Publications by authors named "Rajeev Sharan"

28 Publications

  • Page 1 of 1

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction.

Indian J Plast Surg 2021 Jan 30;54(1):53-57. Epub 2020 Nov 30.

Department of Head and Neck Surgery, TATA Medical Center, Kolkata, West Bengal, India.

 The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer.  This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap.  At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1721522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012785PMC
January 2021

Radiation-induced hypothyroidism in patients of oral squamous cell carcinoma: A retrospective analysis of 195 patients.

Indian J Cancer 2021 Jan 27. Epub 2021 Jan 27.

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India.

Background: Radiation-induced hypothyroidism (RIH) is common after neck irradiation, and biochemical evaluation of thyroid function is recommended periodically for early diagnosis and treatment. This study aimed to evaluate the predictors of RIH after completion of adjuvant radiotherapy (RT) for primary oral squamous cell carcinoma (OSCC).

Methods: This is a retrospective study involving 195 patients who received RT after surgery for OSCC between August 2011 and December 2016. Thyroid function tests were obtained every 6 months and patients were considered to be hypothyroid if thyroid-stimulating hormone level was >5 mIU/mL.

Results: The study cohort comprised 130 men with a median age of 52 years (range 21-77 years). About 107 (54.87%) patients developed hypothyroidism, with a median of 21 months (range 2-67 months) for the development of RIH. Women [41 (63.1%) versus 66 (50.8%), p=0.035], addition of chemotherapy [36 (63.2%) versus 71 (51.4%), p= 0.019], and higher cumulative dose to the thyroid gland (median dose 4690 cGy versus 2981 cGy, P < 0.001) resulted in higher incidence of RIH on univariate analysis. On multivariate Cox regression analysis, female sex (P = 0.042), bilateral irradiation (P = 0.046), and cumulative dose to the thyroid (P = 0.001) were factors associated with increased risk of developing RIH.

Conclusion: The addition of chemotherapy, high dose of radiation to the thyroid gland, bilateral irradiation, and female sex were at higher risk of developing RIH. However, more studies are required to identify the dose-volume constraints of the thyroid gland.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijc.IJC_946_19DOI Listing
January 2021

Factors predicting contralateral nodal spread in papillary carcinoma of thyroid.

Indian J Cancer 2021 Jan 27. Epub 2021 Jan 27.

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India.

Background: Lymph node metastasis (LNM) is evident in about 20-50% of cases at presentation in papillary carcinoma thyroid (PTC). There are no clear recommendations for the need and extent of lateral and central compartment dissection in PTC.

Methods: A total of 83 patients who underwent total thyroidectomy and bilateral selective neck dissection for diagnosed PTC from September 2011 to October 2017 were retrospectively analyzed.

Results: Tumor site was bilobar or involving isthmus in 40 patients. Contralateral LNM was seen in 42 patients. Both radiological (median size 2.6 cm, P = 0.051) and pathological (median size 3.65 cm, P = 0.015) size of tumor, tumor involving isthmus or bilateral lobes (P = 0.006), and lymphovascular invasion (LVI) (P = 0.026) had significant correlation with contralateral LNM.

Conclusion: Size and site of tumor, ipsilateral lateral compartment nodes involvement, and LVI status of tumor significantly increases the probability of contralateral LNM in patients of PTC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijc.IJC_684_19DOI Listing
January 2021

Two novel cell culture models of buccal mucosal oral cancer from patients with no risk-habits of tobacco smoking or chewing.

Oral Oncol 2021 02 30;113:105131. Epub 2020 Dec 30.

National Institute of Biomedical Genomics, Kalyani, India. Electronic address:

Objective: Tobacco consumption is one of the major etiological factors for oral cancer, but it also develops in non-tobacco users, with unknown etiologies. Cellular models for tobacco associated oral cancer are available, however; reports of cellular models for studying non-tobacco associated oral cancer are limiting. We report here the establishment and characterization of two novel buccal mucosal cancer cell lines 'GBC02' and 'GBC035' derived from non-tobacco users.

