International Journal of Head and Neck Surgery

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2017 | July-September | Volume 8 | Issue 3

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Nidhi V Maggon, Ashwani Sethi

Tonsillectomy: Patient Response-based Assessment and Results in Urban Indian Population

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:4] [Pages No:89 - 92]

Keywords: Benefits, Patient-reported outcome measure, Tonsillectomy

   DOI: 10.5005/jp-journals-10001-1312  |  Open Access |  How to cite  | 


Introduction: Tonsillectomy has been considered a controversial surgical procedure due to absence of unequivocal evidence in favor of its benefits. We carried out a standardized patient response-based assessment study to evaluate the benefits. Materials and methods: A total of 62 patients in the age group of 4 to 11 years underwent a preoperative assessment of their symptoms [three groups: recurrent upper respiratory infection (URI), sleep-disordered breathing (SDB), or both] on a T-14 standard questionnaire and, if they met the standard criteria, were taken up for coblation-assisted tonsillectomy and/or adenoidectomy. Their postoperative responses were assessed and benefits compared statistically. Results: A total of 62 patients in three groups underwent the procedure and their postoperative T-14 responses at 3 and 6 months were evaluated. There was a statistically significant improvement in their scores at 3 months in all three groups. However, the improvement was static and did not continue at 6 months. Conclusion: Tonsillectomy, with or without adenoidectomy, is a beneficial procedure for all three categories of patients (based on symptoms) and brings significant improvement on a standardized patient response-based assessment scoring system in patients selected based on a standard criteria.



Role of Autologous Costal Cartilage Grafts in Otolaryngology Practice: A Surgical Review

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:5] [Pages No:93 - 97]

Keywords: Autologous grafts, Costal cartilage, Laryngotracheal reconstruction, Rhinoplasty

   DOI: 10.5005/jp-journals-10001-1313  |  Open Access |  How to cite  | 


Aim: The aim of this article is to describe the advantages and disadvantages of the costal cartilage grafts in reconstruction from the otolaryngologist's perspective and have an analysis of the surgical review of the use of this autologous graft in reconstructive procedures. Materials and methods: A retrospective case series was conducted from 2010–2015. A total of 23 patients were selected and they were categorized depending on the defects and reconstructive procedures performed; 6th, 7th, and/or 8th rib grafts were harvested and carved according to the nature and site of the defect. The remodeled grafts were used for augmentation rhinoplasty (14 patients), laryngotracheal reconstruction (7 patients), and microtia repair (2 patients). Results: The age group of study population was 8 to 57 years. All patients had improved outcomes, barring a minimal warping effect in recipient area. Conclusion: High viability, good texture, and availability in large sum make rib grafts ideal for reconstruction in otolaryngological procedures. Clinical significance: Knowledge of various grafts and reconstruction techniques is important for otolaryngologist practice. This study describes briefly about the techniques and role of costal cartilage grafting in the esthetically complex head and neck region.



Virani J Shamsuddin, Sanjeev Patni, Shashikant Saini, Kamal K Lakhera, Gurdyal S Kalra

Reconstruction of Oromandibular Defects by Vascularized Free Flaps: The Radial Forearm Free Flap and Fibular Free Flap as Major Donor Sites

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:4] [Pages No:98 - 101]

Keywords: Fibular free flap, Free flaps, Oral cancer, Oromandibular defects, Plastic reconstruction, Radial forearm free flap

   DOI: 10.5005/jp-journals-10001-1314  |  Open Access |  How to cite  | 


Restoration of good morphology and function are primary goals in the reconstruction of oral cavity defects. Several free flaps have been used in the reconstruction of bone and soft tissue defects in the oral cavity. We are reporting our experience in oromandibular defect reconstruction using radial forearm free flap (RFFF) and vascularized fibular free flap (VFFF). Of 228 total patients who had free flap reconstruction, 106 patients required reconstruction of oral soft tissue with an RFFF, and 122 patients required reconstruction of mandibular defects with a VFFF. Predictable results in terms of function and esthetics with minor donor site complications can be expected with the use of RFFF and VFFF for defects of the oral cavity.



