Long-term swallow outcomes and factors affecting swallowing dysfunction and quality of life among oral cancer patients: a prospective observational study.

BACKGROUND: Oral cancer is one of the most common cancers among the Indian population. India bears the most burden of oral cancer globally. Impairment of swallowing function is often seen after treatment for oral cancer. The oral phase of swallowing is disrupted in patients undergoing resection for oral cancer. The primary purpose of this study was to evaluate the long-term swallowing outcomes of oral cancer patients using a patient-reported outcome questionnaire. METHODOLOGY: All consecutive oral cancer patients in the cT2-T4 category undergoing curative-intent surgery and reconstruction at our institute from March 2020 to March 2022 were included in the study. The Sydney Swallow questionnaire (SSQ) and functional oral intake scale (FOIS) assessed swallowing outcomes six months after definitive treatment. WHO BREF quality-of-life questionnaire was used to assess health-related quality of life. RESULTS: A total of seventy patients with oral cancer were included. The median age was 49 years. The majority of them were males (90%). Tumors with cT4 constituted 62%; the rest, 48%, were cT2 and cT3 categories. The bulk of them were buccoalveolar tumors (64.3%. Almost two-thirds of the patients received multimodal treatment. Trismus and xerostomia were at 46% and 88%, respectively. The mean SSQ score was 257.4 ± 99.1. Swallowing outcomes are affected by T stage (p = 0.01), extent of resection (p = 0.01), multimodality treatment (p < 0.01), trismus (p = 0.05), and xerostomia (p = 0.01). Almost 69% of them required special food preparation for swallowing (FOIS 4&5). Patients with buccoalveolar disease (p = 0.05) had significantly poor quality of life. CONCLUSION: An advanced stage with extensive resection and receiving multimodal treatment has adverse swallowing outcomes. Post-treatment trismus and xerostomia also significantly affected swallowing results.

Occipital Artery-Based Fascio-Cutaneous Pedicle Flap in Reconstruction of Head and Neck Defects: A Saviour Under Challenging Times.

Head and Neck cancer management has undergone many changes in the past few decades. Primarily advancements in reconstructive surgery for complex head and neck defects after extensive ablative surgeries. Many factors need to be considered in deciding the type of reconstruction. Any reconstruction is not without complications. We wish to present the reconstructive challenges we faced in recent times to reconstruct composite head and neck defects, situation where a salvage flap has to be chosen in a failed regional flap. An occipital artery-based pedicled fascio cutaneous flap is one such rescuer flap. It is a retrospective study of case records from January 2018 to January 2021 at our institute. Reviewed the clinical data of Cases in which occipital artery-based flap was used to reconstruct the composite head and neck defects. In the era of microvascular flap reconstruction, utilization of regional flaps is still a choice of reconstruction in the resource constraint setting. A less explored occipital artery-based flap is a reliable regional flap can be used in select cases with a good success.

Revisiting the Predictive Factors for Nodal Metastasis in Oral Cancers-a Leap Towards Personalized Patient Treatment Approach.

The incidence of oral squamous cell carcinoma is steadily increasing globally, and even with a better understanding of tumor biology and advanced treatment modalities, the survival of OSCC patients is still not improved. A single metastatic cervical node can decrease survival by 50%. Our study intends to identify the clinical, radiological, and histological factors, significant for nodal metastasis in the pretreatment setting. Ninety-three patients' data is prospectively collected and analyzed to identify the significance of various factors in predicting nodal metastasis. Clinical factors like smokeless tobacco and nodal characteristics and T category and radiological factors like the number of specific nodes were significant for pathological nodes on univariate analysis. Ankyloglossia, radiological ENE, and radiological nodal size were significant on multivariate analysis also. In the pretreatment setting, clinicopathological and radiological factors can be used to predict nodal metastasis in generating predictive nomograms and for better planning of treatment.

Radiological tumor thickness as a clinical predictor of pathological depth of invasion in oral squamous cell carcinoma: a retrospective analysis.

PURPOSE: Inclusion of depth of invasion (DOI) in the recent AJCC/UICC TNM staging for oral cancer has incorporated the concept of tumor third dimension and its prognostic importance. However, there is no uniform consensus about measuring DOI at clinical setting at present. For more practical reasons, radiological tumor thickness (rTT) is a simple and practical measurement which can be used as a clinical predictor of pDOI. METHODS: We compared rTT and pathological DOI (pDOI) of 179 patients with OSCC who underwent curative surgery from April 2018 to April 2020 at AIIMS Rishikesh, India. Spearman correlation was used to determine correlation between rTT and pDOI. ROC curve was used to determine inter-group cutoff values. RESULTS: Overall, rTT showed a strong correlation with pDOI (rho = 0.74; 95% CI 0.667-0.8; p < 0.001). The inter-group cutoff value for rTT were 8 mm (Sn 89.1%; Sp 53.2%) between Group A (pDOI ≤ 5 mm) and B (pDOI > 5 mm, ≤ 10 mm), and 14 mm (Sn 89.5%; Sp 78.3%) between Group B and C (pDOI > 10 mm), respectively. CONCLUSIONS: rTT is a clinical predictor of pDOI in OSCC, and may be considered as a surrogate of DOI in the clinical setting.