Materials And Methods: Short tandem repeats (STR) profiling, Next-generation sequencing for whole-genome, exome and copy number alterations, immunofluorescence, flow-cytometry, proliferation, live-cell chemotaxis, 3D-spheroid formation, chemotherapy response, gene-expression microarray, gene-set enrichment analysis and xenograft development were performed.

Results: Sources of the established cultures were matched to their donors through STR profiling. Genome sequence analysis revealed somatic mutations in TP53, CASP8, CDKN2A for GBC02 with deletions and amplifications encompassing CDKN2A, FAT1 and CCND1, PIK3CA, SOX2, EGFR, MYC genes, respectively. GBC035 harbored mutations in FAT1, NOTCH1, HRAS, CDKN2A, HLA-B, HLA-A genes. While GBC035 cells showed higher E-Cadherin positive cell-cell junctions and collective cell migration in chemotaxis; GBC02 cells were vimentin-positive and demonstrated individual cell migration. Further, exhibiting their relevance to preclinical research, GBC02 3D-spheroids demonstrated enrichment of development-related gene-signatures in microarray transcriptome analysis and were resistant to Cisplatin, but showed sensitivity to cancer stem cells-targeting drug, Salinomycin. Additionally, tumorigenic ability of GBC02 was demonstrated.

Conclusions: Altogether, we present here comprehensively characterized unique cell lines established from non-tobacco associated tumors, which may serve as models for preclinical investigations of oral cancers caused independent of tobacco usage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oraloncology.2020.105131DOI Listing
February 2021

Nodal yield and topography of nodal metastases from oral cavity squamous cell carcinoma - An audit of 1004 cases undergoing primary surgical resection.

Oral Oncol 2021 02 16;113:105115. Epub 2020 Dec 16.

Head and Neck Surgery, Tata Medical Center, Kolkata, India.

Objectives: Nodal metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Detailed topographic study of metastasis can guide surgical and adjuvant radiation treatment protocols.

Methods: Retrospective analysis of distribution of nodal spread was done by auditing pathology records of 1004 patients who underwent primary surgical management at our center.

Results: The median nodal yield was 41 (range of 9-166) nodes, per patient. Metastasis was present in 42.9% patients, of which 52.3% demonstrated extranodal extension. Reclassification by AJCC8 criteria resulted in up-staging in 35.6% patients (pN1, pN2a, pN2b, pN2c, pN3a and pN3b in 13.1%, 3.7%, 6.9%, 0.9%, 0%, 18.1% respectively). Ipsilateral levels Ib and IIa were involved in a quarter of patients each, while IIb, IV and V were involved in < 4%, 3% and 1% of patients, respectively. Contralateral nodal metastasis was present in 5.4%. Skip metastases to level IV were 2.2% and 1.2% for tongue and gingivobuccal primaries. Tongue primaries had a lower likelihood of involving level Ib, but higher of level IIa and III, compared to gingivobuccal primaries, and a lower likelihood of extranodal extension. Primary site did not influence nodal metastasis to levels IIb, IV or V, but other factors like lymphovascular invasion, pT stage and margin status had an influence.

Conclusion: This large series with high nodal yield, shows low level of metastasis to level IIb, IV and V, which can help modify future guidelines for extent of surgery and avoid targeted adjuvant radiation to specific levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oraloncology.2020.105115DOI Listing
February 2021

Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma.

Head Neck 2021 Feb 6;43(2):520-533. Epub 2020 Oct 6.

Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India.

Background: The prognostic significance of various histopathologic lymph node-based biomarkers in oral squamous cell carcinoma (OSCC) needs further evaluation.

Methods: Retrospective analysis of 212 OSCC patients with regional metastasis to determine the association of extranodal extension (ENE), extent of ENE, size of metastatic deposit, lymph node yield (LNY), lymph node ratio (LNR), and topography of involvement with survival outcomes.

