Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection.

BACKGROUND: Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. METHODS: This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. RESULTS: From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). CONCLUSION: Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

Hyalinizing clear cell carcinoma of the base of tongue.

Hyalinizing clear cell carcinoma is a rare, low-grade neoplasm of the minor salivary glands. It is composed exclusively of epithelial cells with optically clear cytoplasm. There are only a few isolated cases reported in the literature involving the base of tongue. The treatment of choice is wide excision and selective neck dissection, with or without radiotherapy. The prognosis of these tumours is good. A 57-year-old male patient presented with a lesion in the base of tongue, which was well enhanced on contrast computerized tomography scan. Once confirmed by biopsy, the hyalinizing clear cell carcinoma was resected via a transcervical approach. The patient underwent postoperative radiotherapy. There was no evidence of locoregional recurrence or distant metastasis at 18 months of follow up.

Methane oxidation in an intensively cropped tropical rice field soil under long-term application of organic and mineral fertilizers.

Methane (CH4) oxidation is the only known biological sink process for mitigating atmospheric and terrestrial emissions of CH4, a major greenhouse gas. Methane oxidation in an alluvial soil planted to rice (Oryza sativa L.) under long-term application of organic (compost with a C/N ratio of 21.71), and mineral fertilizers was measured in a field-cum-laboratory incubation study. Oxidation rates were quantified in terms of decrease in the concentration of CH4 in the headspace of incubation vessels and expressed as half-life (t(1)2) values. Methane oxidation rates significantly differed among the treatments and growth stages of the rice crop. Methane oxidation rates were high at the maximum tillering and maturity stages, whereas they were low at grain-filling stage. Methane oxidation was low (t(1)2) = 15.76 d) when provided with low concentration of CH4. On the contrary, high concentration of CH4 resulted in faster oxidation (t(1)2) = 6.67 d), suggesting the predominance of "low affinity oxidation" in rice fields. Methane oxidation was stimulated following the application of mineral fertilizers or compost implicating nutrient limitation as one of the factors affecting the process. Combined application of compost and mineral fertilizer, however, inhibited CH4 oxidation probably due to N immobilization by the added compost. The positive effect of mineral fertilizer on CH4 oxidation rate was evident only at high CH4 concentration (t(1)2 = 4.80 d), while at low CH4 concentration their was considerable suppression (t(1) = 17.60 d). Further research may reveal that long-term application of fertilizers, organic or inorganic, may not inhibit CH4 oxidation.

A Short Term Subjective and Objective Analysis of Modified Endoscopic Lothrop's Procedure and Its Functional Outcome: Our Experience.

To study the short-term functional outcomes of the endoscopic modified Lothrop procedure with well defined subjective and objective criteria. It's a retrospective cohort study with chart review carried out at a tertiary referral center. 31 patients with chronic frontal sinusitis who underwent endoscopic modified Lothrop's procedure with uncinate preservation during the period Jan 2011-2014 were followed up for a period of minimum 6 months. Assessment was done post-operatively based on subjective severity score and Kennedy's 5 point endoscopic criteria. Subjective improvement was seen in all symptoms whereas statistically significant improvement was found for the three parameters headache (p < 0.025), nose block (p < 0.03) and rhinorrhea (p < 0.05). Post operative nasal endoscopy revealed crusting and polypoidal mucosa in few patients which were managed conservatively. Asymptomatic narrowing of ostium seen in two patients. No complications were identified. The study illustrates the benefit obtained from endoscopic modified Lothrop's surgery in chronic frontal sinusitis refractory to medical treatment and standard endoscopic sinus surgery.

Foreign body in the ethmoid sinus.

An air gun pellet lodged in the posterior ethmoid sinus in a 1-year-old child is described. Functional endoscopic sinus surgery enabled the removal of the pellet, obviating an external ethmoidectomy.

Prevention and management of synechia in pediatric endoscopic sinus surgery using dental wax plates.

Synechia formation is a very common complication of endoscopic sinus surgery (ESS). Inspite of meticulous post-operative care, synechia do form in quite a large number of patients. Moreover, frequent post-operative cleaning may not be possible without general anesthesia in non-compliant patients, especially children. This study compares the incidence of synechia following pediatric ESS with or without spacer/tamponade in the operated cavity. The authors have found dental wax plates to be equally effective and more economical spacers compared to Merocel tamponade, in prevention and management of synechia in the pediatric age group.

Endoscopic adenoidectomy in a case of Scheie syndrome (MPS I S).

The mucopolysaccharidoses (MPS) are a heterogeneous group of relatively rare, progressive, inherited lysosomal storage disorders, characterized by a deficiency of lysosomal enzymes which are responsible for the stepwise degradation of glycosaminoglycans. Their deficiency leads to the accumulation of glycosaminoglycans in various organs causing progressive disruption of cellular functions and multiple systemic effects including otolaryngological problems, upper airway obstructive disease being the most common. Scheie syndrome (MPS I S) is due to the deficient activity of alpha-L-iduronidase leading to the intralysosomal accumulation of dermatan sulfate and heparan sulfate. We present our experience in one such case occuring in a 6-year-old girl with ENT manifestations and who underwent a successful endoscopic adenoidectomy for symptomatic adenoid hypertrophy. This procedure was preferred over a conventional adenoidectomy in order to avoid complications associated with abnormal cervical vertebrae.

