Rats and rabbits as pharmacokinetic screening tools for long acting intramuscular depots: case study with paliperidone palmitate suspension.

Development of prodrug of 9-hydroxyrisperidone (paliperidone) long-acting intramuscular injection has enabled delivery over four-week time period with improved compliance. The key aim of this work was to establish a reliable preclinical model which may potentially serve as a screening tool for judging the pharmacokinetics of paliperidone formulation(s) prior to human clinical work. Sparse sampling composite study was used in rats, (Wistar/Sprague-Dawley (SD; n = 10)) and a serial blood sampling study design was used in rabbits (n = 4). Animals received intramuscular injection of paliperidone palmitate in the thigh muscle at dose of 16 (rats) and 4.5 mg/kg (rabbits). Samples were drawn in rats (retro-orbital sinus) and rabbits (central ear artery) and were analysed for paliperidone using liquid chromatography-mass spectrometry/ mass spectrometry (LC-MS/MS) assay. The plasma data was subjected to pharmacokinetic analysis. Following intramuscular injection of depot formulation in Wistar/SD rats and rabbits, absorption of paliperidone was slow and gradual with median value of time to reach maximum concentration (Tmax) occurring on day 7. The exposures (i.e. area under the curve (AUC; 0-28) days) were 18,597, 21,865 and 18,120 ng.h/mL, in Wistar, SD and rabbits, respectively. The clearance was slow and supported long half-life (8-10 days). Either one of the two models can serve as a research tool for establishing pharmacokinetics of paliperidone formulation(s).

Bottle Gourd (Lagenaria Siceraria) Juice Poisoning.

We present the case of a young woman who presented to us with multiple episodes of vomiting, followed by hematemesis and abdominal pain after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors and antiemetics and discharged in stable condition. As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. There is no known antidote for this toxicity, and clinicians treat such patients symptomatically only.

Ovarian Germ Cell Tumors in North-Western India: A Comprehensive 3-Year Retrospective Study of 145 Cases at a Tertiary Cancer Hospital.

Germ cell tumors encompass a broad spectrum of neoplasms arising from germ cell lineage, demonstrating varying histological profiles and clinical presentations. These tumors encompass a range of benign and malignant entities. While global trends provide insights into their prevalence, specific regional variations, such as those within North-Western India, remain less explored. This study seeks to bridge this knowledge gap by examining the prevalence and characteristics of germ cell tumors within a tertiary cancer hospital. In this retrospective analysis, all cases of germ cell tumors diagnosed over a 3-year period in the specified tertiary cancer hospital were included. Cases with incomplete records or inadequate pathological data were excluded. Data encompassing histological subtypes, patient age distribution, clinical presentations, and histopathological features were collected and analyzed. The study comprised 145 cases of germ cell tumors. Teratomas were the most prevalent subtype, with mature teratomas accounting for the majority. The highest incidence occurred within the 21-30-year age group with a mean age of 24.77 years. Abdominal mass (56%) and abdominal pain (34%) were the prominent clinical presentations. Benign cases constituted the majority 85.5%. Solid tumors (p < 0.00001) and tumors more than 10 cm (p .029028) were found to have a high propensity to be malignant, which was proven to be statistically significant. This study comprehensively explains germ cell tumors' prevalence, clinical features, and histopathological subtypes in a tertiary cancer hospital in North-Western India. The predominance of teratomas, particularly mature ones, aligns with global trends. The age distribution and clinical presentations reflect common patterns. The diverse histopathological appearances underscore the heterogeneous nature of germ cell tumors. This study offers valuable insights for clinical management and further regional research.

Giant Renal Angiomyolipoma: A Rare and Formidable Challenge: A Case Report.