Wilma D Silvia, S Vinay Babu

Clinical Evaluation and Management of Deep Neck Space Infections

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:5] [Pages No:102 - 106]

Keywords: Deep neck space infection, Ludwig's angina, Odynophagia, Peritonsillar abscess

   DOI: 10.5005/jp-journals-10001-1315  |  Open Access |  How to cite  | 



Jeremiah R Moshy, Shaban D Shaban

A Novel Technique for Surgical Reduction of Long-standing Temporomandibular Joint Dislocation

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:5] [Pages No:107 - 111]

Keywords: Long-standing dislocation, Surgical reduction, Temporomandibular joint

   DOI: 10.5005/jp-journals-10001-1316  |  Open Access |  How to cite  | 


Introduction: The dislocation of the temporomandibular joint (TMJ) typically occurs when the mandibular condyle becomes displaced out of the glenoid fossa. Long-standing TMJ dislocation may rarely be treated by conventional methods of closed reduction, thus needing surgical intervention ranging from various indirect traction techniques to direct exposure of the TMJ. Aim: This article aimed at bringing into attention of the scientific community a new surgical technique for the management of long-standing TMJ dislocation. Materials and methods: A surgical technique of reducing longstanding TMJ dislocation dubbed as the “Shabani maneuver” has been described. The technique utilizes an externally applied force by physician/surgeon at the mandibular notch which is accessed through a preauricular incision. After making the incision, the mandibular notch is accessed and a Warwick- James elevator is then directed at the notch. An inferiorly directed force is applied once the instrument is secured around the notch and with a combination of conventional method, the condylar head is reduced back to the glenoid fossa. Results: A total of 20 patients with long-standing TMJ dislocation were treated using the technique described. Out of those, 19 patients (95%) were successfully treated. The age range of the patient was between 19 and 81 years with a mean age of 37.75 ± 18.12 years. Yawning was the common cause for dislocation (65%). The mean duration of dislocation was 3.6 months, with the commonest reason for delay in treatment seeking being poverty. Conclusion: This invasive surgical technique is useful where conventional approaches have been tried and proved futile in multiple attempts to reduce long-standing cases of TMJ dislocation. Clinical significance: By describing a new and novel surgical technique for the reduction of long-standing TMJ dislocation, this study promotes its use in clinical practice, especially in settings of developing countries where due to low socioeconomic status, accessibility to operating theater is limited.



Abhishek Bhardwaj, Shashank Gupta, Rojita Moirangthem, Abhimanyu Anant, Naresh Bharadwaj

Intralesional Bleomycin as Therapeutic Modality for Low-flow Venous Malformations: Treatment on Outpatient Basis

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:6] [Pages No:112 - 117]

Keywords: Bleomycin, Injections, Intralesional, Sclerotherapy, Vascular malformations

   DOI: 10.5005/jp-journals-10001-1317  |  Open Access |  How to cite  | 


Introduction: Venous malformations (VMs) are the most common type of vascular malformations in the human body, most commonly involving head and neck region. Intralesional sclerotherapy with and without image guidance has been used as therapeutic modality with effective outcome. The aim of our study was to evaluate the result of intralesional bleomycin injection without image guidance in low-flow VMs of head and neck. Materials and methods: This was an observational study conducted in the Department of Otorhinolaryngology, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India, between September 2014 and November 2016. Fifty-five patients, 27 males and 28 females, diagnosed as low-flow VM based on clinical features and ultrasound, were treated with multiple doses of intralesional bleomycin injection at 3 weeks interval on an outpatient basis. Reduction in size, occurrence of adverse reactions, and recurrence were observed and recorded. Outcomes were graded as complete reduction (>90% reduction), considerable reduction (50–90% reduction), partial reduction (20–50% reduction), and no change (<20% reduction). Treatment was considered successful in cases of complete or considerable reduction. Results: A total of 50 (90.9%) patients were successfully treated. Complications were minor and included small skin ulcer in 4 (7.2%) and hyperpigmentation in 3 (5.4%) patients. No recurrence was noted. Conclusion: Intralesional bleomycin sclerotherapy serves as an excellent treatment modality for low-flow VMs. Such patients can be treated on an outpatient basis without fear of any major complication.



Shivakumar Thiagarajan, Sajith Babu, Hamsa Nandini, KP Kavitha

Clear Cell Odontogenic Carcinoma of the Mandible: Diagnostic Difficulty and Therapeutic Dilemma

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:3] [Pages No:118 - 120]

Keywords: Clear cell, Locally aggressive, Odontogenic carcinoma, Surgery

   DOI: 10.5005/jp-journals-10001-1318  |  Open Access |  How to cite  | 


Clear cell odontogenic carcinoma (CCOC) is a rare tumor commonly involving the mandible, in elderly women. It is locally aggressive with a tendency to spread to lymph nodes and also has distant metastasis. Until date, only about 100 cases have been reported in the literature. Here, we report one such case in a 60-year-old lady who presented with a nonhealing ulcer of the oral cavity following a tooth extraction. She underwent surgery followed by adjuvant radiotherapy and is on follow-up for over 6 months, free of disease. The CCOC must be considered as one of the differential diagnosis in tumors involving the jaw with a radiolucent lesion as seen on an orthopantomogram (OPG) and clear cell component histopathologically. We have also done a literature review of the reports published so far and the best possible treatment options have been discussed in the light of these evidences.