Congenital internal carotid artery aneurysm.

Congenital carotid aneurysms are frequently found in the intracranial arteries but rarely seen in extracranial part of the internal carotid artery. A case of a congenital internal carotid artery aneurysm at the skull base was treated in a 13-year-old female child. This case is being presented for its rarity and also to highlight the ease of exposing the upper end of the aneurysm via lateral skull base approach. Infratemporal fossa approach was adopted in this case. The carotid canal was drilled off and the upper end of the aneurysm in the intrapetrous part was mobilized and vascular clip applied before dissection of the aneurysm. Relevant literatures pertaining to this case are also reviewed.

Paecilomyces fungus infection of the paranasal sinuses.

Fungal infections caused by Paecilomyces species are very rare and occur in adult patients with impaired host defences or following foreign body implants. They are found worldwide in soil and decaying vegetation. We describe a case of an 8 year old child who came with complaints of left sided nasal obstruction and discharge, telecanthus, diplopia and epiphora. On examination and investigation he had pansinusitis caused by P. lilacinus. An endoscopic sinus surgery was done and the patient was on oral Itraconazole for 6 months. To our knowledge, this is the first case reported in the paediatric age group.

Giant neurofibroma of the tongue.

Neurofibroma of the tongue arising from the hypoglossal nerve is rare [7], but a combined neurofibroma of the hypoglossal and lingual nerve is extremely rare in the English literature to our knowledge [4,6]. Here one such case is being presented for its rarity, peculiarity of its clinical presentation and the surgical approach to excise it.

Clear cell carcinoma of the larynx--a case report.

Clear cell carcinoma (CCC) of the larynx is extremely rare and to the best of our knowledge no such case has been reported in the paediatric age group. These tumours resemble the clear cell carcinoma of the major and minor salivary glands. We report such a lesion in a 15 years old boy presenting with hoarseness and an exophytic growth in the glottis. A frontolateral conservation laryngectomy with laryngoplasty was done and over 2 years follow-up has shown no evidence of loco-regional recurrence and he enjoys an acceptable voice.

Butachlor inhibits production and oxidation of methane in tropical rice soils under flooded condition.

In laboratory incubation experiments, application of a commercial formulation of the herbicide butachlor (N-butoxymethyl-2-chloro-2',6'-diethyl acetanilide) to three tropical rice soils, widely differing in their physicochemical characteristics, under flooded condition inhibited methane (CH4) production. The inhibitory effect was concentration dependent and most remarkable in the alluvial soil. Thus, following application of butachlor at 5, 10, 50 and 100 microg g(-1) soil, respectively, cumulative CH4 production in the alluvial soil was inhibited by 15%, 31%, 91% and 98% over unamended control. Since CH4 production was less pronounced in the sandy loam and acid sulfate soil, the impact of amendment with butchalor, albeit inhibitory, was less extensive than the alluvial soil. Inhibition of CH4 production in butachlor-amended alluvial soil was related to the prevention in the drop in redox potential as well as low methanogenic bacterial population especially at high concentrations of butachlor. CH4 oxidation was also inhibited in butachlor-amended alluvial soil with the inhibitory effect being more prevalent under flooded condition. Inhibition in CH4 oxidation was related to a reduction in the population of soluble methane monooxygenase producing methanotrophs. Results demonstrate that butachlor, a commonly used herbicide in rice cultivation, even at very low concentrations can affect CH4 production and its oxidation, thereby influencing the biogeochemical cycle of CH4 in flooded rice soils.

An endoscopic approach to the deviated nasal septum--a preliminary study.

The authors have used the nasal endoscope for the precise identification of pathological abnormalities of the nasal septum in relation to the lateral nasal wall including the osteo-metal complex and in its ultraconservative management. The aim of the study was to compare the efficacies of endoscope-aided septoplasty (EAS) over traditional septoplasty (TS) in treating the pathological septum and turbinates, performed in 30 cases each. The subjective assessment was carried out by visual analogue scores and objective assessment by nasal endoscopy. This study demonstrates the superiority and limitations of the endoscopic approach in managing a deviated nasal septum and the turbinates. The endoscope-aided technique was found to be more effective in relieving the contact areas and nasal obstruction (p = < or = 0.05). The authors advocate a combined approach--an endoscopic approach for inaccessible posterior deviation and the conservative traditional technique for accessible anterior deviation of the nasal septum.

Unusually large mastoid antrum ('mega antrum').