Financial toxicity and mental well-being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic - A cross-sectional study.

OBJECTIVES: The primary outcome measures evaluated the financial toxicity and mental well-being of the oral cancer survivors. METHODS: A cross-sectional study of oral cancer survivors who were disease-free for more than 6 months after treatment and visited the hospital for a routine follow-up is included in the study. Mental well-being and financial toxicity were evaluated using the Depression, Anxiety, and Stress Scale - 21 (DASS 21) and Comprehensive Score for financial Toxicity (COST- Functional Assessment of Chronic Illness Therapy) questionnaires. A literature review was done to compare the results with financial toxicity and mental health in cancer patients from the pre-pandemic era. RESULTS: A total of 79 oral cancer survivors were included in the study, predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The median age is 49). The full-time employment dropped from 83.5% in the pre-treatment period to 21.5% post-treatment. Depression was observed in 58.2% and anxiety in 72.2%. Unemployed survivors were observed to have more depression (OR = 1.3, 95% confidence interval (CI) = 0.3-5.4, p = 0.6), anxiety (OR = 3.5, 95% CI = 0.3-21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3-6.6, p = 0.5) than rest of the cohort. On univariate analysis, unemployed survivors (M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. Survivors with depression (M = 16.4 ± 7.1, p = 0.06) and stress (M = 14.4 ± 6.8, p = 0.002) had poor financial toxicity scores. On multifactorial analysis of variance, current employment (p = 0.04) and treatment modality (p = 0.05) were significant factors impacting the financial toxicity. CONCLUSION: There is a trend towards increased incidence of depression, anxiety, and stress among oral cancer survivors compared to the literature from the pre-COVID era. There is significant financial toxicity among either unemployed or part-time workers. This calls for urgent public/government intervention to prevent the long-term impact of financial toxicity on survival and quality of life.

Chondrocutaneous conchal graft for optimal reconstruction of full-thickness lower eyelid defect: a reconstructive challenge.

Non-melanoma skin cancers of the head and neck region require optimal management encompassing oncological safety, minimal functional and cosmetic morbidity. The eyelid reconstruction poses a reconstructive challenge as it should include both anatomical and functional integrity. Full-thickness eyelid defects post resection can be managed with chondrocutaneous grafts. We present to you a case of a man in his 70s, who presented with left lower eyelid squamous cell carcinoma, who had a full-thickness eyelid defect, post ablative resection. Composite chondrocutaneous conchal graft with forehead flap was used to provide adequate functional and cosmetic outcomes. The patient has normal vision, with no exposure keratitis and complications.

Analysis of the Role of Selective Neck Dissection in Clinically Node-Positive T3/T4 Oral Cancers.

INTRODUCTION: The concept of selective neck dissection (SND) in locally advanced oral cancers is emerging. Contemporary studies support the feasibility of SND in selected node-positive oral cancers with early primaries. Nevertheless, the suitability of SND in clinically node-positive (cN+) oral cancers with advanced primaries (T3/T4) is unknown. AIM: This study explores if patients with cN+ advanced primaries were suitable candidates for SND by spotting the involved lymph node distribution in various stations of the neck. Secondary objectives were to check if predictive clinicopathological factors for metastases to the neck in general also apply for lymph node metastases to levels IV and V. METHODS: The present retrospective study analysed the distribution of pathologically involved lymph nodes in 134 patients and explored the interrelation of various predictive factors and cervical metastases overall and those specific to levels IV and V. RESULTS: Level V was involved in 6.7% (6/83) of T4 and none of the T3 primaries. Depth of invasion (DOI), perineural invasion (PNI), and skin invasion were statistically significant predictors for nodal metastases in general on multivariate analysis. CONCLUSION: Our analysis supports the option of considering SND, sparing level V in patients with cN+ oral cancers in a subset with T3 primary and nodal stage N2 and below.

Clinicopathological Difference Between Gingivobuccal and Oral Tongue Cancers: A Cross-Sectional Observational Study from a Tertiary Healthcare Centre in Northern India.

