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Background: Surgery is the mainstay in the management of thyroid cancer. Surgical outcomes need to be tempered against the excellent prognosis of the disease.Aims: This study aims to study the surgical outcomes including the 30-day morbidity and 5-year survival of thyroid cancer patients.Settings and Design: Retrospective analysis of a prospectively maintained surgical database in a tertiary cancer center in India.Materials and Methods: We analyzed 221 surgically treated patients in the year 2012.Statistical Analysis: Used IBM SPSS 24.0 (Armonk, NY) with p < 0.05.Results: The median age was 40 years with predominantly papillary thyroid carcinoma (55%). Localized disease in 47% of cases, locoregional disease in 42.5% and distant metastasis in 10.2% of cases at presentation was noted. Treatment naïve patients were 71% and revision surgeries were done in 29% patients. Extended thyroidectomy constituted 11% of the surgeries. Temporary hypocalcemia was seen in 30.8% of patients, 5% requiring intravenous calcium supplementation. Vocal cord palsy as per nerve at risk and chyle leak were seen in 4.5% and 3.1%, respectively. Aggressive histology, extended thyroidectomy, and inadvertent parathyroidectomy were significant factors associated with complications. Five year estimated overall survival with median follow-up of 50 months was 98%, and event-free survival was 84.8%. Advanced age, distant metastasis at presentation and aggressive histology connoted poor outcomes.Conclusion: Thyroid cancer, irrespective of the extent of disease, has good prognosis. Aggressive histology, the extent of thyroid surgery, distant metastasis and age are important factors, which should be factored in the algorithm of thyroid cancer management. [ABSTRACT FROM AUTHOR]

Context: Head and neck surgeries are complex. Wound complications are associated with considerable morbidity and can result in delay in the adjuvant treatment. Identification of factors will help in formulating preventive guidelines. Aims: The aim of this study is to identify perioperative factors responsible for wound complications. Settings and Design: Prospective study of 186 head and neck patients. Subjects and Methods: Pre-operative, intraoperative and post-operative factors were recorded. Each patient was evaluated for minor and major wound complications twice daily during the hospital stay. Statistical Analysis: Chi-square test was used for univariate and log regression test was used for multivariate analysis. Results: The overall wound complication rate was 29% with 7% major and 22% minor complications. On univariate analysis, laryngeal and hypopharyngeal location, advanced T stage, poor oral hygiene, clean-contaminated surgery, low Karnofsky performance status (KPS), flap reconstruction, blood loss more than 1000 ml, perioperative blood transfusion, duration of surgery greater than 4.3 h and post-operative hemoglobin lesser than 11 g%, post-operative tracheostomy and resection of mandible were statistical significant factors. On multivariate analysis, post-operative tracheostomy, low KPS, post-operative serum albumin less than 3.7 g/dl and duration of surgery greater than 4.3 h were significant factors. Conclusion: Apart from unavoidable factors, it is essential to take care of certain factors viz nutrition, haemoglobin, oral hygiene, asepsis and repeating antibiotics in prolonged surgery. [ABSTRACT FROM AUTHOR]

Aim: To assess the usefulness of single-staged posteriorly based dorsal tongue flap in oral cavity reconstruction following ablative surgery, in terms of flap viability, functional outcome and donor site morbidity. Materials and Methods: A prospective database of patients who were reconstructed with dorsal tongue flap between July 2006 and November 2010 was used. Results: There were 27 patients who had tongue flap reconstruction in this period. Size of the defect following excision ranged from 3.5-5 cm in greatest dimension. Marginal mandibulectomy was done in thirteen patients and in twelve patients mucoperiosteal stripping was done. There was no partial or total flap loss in our series. Two patients had minor salivary leak which was managed conservatively. All the patients had adequate mouth opening, good swallowing and speech following surgery. Conclusion: Dorsal tongue flap is a simple and reliable flap for intra oral reconstruction. It provides good functional results without much morbidity. [ABSTRACT FROM AUTHOR]

Xeroderma pigmentosum (XP) is a rare autosomal recessive genodermatosis associated with hypersensitivity to ultraviolet light due to defects in Deoxyribonucleic acid (DNA) repair. These patients have more than a 1000-fold increased risk of developing skin cancers. Although multiple cutaneous malignancies are common, the simultaneous occurrence of angiosarcoma and basal cell carcinoma is a rare phenomenon. We report a case of a 25-year-old male with XP with angiosarcoma scalp and basal cell carcinoma of face and occiput and discuss the treatment of this aggressive neoplasm with a review of the literature pertaining to it. [ABSTRACT FROM AUTHOR]

