Choice of Regional Flaps for Oral Cancer Defects: Relevance in Current Era.

INTRODUCTION: Microvascular free flaps (MVFF) are the current standard of care for reconstruction of oral ablative defects; however, pedicled myocutaneous flaps (PMCF) are still used widely in India. The rationale behind the preference for selecting PMCF in the present era is not well understood. The associated complications and swallowing outcomes are variable. METHODS: We retrospectively analysed the records of patients who underwent reconstructive surgery for oral cancer ablative defects over a 3-year period. RESULTS: Ninety-seven pedicled myocutaneous flaps [89 pectoralis major myocutaneous (PMMC) flaps, eight lower trapezius island myocutaneous (TMC) flaps] and 113 MVFFs were performed. The reasons for selecting PMCF were financial constraints 38.7%, MVFF salvage 22.5%, medically compromised 10.7%, vessel-depleted neck 6.4%, old age with PS2 + 5.3%, early recurrence 5.3%, borderline resectable 4.3%, palliative resection 2.1%. Overall complication rate was 20.4%. Of patients, 50.7% and 34.7% were on regular and semisolid diet, respectively; 66.6% had acceptable swallowing-related social well-being. CONCLUSION: PMCFs have an important role in developing countries with patients having financial constraints. The other potential reasons driven by patient factors were discussed. The swallowing outcomes are good, with majority of the people having socially acceptable swallowing function.

Clinical profiling and management outcome of atypical skull base osteomyelitis.

Background: Malignant otitis externa or skull base osteomyelitis arises as a complication of otological infection in immunocompromised individuals, especially elderly diabetics. With increasing awareness of the disease and better diagnostic modalities, there has been an increased reporting of atypical osteomyelitis of skull base (AOSB). Atypical osteomyelitis of skull base is a relatively rare yet an emerging clinical entity that also occurs in immunocompromised elderly individuals, however, in the absence of a pre-existing otological or rhinological infection. The purpose of this study was to review the clinical presentation and treatment protocol followed in patients diagnosed with atypical skull base osteomyelitis.Methods: A retrospective audit of medical records of patients diagnosed with AOSB between 2014 and 2018 was done. Clinical presentation and radiological assessment done prior to intervention was noted. All patients underwent transnasal endoscopic biopsy of tissue from clivus. Histopathological and microbiological profiling of biopsied tissue and treatment protocol followed was noted.Results: A total of 10 patients were included in the study out of which eight were male and two female. Eight patients were known diabetics and one patient had been on chronic oral steroid use. Majority presented with a vague dull aching headache and with one or more cranial nerve (CN) palsy(s). Radiological imaging showed clival involvement for all. All were managed conservatively with appropriate antibiotics. Disease resolution was defined as either complete resolution of symptoms and/or no residual lesion noted on follow-up MRI of skull base.Conclusions: Individuals presenting with non-specific symptoms of headache with CN palsy(s) with no obvious otological/rhinological infections, should raise suspicion of atypical skull base osteomyelitis. Histopathological diagnosis and microbiological assessment are an essential aid in conservative management with higher antibiotics. Patient compliance and long-term follow-up is essential for adequate and complete resolution of disease.

Intraosseous Hemangioma of Sella: Case Report and Review of Literature.

BACKGROUND: Primary intraosseous hemangioma (PIH) of the skull base, when localized in the sella, is a rare, benign lesion that can mimic other common sellar tumors. Such tumors may be asymptomatic incidental radiologic findings or present with nonspecific symptoms (e.g., headaches). CASE DESCRIPTION: :We present a case of a primary intraosseous hemangioma of the body of sphenoid bone extending into the sellar cavity, clinicoradiographically mimicking an atypical pituitary adenoma. CONCLUSIONS: PIH should be included as a rare differential diagnosis in cases of space-occupying sellar lesions with atypical features. Radiologic and intraoperative findings may be suited to entertain a probable diagnosis; however, a definite diagnosis can only be obtained via histopathologic analysis. Surgical excision may be chosen under the assumption of dealing with a primary pituitary lesion, but extent of resection depends on the accessibility, extent, involvement of surrounding structures (such as the internal carotid artery/cavernous sinus), and control of intraoperative bleeding. When facing inoperable or residual lesions, radiotherapy can be a viable option.

Amelanotic malignant melanoma of the cervical oesophagus.

We report the case of a young woman who presented with progressive dysphagia and swelling in the anterior aspect of the neck of short duration. On evaluation, she was diagnosed with amelanotic malignant melanoma of the cervical oesophagus. She underwent total laryngopharyngo-oesophagectomy with gastric transposition with bilateral modified radical neck dissection with feeding jejunostomy and a permanent tracheostomy with postoperative combined chemoradiation therapy. However, in spite of aggressive treatment, the patient expired 8 months after initial presentation with distant metastasis.

Acute prevertebral abscess secondary to infected pancreatic pseudocyst.

We report a case of a middle aged, man with diabetes who presented with dysphagia and odynophagia. On evaluation, he was diagnosed to have an acute prevertebral abscess with an unusual aetiology, an infected pseudocyst of pancreas. Contrast-enhanced CT revealed an enhancing collection in the prevertebral space extending to the retrogastric space and communicating with the body of the pancreas via the oesophageal hiatus. Transoral incision and drainage of the prevertebral abscess were performed. Nasogastric tube was placed in the prevertebral space for continuous drainage and daily irrigation. Supportive intravenous broad spectrum antibiotic therapy along with the surgical intervention led to the resolution of the prevertebral abscess and the infected pancreatic pseudocyst.