How to cite this article:
Babu S, Singh A, Nayanar S, Muttath G, Balasubramanian S. Neck Nodes at Level IIB in Oral Cavity Carcinoma: Can We Leave Behind Visible Nodes?. Int J Head Neck Surg 2018; 9 (4):117-120.
Introduction: Oral cancer patients have a chance of metastasis to the cervical nodes. A prophylactic neck dissection is advised in clinically undetectable necks. The extent of the neck dissection has been in doubt and various levels with a low propensity are usually skipped such as level IIB. Though a routine level IIB node dissection is not suggested in patients with N0 neck, it is often confusing when visible nodes are present in this subgroup.
Patients and methods: A prospective analysis of consecutive oral cancer patients was conducted to see for level IIB nodes in an ipsilateral neck dissection.
Results: Forty-four patients underwent a neck dissection, including level IIB, retrieving 165 nodes from level IIB. Stage-wise distribution was 9, 22, 3, and 10 patients in T1, T2, T3, and T4 stages with majority in tongue cancers. An estimated 30 patients had a clinically node-positive disease, but only 18 underwent a modified or radical neck dissection. A pathologically node positive disease was seen in 12 patients, but only two had level IIB positive (0.01%), both of which had positive level IIA nodes.
Conclusion: This study adds to the evidence that the majority of nodes in level IIB are reactive nodes and a metastasis to this group in isolation is unlikely.
Oral lesions of tuberculosis, though uncommon, are often seen in both the primary and secondary stages of the disease. In secondary tuberculosis, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes, or in any other part of the body and can be detected by a systemic examination. Primary oral tuberculosis may present as a diagnostic challenge for the clinician. Here we report a case of tuberculosis of oral cavity with primary in lung (a cavity lesion) and sputum positive for acid fast bacilli. However, the biopsy from the lesion was negative.
Salvage surgery is always a challenging choice and must even more fulfil both oncologic requirements and quality-of-life issues. In head and neck patients, the most important goals are pain relief, preservation of breathing and deglutition, acceptable cosmetic results, and a sufficient quality of the residual life. When surgery is still considered an option, a safe, quick-recovering, and function-saving technique should be chosen. The author\'s experience and an illustrative case report are described.
Hitendra Prakash Singh,
Aim: Fusion defects of maxilla and mandible are a rare congenital anomaly that affect the growth and development of patients in varying extents. Authors intend to present a case of incomplete synechiae of the oral cavity.
Background: Congenital maxillo-mandibular fusions present with varying degree of involvement of mucosa, soft tissues and bone and can cause aerodigestive problems in the neonatal period.
Case description: A 5-day-old male child was referred from pediatrics for evaluation for complaints of inability to feed. On examination, a mucosal band was noted connecting the floor of the mouth with the hard palate, with free margins on both sides. After proper consent, the mucosal band was completely excised under local anesthesia and hemostasis was achieved. The rest of the oral cavity and oropharynx was normal except cleft palate.
Conclusion: These types of anomalies have to be diagnosed as early as possible in the early neonatal life. Early diagnosis and appropriate management should be instituted to prevent risks of asphyxia, aspiration pneumonitis, growth retardation, malnutrition, facial growth abnormalities, and improper eruption of teeth.
Clinical significance: As there are various types of presentations, the treatment needs to be individualized.
Rashu P Mittal,
Rajesh R Yadav,
Shashikantkant K Mhashal,
Payal R Mittal
How to cite this article:
Mittal RP, Yadav RR, Mhashal SK, Mittal PR. Occult Metastatic Papillary Thyroid Carcinoma Presenting as Submandibular Mass: An Unusual Case. Int J Head Neck Surg 2018; 9 (4):131-133.
Papillary carcinoma is the most common variant of thyroid cancer. A tumor less than 1 cm in size is labelled as the papillary thyroid micro-carcinoma (PTMC). Such tumors have an excellent prognosis, although a few may metastasize to cervical neck nodes. However, an infiltrated palpable neck node without evidence of thyroid disease is rare. Here, we report a case of an isolated submandibular metastasis from a clinically occult papillary thyroid carcinoma in a 40-year-old woman. The initial surgery was performed on the basis of the fine needle aspiration cytology (FNAC) report of basal cell adenoma vs cellular pleomorphic adenoma. The case was a total histopathological surprise as it was reported as a metastasis from papillary thyroid carcinoma. Subsequently total thyroidectomy and modified neck dissection was performed as per the standard surgical guidelines.
Background: Angiolymphoid hyperplasia with eosinophilia (ALHE) is considered as a rare, benign vascular lesion that mainly affects the skin and subcutaneous tissues of the head and neck region, but is rare in the oral cavity. Its etiology and pathogenesis remains unclear and its diagnosis is based on the histopathological findings. Here we report a case of ALHE showing a swelling in the oral cavity mucosa.
Case description: A 24-year-old female presented to our outpatient department with the complaints of a painless swelling in the oral cavity on the right cheek since 1 month. The patient underwent excision of the swelling intraorally, and diagnosis of ALHE was made based on the histopathological findings of a chronic inflammatory infiltrate admixed with proliferating blood vessels.
Conclusion: ALHE is rare in the oral cavity mucosa and can present a diagnostic dilemma.
Clinical significance: ALHE should be considered as a differential diagnosis of a submucosal swelling in the oral cavity and complete excision of the swelling helps in both diagnostic and definitive treatments.
Background: Onchocerciasis is the world\'s second commonest infectious cause of blindness. It is transmitted by the bite of the Simulium blackfly, which transmits the infective-stage larva into the human skin and mainly affects the people in the rural areas of Sub-Saharan Africa, Yemen, and those living in parts of Central and South Africa. The first case of ocular onchocerciasis in India was a woman from rural Assam, northeastern India reported in 2011. Here we report a rare case of onchocerciasis—a patient from a non-endemic region of Bengaluru, India, showing a swelling in the orbital region.
Case description: A 55-year-old women was presented to our outpatient department with the complaints of a swelling below the left eyebrow since 2 months and drooping of the left upper eyelid since 1 month. The patient underwent excision of the swelling after CT and FNAC of the swelling. The worm in the wall of the excised cyst was identified as Onchocerca volvulus, on the basis of morphological features observed in histopathology. The patient was treated with a single oral dose of Ivermectin (150 μg/kg), and on follow-up at 4 months, she has not shown any recurrence of symptoms or fresh complaints.
Conclusion: Onchocerciasis, though rare, can be a differential diagnosis of a subcutaneous swelling in the body.
Clinical significance: Knowledge and awareness regarding the presence of this filarial worm in India is required, as it is rare and reporting of further cases needs to be done.