Objective: Total thyroidectomy with or without central compartment dissection is the treatment of choice for thyroid carcinoma. Extensive dissection along the recurrent laryngeal nerve (RLN) can lead to vocal cord fixity and hoarseness even without nerve sacrifice. Recovery rates after surgery for thyroid cancers have not been well documented. The aim of the study is to analyze the incidence of vocal cord palsy (VCP) and its recovery rates in patients operated for thyroid cancers. Methodology: We performed a retrospective study on prospectively collected data in 152 thyroidectomy patients with 254 RLNs at risk. All patients underwent a laryngoscopic examination to document vocal cord function in the immediate postoperative period and on subsequent follow‐up. Incidence of VCP, recovery rates, univariate and multivariate analysis to identify risk factors for permanent VCP were calculated using binary logistic regression. Results: In our study, 28% patients underwent redo surgeries and 74% patients had dissection of the central compartment. The immediate postoperative RLN palsy rate was 11.2%, with a palsy rate of 9% and 16.2% in the per primum and redo surgery cohorts. On follow‐up, there was complete recovery of VCP in 66.7% of these nerves. The incidence of permanent RLN palsy was 3.9%. The mean time to recovery was 9.6 months. Conclusion: Vocal cord dysfunction recovered in most patients in this high‐risk cohort. There was a significant recovery even in the redo surgery group and a policy of watchful waiting is recommended in the absence of severe symptoms. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Limited data exists regarding the impact of intensification of adjuvant therapy in resected Oral Cavity Squamous Cell Carcinomas (OCSCC) with adverse prognostic features on histopathology. This was a three-arm phase III, randomised trial including patients with resected advanced OCSCC. Randomisation was done in a 1:1:1 ratio: Arm-A- standard adjuvant radiation therapy (RT) 60Gy/30 fractions over 6 weeks versus Arm-B-concurrent chemoradiation versus Arm-C-accelerated radiation therapy (6 d a week). The trial was powered to detect an absolute difference of 10% in 5-year Locoregional Control (LRC). The trial was conducted between June 2005 and March 2013. Majority of the patients were males, had T3-T4 disease, had N2–N3 nodal status and had Extra-Capsular Extension (ECE) in nodes. The median follow-up was 95.9 months. There was no difference between the three arms (A versus B versus C) for 10-year locoregional control (LRC): 60.2% versus 61.4% versus 65.7%, p = 0.57; disease free survival (DFS): 37.4% versus 43.9% versus 39.6%, p = 0.40; or Overall Survival (OS): 39.7% versus 46.6% versus 40.4%, p = 0.40. There was no benefit of intensification with either modality in patients with any single adverse pathological factor. A benefit of intensification could be seen in patients with a combination of high-risk features: T3-T4 primary tumours with N2–N3 nodes along with ECE for DFS (Arm B versus Arm A HR) = 0.53, Arm C versus Arm A HR = 0.63) and OS (Arm B versus Arm A HR = 0.58, Arm C versus Arm A HR = 0.60). All optimally resected OCSCC with adverse features did not benefit from intensification of adjuvant therapy. Only a cohort of patients with a combination of high-risk features are likely candidates for intensification. NCT00193843. • Phase III RCT comparing adjuvant radiation therapy versus CTRT versus accelerated radiation therapy in high risk oral cavity squamous cell carcinomas. • 900 patients accrued (1:1:1 randomisation), positive margins in <1% patients. • No benefit in outcomes with intensification in overall population (n = 900). • No benefit in patients with isolated extra-capsular extension , lymphovascular embolisation , perineural invasion or high T stage. • Benefit seen with coexistent T3-T4, N2–N3 and extra-capsular extension. [ABSTRACT FROM AUTHOR]

Background: Locally advanced oral cancer is mainly treated by multimodality i.e. surgery followed by adjuvant therapy. Tongue cancer holds a poor prognosis despite of the advances in various treatment modalities. In the era of organ preservation, surgery for locally advanced tongue cancer is too morbid. Management of Locally advanced tongue cancer (LADTCA) surgery revolves around poor prognosis due to early recurrences and morbid surgery which require extensive reconstruction. Material and methods: Retrospective study of patients with histologically proven squamous cell carcinoma of LADTCA who underwent surgery at our centre during 2008–2011 were analyzed for different histopathological parameters and recurrence patterns. Results: We reviewed the charts of 874 patients. Wide excision was done in 671 patients and major glossectomy done for 203 patients. Out of these, 57 patients were included in the study after fulfilling the inclusion criteria. All underwent major glossectomy with neck dissection and reconstruction. The mean age was 47.5yrs with majority males. Thirty percent patients were young (<40yrs). Majority had pedicled flap reconstruction (74%) and 23% underwent free microvascular flaps. Sixty percent had thickness more than 2cm.Sixty percentage of patients had perineural invasion. Nodal positivity rate was 64% with unilateral nodal positivity in 39% and bilateral positivity in 28% patients. Perinodal extension was seen in 53% of patients. Ninety-four percent had free margins and 6% had involved margins. Median Disease free survival was 7month. Sixty-three percent of patients had recurrence i.e. local recurrence and/or regional recurrence in 65% and distant metastasis and/or local disease in 35% patients. Perineural invasion (p =0.011), nodal metastasis (p =0.006), perinodal extension (P =0.031), bilateral node positivity (p =0.012) were significantly correlated with recurrence. Conclusion: Major glossectomy achieves good palliation of symptoms and offers potential chance of cure in selected cases. [Copyright &y& Elsevier]