Niraj Mohan, Yi Y Chia, Chung FJ Ng, Gopalakrishna N Iyer, Hiang K Tan, Ngian C Tan, Siti Radhziah

Lymph Node Metastasis from Papillary Thyroid Carcinoma or Tuberculous Lymphadenitis: A Diagnostic Dilemma

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:4] [Pages No:121 - 124]

Keywords: Metastasis, Papillary thyroid cancer, Tuberculosis

   DOI: 10.5005/jp-journals-10001-1319  |  Open Access |  How to cite  | 


Background: Papillary thyroid carcinoma commonly presents with nodal metastases. The recommended treatment modality is total thyroidectomy with lateral neck dissection, i.e., a rather invasive surgical procedure with associated complications. Aim: A rare case of coexistence of papillary thyroid carcinoma (PTC) and tuberculous cervical lymphadenitis in a patient that presented as a diagnostic and management dilemma intraoperatively is reported. Case report: We hereby report a case of a Chinese female, who presented with a goiter and associated painful right lateral neck swellings. After preoperative investigations were done, the initial diagnosis was PTC with nodal metastases. However, the enlarged lymph nodes were eventually found out to be secondary to tuberculous infection through polymerase chain reaction (PCR) done on the surgical specimens. Conclusion: In a small subset of patients with PTC, cervical lymphadenopathy is secondary to tuberculosis rather than nodal metastases. If preoperative and intraoperative investigations could be utilized to diagnose tuberculous lymphadenitis, lateral neck dissection could potentially be avoided. Clinical significance: This clinical entity of coexistence of PTC and tuberculous cervical lymphadenopathy has only been minimally reported in the literature. In our patient, it was even more clinically significant as the enlarged lymph nodes were in close proximity to the innominate vessels, and thus required the potential need of a sternal split if the innominate vessels were injured in the process of surgery. In future, further studies would be recommended to determine the best approach for the management of concomitant PTC and tuberculous lymphadenitis, and future patients could benefit in terms of avoiding the complications associated with a potentially unnecessary invasive surgery.



Sultanipura N Somashekhar

Dermoid Cyst of Neck: A Diagnostic Dilemma and a Therapeutic Challenge

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:3] [Pages No:125 - 127]

Keywords: Computed tomography, Dermoid cyst, Extraoral approach, Floor of mouth, Ranula

   DOI: 10.5005/jp-journals-10001-1320  |  Open Access |  How to cite  | 


Dermoid cysts are benign congenital tumors of ectoderm origin usually arising from the midline where the fusion of embryonic structures of both sides occurs. However, dermoid cyst can occur on the lateral part of the floor of the mouth. Neck swellings are difficult to diagnose clinically and are close to vital structures. An adult female who presented with a swelling in the right submandibular region of 3-year duration was evaluated and treated surgically. Ranula is a type of mucocele, a disorder of salivary gland usually found in the floor of the mouth. We hereby present this rare mode of presentation of a dermoid cyst with a diagnostic dilemma and a surgical challenge.4



Bajarang Prasad Sah, Sudeep Mishra, Sachin L Shilpakar, Dillu R Kandel

Inflammatory Myofibroblastic Tumor: A Rare Tumor in the Tongue

[Year:2017] [Month:July-September] [Volume:8] [Number:3] [Pages:3] [Pages No:128 - 130]

Keywords: Malignant tumor of tongue, Myofibroblastic tumor, Pseudotumor of tongue

   DOI: 10.5005/jp-journals-10001-1321  |  Open Access |  How to cite  | 


Inflammatory myofibroblastic tumor (IMT) consists of myofibroblastic and inflammatory cell infiltration in the tissues. Recurrence and malignant transformation rate of this tumor is very unusual and regarded as benign fibroinflammatory disease. The etiological factor of this tumor is unknown but infection, trauma, and immunologic factors are blamed. In this case report, we report a 30-year-old woman with a proliferative mass on her right side of tongue, which was diagnosed as “IMT.” Inflammatory myofibroblastic tumor is very rarely found on tongue. This type of tumor may be misdiagnosed as malignant tumor because of its diagnostic difficulties. Wide local excision of tumor was done for an adequate treatment. Conclusion: Clinical as well as radiological behavior of IMT is aggressive, so it may be misdiagnosed as malignant tumor. Therefore, its accurate diagnosis is vital to prevent unnecessary radical resection.


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