Results: The presence of ENE, larger nodal deposit, higher pN stage, lymph nodes in the lower levels, and patients who did not receive adjuvant treatment had poor disease-free survival (DFS). In addition, more positive nodes and high LNR showed worse overall survival (OS). ENE beyond 5 mm resulted in poorer outcomes. Larger sizes of metastatic deposit predisposed to ENE. Multivariate analyses showed only lower level of neck involvement to affect both DFS and OS.

Conclusions: Lymph node metastasis to lower levels and other lymph node characteristics affect prognosis and must be considered in the evolution of staging systems for OSCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.26499DOI Listing
February 2021

Contribution of Weight and Volume of the Extirpated Thyroid Gland on Voice Alterations After Total Thyroidectomy in Patients With Papillary Carcinoma of the Thyroid.

J Voice 2020 Mar 19. Epub 2020 Mar 19.

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India. Electronic address:

Purpose: Voice change after thyroid surgery is common despite preservation of laryngeal nerves. In this study, we sought to find if the change in voice after total thyroidectomy is related to the weight and volume of the removed thyroid gland.

Methods: This is a prospective cohort study of 50 patients of papillary carcinoma of the thyroid treated with total thyroidectomy from December 2016 through May 2018. Both objective and subjective voice parameters were analyzed preoperatively and at 1 and 3 months following surgery.

Results: A cohort of 29 patients, with a median age of 31 years (18-64 years), comprising 22 women were eligible for final analysis. Speaking fundamental frequency showed a mean change of 17.21 Hz (SD 34.49) while the mean intensity change was 5.54 dB (SD 18.21). The mean weight and volume of thyroid gland was 18.99 g (SD 8.93) and 15.67 ml (SD 8.70), respectively. On multivariate analysis, both weight and volume affected the range of frequency (P = 0.002 and 0.035, respectively) and range of intensity (P = 0.014 and 0.008, respectively).

Conclusion: Larger thyroid tumors are more likely to be associated with transient change in voice quality following their surgical removal despite physical preservation of external and recurrent laryngeal nerves, which may persist up to 3 months. This study affirms that perturbations in voice after thyroidectomy can still exist in spite of clinical demonstration of integrity of neuromuscular function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvoice.2020.02.014DOI Listing
March 2020

Redefining adequate margins in oral squamous cell carcinoma: outcomes from close and positive margins.

Eur Arch Otorhinolaryngol 2020 Apr 2;277(4):1155-1165. Epub 2020 Jan 2.

Department of Head and Neck Surgery, Tata Medical Center, Calcutta, West Bengal, 700160, India.

Purpose: Adequacy of surgical margins impacts outcomes in oral cancer. We sought to determine whether close and positive margins have different outcomes in patients with oral cancer.

Methods: Retrospective data from 612 patients with oral carcinoma were analyzed for the effect of margin status on locoregional recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS).

Results: A total of 90 cases (14.7%) had close margins and 26 patients (4.2%) had positive margins. Recurrences were documented in 173 patients (28%), of which 137 (22% of the study sample) were locoregional, and 164 patients (27%) had died. Among patients with close or positive margins, a cutoff of 1 mm optimally separated LRFS (adjusted p = 0.0190) and OS curves (adjusted p = 0.0168) whereas a cutoff of 2 mm was sufficient to significantly separate DFS curves (adjusted p = 0.0281).

Conclusions: Patients with oral carcinoma with positive margins (< 1 mm) had poorer outcomes compared to those with close margins (1-5 mm) in terms of LRFS, DFS and OS. There is a suggestion that a cutoff of < 2 mm might provide slightly more separation for DFS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-019-05779-wDOI Listing
April 2020

Clinicopathologic Determinants of Outcome in Pathologic T4a (pT4a) Squamous Cell Carcinoma of the Gingivobuccal Subsite of the Oral Cavity.

Indian J Surg Oncol 2019 Dec 27;10(4):594-599. Epub 2019 Jun 27.

1Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal 700160 India.

