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Germ cell tumors encompass a broad spectrum of neoplasms arising from germ cell lineage, demonstrating varying histological profiles and clinical presentations. These tumors encompass a range of benign and malignant entities. While global trends provide insights into their prevalence, specific regional variations, such as those within North-Western India, remain less explored. This study seeks to bridge this knowledge gap by examining the prevalence and characteristics of germ cell tumors within a tertiary cancer hospital. In this retrospective analysis, all cases of germ cell tumors diagnosed over a 3-year period in the specified tertiary cancer hospital were included. Cases with incomplete records or inadequate pathological data were excluded. Data encompassing histological subtypes, patient age distribution, clinical presentations, and histopathological features were collected and analyzed. The study comprised 145 cases of germ cell tumors. Teratomas were the most prevalent subtype, with mature teratomas accounting for the majority. The highest incidence occurred within the 21-30-year age group with a mean age of 24.77 years. Abdominal mass (56%) and abdominal pain (34%) were the prominent clinical presentations. Benign cases constituted the majority 85.5%. Solid tumors (p < 0.00001) and tumors more than 10 cm (p .029028) were found to have a high propensity to be malignant, which was proven to be statistically significant. This study comprehensively explains germ cell tumors' prevalence, clinical features, and histopathological subtypes in a tertiary cancer hospital in North-Western India. The predominance of teratomas, particularly mature ones, aligns with global trends. The age distribution and clinical presentations reflect common patterns. The diverse histopathological appearances underscore the heterogeneous nature of germ cell tumors. This study offers valuable insights for clinical management and further regional research.
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Surgical site infections (SSI) following head and neck oncology surgery can lead to significant morbidity and healthcare costs. This cross-sectional study was used to investigate a potential link between pre-operative 25-hydroxy vitamin D deficiency and an increased risk of surgical site infections in patients undergoing oral cavity oncology surgery. This cross-sectional study was conducted at a tertiary center in northwestern India from May 2022 to May 2023. Patients scheduled to undergo oral cavity oncology surgery during this period were eligible for inclusion. Patients with complete pre-operative 25-hydroxy vitamin D levels and documented post-operative wound infection status were included in the analysis. A total of 85 patients who underwent oral cavity oncology surgery were included in the study. Among them, 30.58% (26 patients) had pre-operative vitamin D deficiency, The overall incidence of surgical site infection (SSI) was 36.47% (31 patients). Among the patients with pre-operative vitamin D deficiency, 23 (88.5%) developed surgical site infections. Finally, pre-operative levels of 25-hydroxy vitamin D, pre-operative poor oral hygiene, and low albumin were confirmed as statistically significant independent predictors of SSI. After doing multivariate analysis, vitamin D deficiency was found to be a significant predictor of post-op wound infection [adjusted odds ratio - 0.71 (95% CI 0.61-0.82); p value < 0.001]. This study highlights the significant association between pre-operative 25-hydroxy vitamin D deficiency and an increased risk of surgical site infections in patients. Vitamin D plays a crucial role in modulating the immune response, promoting antimicrobial peptides, and enhancing wound healing. These findings support the importance of assessing and addressing vitamin D deficiency in patients scheduled for oral cavity oncology surgery to potentially reduce the incidence of SSIs.
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Duodenal lipoma is a very rare entity with limited case reports present in literature. But duodenal ampullary lipomas are even more rare in nature. Owing to the recent advances in endoscopy and modern imaging techniques, more cases are being diagnosed and treated. However, challenge lies in performing a less invasive and least morbid procedures to treat them surgically in such complex location of tumour. To study the diagnosis and treatment of duodenal ampullary lipoma in a young male patient and challenges faced during surgical management. A 15-year-old young boy presented to us with complaints of intermittent upper gastrointestinal bleed and jaundice since last 2 months. At admission, his serum haemoglobin was 3 g% for which he was transfused 3 units of packed blood cells for optimization. On further evaluation, CT scan abdomen revealed 71 × 49 mm large heterogeneous mass in D3 segment of duodenum causing duodeno-duodenal intussusception involving D1 and D2 segment along with ampullary region with mass being the lead point. There was compression of CBD with dilatation measuring 11 mm in diameter and mild IHBR dilatation. UGIE revealed narrowing at D1-D2 junction due to polypoidal lesion with overlying smooth mucosa with no active bleeding point identified. His blood parameters were normal except for low haemoglobin (before blood transfusion) and total serum bilirubin of 2.3 mg/dl.He was optimized for surgery and underwent exploratory laparotomy with duodenotomy at D2 with mass excision of 7 × 5 cm sessile polyp with base over ampulla followed by plastic repair of sphincter of Oddi (pancreas preserving procedure). He was started on oral liquids on POD 3 and was discharged on normal diet by POD 7 with an uneventful recovery. Result of histopathological report revealed, on gross cut section, the presence of mass of 7 × 5 × 3 cm size with smooth mucosa and fibrofatty tissue. On microscopic examination, diagnosis of submucosal lipomatous polyp was made. Our case report indicated duodenal ampullary lipoma is extremely rare entity. The symptoms are nonspecific and CT scan abdomen is the first investigation of choice for diagnosis. The treatment depends on the patient's condition as well as the size and position of the tumour. In our case report, the tumour base was exactly at the level of ampulla where we performed complex procedure of local excision of mass with sphincteroplasty avoiding major Whipple procedure for such benign condition. It provided rapid postoperative recovery to the patient.
