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.

Cerebral venous thrombosis: an unanticipated consequence of unilateral internal jugular vein ligation.

Retrograde cerebral venous thrombosis (CVT) is a rare complication following internal jugular vein (IJV) ligation. The patient described in this report is a male in his 30s with locally advanced carcinoma tongue. He underwent near-total glossectomy and bilateral neck dissection. Due to heavy nodal burden, his right IJV had to be sacrificed. The patient presented with features of raised intracranial pressure (ICP) postoperatively. Magnetic resonance venogram of the brain revealed CVT involving sigmoid and transverse sinus. This case report describes a perplexing case of right-sided IJV ligation giving rise to CVT, resulting in raised ICP. Although the contralateral cerebral venous system was found to be normal, it failed to compensate for the obstructed outflow on the affected side. In this case report, we have elucidated the possible mechanism for the development of raised ICP and described the management in the light of existing evidence.

Cross-Sectional Analysis of Videonystagmography (VNG) Findings in Balance Disorders.

OBJECTIVE: To understand the videonystagmography (VNG) findings in various balance disorders in 67 patients who presented to the outpatient department of an otorhinolaryngology clinic. MATERIALS AND METHODS: This cross-sectional study was conducted in the outpatient department of the otorhinolaryngology clinic of a tertiary care center. A total of 67 patients between the age group of 18 and 70 years with balance disorders were included in the study. VNG findings in different balance disorders were observed and analyzed. RESULTS: A total of 67 patients were enrolled in the study. Findings like caloric inversion and optokinetic nystagmus do not always indicate a central balance disorder due to technical errors and other limitations during the test. However, abnormal saccades seem to be a more relevant finding in central disorders. Rare variants of benign paroxysmal positional vertigo (BPPV) like multiple canal BPPV were also diagnosed using VNG. CONCLUSION: VNG has come out as a very useful test in our study aiding in 75% of diagnoses. The overall benefits of VNG in balance disorders are immense and necessitate their inclusion in every vertigo clinic.

Supernumerary Tooth: Endoscopic Removal for a Rare Cause of Recurrent Epistaxis.

The presence of ectopic (supernumerary) teeth is common odontogenic problem in clinical practice. Its presence in dentate region is common but rare in the non dentate areas such as nose and maxillary sinus. The intranasal teeth generally remain asymptomatic but can get misdiagnosed for foreign body, or may present as complications like headache, epistaxis, nasal obstruction, rhinolith formation, oroantral fistula and sinusitis. Here, we discuss a case of intranasal tooth as a rare cause of profuse and recurrent epistaxis. The clinical, radiological findings and surgical treatment via endoscopic approach of this rare entity has been discussed. This interesting case report highlights the need to look beyond nose as cause for epistaxis. Endoscopic removal for this entity can be a preferred option to help minimize complications.

Subjective and Objective Assessment of Effect of Allergic Rhinitis on Voice in Indian Patients.

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR.