Infrahyoid flap revisited - A head and neck surgical perspective in the Indian setting.

PURPOSE: In India, head and neck cancer contributes to about 35% of all malignancies. Among head and neck squamous cell cancers, buccal mucosa and tongue are the most common subsites. Reconstruction of defects after resection of primary in these subsites with acceptable cosmetic and functional outcomes remains a challenging task. In the era of free flaps, many pedicled flaps are being overlooked. Infrahyoid flap (IHF) is one among them. This study discusses the feasibility of IHF in reconstruction of small and medium-sized defects in subsites of the oral cavity. MATERIALS AND METHODS: This study is a retrospective analysis of 23 patients who underwent IHF and reconstruction after excision of primary in a case of oral cavity squamous cell carcinoma from January 2010 till November 2017 with a median follow-up of 15 months. Patients who were diagnosed as a case of squamous cell carcinoma in oral cavity subsites (T1-T3 and N0/N1-N2) and in whom the anticipated defect size was small to medium were included. The evaluation was then done based on the possibility to reach recipient site, vitality after transposition, definitive integration, and clinical outcome. RESULTS: Out of 23 patients, 5 patients had flap-related complications of which 1 patient had total skin paddle necrosis and 4 patients had partial skin paddle necrosis at distal end. However, no patient developed oro-cutaneous fistula or required corrective surgery. The maximum flap dimension was 9 × 4 cm and average flap dimension was 6 × 4 cm. The postoperative outcome of all patients remained uneventful. CONCLUSION: The infrahyoid myocutaneous flap is a reliable and convenient flap which can be used as a good alternative for free flaps in small and medium-sized defects of the oral cavity.

Malignant Peripheral Nerve Sheath Tumor of the Parotid Gland.

Malignant peripheral nerve sheath tumor (MPNST) refers to spindle cell sarcomas arising from or separating in the direction of cells of peripheral nerve sheath. The MPNST of the parotid gland is an extremely rare tumor, accounts for < 5% of all soft tissue sarcomas, and carries a poor prognosis. In this article, we report a case of MPNST of parotid gland in a 45-year-old male and review its diagnostic and therapeutic challenges. A 45-year-old male presented with right parotid swelling for 2 years with rapid increase in size over the last 3 months. He underwent right total conservative parotidectomy with selective neck dissection. Reconstruction was done with microvascular anterolateral thigh flap. On immunohistochemistry, the tumor cells expressed CD 56 diffusely and S 100 focally. Tumor was immunonegative for CK, Desmin, SOX - 10, and SMA consistent with MPNST. The MPNSTs arising as parotid mass are very rare and aggressive tumors. The role of IHC is paramount in establishing the diagnosis. Multimodal management including wide surgical resection, neck dissection, and adjuvant chemoradiotherapy is the choice of treatment.

Scanning Electron Microscopic Studies on the Gills of the Catfish Heteropneustes fossilis (Bloch) Exposed to Copper at Varying pH.

Alterations in gill ultra-structure of the catfish, Heteropneustes fossilis exposed to copper at varying pH were investigated using scanning electron microscopy. Fish were treated with 3 ppm copper sulphate (48 h LC50 concentration at pH 7 ± 0.5) at varying pH of diluent water. Low pH resulted in higher copper (30.01 µg/g dry wt.) accumulation on gills as compared to neutral and high pH treatments, at 18.01 and 16.07 µg/g respectively. Post (48 h) exposure observations included lesions in gills of the treated fish, epithelial lifting, loss of alignment of primary and secondary lamellae, hyperplasia, and hypertrophy of the respiratory epithelium. Fish at pH 5 ± 0.5 showed relatively greater injury compared to pH 8 ± 0.5. The severity of gill damage in copper treated fish followed the sequence of pH 5 ± 0.5 > pH 7 ± 0.5 > pH 8 ± 0.5. Results indicate the synergistic stress caused in fish gill due to acute toxicity of copper and low pH.