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Basal cell carcinoma is the most common cancer worldwide. Most of basal cell carcinoma can be detected in the early stages and are generally well controlled with local resection. Despite the high incidence of BCC, intramucosal BCC is a very rare clinical entity. We hereby present a rare case report of pigmented BCC on soft palate and review the literature of this entity.
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Introduction: Pectoralis major myo-cutaneous (PMMC) flap continues to be a widely used tool to reconstruct oral cavity defects. But an unreliable and unstable vascular supply can lead to complications like flap loss, Oro-cutaneous fistula and wound dehiscence. Preservation of the lateral thoracic artery (LTA) has been suggested to improve the vascularity of the skin paddle. The present study aspires to compare the complications and flap related outcomes after preserving or sacrificing the LTA while reconstructing oral cavity defects with bi-folded PMMC flap. Materials and Methods: Retrospective analysis of the data of 61 male patients who were reconstructed with bi-folded PMMC flaps between January 2022 and September 2022 was done. 36 patients were reconstructed using a PMMC flap where the LTA was sacrificed, whereas in 25 patients the LTA was preserved. Data was analyzed in terms of patient factors and flap related complications. Results: The overall complication rate including major/minor complications was 44.26% with flap detachment at 22.95% being the commonest complication observed. 13.11% patients developed an Oro-cutaneous fistula and partial and complete flap loss were seen in 9.83% and 4.91% respectively. LTA preservation was significantly associated with only decreased flap detachment rates (p value < 0.05). No significant association was noticed between other flap related complications and LTA preservation. Conclusion: Reconstructing larger defects with a PMMC flap where the LTA is preserved can help improve the vascularity of the flap and decrease various major/minor flap related complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04123-3.
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In oral cancer surgeries, oncological outcomes take precious driverseat. But the copassengers like reconstruction, cosmesis, swallowing and speech outcomes deserve equivalent importance. Submental Artery Island Flaps (SAIF) provide an underutilized and extremely versatile option for reconstruction of defects following early stage oral cavity tumour resections. In this prospective observational analysis, we describe the technique, challenges and outcomes of SAIF at our tertiary care institute. Sixteen patients with Stage I and II oral cavity cancers were enrolled between June 2020 to May 2021. Verrucous carcinomas were five and well differentiated carcinomas were 11 patients. After tumour excision and neck dissections, defects were reconstructed with Pedicled submental flaps. Complications and functional outcomes were analyzed over two years. Nineteen percent were ladies and 81% were gentlemen. Median age was 52 years. Tongue tumours formed majority with 56% cases. Largest skin paddle taken was 36 cm2. Flap survival was 88%. There were variations in venous drainage of flaps which have been depicted in case figures. There was no report of orocutaneous fistula. Grade 3-4 speech satisfaction was achieved by 81.2% patients at 6 months. Swallowing was excellent, grade 4-5 for 100% of patients at 6 months. One patient had distant metastasis at 7 months and died. SRLR (Submental flap Recurrences) and trismus were zero percent at two years. The unexplored field of submental flaps can be used for oral cancer reconstructions in a versatile way. Donor site easy closures, no scars on face, early resumption of daily activities and short hospital stay makes it one of the ideal options in early stage oral cavity defects.
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INTRODUCTION: Head and neck malignancies are responsible for 30% of all cancers in India with a dramatic increase in numbers due to widespread tobacco consumption. This study aims to assess the epidemiological and histopathological spectrum of these tumors. MATERIALS AND METHODS: A large retrospective review of 5469 biopsy-proven patients presenting between 2018 and 2022 with head and neck cancers was done. Tumors were analysed for distribution according to sites of presentations, gender, age and histopathological profiles. RESULTS: With a male-to-female ratio of 4.2:1, men constituted 80.80% of the study population. Mean age of presentation in women was 53.5 years, whereas men presented at an earlier age of 47.2 years. Oral cavity was the commonest site involved (59.7% cases) followed by the oropharynx (23.8% cases). Buccal mucosa was the commonest subsite involved with 1112 cases followed by tongue lesions with 1088 cases. Larynx was responsible for 17.04% of cases. All subsites were more commonly affected in men with the highest Male: Female ratio of 8.29:1 seen in larynx. The lowest ratio of 1.02:1 was seen in lesions of the face and scalp. Squamous cell carcinoma (SCC) was the most common histopathological diagnosis encountered in 88.97% of cases followed by basal cell carcinoma which was seen in 2.10% lesions. CONCLUSION: Oral cavity lesions constitute the bulk of head and neck cancer presentations in India. The disease is more prevalent in men overall and men present at a younger age in comparison to women. SCC is the most prominent histopathology encountered in our study.
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Although microvascular free flaps are considered the first choice in head and neck cancer defect reconstruction, their use is limited in developing regions by availability of resources and the expertise .The Bipaddle pectoralis major myocutaneous flap (PMMC flap) is a commonly used flap in head and neck cancer reconstruction, but in literature flap is associated with high incidence of drawbacks including donor site morbidity and added bulk of the flap reducing cosmetics and function. The purpose of the study is to evaluate the Bipaddle PMMC flap reliability, operative technique and outcome in reconstructive head and neck cancer surgery in the era of microvascular free flaps. Its a prospective study in which the records of 50 patients treated with Bippadle PMMC flap reconstruction between January 2022 to July 2022 were systematically collected and reviewed. Data of recipient site, serum albumin, history of adjuvant, recurrence, defect dimension, type of donor site closure, length of hospital stay, postoperative complications and outcomes were analysed. There were 45 males and 5 females with a mean age of 41 years (31-60). Bipaddle PMMC flap reconstruction was done in all patients of advanced squamous cell carcinoma of oral cavity. There were two males with complete necrosis of flap salvaged with latissimus dorsi flap and forehead flap. Minor infections were noted in two female and one male patient, managed conservatively and recovered well with acceptable final outcome. The Bipaddle PMMC flap is reliable for large defects in head and neck reconstructive surgery, particularly when a bulky flap is required to reconstruct composite defects where the lesion is involving the skin. Placing the flap horizontally with inclusion of nipple and areola in most of the patients increased the reach and size of available flap.
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Fibromatosis is a rare locally aggressive benign tumour which arises from the musculoaponeurotic structures throughout the body. In the oral and maxillofacial region, It has been described under a variety of synonyms, including 'extra articular desmoids', 'desmoids tumours', 'grade-1 fibrosarcomas','non metastasizing fibrosarcoma'and 'aggressive fibromatosis'. The pecularity of this entity in paranasal sinuses is that it is rare in this location and are locally aggressive with higher rates of recurrence in a relatively restricted area.The purpose of this study is to present a rare case report and reviewing the literature of this entity.
