Transzygomatic Approach to Skull Base: History, Evolution, and Possibility of a Simple Modification.

The surgical approaches to anterior, middle, and lateral skull base have evolved drastically, transcending from an era of oblivion to well-defined and systematically executed, state-of-the-art, refined surgery. The transzygomatic approach, which was developed to access the nasopharynx, has been applied to versatile locations of skull base pathology, with continuous evolution and modification of the osteotomies and skin flaps involved. A simple modification is proposed which could help reach a compromise between the wide exposure provided by the hemicoronal incision and the minimally invasive preauricular approach.

Patterns of Neck Nodal Metastasis from Oral Cavity Carcinoma.

Nitin KhuntetaObjectives The aim is to study the patterns of lymph node metastasis from various sites in oral cavity cancer and determine the risk factors for metastasis. Materials and Methods It is a prospective observational study. The inclusion criteria were-245 patients of carcinoma buccal mucosa, anterior two-thirds of tongue, hard palate, oral surface of soft palate, floor of mouth, vestibule, and alveolus. The exclusion criteria were-patients who had received preoperative chemotherapy or radiotherapy and patients with recurrent disease. Statistical Methods All data were analyzed using SPSS 18.0 and Graphpad prism 7 software for statistical analysis. Count data have been expressed as percentages (%). The χ 2 test was used for univariate analysis of the risk factors of cervical lymph node metastasis. The odds ratio value (with 95% confidence interval) was used to express the risk of cervical lymph node metastasis. p -Value of <0.05 was considered as the difference with statistical significance. Results The most common site involved was buccal mucosa. Patterned lymph node metastasis was seen in 93.5% cases. Skip metastasis was seen in 4.31% cases. Level I b was the most common site of nodal involvement for all primary subsites of oral cavity cancer. The incidence of positive nodes on histopathological analysis was highest in cases of lower alveolus (63.15%), followed by tongue. Conclusion In our study, patterns of lymph node metastasis for oral cavity cancer were comparable to other studies with large number of subjects. The incidence of skip metastasis or aberrant status was low. On multivariate analysis, depth of invasion of tumor, pathologic grade, pathologic T stage, and morphologic type of growth were found to be independent predictors of risk for metastasis.

The Mandible Sparing "POSC Technique" for Management of Middle and Posterior Third Tongue Cancers.

Cancer of the tongue forms more than 50% of oral cavity cancers. Generally, patients come with locally advanced tongue cancer. The treatment for this cancer is multi-modality. For resectable cancer, multiple surgical approaches are described in the literature. Mandibulotomy for resection of the middle and posterior third oral cancer is a well-established technique but it has its attended morbidity. We present our results of a new surgical technique, called the Peroral and submandibular cervical surgical approach wherein tongue cancer of middle third and posterior third is resected without mandibulotomy. The advantages of this technique are that the complications of malunion or non-union of bone are avoided, no chances of osteoradionecrosis or osteomyelitis, no need of periosteal elevation or damage, the malignancy is removed with wide margin with minimal blood loss, there is no scar on face or chin, morbidity of surgery is minimal. Also, the technique is easily reproducible.

Total Laryngectomy for Treatment of T4 Laryngeal Cancer: Trends and Survival Outcomes.

INTRODUCTION: Management of advanced laryngeal cancer has shown fluctuating trends during the last few decades. Though many extensive reports are available in the literature regarding survival outcomes for advanced laryngeal cancer, there is a paucity of elaborate systematic reviews giving a complete picture of facts and figures. The present analysis brings to attention the most relevant data in a focused and up to date format, for simpler interpretation of evidence-based inference. OBJECTIVE: To present the trends in the treatment of T4 laryngeal cancer over the past few decades and analyze survival outcomes for different treatment modalities in the management of T4 laryngeal cancer by way of systematic review. METHODS: An electronic search was conducted using the terms "total laryngectomy", "T4 laryngeal cancer", "survival outcomes" in combination with the following search strategy : Search block Laryngeal cancer - "Laryngeal Neoplasms"[Mesh] OR ((Laryngeal[tiab] OR larynx[tiab] OR "Larynx"[Mesh]) AND ("Neoplasms"[Mesh] OR neoplasm* [tiab] OR tumor* [tiab] OR tumour* [tiab] OR cancer* [tiab] OR malignancy* [tiab] OR carcinoma* [tiab] OR neoplasm* [tiab] OR oncology* [tiab])); Search block Total laryngectomy - "Laryngectomy"[Mesh] OR total laryngectomy*[tiab] OR total laryngopharyngectomy*[tiab] OR total pharyngolaryngectomy*[tiab]; Search block T4 - t4[tiab]. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, SCOPUS and Cochrane Library. 304 articles had been published till June 2017, which included prospective studies, randomized controlled trials, retrospective studies, and smaller descriptive studies. References of the selected studies were further searched for relevant articles. Apart from this, a search was conducted on Google Scholar to obtain related articles. RESULTS: Numerous studies, as mentioned in this review, provide authentic evidence in relation to the efficacy and outcome of surgical treatment for T4 laryngeal cancer. To address the problem of heterogeneity with regards to patient selection, numerous reports pertaining to T4 patients exclusively have been included. CONCLUSION: Total laryngectomy remains the gold standard for management of T4a laryngeal cancer. After the unparalleled oncological outcomes of more than a century, the technique has stood the test of time. An exhaustive review of the literature has been presented, discussing the trends in the treatment of advanced laryngeal cancer across different continents. However, it must be specified that the purpose of the study is not to prove one treatment protocol to be superior to the other but to bring out patterns of adherence to protocols and guidelines as suggested by multidisciplinary consensus reports and the consequent outcomes.