Renal angiomyolipoma (AML), also referred to as renal hamartoma, is a rare solid tumor without malignant characteristics. The inheritance pattern of renal AML is autosomal dominant. If the lesion grows to a large size, a series of clinical manifestations and serious complications may occur. We herein present a case of giant renal AML in a 49-year-old female patient, who presented with left-sided abdominal bloating for 1 month. Following abdominal ultrasound and computed tomography examination, the patient underwent total left nephrectomy. The resected mass was sized 18 × 15 × 11 cm. Postoperative histopathological examination confirmed the lesion as a giant renal AML. There are only few cases of giant renal AML (> 10 cm) reported in the literature to date. Due to the large size of the tumor, it is crucial to report similar cases, their diagnosis, and treatment.

Association Between Pre-operative 25-Hydroxy Vitamin D Deficiency and Surgical Site Infection After Oral Cavity Oncology Surgery: a Cross-Sectional Study in a Tertiary Cancer Center in Northwestern India.

Surgical site infections (SSI) following head and neck oncology surgery can lead to significant morbidity and healthcare costs. This cross-sectional study was used to investigate a potential link between pre-operative 25-hydroxy vitamin D deficiency and an increased risk of surgical site infections in patients undergoing oral cavity oncology surgery. This cross-sectional study was conducted at a tertiary center in northwestern India from May 2022 to May 2023. Patients scheduled to undergo oral cavity oncology surgery during this period were eligible for inclusion. Patients with complete pre-operative 25-hydroxy vitamin D levels and documented post-operative wound infection status were included in the analysis. A total of 85 patients who underwent oral cavity oncology surgery were included in the study. Among them, 30.58% (26 patients) had pre-operative vitamin D deficiency, The overall incidence of surgical site infection (SSI) was 36.47% (31 patients). Among the patients with pre-operative vitamin D deficiency, 23 (88.5%) developed surgical site infections. Finally, pre-operative levels of 25-hydroxy vitamin D, pre-operative poor oral hygiene, and low albumin were confirmed as statistically significant independent predictors of SSI. After doing multivariate analysis, vitamin D deficiency was found to be a significant predictor of post-op wound infection [adjusted odds ratio - 0.71 (95% CI 0.61-0.82); p value < 0.001]. This study highlights the significant association between pre-operative 25-hydroxy vitamin D deficiency and an increased risk of surgical site infections in patients. Vitamin D plays a crucial role in modulating the immune response, promoting antimicrobial peptides, and enhancing wound healing. These findings support the importance of assessing and addressing vitamin D deficiency in patients scheduled for oral cavity oncology surgery to potentially reduce the incidence of SSIs.

Can Lateral Thoracic Artery Preservation Improve Results in Large PMMC Flaps? - Our Experience of 61 Cases from Northern India.

Introduction: Pectoralis major myo-cutaneous (PMMC) flap continues to be a widely used tool to reconstruct oral cavity defects. But an unreliable and unstable vascular supply can lead to complications like flap loss, Oro-cutaneous fistula and wound dehiscence. Preservation of the lateral thoracic artery (LTA) has been suggested to improve the vascularity of the skin paddle. The present study aspires to compare the complications and flap related outcomes after preserving or sacrificing the LTA while reconstructing oral cavity defects with bi-folded PMMC flap. Materials and Methods: Retrospective analysis of the data of 61 male patients who were reconstructed with bi-folded PMMC flaps between January 2022 and September 2022 was done. 36 patients were reconstructed using a PMMC flap where the LTA was sacrificed, whereas in 25 patients the LTA was preserved. Data was analyzed in terms of patient factors and flap related complications. Results: The overall complication rate including major/minor complications was 44.26% with flap detachment at 22.95% being the commonest complication observed. 13.11% patients developed an Oro-cutaneous fistula and partial and complete flap loss were seen in 9.83% and 4.91% respectively. LTA preservation was significantly associated with only decreased flap detachment rates (p value < 0.05). No significant association was noticed between other flap related complications and LTA preservation. Conclusion: Reconstructing larger defects with a PMMC flap where the LTA is preserved can help improve the vascularity of the flap and decrease various major/minor flap related complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04123-3.

Submental Artery Island Flaps (SAIF) for Oral Cavity Cancer: Surgical Technique and Tertiary Care Experience.