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Angiosarcoma of bone is very rare entity, accounting for less than 1% of all primary bone sarcomas with associated poor prognosis. We hereby present a case report of angiosarcoma of tibia in a young boy and reviewed its literature and management of the disease. A 21-year young male presented to us with complaints of pain and swelling over left lower leg since last 3 months. On evaluation, MRI lower leg revealed multiloculated lesion of size 32×36×52 mm showing multiple fluid-fluid levels which was hyperintense on T2 images in left distal tibial metaphysis showing endosteal scalloping with cortical destruction along lateral border and abuts the physis. Image-guided biopsy was done. PET CT revealed no evidence of metastasis. Histopathology report revealed tumor involving bone and soft tissue comprising of plump ovoid to epitheloid/spindled cells in nests and focal fascicles with marked nuclear atypia, prominent nucleoli and mitotic figures with vascular pattern with thick walled vessels, many haemosiderophages. Differentials of telangiectatic osteosarcoma/adamantioma was made. On further IHC studies, tumor cells were found positive for SATB2, CD31, ERG while negative for CK, P40, DESMIN, MYOGENIN, TLE-1, S-100. Diagnosis of angiosarcoma of tibia was confirmed. Decision to give neo-adjuvant chemotherapy with doxorubin/Ifosfamide-based regimen was made followed by later with limb salvage surgery. He received 5 cycles of chemotherapy 3 weekly regimen which he tolerated well. Repeat MRI leg showed partial reduction in tumor size but there was presence of pathological fracture seen with some extraosseous component of tumor. Limb salvage surgery was not possible and he underwent below knee amputation. His postoperative recovery was eventful. Final histopathology confirmed diagnosis of angiosarcoma tibia. Case was discussed in multidisciplinary tumor board and he was started on alternate chemotherapy with Injection docetaxel and gemcitabine-based regimen. He had received 3 cycles of this regimen till now and is disease free from last 3 months. Angiosarcoma of bone is a very rare entity; the literature is limited regarding treatment and outcome of patients with this tumor. Most information is currently available from case reports, and treatments are based on guidelines for other types of primary bone sarcomas. We hereby present a case report of angiosarcoma of tibia in a young boy and reviewed its literature, diagnostic dilemmas associated with it and management of the disease after discussing in multidisciplinary board. Role of chemotherapy, surgery, and their sequencing is not well defined. Prospective trials are required to manage this rare entity.
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The best biocontroller Bacillus subtilis produced silver nanoparticles (AgNPs) with a spherical form and a 62 nm size through green synthesis. Using UV-vis spectroscopy, PSA, and zeta potential analysis, scanning electron microscopy, and Fourier transform infrared spectroscopy, the properties of synthesized silver nanoparticles were determined. Silver nanoparticles were tested for their antifungicidal efficacy against the most virulent isolate of the Aspergillus flavus fungus, JAM-JKB-BHA-GG20, and among the 10 different treatments, the treatment T6 [PDA + 1 ml of NP (19: 1)] + Pathogen was shown to be extremely significant (82.53%). TG-51 and GG-22 were found to be the most sensitive groundnut varieties after 5 and 10 days of LC-MS QTOF infection when 25 different groundnut varieties were screened using the most toxic Aspergillus flavus isolate JAM- JKB-BHA-GG20, respectively. In this research, the most susceptible groundnut cultivar, designated GG-22, was tested. Because less aflatoxin (1651.15 g.kg-1) was observed, treatment T8 (Seed + Pathogen + 2 ml silver nanoparticles) was determined to be much more effective. The treated samples were examined by Inductively Coupled Plasma Mass Spectrometry for the detection of metal ions and the fungicide carbendazim. Ag particles (0.8 g/g-1) and the fungicide carbendazim (0.025 g/g-1) were found during Inductively Coupled Plasma Mass Spectrometry analysis below detectable levels. To protect plants against the invasion of fungal pathogens, environmentally friendly green silver nanoparticle antagonists with antifungal properties were able to prevent the synthesis of mycotoxin by up to 82.53%.
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Benzimidazóis , Carbamatos , Fungicidas Industriais , Nanopartículas Metálicas , Antifúngicos/farmacologia , Aspergillus flavus , Prata/farmacologia , Prata/química , Nanopartículas Metálicas/química , Aspergillus , Bactérias , Extratos Vegetais/química , Espectroscopia de Infravermelho com Transformada de Fourier , Antibacterianos/química , Testes de Sensibilidade MicrobianaRESUMO
The standard treatment approach for metastatic breast cancer with HR- and Her-2-neu + disease is trastuzumab with systemic therapy. But in patients having severe cardiac dysfunction, trastuzumab is avoided. Various combination regimens are available in that setting, but no study has shown better efficacy of capecitabine monotherapy in this setting. We hereby present a case report of using capecitabine monotherapy in first-line setting, and the patient had complete resolution of lung metastasis from the last 2 years. A 64-year-old postmenopausal lady with a known case of breast carcinoma in the left side diagnosed in the year 2016 with hormone receptor-positive, Her2-negative disease completed chemoradiation and on is aromatase inhibitor from the last 5 years. She complained of breathlessness and fatigue lasting for 1 month in July 2021. On evaluation, chest CT scan revealed multiple bilateral lung metastases along with 3×3 cm right-sided breast lump with no metastasis elsewhere in the body. Core needle biopsy of breast lump and CT-guided left lung nodule biopsy were performed which revealed infiltrating carcinoma with immunohistochemical markers showing tumor cells positive for Her-2-neu with hormone receptor-negative disease. PET-CT scan was done which revealed FDG avidity in bilateral lung fields and right breast lump with no disease elsewhere. Her echocardiography showed ejection fraction of 40% owing to which injection trastuzumab was deferred and the plan to start tablet capecitabine 1000 mg twice BD days 1-14 cycles every 21 days was made. She showed improvement in symptoms with PET-CT scan revealing resolution of lung metastasis from the last 2 years. Trastuzumab in combination with pertuzumab and taxane is the standard of care for metastatic breast carcinoma with hormone receptor-negative and Her2-positive disease. But in patients who are elderly, frail with severe cardiac dysfunction, trastuzumab-based regimen is contraindicated. No study demonstrated efficacy of capecitabine monotherapy in this subset of disease. More prospective studies are required to identify patients who can benefit from capecitabine monotherapy in first-line setting in this subset of disease. Also capecitabine usage has several advantages mainly low cost and availability in oral form, and patients can be followed up on OPD basis.
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Human papillomaviruses (HPVs) are circular, nonenveloped small double-stranded DNA viruses that infect stratified epithelium and can cause a number of life-threatening diseases. HPV is the central risk factor for developing cervical cancer and is estimated that approximately 98% of this disease is associated with oncogenic types of HPV. HPV infection leads to an estimated 266,000 cervical cancer deaths annually. Therefore, the objective of this study was to determine the prevalence of HPV infection and risk factors associated with cervical lesion among women attending the cervical cancer screening clinic at the Ethiopian Family Guidance Association, Addis Ababa. A cross-sectional study was conducted to determine the prevalence of HPV infection. Data were collected using a questionnaire and samples leftover from cervical screening were taken. The leftover swab was air dried and DNA was extracted and amplified by using a PCR. A total of 247 women were included in the study. The prevalence of HPV was 9.72% among the population studied. Of all participants, 27.13% were positive for cervical intraepithelial neoplasia-1 (CIN1). CIN1 positivity was found in half of HPV positive women. Among HPV positive women, half of them had started sexual intercourse at ages 12-17 years and 41.66% were women who gave birth at ages 12-17 years. The high prevalence of HPV and the CIN1 positive group were ages 36-57 and women with multiple sexual partners. The other groups with the highest CIN1 positive were 22.39% grade (9-12) and 20.9% primary (1-8) and uneducated women. Among HPV positive women, 83.33% had an abortion history and 80% miscarried in the first trimester. Among the CIN1 positives, 53.73% had more than two sexual partners. Among HPV positive women, half of them were users of contraception methods. In conclusion, the highest prevalence of HPV is among women who began sexual intercourse earlier and who gave birth at 12-17 years of age, have an abortion history, with MSP and oral contraceptive methods users. In addition to HPV, early pregnancy and sexual intercourse at 12-17 years of age, abortion, MSP, and oral hormonal contraceptives are factors in cervical cancer. Finally, most women do not have enough knowledge and awareness about cervical cancer and the risk factor.
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Infecções por Papillomavirus , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/complicações , Detecção Precoce de Câncer , Prevalência , Etiópia/epidemiologia , Estudos Transversais , Papillomaviridae/genética , Displasia do Colo do Útero/patologia , Fatores de Risco , Anticoncepcionais Orais/efeitos adversosRESUMO
Groundnuts are mostly contaminated with the mold Aspergillus flavus which produces a carcinogenic mycotoxin called as aflatoxin. It is very important to understand the genetic factors underlying its pathogenicity, regulation, and biosynthesis of secondary metabolites and animal toxicities, but it still lacks useful information due to certain gaps in the era of modern technology. Therefore, the present study was considered to determine the key genes and metabolites involved in the biosynthesis of aflatoxin by using a molecular approach in a virulent strain of Aspergillus. The whole genome sequence of highly toxic and virulent Aspergillus isolates JAM-JKB-B HA-GG20 revealed 3,73,54,834 bp genome size, 2, 26, 257 number of contigs with N50 value of 49,272 bp, 12,400 genes and 48.1% of GC contained respectively. The genome sequence was compared with other known aflatoxin producing and non-producing genome of Aspergillus spp. and 61 secondary metabolite (SM) gene clusters were annotated with the toxic strain JAM-JKB-BHA-GG20 which showed similarity with other Aspergillus spp. A total number of eight genes (ver-1, AflR, pksA, uvm8, omt1, nor-1, Vha and aflP) were identified related to biosynthesis of aflatoxin and ochratoxin. Also, 69 SSR with forward and reverse primers and 137 di and tri nucleotide motifs were identified in the nucleotide sequence region related to aflatoxin gene pathway. The genes and putative metabolites identified in this study are potentially involved in host invasion and pathogenicity. As such, the genomic information obtained in this study is helpful in understanding aflatoxin gene producing pathway in comparison to other Aspergillus spp. and predicted presence of other secondary metabolites clusters viz. Nrps, T1pks etc. genes associated with a biosynthesis of OTA mycotoxin.