Carcinoma of the gingivobuccal complex is one of the most common cancers in India and patients usually present in an advanced stage. There is limited data in literature regarding the factors predicting outcome in pathological T4a patients. In this study, we aimed to study the clinic-pathological factors which may influence treatment outcomes in pT4a patients. This is a retrospective study of 121 patients who underwent surgery for oral squamous cell carcinoma between August 2011 and December 2016, staged pT4a. Overall survival (OS) and disease-free survival (DFS) were analyzed for variables including age, depth of invasion, margin status, differentiation, nodal status, extranodal spread, lymphovascular and perineural spread, and adjuvant treatment. The study cohort comprised 93 males with mean age 60.28 years (S.D. 11.25). Median DFS was 21 months (range 9 to 2374 days) whereas median OS was 24.5 months (range 9 to 2374 days). On univariate analysis, lymphovascular invasion, perineural invasion, cervical nodal metastasis, and extranodal extension had a statistically significant effect on both DFS and OS. On multivariate analysis, age ( = 0.014) and adjuvant radiotherapy ( = 0.010) were the statistically significant factors affecting OS. None of the factors affected DFS on multivariate analysis. Patients staged pT4a with cervical nodal metastasis, extranodal extension, lymphovascular invasion, and perineural invasion have reduced OS and DFS. On multivariate analysis, lower age at presentation and adjuvant radiation improved patient outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13193-019-00950-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895327PMC
December 2019

Novel Technique to Increase the PMMC Flap Pedicle Length by Coplanar Rotation Along the Pedicle Axis.

J Maxillofac Oral Surg 2019 Dec 23;18(4):637-639. Epub 2019 Jan 23.

Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal 700 156 India.

Pectoralis major myocutaneous flap (PMMC) continues to be a prime tool in the armamentarium for the reconstruction of head and neck malignancies even though free flaps have proved their versatility in functional and cosmetic outcomes. It still holds significance in both primary reconstruction and salvage procedures in head and neck malignancies. Inadequate infrastructure and resources make PMMC a preferred choice in many high-volume centres of developing countries. However, the length of the PMMC flap becomes a limiting factor for the distance that flap can be transferred when extensive reconstructions are being planned (Kudva et al. in J Maxillofac Oral Surg 14:481-483, 2015). We propose a modification in the conventional technique that maximises the length of the pedicle in orofacial reconstruction. Our technique allows the rotation of skin paddle along the longitudinal axis of the pedicle at the distal end along the same plane. This technique provides an easily reproducible and reliable technique that enables the surgeon to enhance the reach of the skin paddle and flexibility considerably.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12663-019-01184-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795666PMC
December 2019

Unusual loco-regional presentation in papillary carcinoma of thyroid: A case series.

Indian J Cancer 2019 Oct-Dec;56(4):325-329

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India.

Background: Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites.

Materials And Methods: Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series.

Results And Conclusion: Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijc.IJC_368_18DOI Listing
February 2020

A subtype of cancer-associated fibroblasts with lower expression of alpha-smooth muscle actin suppresses stemness through BMP4 in oral carcinoma.

Oncogenesis 2018 Oct 5;7(10):78. Epub 2018 Oct 5.

National Institute of Biomedical Genomics, Kalyani, India.