In oral cancer surgeries, oncological outcomes take precious driverseat. But the copassengers like reconstruction, cosmesis, swallowing and speech outcomes deserve equivalent importance. Submental Artery Island Flaps (SAIF) provide an underutilized and extremely versatile option for reconstruction of defects following early stage oral cavity tumour resections. In this prospective observational analysis, we describe the technique, challenges and outcomes of SAIF at our tertiary care institute. Sixteen patients with Stage I and II oral cavity cancers were enrolled between June 2020 to May 2021. Verrucous carcinomas were five and well differentiated carcinomas were 11 patients. After tumour excision and neck dissections, defects were reconstructed with Pedicled submental flaps. Complications and functional outcomes were analyzed over two years. Nineteen percent were ladies and 81% were gentlemen. Median age was 52 years. Tongue tumours formed majority with 56% cases. Largest skin paddle taken was 36 cm2. Flap survival was 88%. There were variations in venous drainage of flaps which have been depicted in case figures. There was no report of orocutaneous fistula. Grade 3-4 speech satisfaction was achieved by 81.2% patients at 6 months. Swallowing was excellent, grade 4-5 for 100% of patients at 6 months. One patient had distant metastasis at 7 months and died. SRLR (Submental flap Recurrences) and trismus were zero percent at two years. The unexplored field of submental flaps can be used for oral cancer reconstructions in a versatile way. Donor site easy closures, no scars on face, early resumption of daily activities and short hospital stay makes it one of the ideal options in early stage oral cavity defects.

Epidemiological and Histopathological Analysis of Head and Neck Cancers in Northern India- A Retrospective Review.

INTRODUCTION: Head and neck malignancies are responsible for 30% of all cancers in India with a dramatic increase in numbers due to widespread tobacco consumption. This study aims to assess the epidemiological and histopathological spectrum of these tumors. MATERIALS AND METHODS: A large retrospective review of 5469 biopsy-proven patients presenting between 2018 and 2022 with head and neck cancers was done. Tumors were analysed for distribution according to sites of presentations, gender, age and histopathological profiles. RESULTS: With a male-to-female ratio of 4.2:1, men constituted 80.80% of the study population. Mean age of presentation in women was 53.5 years, whereas men presented at an earlier age of 47.2 years. Oral cavity was the commonest site involved (59.7% cases) followed by the oropharynx (23.8% cases). Buccal mucosa was the commonest subsite involved with 1112 cases followed by tongue lesions with 1088 cases. Larynx was responsible for 17.04% of cases. All subsites were more commonly affected in men with the highest Male: Female ratio of 8.29:1 seen in larynx. The lowest ratio of 1.02:1 was seen in lesions of the face and scalp. Squamous cell carcinoma (SCC) was the most common histopathological diagnosis encountered in 88.97% of cases followed by basal cell carcinoma which was seen in 2.10% lesions. CONCLUSION: Oral cavity lesions constitute the bulk of head and neck cancer presentations in India. The disease is more prevalent in men overall and men present at a younger age in comparison to women. SCC is the most prominent histopathology encountered in our study.

Bipaddle Pectoralis Major Myocutaneous Flap (PMMC) for Complex Composite Oral Cavity Defects: An Experience of a Tertiary Cancer Centre.

Although microvascular free flaps are considered the first choice in head and neck cancer defect reconstruction, their use is limited in developing regions by availability of resources and the expertise .The Bipaddle pectoralis major myocutaneous flap (PMMC flap) is a commonly used flap in head and neck cancer reconstruction, but in literature flap is associated with high incidence of drawbacks including donor site morbidity and added bulk of the flap reducing cosmetics and function. The purpose of the study is to evaluate the Bipaddle PMMC flap reliability, operative technique and outcome in reconstructive head and neck cancer surgery in the era of microvascular free flaps. Its a prospective study in which the records of 50 patients treated with Bippadle PMMC flap reconstruction between January 2022 to July 2022 were systematically collected and reviewed. Data of recipient site, serum albumin, history of adjuvant, recurrence, defect dimension, type of donor site closure, length of hospital stay, postoperative complications and outcomes were analysed. There were 45 males and 5 females with a mean age of 41 years (31-60). Bipaddle PMMC flap reconstruction was done in all patients of advanced squamous cell carcinoma of oral cavity. There were two males with complete necrosis of flap salvaged with latissimus dorsi flap and forehead flap. Minor infections were noted in two female and one male patient, managed conservatively and recovered well with acceptable final outcome. The Bipaddle PMMC flap is reliable for large defects in head and neck reconstructive surgery, particularly when a bulky flap is required to reconstruct composite defects where the lesion is involving the skin. Placing the flap horizontally with inclusion of nipple and areola in most of the patients increased the reach and size of available flap.