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Aflatoxinas , Aspergillus flavus , Aspergillus flavus/genética , Aspergillus flavus/metabolismo , Aspergillus/metabolismo , Genes Fúngicos , Sequenciamento Completo do GenomaRESUMO
BACKGROUND: Oral cavity cancers, the second most common type in India, are responsible for 10% of the overall cancer burden. With a recurrence rate of 30% to 40% and a 5-year survival rate of 50%, these malignancies account for substantial morbidity and mortality. Despite advances in treatment modalities, survival rates following treatment completion have not improved significantly. The present study aimed to establish specific epidemiological and pathological factors responsible for recurrence after treatment completion in buccal mucosa cancers. METHODS: A retrospective analysis of the data of 116 patients treated for biopsy-proven cancers of the buccal mucosa was undertaken 1 year after treatment completion. Factors such as age, sex, education, lymphovascular invasion, extranodal extension (ENE), perineural invasion, depth of invasion, and pathological margin status were compared between patients who presented with recurrence and those who did not. Statistical significance was set at p< 0.05. RESULTS: Of the 116 patients, 40 (34.5%) developed a recurrent disease within 1 year. The mean age of the study population was 43.3 years, and males constituted 91.4% of the included patients. Ipsilateral buccal mucosa was the commonest site of disease recurrence. Neck node metastasis, ENE, and margins of resection < 5 mm were significantly related to the recurrence of disease. However, surprisingly, lymphovascular invasion, perineural invasion, and depth of invasion > 10 mm did not show statistically significant associations. CONCLUSION: Neck node metastasis, ENE, and margins of resection < 5 mm were the histopathological factors associated with recurrence in cancers of the buccal mucosa.
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Various methods of reconstruction are available for reconstructing oral cancer defects, but all of them have their inherent drawbacks. The superiorly based platysma myocutaneous flap is a common reconstruction option for intra-oral defects following oral cancer resections. We present our results of using platysmal flaps in reconstructing intraoral defects following oral cavity cancer resection in our 7 patients along with resection of three cases of premalignant conditions of oral cavity. All the patients were males of age ranging from 24 to 42 years and diagnosed as squamous cell carcinoma of oral cavity stage I and II were included in this study.Of 10 patients eight had no postoperative complications. One patient developed partial skin loss of neck donor site, which was managed conservatively. Other patient had complete flap loss which healed with secondary intention. We recommend this flap as incision is always away from the face, the scars are hidden beneath collars and the patients are very comfortable with good cosmetics and functional outcomes.\.
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Orbital defects represent difficulties in head and neck reconstruction owing to 3-dimensional complexity of the socket with aim to restore form and function. Recommended methods of reconstruction include mucosal and skin grafts free microvascular myofascial or fasciocutaneous flaps. However, most frequently, reconstruction of orbital defects calls for measures somewhere in between. The temporoparietal fascia flap (TPFF) fits well as it provides thin, pliable coverage of defects with dependable blood supply, tolerance for a large degree of rotation and minimal donor site morbidity. We hereby present our experience and results of 10 cases using TPPF and temporalis muscle post orbital exentration defects.Ten patients (7 male and 3 females) age ranging from 25 to 64 years underwent reconstruction of orbital exenteration defects using TPPF and temporalis muscle from June 2019 to June 2020 in our department. The primary disease was squamous cell carcinoma (SCC) of orbital structures (anterior compartment) in all 10 patients. All cases were clinically N0 and M0.All patients had successful transfer of TPFF grafts and temporalis muscle transfer without flap compromise. TPPF was used in all 10 patients while Temporalis muscle flap was used to fill orbital socket in our 9 patients. Temporoparietal fascial flap showed viable option for subtle orbital and malar contour defect. All patients had intact dura with residual orbital cavity after resection reconstructed with TPPF and temporalis muscle without any additional flap usage. No frontal paralysis or orbital fistula was seen but local recurrence occurred in one patient in follow up and managed with RT. The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction.