Cancer-associated fibroblasts (CAFs) demonstrate the characteristics of myofibroblast differentiation by often expressing the ultrastructure of alpha-smooth muscle actin (αSMA). However, heterogeneity among cancer-associated fibroblasts (CAFs), with respect to αSMA expression, has been demonstrated in several clinical studies of oral cancer. Like normal stem cells, stem-like cancer cells (SLCCs) are also regulated extrinsically by its microenvironment; therefore, we postulated that the heterogeneous oral-CAFs would differently regulate oral-SLCCs. Using transcriptomics, we clearly demonstrated that the gene expression differences between oral tumor-derived CAFs were indeed the molecular basis of heterogeneity. This also grouped these CAFs in two distinct clusters, which were named as C1 and C2. Interestingly, the oral-CAFs belonging to C1 or C2 clusters showed low or high αSMA-score, respectively. Our data with tumor tissues and in vitro co-culture experiments interestingly demonstrated a negative correlation between αSMA-score and cell proliferation, whereas, the frequency of oral-SLCCs was significantly positively correlated with αSMA-score. The oral-CAF-subtype with lower score for αSMA (C1-type CAFs) was more supportive for cell proliferation but suppressive for the self-renewal growth of oral-SLCCs. Further, we found the determining role of BMP4 in C1-type CAFs-mediated suppression of self-renewal of oral-SLCCs. Overall, we have discovered an unexplored interaction between CAFs with lower-αSMA expression and SLCCs in oral tumors and provided the first evidence about the involvement of CAF-expressed BMP4 in regulation of self-renewal of oral-SLCCs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41389-018-0087-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172238PMC
October 2018

Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction.

J Oral Maxillofac Surg 2014 Jan 12;72(1):222-31. Epub 2013 Aug 12.

Lecturer, Department of Surgical Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati, India.

Purpose: Although much has been mentioned in the literature worldwide regarding the outcome of pectoralis major myocutaneous flaps (PMMFs), hardly any studies are available that mention the outcome of PMMFs in female patients. It has been presumed that complication rates after PMMF reconstruction in female patients are higher because of the presence of more adipose tissue in the flap. The objective of this study was to analyze our data regarding the outcomes of PMMFs in female patients with oral cancer undergoing reconstruction after tumor ablation.

Materials And Methods: In this retrospective study from January 2008 to May 2012, performed in a single institution in south India, we have analyzed our data on PMMFs in 140 female patients with oral cancer. The operative technique used was essentially the same as that described originally by Ariyan. However, to preserve the deltopectoral flap area, the incision was appropriately modified in a manner as described by Schuller.

Results: The mean age of the patients was 52.36 years, with a range from 30 to 76 years. They presented mostly with ulcers or ulceroproliferative lesions. Most of the patients had a history of tobacco and betel nut chewing. All of them underwent composite resection and reconstruction with PMMF under general anesthesia. Of the patients, 30 (21.4%) had complications, comprising infection (8), superficial flap necrosis (11), combined wound infection and superficial flap necrosis (3), total flap failure (2), and orocutaneous fistula (6).

Conclusions: PMMF reconstruction is a reliable and cosmetically acceptable method of reconstruction in female patients for oral cavity defects after tumor ablation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2013.06.205DOI Listing
January 2014

Intraoperative transillumination to determine the extent of frontal sinus in subcranial approach to anterior skull base.

Skull Base 2011 Mar;21(2):71-4

We sought to determine the extent of the frontal sinus by intraoperative transillumination through the superomedial orbital wall in a subcranial approach to the anterior skull base. After raising a bicoronal flap, the frontal sinus was transilluminated through the superomedial orbital wall with a fiber-optic light source, delineating the extent of the frontal sinus. The frontal sinus boundary was marked with a marker pen. A frontal sinus anterior wall osteotomy was performed with a sagittal saw, staying within the confines of the frontal sinus marking. A bone flap was removed, and the posterior wall was drilled out. The remaining procedure was performed in a standard fashion. At the end of the procedure, the bone flap was fixed with a titanium plate. A total of 58 patients had undergone craniofacial resection from January 2004 to December 2007. In 13 patients, a subcranial approach was employed using the transillumination technique. Transillumination was successful in delineating the frontal sinus periphery in all 13 patients. Intraoperative transillumination of the frontal sinus through the superomedial orbital wall is a simple and effective method to delineate the frontal sinus periphery in a subcranial approach to the anterior skull base.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0030-1261267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312596PMC
March 2011

Reconstructive indications of simultaneous double free flaps in the head and neck: a case series and literature review.

Microsurgery 2012 Sep 21;32(6):423-30. Epub 2012 Mar 21.

Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

Extensive and complex defects of the head and neck involving multiple anatomical and functional subunits are a reconstructive challenge. The purpose of this study is to elucidate the reconstructive indications of the use of simultaneous double free flaps in head and neck oncological surgery. This is a retrospective review of 21 consecutive cases of head and neck malignancies treated surgically with resection and reconstruction with simultaneous use of double free flaps. Nineteen of 21 patients had T4 primary tumor stage. Eleven patients had prior history of radiotherapy or chemo-radiotherapy. Forty-two free flaps were used in these patients. The predominant combination was that of free fibula osteo-cutaneous flap with free anterolateral thigh (ALT) fascio-cutaneous flap. The indications of the simultaneous use of double free flaps can be broadly classified as: (a) large oro-mandibular bone and soft tissue defects (n = 13), (b) large oro-mandibular soft tissue defects (n = 4), (c) complex skull-base defects (n = 2), and (d) dynamic total tongue reconstruction (n = 2). Flap survival rate was 95%. Median follow-up period was 11 months. Twelve patients were alive and free of disease at the end of the follow-up. Eighteen of 19 patients with oro-mandibular and glossectomy defects were able to resume an oral diet within two months while one patient remained gastrostomy dependant till his death due to disease not related to cancer. This patient had a combination of free fibula flap with free ALT flap, for an extensive oro-mandibular defect. The associated large defect involving the tongue accounted for the swallowing difficulty. Simultaneous use of double free flap aided the reconstruction in certain large complex defects after head and neck oncologic resections. Such combination permits better complex multiaxial subunit reconstruction. An algorithm for choice of flap combination for the appropriate indications is proposed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/micr.21963DOI Listing
September 2012

Salivary gland tumours: profile and management at a tertiary cancer centre.

J Indian Med Assoc 2011 Jun;109(6):381-5

Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029.

Salivary gland tumours comprise a varied group of benign and malignant neoplastic lesions posing a challenge to surgeon. To review the profile of salivary gland tumours presenting to a referral cancer centre and their overall management, a retrospective analysis of prospective head and neck cancer database of the surgical oncology department of Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS) was performed. Forty patients of salivary gland tumours treated between 1995 and 2003 were analysed. All computations including recurrences and survival were carried out using the statistical package for social sciences (SPSS) for windows software (SPSS Inc, USA). The profile of salivary gland tumours presenting to a cancer centre setting was found to be different - 77.5% being malignant tumours and the remaining 22.5% werebenign tumours. Most common site of involvement was the parotid gland (72.5%). Muco-epidermoid carcinoma and adenocarcinomas were the most common histological types. Conservative resection was adequate for benign tumours. For primary malignant tumours, radical surgery with or without neck dissection and appropriate reconstruction, combined with postoperative radiotherapy was effective in achieving good locoregional control. Optimal management of primary tumour along with appropriate neck dissection including resection of the involved salivary gland is necessary for the management of metastatic salivary gland tumours.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2011

Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome.

Ann Plast Surg 2011 Mar;66(3):261-6

Head and Neck Institute, and Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

The purpose of this study was to report the effectiveness of the lateral arm free flap (LAFF) in the reconstruction of oral tongue defects, the subsite in which it may have advantage over the other donor sites. This is a retrospective analysis of 48 consecutive cases of LAFF used for the reconstruction of partial glossectomy defects for squamous cell carcinoma of the oral tongue. Primary defect and donor-site morbidity and the functional and aesthetic outcomes were assessed in 37 evaluable patients, with a minimum of 6 months follow-up. Patient-reported Visual Analog Scale score from 0 (minimum satisfaction) to 10 (maximum satisfaction) was used to evaluate the aesthetic outcome. The follow-up was for 6 to 52 months (mean, 24 months). The flap was successful in 45 (93.8%) patients. The commonest observed donor-site morbidity was a broad scar, but it did not cause much patient dissatisfaction because it could be covered with appropriate dressing. Speech was normal or near-normal in all patients. Poor functional outcome was associated with adjuvant postoperative radiotherapy. The visual analog scale score for the aesthetic satisfaction (mean [standard deviation]) was 6.58 (1.82) for primary site and 7.13 (1.99) for the donor site. LAFF is an excellent option for the reconstruction of partial glossectomy defects of oral tongue without significant involvement of the floor of mouth and base of tongue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SAP.0b013e3181d50e9eDOI Listing
March 2011

Transmandibular approach for excision of maxillary sinus tumors extending to pterygopalatine and infratemporal fossae.