A Randomized, Double-Blind, Phase III Study in India for Comparing Efficacy, Safety, and PK of ZRC-3277 (Pertuzumab Biosimilar) With Perjeta® in Patients With HER2-Positive Metastatic Breast Cancer.

INTRODUCTION: To evaluate the efficacy, safety, pharmacokinetics (PK), and immunogenicity of ZRC-3277 (pertuzumab biosimilar) with Perjeta® (pertuzumab) in previously untreated patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). PATIENTS AND METHODS: This phase III, multicenter, double-blind study across 38 sites in India randomized (1:1) patients with HER2-positive MBC in either the ZRC-3277 or Perjeta® group. Both groups also received trastuzumab and docetaxel. Of 268 enrolled patients, mITT population had 243 patients (119 and 124 in the ZRC-3277 and Perjeta® groups, respectively). The primary objective was to compare the between-group objective response rate (ORR) after 6 cycles of treatment. ORR was determined by evaluating scans of computed tomography or magnetic resonance imaging following Response Evaluation Criteria in Solid Tumor (RECIST 1.1). Two-sided 95% confidence interval (95% CI) for the difference in ORR was determined to evaluate the noninferiority of ZRC-3277 to Perjeta®. The secondary outcomes included the assessment of PK, immunogenicity, and safety between the 2 groups. RESULTS: In the mITT population, 104 (87.39%) and 114 (91.94%) participants achieved the ORR in the ZRC-3277 and Perjeta® groups, respectively. For predefined -15% noninferiority margin, obtained 2-sided 95% CIs (-12.19%, 3.11%) for the difference in ORR (-4.55%) between the 2 groups demonstrated the noninferiority of ZRC-3277 to Perjeta®. PK, immunogenicity, and safety were not significantly different between the 2 groups. CONCLUSION: Efficacy, PK, immunogenicity, and safety profiles of ZRC-3277 was found to be similar to those of Perjeta®.

Platysmal Myocutaneous Flap for Intra Oral Defects:Is It an Underutilized Option? Our Experience of 10 Cases.

Various methods of reconstruction are available for reconstructing oral cancer defects, but all of them have their inherent drawbacks. The superiorly based platysma myocutaneous flap is a common reconstruction option for intra-oral defects following oral cancer resections. We present our results of using platysmal flaps in reconstructing intraoral defects following oral cavity cancer resection in our 7 patients along with resection of three cases of premalignant conditions of oral cavity. All the patients were males of age ranging from 24 to 42 years and diagnosed as squamous cell carcinoma of oral cavity stage I and II were included in this study.Of 10 patients eight had no postoperative complications. One patient developed partial skin loss of neck donor site, which was managed conservatively. Other patient had complete flap loss which healed with secondary intention. We recommend this flap as incision is always away from the face, the scars are hidden beneath collars and the patients are very comfortable with good cosmetics and functional outcomes.\.

Use of Temporalis Muscle and Temporoparietal Fasciocutaneous Flap (TPPF) for Orbital Exentration Defects: Our Experience of 10 Cases.