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Spindle cell neoplasm of the tonsil are rare (Minami et al. in Am J Otolaryngol 29(2):123-125, 2008) and can be difficult to diagnose due to their non-specific clinical presentation and histological characteristics (Su et al. in J Chin Med Assoc 69(10):478-483, 2006). Differential diagnoses include lymphoma and squamous cell carcinoma (Hyams in Clin Otolaryngol Allied Sci 3(2):117-126, 1978). Oropharyngeal spindle cell neoplasms were more likely to occur in the tongue base and tonsil (58%) (Gerry et al. in Ann Otol Rhinol Laryngol 123(8):576-583, 2014). In this article, we report a case of tonsillar spindle cell neoplasm which is extremely rare.
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Background: Restoration of form and function of the oral cavity post resection for oral cavity malignancies is an enormous challenge in head and neck reconstructive surgery. The facial artery musculo-mucosal (FAMM) flap is an unexplored, underutilized yet an extremely versatile option for such defects. In this analysis we review the performance of the FAMM flap used to reconstruct tongue/floor of mouth (FOM) defects following tumor resection. Materials and Methods: In this retrospective analysis, demographic and disease profiles of 15 patients with Tongue and Floor of Mouth carcinomas reconstructed with a FAMM flap between January 2019 to January 2021 were studied. Complications and functional outcomes were analyzed. Results: Fifteen patients (10 men, 5 women) were reconstructed using a FAMM flap. Mean age of the study sample was 46.46 years (28-60 years). One flap was lost due to complete flap necrosis following venous congestion, two other flaps suffered distal tip necrosis. Three patients developed an Oro-cutaneous fistula, with one going on to develop a surgical site infection of the neck wound. Patients reconstructed for FOM defects had an excellent functional outcome. For patients reconstructed for a tongue defect, 33.33% of patients complained of restricted tongue mobility and 44.44% were dissatisfied with the quality of speech post operatively. Conclusion: The versatile FAMM flap is a reliable, easy to harvest and scarless flap. It provides excellent cosmetic and functional results FAMM flap allowing early resumption of normal daily activities making it an ideal option to reconstruct small to medium sized oral cavity defects.
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Medullary carcinoma of the thyroid is a rare type of thyroid cancer that arises from the parafollicular cells or C-cells, which produce calcitonin. It accounts for approximately 5-10% of all thyroid cancers (Leboulleux et al. in Clin Endocrinol 61(3):299-310, 2004). The main treatment for medullary thyroid carcinoma is surgery, which involves the removal of the thyroid gland and any affected lymph nodes. In advanced cases where the cancer has spread to nearby structures such as the trachea (Gupta et al. in Indian J Surg Oncol 11(1):75-79, 2020), tracheal resection followed by reconstruction may be necessary to remove the cancer (Chernichenko et al. in Curr Opin Oncol 24(1):29-34, 2012) and restore proper breathing, closure of large tracheal defect can be done with pectoralis major myocutaneous flap (Salmerón-González et al. Plast Surg Nurs 38. 162-165, 2018). In this article, we report a case of recurrent medullary carcinoma thyroid with tracheal infiltration and tracheal resection was done, both of which is extremely rare. A 38-year-old male patient with a history of total thyroidectomy presented with recurrence was referred to our department, his previous biopsy and IHC revealed medullary carcinoma thyroid. Ga-68 DOTA PET CT scan was done which showed PET avid residual mass over right side, multiple bilateral cervical nodes, and tracheal infiltration (Fig. 1) then underwent a bronchoscopy showing involvement of the second, third, and fourth tracheal ring. Bilateral neck dissection with sleeve resection of trachea with overlying residual tumor was done and was sent for frozen which revealed positive margins and re-excision of margins was done, which lead to large defect (Fig. 2) which could not be closed primarily with a Montgomery T Tube. A de-epithelized pectoralis major myocutaneous flap used to close the tracheal defect followed by placing the Montgomery T Tube (Fig. 3).Post-operative period was uneventful. The final histopathology report showed R0 resection of tumor. T tube was removed after 4 weeks.