Outcome of Treatment in Verrucous Carcinoma of Oral Cavity: A Tertiary Rural Hospital Experience.

Verrucous carcinoma of oral cavity is a highly well differentiated variant of squamous cell carcinoma with a low potential for invasion and metastasis. It is prevalent in the tobacco quid chewing population in our region. In this observational study, we reviewed the medical case records of 58 patients treated for oral verrucous carcinoma staged T2 to T4a. All patients underwent wide excision of tumour which included marginal mandibulectomy in 22 and hemimandibulectomy in 23 patients along with neck dissection saving the accessory nerve and internal jugular vein. 5 patients were found to have bone involvement along the alveolar sockets. 11 patients had other associated premalignant lesions in oral cavity. Only 2 patients had lymph node metastasis without extra nodal spread in submandibular region. With a mean follow up of 6 years and minimum follow up of 1 year, 3 patients had local recurrence. All these 3 patients had bone involvement and 2 of them had lymph node metastasis on histopathological examination. 3 patients who had associated premalignant lesions developed second primary in oral cavity after 3 years. In our experience, verrucous carcinoma has good prognosis when treated by surgery. Bone involvement along alveolar sockets and associated oral premalignant lesions adversely affect the outcome. There was no difference in the outcome between selective and modified radical neck dissection. Therefore selective neck dissection (supraomohyoid) would be adequate in treating these patients. Adjuvant radiotherapy can be reserved for T4a lesions or for positive margins.

Evaluation of Tumour Volume as a Prognostic Factor in Carcinoma Buccal Mucosa.

(1) To determine tumor volume by clinical measurement, imaging and histopathological examination in patients with squamous carcinoma of buccal mucosa. (2) To correlate tumor volume with lymph-node metastasis and loco-regional control. Retrospective Observational Study. Rural tertiary care hospital. 75 Patients undergoing surgery for T2 (68%) and T3 (32%) Oral squamous carcinomas were included in this observational study. Tumor volume-a product of maximum length, breadth and thickness, was determined clinically and by imaging. Tumor volume on histopathology was documented and correlated with lymph-node metastasis. After 13 months minimum follow-up, tumor volume was correlated with loco-regional control. Recurrences were analysed with regard to tumor volume, depth of invasion, lymph-node metastasis and resection margins. Average tumor volume was 7.1 cm3among T2 and 14.4 cm3among T3. 25% of T2 tumors had metastatic lymph-nodes compared to 33.3% in T3. There was positive correlation between tumor volume and lymph-node metastasis. Lymph-node metastasis was absent when tumor volume was < 8 cm3. There were 4 local and 2 regional recurrences in this study. Average histopathological tumor volume among patients who had local recurrence was 12.95 cm3. Regional recurrences occurred in tumors staged N2b and N3b on histopathology. Average depth of invasion in patients with recurrence was 10.33 mm.. Tumor volume represents actual tumor load and correlates with lymph node metastasis and prognosis in oral cancers. Depth of invasion and tumor thickness influence staging and prognosis. Large volume tumors have poor oncological outcome.

Outcome of Treatment in Locally Advanced Upper Alveolar Carcinoma Extending to Infra-temporal Fossa.

Squamous cell carcinoma of oral cavity has a high prevalence in our region. Upper alveolar cancers are uncommon but present with locally advanced disease extending to infra temporal fossa. The outcome of treatment in these tumors is poor. Surgery followed by adjuvant therapy is the mainstay of treatment. We are presenting a retrospective analysis of outcome of treatment in 20 patients with locally advanced (T4b) upper alveolar carcinoma treated by infra-structure maxillectomy with compartment resection of infra-temporal fossa and neck dissection followed by adjuvant radiotherapy or radiotherapy with chemotherapy. Study period was from 2013 to 2018. Minimum follow up was 12 months and mean follow up 30 months. 12 patients are alive and disease free, 6 patients had local recurrence and 2 patients had regional recurrence with one having pulmonary metastasis. We observed that positive or close margins (< 5 mm after formalin fixation) predisposed to early recurrence. Erosion of pterygoid plates was a poor prognostic factor. Cervical lymph node metastasis occurred late in disease, but carried poor prognosis. Compartment resection of infra temporal fossa gave better outcome compared to other studies which reported outcome of treatment in upper alveolar cancers.

Lethal Midline Granuloma: An Enigma in Diagnosis-A Rare Case Report.

Lethal midline granuloma is a rare disease, characterised by progressive unrelenting necrosis and mutilation of nose, midline facial tissues and other respiratory passages. This particular type of disease is heterogeneous in its pathogenesis, non-specificity of symptoms obscures timely and correct diagnosis and is responsible for delay in of treatment which can be detrimental as this disease calls for immediate intervention. We present a case report of 60 year old female who gave short one-month history of clinical symptoms.

Microsurgical Anatomy of Stapedius Muscle: Anatomy Revisited, Redefined with Potential Impact in Surgeries.

Stapedius muscle even though being the smallest skeletal muscle in human body, it has a major role in otology. As many of the distinguished books in otology missed to explain much about stapedius muscle, and also considering the need for the anatomy based visit to this small muscle we felt it was important to have a exercise like this. In the dissection hall of our institution we dissected 32 cadaveric temporal bones and delineated stapedius muscle as a part of PG teaching programme to have a clear idea of the anatomy of stapedius muscle, its origin, attachment, extension, size (all dimensions). Length of the stapedius muscle varied between 9 and 11 mm. Stapedial tendon measured about 2 mm. The muscle had a classical sickle shape with tendon looking like the handle of the sickle. It has a bulky belly with a maximum breadth of 2-3 mm. It was found to be medial to midportion of vertical limb of facial nerve. All of our temporal bones measured size varied from 9 to 11 mm in length excluding stapedial tendon. Stapedial tendon measured almost 2 mm. Muscle is classical sickle shaped with tendon acting like the handle of the sickle. It has a bulky tummy which forms the maximum breadth of 1-3 mm. Why to have a clear idea about the anatomy of stapedius muscle is that, unless the anatomy is clear there is chance of confusing the muscle with that of facial nerve while doing facial nerve grafting and also while drilling for facial nerve decompression in experienced hands may get confused and decompress the muscle. Stapedius muscle said to be the smallest muscle in the body, but its not as small as its been described. Detailed awareness of the anatomy of stapedius muscle is needed so as to avoid confusion while facial nerve grafting and while drilling.