Orbital defects represent difficulties in head and neck reconstruction owing to 3-dimensional complexity of the socket with aim to restore form and function. Recommended methods of reconstruction include mucosal and skin grafts free microvascular myofascial or fasciocutaneous flaps. However, most frequently, reconstruction of orbital defects calls for measures somewhere in between. The temporoparietal fascia flap (TPFF) fits well as it provides thin, pliable coverage of defects with dependable blood supply, tolerance for a large degree of rotation and minimal donor site morbidity. We hereby present our experience and results of 10 cases using TPPF and temporalis muscle post orbital exentration defects.Ten patients (7 male and 3 females) age ranging from 25 to 64 years underwent reconstruction of orbital exenteration defects using TPPF and temporalis muscle from June 2019 to June 2020 in our department. The primary disease was squamous cell carcinoma (SCC) of orbital structures (anterior compartment) in all 10 patients. All cases were clinically N0 and M0.All patients had successful transfer of TPFF grafts and temporalis muscle transfer without flap compromise. TPPF was used in all 10 patients while Temporalis muscle flap was used to fill orbital socket in our 9 patients. Temporoparietal fascial flap showed viable option for subtle orbital and malar contour defect. All patients had intact dura with residual orbital cavity after resection reconstructed with TPPF and temporalis muscle without any additional flap usage. No frontal paralysis or orbital fistula was seen but local recurrence occurred in one patient in follow up and managed with RT. The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction.

Unusual Presentation of Tonsillar Spindle Cell Neoplasm: A Case Report.

Spindle cell neoplasm of the tonsil are rare (Minami et al. in Am J Otolaryngol 29(2):123-125, 2008) and can be difficult to diagnose due to their non-specific clinical presentation and histological characteristics (Su et al. in J Chin Med Assoc 69(10):478-483, 2006). Differential diagnoses include lymphoma and squamous cell carcinoma (Hyams in Clin Otolaryngol Allied Sci 3(2):117-126, 1978). Oropharyngeal spindle cell neoplasms were more likely to occur in the tongue base and tonsil (58%) (Gerry et al. in Ann Otol Rhinol Laryngol 123(8):576-583, 2014). In this article, we report a case of tonsillar spindle cell neoplasm which is extremely rare.

Postoperative Analgesic Efficacy of Intraoperative Pectoral Nerve Block for Modified Radical Mastectomy: a Double-Blind Prospective Randomised Interventional Study.

Severe acute postoperative pain following breast surgery increases the risk of persistent pain and affects the recovery of patients. Recently, pectoral nerve (PECs) block has gained significance as a regional fascial block that can provide adequate postoperative analgesia. This study aimed to evaluate the safety and efficacy of PECs II block, which was given intraoperative under direct vision after performing modified radical mastectomy for breast cancer patients. This prospective randomised study was comprised of a PECs II group (n = 30) and a control group (n = 30). Group A patients received 25 ml of 0.25% bupivacaine for PECs II block intraoperatively after the surgical resection was done. Both groups were compared with respect to the demographic and clinical parameters, total intraoperative fentanyl dose, total duration of surgery, postoperative pain score (Numerical Rating Scale) and the analgesic requirement, postoperative complications, postoperative duration of hospital stay, and the outcome. Intraoperative PECs II block was not associated with any increase in the duration of surgery. The postoperative pain scores were significantly higher in the control group till 24 h after the surgery, and so was the postoperative analgesic requirement. Patients in the PECs group were found to have rapid recovery and decreased postoperative complications. Intraoperative PECs II block is not only safe, time-saving procedure but also significantly reduces the postoperative pain and analgesic requirement in breast cancer surgeries. It is also associated with a faster recovery, decreased postoperative complications, and better patient satisfaction.

Latissimus Dorsi kiss Flap for Reconstruction of Large Chest Wall Defect-an Underutilized Option?

The utility of pedicled latissimus dorsi kiss flap for the reconstruction of chest wall defect is still an underutilized option. But the peculiar design and structure of the kiss flap with two semicircular flaps of equal diameter with same vascular trunk makes it amenable to cover large chest wall defects especially at places where plastic surgery facility is unavailable. We have used this flap to reconstruct large chest wall defect of size 20×18 cm in our patient operated for recurrent chest wall dermatofibrosarcoma protuberans. In the follow-up, both recipient kiss latissimus dorsi flap and donor site flap healed well without edema or extravasation.