Oral Oncol 2009 Aug 21;45(8):720-6. Epub 2008 Dec 21.

Head and Neck Institute, Amrita Institute of Medical Sciences and Research Centre, Elamakkara, Kochi, Kerala, India.

En bloc resection of maxillary sinus tumors that extend through the posterior wall necessitates resection of maxilla along with pterygopalatine and infratemporal fossae contents. This cannot be readily performed by conventional anterior maxillectomy approaches. The objective of this study is to evaluate the effectiveness of transmandibular approach for the excision of maxillary sinus tumors extending to pterygopalatine and infratemporal fossae. This is a retrospective review of 15 consecutive patients who underwent maxillectomy with transmandibular approach for tumors with posterior extension, between January 2004 and February 2008. The principal outcome parameter was the margin status on final histopathology report. In addition, evaluable patients were reviewed to assess the morbidity of the procedure using pre-defined parameters. All the patients had negative margins at the infratemporal fossa region. Varying degree of trismus was present in all patients. The cosmetic outcome of the procedure was excellent. Other anterior and transcranial approaches could be combined with this procedure when indicated. We conclude that transmandibular approach is an effective technique for resection of maxillary tumors with posterior extension to the pterygopalatine and infratemporal fossae. The procedure has acceptable morbidity and the aesthetic and functional results are satisfactory.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oraloncology.2008.11.005DOI Listing
August 2009

Esthetic and anatomic basis of modified lateral rhinotomy approach.

J Oral Maxillofac Surg 2009 Jan;67(1):231-4

Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2008.07.012DOI Listing
January 2009

A simplified technique of free flap pedicle transfer for reconstruction of defects following head and neck cancer ablation.

J Surg Oncol 2009 Jan;99(1):80-1

Head and Neck Institute, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.

Free flaps are being widely used for reconstruction of defects following head and neck cancer ablation. The pedicle of the flap is usually tunneled into the neck wound for anastomosis to the neck vessels. This transfer of the pedicle can be technically difficult to execute and associated with difficulties of torsion and kinking. No effective method has been so far reported to make this procedure easy and safe. A very easy and effective method for the pedicle transfer is described in this report, which has been practiced successfully in our head and neck service in more than 175 free flaps.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jso.21162DOI Listing
January 2009

Increased plate and osteosynthesis related complications associated with postoperative concurrent chemoradiotherapy in oral cancer.

Head Neck 2008 Nov;30(11):1422-30

Head and Neck Institute, Amrita Institute of Medical Sciences and Research Centre, Amrita Lane, Elamakkara PO, Kochi, Kerala, India.

Background: Plate osteosynthesis is a widely used technique in head and neck reconstructive surgery. The objective of this study was to determine whether postoperative chemoradiotherapy, which was recently introduced for high-risk head and neck cancer, affects plate and osteosynthesis related complications.

Methods: Fifty-two consecutive patients, who had undergone plate osteosynthesis for mandibular reconstruction between October 2003 and September 2006, were included in the study. The patients were divided into 3 groups: (1) surgery alone (n = 19), (2) surgery with postoperative radiotherapy (n = 14), and (3) surgery with concurrent chemoradiotherapy (n = 19). Outcome measures included any bone or plate related complications.

Results: The plate and osteosynthesis related complications occurred in 10.5% of patients in surgery-alone group, 28.6% in surgery with postoperative radiation group, and 63.2% in surgery with postoperative concurrent chemoradiotherapy group. The differences in the complication rates among these 3 groups were statistically significant (p = .003). In univariate analysis, postoperative radiation (p = .007) and concurrent chemotherapy (p = .003) were found to be significantly associated with complications. In multivariate analysis, only concurrent chemotherapy was found to be statistically significant (p = .002) with odds ratio of 7.72.