Gingivobuccal and oral tongue squamous cell carcinomas are commonly considered together as a single clinical entity for staging and treatment purposes. Though there is data suggesting a significant difference between SCC of various oral cavity subsites, very few studies have compared clinicopathological characteristics between the tongue and gingivobuccal primaries. We retrospectively analysed 225 patients with biopsy-proven gingivobuccal (GB) and oral tongue (OT) SCC operated between April 1, 2018 and April 30, 2021 in All India Institute of Medical Sciences, Rishikesh, India to compare their clinicopathological characteristics. Demographic, clinical and histopathological data were collected from electronic medical records. An independent sample t-test was used to compare means and Pearson chi-square test or Fisher exact test was applied to compare the distribution of categorical variables. A relative male preponderance (12:1 vs. 5:1, p = 0.036) and increased smokeless tobacco consumption (82% Vs. 69%, p = 0.003) was seen in GB-SCC. Significantly higher proportion of patients with OT-SCC presented with early primaries (T1/T2) (54.1% vs. 24.8%, p < 0.001). Similarly, a higher proportion of GB-SCC patients presented with palpable neck nodes (cN +) (81% Vs. 67%, p = 0.02). Due to early primary tumours at presentation, stage I/II disease was also significantly higher in cases of OT-SCC (36.5% Vs.13.7%, p < 0.001). No difference was noticed in age at presentation, neck node status, and other clinicopathological parameters. GB-SCC has a higher male preponderance than OT-SCC due to relatively higher consumption of smokeless tobacco in males. Oral tongue cancers presented at an earlier stage than gingivobuccal malignancies. No difference in neck node status, however, suggests a relatively aggressive disease behaviour and early regional metastasis in tongue cancers. Follow up data regarding recurrence and survival is required to further characterise the differences between these two common OSCC subsites.

Pedicled Latissimus Dorsi Myocutaneous Flap-an Effective Reconstructive Option for Extensive Buccal Cancer Resection in Resource Constrained and Salvage Settings.

Free flaps are the gold standard for reconstruction of extensive buccal cancer resections. However, salvage surgeries in previously operated and radiated necks, cost, increased operating time, and patient co-morbidities limit their routine use in high volume and resource-constrained settings. Pectoralis major myocutaneous (PMMC) flap is the mainstay of reconstruction of large buccal defects. However, reconstruction becomes a challenge during salvage of recurrences where PMMC has been utilized in previous reconstruction and in female patients where PMMC harvest results in major donor site morbidity. A retrospective analysis of clinical data of 13 consecutive patients (eight male and five female) with through and through buccal cancer resection defects reconstructed using pedicled latissimus dorsi (LD) flap from July 2018 to September 2019 was performed. The indications of using an LD flap were salvage surgeries for recurrences where PMMC was used in earlier reconstruction, medical co-morbidities, vessel depleted necks, and financial constraints precluding use of free flaps. The mean follow-up period was 9.84 months. The mean operating time post-resection was 2 h and 26 min. The mean hospital stay was 12.61 days. All patients could be decannulated successfully (mean duration 9.69 days) and 12 could be weaned off feeding tube. None of the patients had any major flap related or donor site complications. Pedicled LD flap has a limited but an effective reconstructive role for extensive buccal cancer ablation as an alternative to free flaps and PMMC in salvage and resource-constrained situations.

O to T Flap for Central Forehead Defect Reconstruction.

The reconstruction of central forehead defect is challenging because of the paucity of the adjacent extensible tissue and aesthetic importance of the area. Reconstruction of this region should be done keeping in mind brow symmetry and natural hairline. Camouflaging the final scar lines in wrinkles or hairline should be the final goal. Even small resections in this region can be surprisingly difficult owing to resistance offered by galea to advancement despite significant undermining due to its inelastic composition and position over the skull's natural convexity. Following, we present a case report wherein we describe a technique for the reconstruction of central forehead defects using simple Burrow's triangles.

Comparative Study of Management of BPPV (Benign Paroxysmal Positional Vertigo) with only Drugs Versus Drugs Plus Epley Manoeuvre.

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. The importance of early diagnosis and treatment can lead to a much improved quality of life for patients afflicted by this ailment. It is presently common for physicians to treat these patients mainly with benzodiazepines, antihistamines, and anticholinergic medications, especially if the history and physical is consistent with BPPV. This method of treatment has had questionable success. Several reviews of the management of vertigo have shown that no medication in current use has well established curative or prophylactic value or is suitable for long-term treatment. Epleys manoeuvre is also used in the treatment of BPPV. This manoeuvre relocates free floating particles from the affected semi-circular canals back into utricle, thus relieving the symptoms of vertigo. The purpose of this study is to compare the efficacy of Epleys manoeuvre with conventional drug therapy versus conventional therapy alone in patients who present with vertigo. The purpose of this study to evaluate and examine two methods of treatment.

Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study.

Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.

Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study

ABSTRACT Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.