Patients who present with a unilateral non-tender bony swelling in the mastoid region without any clinical evidence of middle ear infection could be diagnosed as having a fibrous or bony lesion affecting the temporal bone. In such cases, if there is radiological evidence of large lucent area in the mastoid antrum without any bony dehiscence one should keep in mind in the differential diagnosis a mega antrum in addition to congenital cholesteatoma and eosinophilic granuloma. A large lytic lesion in the mastoid segment of the temporal bone with an intact tympanic membrane therefore presents a diagnostic dilemma. A case of an unusually large mastoid antrum in an young adult with no middle ear suppuration and a cosmetically unacceptable swelling behind the ear is presented.

Osteogenic sarcoma of sphenoid bone: an extended lateral skull base approach.

Osteogenic sarcoma involving the sphenoid bone is an extremely rare condition. The rarity of the disease and the close proximity of the sphenoid bone to the various important intracranial structures poses a real challenge in diagnosis and surgical management of these lesions. An extended lateral craniofacial resection by a multidisciplinary approach was carried out in one such case to attempt en bloc resection. This case is presented and also a review of the relevant literature.

Rosai-Dorfman disease of the subglottis.

A case of subglottic narrowing caused by an extranodal deposit of sinus histiocytosis in a 29-year-old man is reported. The characteristic features of Rosai-Dorfman disease, such as massive painless cervical lymphadenopathy, fever, raised erythrocyte sedimentation rate and raised white cell count, were all found to be absent. However, typical histological features, such as diffuse lymphoplasmacytic infiltrate, Russel bodies, foamy histiocytes and histiocytes with emperipoiesis, confirmed the diagnosis. Rosai-Dorfman disease is an uncommon disorder and its presentation with progressive subglottic narrowing is extremely rare. Our experience in the management of this condition is reported and the review of literature is discussed.

Dual ectopic thyroid: a report of two cases.

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue at a site other than in its usual pretracheal region. Usually it occurs along the path of descent of the developing thyroid primodium from the foramen caecum, commonest being lingual followed by sublingual and in the anterior midline of neck at, or below, the level of the hyoid bone. It is unusual for lingual thyroid to present simultaneously with another ectopic thyroid; reported here are two such cases.

Endoscopic physiologic approach to allergy-associated chronic rhinosinusitis: a preliminary study.

Patients with allergy-associated chronic rhinosinusitis respond poorly to functional endoscopic sinus surgery (FESS), probably because of the altered nasosinus ventilatory physiology and the increased contamination of the nasosinus mucosa by the offending allergens. With this in mind, we describe the concept and technique of functional endoscopic nasosinus surgery (FENS) in such cases. The advantages of this technique are that it preserves the uncinate process, it limits ethmoidal exenteration via a transbullar approach, and it simultaneously corrects both septal and lateral wall pathologies. The aim of our randomized prospective study was to subjectively and objectively compare the efficacy of FESS and FENS in 64 patients with allergy-associated chronic rhinosinusitis. Subjective assessment was ascertained by visual analog scores, and objective assessment was made by nasal endoscopy. In this preliminary study, we found that FENS was superior to FESS in treating chronic sinusitis associated with nasal allergy.

KTP Laser in Laryngeal Amyloidosis: Five Cases with Review of Literature.

To study the clinical presentation and review the options in the management of laryngeal amyloidosis. To study the efficacy of KTP 532 laser in the excision of laryngeal amyloidosis. Study was conducted in our department in a tertiary care hospital between Jan 2001 and Feb 2010. We report five patients who presented with hoarseness of voice and localized laryngeal lesions. The biopsy proven laryngeal amyloidosis lesions were excised microendoscopically using KTP 532 laser in three patients and other two patients were kept only on follow-up as they refused further surgery. The patients were evaluated for systemic amyloidosis. The average duration of follow up was 2.6 years (3 months 6 years). All the five patients in our study were asymptomatic with no evidence of recurrence at their last follow up. In our small case series, KTP 532 laser excision of the laryngeal amyloidosis had a favorable outcome. Long term follow up is required to rule out recurrence and systemic involvement.

Modified Stennert's Protocol in Treating Acute Peripheral Facial Nerve Paralysis: Our Experience.

The aim of this study was to know the effect of modified Stennert's protocol on Bell's palsy and delayed onset post traumatic facial nerve paralysis. Retrospective study method which included 26 patients was done. Of this 19 patients had Bell's palsy and seven patients had delayed onset post traumatic facial nerve paralysis. All patients started on modified Stennert's protocol. Nineteen patients were observed and had idiopathic facial nerve paralysis. Fifteen patients showed clinical improvement by the 10th day and by the end of 1 month, 18 patients showed significant symptomatic improvement. One patient had residual defects at 6 months. Of the seven patients with delayed onset post traumatic facial nerve paralysis, three patients had to undergo facial nerve decompression, the remaining four receiving only modified Stennert's protocol. Improvement was seen in three patients by the 10th day. By the end of 1 month a total of five patients showed significant symptomatic improvement. Our experience suggests that regardless of the cause, sudden onset facial paralysis responds favorably to administration of modified Stennert's regimen, resulting in faster recovery and lesser sequelae.