"Flap of Hope: a Pectoralis Major Muscle Solution for Tracheal Resection Closure": Case Report.

Medullary carcinoma of the thyroid is a rare type of thyroid cancer that arises from the parafollicular cells or C-cells, which produce calcitonin. It accounts for approximately 5-10% of all thyroid cancers (Leboulleux et al. in Clin Endocrinol 61(3):299-310, 2004). The main treatment for medullary thyroid carcinoma is surgery, which involves the removal of the thyroid gland and any affected lymph nodes. In advanced cases where the cancer has spread to nearby structures such as the trachea (Gupta et al. in Indian J Surg Oncol 11(1):75-79, 2020), tracheal resection followed by reconstruction may be necessary to remove the cancer (Chernichenko et al. in Curr Opin Oncol 24(1):29-34, 2012) and restore proper breathing, closure of large tracheal defect can be done with pectoralis major myocutaneous flap (Salmerón-González et al. Plast Surg Nurs 38. 162-165, 2018). In this article, we report a case of recurrent medullary carcinoma thyroid with tracheal infiltration and tracheal resection was done, both of which is extremely rare. A 38-year-old male patient with a history of total thyroidectomy presented with recurrence was referred to our department, his previous biopsy and IHC revealed medullary carcinoma thyroid. Ga-68 DOTA PET CT scan was done which showed PET avid residual mass over right side, multiple bilateral cervical nodes, and tracheal infiltration (Fig. 1) then underwent a bronchoscopy showing involvement of the second, third, and fourth tracheal ring. Bilateral neck dissection with sleeve resection of trachea with overlying residual tumor was done and was sent for frozen which revealed positive margins and re-excision of margins was done, which lead to large defect (Fig. 2) which could not be closed primarily with a Montgomery T Tube. A de-epithelized pectoralis major myocutaneous flap used to close the tracheal defect followed by placing the Montgomery T Tube (Fig. 3).Post-operative period was uneventful. The final histopathology report showed R0 resection of tumor. T tube was removed after 4 weeks.

Assessment of Operative Time for Lip and Oral Cancers: A Tool to Improve Operative Room Efficiency.

Operation theatre (OT) time utilisation rates can be improved with an assessment of the procedure time that will result in effective scheduling of cases. Our study is the first of its kind to audit the amount of OT time required for a particular surgery in lip and oral cavity cancers, depending on the various components of this complex procedure. This prospective cross-sectional study, based on an operative room database of 323 OT sessions, was conducted in the Department of Surgical Oncology at a tertiary care centre on lip and oral cancer patients from January 1st, 2019 to December 31st, 2020. Various components of the surgery, like the primary site, operating surgeon, type of neck dissection, bone resection, and reconstructive procedure, were noted. The time of entry and exit of the patient from the OT was noted. Operative time and OT time utilisation rates were calculated. SPSS 21.0 statistical tool; Students 'T', ANOVA and Games-Howell tests were applied. In 323 OT sessions, while 303 surgeries were done for primary cases (93.8%), the remaining 20 cases were for recurrent cases (6.2%). Buccal mucosa and the floor of the mouth were the most and least common sites, respectively. The mean OT time was 212.42 ± 73.83 min, the maximum being the primary at alveolus. The mean OT late start time was 70.03 ± 23.41 min and the mean OT runover time was 37.62 ± 43.53 min. The mean time varied significantly with the type of neck dissection, bone resection, and reconstructive surgery done and the operating surgeon. The mean OT time was highest for free flap reconstructive surgery (328.71 ± 62.02 min), but it didn't vary with its type. Considering only the lip and oral cancer surgeries, the OT time utilisation rate was 57.1%. Assessment and quantification of the operative duration of lip and oral cancer surgeries will help in accurate prediction of surgical duration, better OT list planning, and thus improved OT time utilisation rate. Our research not only provides data on the historical mean of procedures, but it may also encourage other centres to adopt our quantitative approach to OT scheduling.