Conclusion: Postoperative concurrent chemoradiotherapy significantly increases plate and osteosynthesis related complications in oral cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.20886DOI Listing
November 2008

Quantitative evaluation of transtemporal and facial translocation approaches to infratemporal fossa.

Skull Base 2008 Jan;18(1):17-27

Head and Neck Institute, Amrita Institute of Medical Sciences, Kerala, India.

Objective: To compare the extent of exposure and surgical maneuverability provided by facial translocation and transtemporal approaches for access to the infratemporal fossa and anterolateral skull base.

Materials And Methods: Surgical procedures were performed on five fresh frozen adult cadavers (ten sides) with no known pathology. Facial transfacial approaches with and without a mandibulotomy and transtemporal approaches were evaluated. OBJECTIVE measures were (1) the distance from the surgical plane to designated anatomic landmarks and (2) the surgical angle of exposure.

Results: Distances from the surgical plane to the anatomic reference points were comparable for most of the access procedures (3 to 6 cm). The extended midfacial translocation and bilateral facial translocation approaches did, however, provide a shorter operative distance (1 to 3 cm) for access to the infratemporal fossa and contralateral structures, respectively. The transtemporal approaches facilitate a better angle of exposure (74 to 84 degrees) to the petrotemporal region, while the transfacial approaches were superior for access to the infratemporal structures.

Conclusions: Based on the results, we propose a clinical algorithm for selecting a surgical approach based on the position and extent of an infratemporal or petrotemporal lesion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-2007-992765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435471PMC
January 2008

Oral cancer prevention.

Oral Maxillofac Surg Clin North Am 2006 Nov;18(4):493-511

Head and Neck Institute, AIMS Hospital, Amrita Lane, Elamakkara, Kochi 682 026, India; Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, New York, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.coms.2006.06.003DOI Listing
November 2006

Organ-preserving multimodality management of squamous cell carcinoma of anal canal.

Indian J Gastroenterol 2005 Sep-Oct;24(5):201-4

Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi.

Aim: To study the efficacy of an organ-preserving, sequential chemoradiation therapy for squamous cell carcinoma of the anal canal, and of salvage surgery in those in whom this treatment fails.

Methods: Forty biopsy-proven untreated patients (28 men) with squamous cell carcinoma of the anal canal received two cycles of chemotherapy using cisplatin and methotrexate, followed by 45 to 60 (median 50) Gy external beam radiotherapy. Salvage surgery was offered to those in whom this treatment failed. Overall survival, disease-free survival and colostomy-free survival were analyzed.

Results: Most patients (n=35; 87%) had T3 or T4 lesions and 5 (12.5%) had involvement of inguinal nodes. Thirty-one patients (77.5%) had complete response after chemoradiation. Only three patients (7.5%) developed chemotherapy-related grade 3 mucositis and myelosuppression. Radiotherapy-related toxicity included grade III cystitis in one patient and grade III proctitis in three patients. Three patients had post-treatment anal stenosis requiring repeated dilatation and two had chronic non-healing ulcers at the anal verge. Nine patients had failure of chemoradiation or disease recurrence; of these, only 5 could undergo salvage surgery. After a median follow up of 60 months, overall survival, disease-free survival and colostomy-free survival were 80%, 77.5% and 72.5%, respectively.

Conclusion: Chemoradiation is effective in the treatment of squamous cell anal cancer and has acceptable toxicity. Surgical salvage may be useful in those with failure of this treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2006

Zinc supplementation: time for public health intervention.

Natl Med J India 2002 Sep-Oct;15(5):280-1

Department of Nephrology, Bhopal Memorial Hospital and Research Center, Madhya Pradesh.

View Article and Find Full Text PDF

Download full-text PDF

Source
January 2003