to measure the skin potentials on the face, and various head and neck carcinomas can be detected in a noninvasive way. The present study is a case control study in the ratio 1:1, comprising two groups of 10 individuals each. The two distinct groups of the study are as follows:

1. Normal subjects group consisting of individuals with no habit of tobacco, with the absence of any lesion active or passive on the skin or buccal mucosa.

2. Cancer patients group consisting of individuals attending the head and neck services at the Tata Memorial Hospital, Mumbai, with the habit of tobacco consumption and having a lesion on the buccal mucosa with biopsy confirming diagnosis of squamous cell carcinoma (SCC).

Sites of SCC were significantly electropositive compared with control sites in normal tissue. But noncancerous lesions yielded no potential difference between the lesion and control sites.

The skin surface potential values are maintained in an individual with no cancerogenesis, whereas in oral squamous cell carcinoma (OSCC) the lesion values are more electropositive than the surrounding areas. This can be used to detect OSCC.

Significance: The device designed is patient-compliant and can be used in cancers of breast, colon, etc. More research work is recommended on skin surface potentials.

Vahanwala SP, Mukherji S, Dhawangale A, Agrawal S. Biopotential Assessment—An Alternative in Oral Squamous Cell Carcinoma Diagnostics: A Study. Int J Head Neck Surg 2015;6(4):168-174.

Bronchogenic cysts are rare congenital malformations of the ventral foregut development usually located in the mediastinum and intrapulmonary regions. Cervical bronchogenic cysts are unusual and have been reported predominantly in the pediatric age population, rarely in adults.

We retrieved and analyzed medical records of all patients who were diagnosed to have bronchogenic cysts within the past 5 years who presented to the surgical departments of pediatric surgery, cardiothoracic, general surgery, ENT, and head and neck surgery.

Thirty-three patients with bronchogenic cysts were identified, five of whom were children and only presented with a cyst in the neck. The details of the patient with cervical bronchogenic cyst are presented and discussed.

Bronchogenic cysts of the neck are rare differential diagnosis of neck masses in adults. The magnetic resonance imaging was found to be specific for diagnosis and preoperative assessment. Complete surgical excision is the treatment of choice, along with the prevention of future complications and establishment of diagnosis.

George AJ, Gaikwad P. Bronchogenic Cyst as a Rare Differential in an Adult Cervical Cystic Swelling. Int J Head Neck Surg 2015;6(4):175-177.

Emanuel H, Willis R. A Fatal Cause for a Common Presentation. Int J Head Neck Surg 2015;6(4):178-180.

This is a case report of synchronous, noncollision head and neck malignancies, consisting of a large polymorphous low-grade adenocarcinoma (PLGA) and an unknown primary squamous cell carcinoma (SCC) that was diagnosed on final pathology.

Positron emission tomography– computed tomography (CT) scan with and without contrast was obtained, which showed a large destructive soft tissue mass emanating from the right maxilla into the right maxillary sinus with invasion into the surrounding tissue and bone, compatible with an underlying primary maxillary malignancy. Increased D-18 fluorodeoxyglucose activity was also seen in the neck corresponding to numerous bilateral cervical lymph nodes. Magnetic resonance imaging showed the extent of the soft tissue mass, which expanded to the inferior aspect of the right orbital floor, with no evidence of gross invasion into the orbit.

The patient underwent a subtotal maxillectomy, bilateral modified radial neck dissection, and reconstruction. Pathology revealed metastatic PLGA present in the right cervical lymph nodes. Left cervical lymph nodes, however, revealed metastatic SSC. The patient was taken back to the operating room and a panendoscopy was performed. Physical examination was benign and multiple biopsies were negative for SSC. The patient underwent radiation therapy for PLGA and unknown primary SSC antigen.

Synchronous tumors of the head and neck are seldom reported and they present unique treatment challenges. This case report discusses the diagnosis, management, and unique nature of two malignant synchronous noncollision tumors in the head and neck.

Fisher AD, McClure SA, Franco J. A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma. Int J Head Neck Surg 2015;6(4):181-186.

Divya GM, Dahiya V, Ramachandran K, Muhammed F. Drug-induced Airway Hematoma. Int J Head Neck Surg 2015;6(4):187-189.

Synovial sarcoma of eyelid is extremely rare. We are reporting a case of massive synovial sarcoma of lower eyelid extending to soft tissues over the anterior wall of maxilla.

A 58-year-old male patient presented with a large mass involving the left lower eyelid and extending over the soft tissues of the anterior wall of the maxilla since 15 years. Clinical examination showed a firm soft tissue mass measuring 16 × 8 × 6 cm involving the left lower eyelid and extending to soft tissues over the maxilla. The mass showed ulceration and was bleeding on touch.

Computed tomography scan showed an exophytic lobulated heterogeneously enhancing mass lesion with intense enhancing capsule measuring 14 × 9.3 × 8.4 cm with few internal areas of necrosis arising from left preseptal region. The lesion was causing erosion at the medial wall and floor of left orbit.

It was clinically diagnosed as hemangiopericytoma. The patient was taken up for surgery and wide excision of the tumor and medial maxillectomy was done. The defect was reconstructed with a glabellar flap.

Mohiyuddin A, Sagayaraj A, Harshita TR, Suresh TN. Monophasic Synovial Sarcoma of the Lower Eyelid: Rare Tumor involving Rare Site. Int J Head Neck Surg 2015;6(4):190-192.

Gupta R, Mohindroo NK, Azad R. Thyroid Tuberculosis: Yes, It is True. Int J Head Neck Surg 2015;6(4):193-194.

Kulkarni M. Vagal Schwannoma and Carotid Body Tumor: Magnetic Resonance Imaging Appearance and Differential Diagnosis. Int J Head Neck Surg 2015;6(4):195-196.