Can a diagnosis of Leiomyosarcoma soft palate be missed in the era of commoner oral carcinomas? - Rare case report and review of literature.

Leiomyosarcomas (LMSs) of the head and neck are an extremely rare entity. Of all smooth muscle tumors, 4%-10% occur in the head and neck and only 0.06% in the oral cavity. Because of its infrequency, it has been associated with both delayed diagnosis and misdiagnosis. Here, we report the clinicopathological findings of a case of primary LMS of the soft palate in a 42-year-old male patient with an emphasis on the judicious use of ancillary diagnostic modalities to arrive at a definitive diagnosis. Intraorally, LMSs present as painless, lobulated, fixed masses of the submucosal tissues in middle-aged or older individuals. The treatment modalities and lymph nodal dissection criteria are dissimilar to more common oral carcinomas. Hence, definitive diagnosis is necessary.

Predicting recurrence in oral cavity cancers: a review of 116 patients with buccal mucosa carcinoma in northwestern India.

BACKGROUND: Oral cavity cancers, the second most common type in India, are responsible for 10% of the overall cancer burden. With a recurrence rate of 30% to 40% and a 5-year survival rate of 50%, these malignancies account for substantial morbidity and mortality. Despite advances in treatment modalities, survival rates following treatment completion have not improved significantly. The present study aimed to establish specific epidemiological and pathological factors responsible for recurrence after treatment completion in buccal mucosa cancers. METHODS: A retrospective analysis of the data of 116 patients treated for biopsy-proven cancers of the buccal mucosa was undertaken 1 year after treatment completion. Factors such as age, sex, education, lymphovascular invasion, extranodal extension (ENE), perineural invasion, depth of invasion, and pathological margin status were compared between patients who presented with recurrence and those who did not. Statistical significance was set at p< 0.05. RESULTS: Of the 116 patients, 40 (34.5%) developed a recurrent disease within 1 year. The mean age of the study population was 43.3 years, and males constituted 91.4% of the included patients. Ipsilateral buccal mucosa was the commonest site of disease recurrence. Neck node metastasis, ENE, and margins of resection < 5 mm were significantly related to the recurrence of disease. However, surprisingly, lymphovascular invasion, perineural invasion, and depth of invasion > 10 mm did not show statistically significant associations. CONCLUSION: Neck node metastasis, ENE, and margins of resection < 5 mm were the histopathological factors associated with recurrence in cancers of the buccal mucosa.

Reconstructing Small-Medium Sized Oral Cavity Defects- Our Experience with the Versatile Famm Flap.

Background: Restoration of form and function of the oral cavity post resection for oral cavity malignancies is an enormous challenge in head and neck reconstructive surgery. The facial artery musculo-mucosal (FAMM) flap is an unexplored, underutilized yet an extremely versatile option for such defects. In this analysis we review the performance of the FAMM flap used to reconstruct tongue/floor of mouth (FOM) defects following tumor resection. Materials and Methods: In this retrospective analysis, demographic and disease profiles of 15 patients with Tongue and Floor of Mouth carcinomas reconstructed with a FAMM flap between January 2019 to January 2021 were studied. Complications and functional outcomes were analyzed. Results: Fifteen patients (10 men, 5 women) were reconstructed using a FAMM flap. Mean age of the study sample was 46.46 years (28-60 years). One flap was lost due to complete flap necrosis following venous congestion, two other flaps suffered distal tip necrosis. Three patients developed an Oro-cutaneous fistula, with one going on to develop a surgical site infection of the neck wound. Patients reconstructed for FOM defects had an excellent functional outcome. For patients reconstructed for a tongue defect, 33.33% of patients complained of restricted tongue mobility and 44.44% were dissatisfied with the quality of speech post operatively. Conclusion: The versatile FAMM flap is a reliable, easy to harvest and scarless flap. It provides excellent cosmetic and functional results FAMM flap allowing early resumption of normal daily activities making it an ideal option to reconstruct small to medium sized oral cavity defects.