Background: Extent of central compartment neck dissection (CCND) in thyroid cancers has been a debate because of associated morbidity. There have been attempts to reduce the extent of surgery in an attempt to decrease morbidity.Patients and Methods: We analyzed the morbidity of CCND from our prospectively maintained surgical morbidity database. CCND was divided into bilateral complete clearance (BCC) and less than complete clearance (LCC). LCC was performed for clinicoradiologically node negative patients. Rates of hypocalcemia and recurrent laryngeal nerve (RLN) palsy rates were compared for LCC versus BCC. We also classified procedures performed in the central neck according to the extent of dissection.Results: Of 153 evaluable patients, BCC was performed in 43.8% and LCC in 56.2%. Rate of postoperative hypocalcemia was 40.2% in BCC group versus 17.4% in LCC group. We had an overall RLN palsy rate of 7.4%. There was no significant difference in RLN palsy rates between the groups.Conclusion: Lesser extent of dissection in central compartment reduces postoperative hypocalcemia but has no influence on RLN palsy rates. [ABSTRACT FROM AUTHOR]

We previously reported a survival benefit of elective neck dissection (END) over therapeutic neck dissection (TND) in patients with clinically node-negative early-stage oral cancer. We now report the results of the second question in the same study addressing the impact of adding neck ultrasound to physical examination during follow-up on outcomes. Patients with lateralized T1/T2 oral squamous cell carcinoma (SCC) were randomized to END or TND and to follow-up with physical-examination plus neck ultrasound (PE+US) versus physical-examination (PE). The primary endpoint was overall survival (OS). Between January 2004 and June 2014, 596 patients were enrolled. This is an intention to treat analysis of 592 analysable patients, of whom 295 were allocated to PE+US and 297 to PE with a median follow-up of 77.47 months (interquartile range (IQR) 54.51–126.48). There was no significant difference (unadjusted hazard ratio [HR], 0.92, 95% CI, 0.71–1.20, p = 0.54) in 5-year OS between PE+US (70.8%, 95% CI, 65.51−76.09) and PE (67.3%, 95% CI, 61.81−72.79). Among 131 patients with neck node relapse as the first event, the median time to relapse detection was 4.85 (IQR 2.33–9.60) and 7.62 (IQR 3.22–9.86) months in PE+US and PE arms, respectively. The N stage in the PE+US arm was N1 33.8%, N2a 7.4%, N2b/c 44.1% and N3 14.7% while in PE was N1 28.6%, N2a 9.5%, N2b/c 39.7%, N3 20.6% and unknown 1.6%. Adding neck ultrasound to physical examination during follow-up detects nodal relapses earlier but does not improve overall survival. • 596 patients with node-negative early oral cancers randomized to PE+US and PE arm. • Median follow-up of trial cohort 77.47 months. • Adding neck US to PE during follow-up detects nodal relapses earlier. • Median time to relapse detection was 4.85 months in PE+US and 7.62 months in PE arm. • This, however, did not translate into an improvement in overall survival. [ABSTRACT FROM AUTHOR]

Congenital pseudoarthrosis (CPT) of the tibia is rare congenital anomaly occurring 1 in 190,000 live births. It is one of the rare causes of limb shortening. A 8-year-old male child born of consanguious marriage came to orthopedic Out Patient Department with history of significant shortening of left leg since birth so much, so that patient cannot use his left leg for walking. His right leg was normal. Family history of neurofibromatosis-I (NF-1) is present. History, photographs and X-rays were taken and patient was diagnosed as a case of CPT of the tibia. Significant association between CPT of tibia and NF-I has been found. The case is of significance to orthopedicians and pediatrician from the management point of view. [ABSTRACT FROM AUTHOR]

Objective: Presence of extracapsular spread (ECS) significantly decreases survival in oral cancer patients. Considering its prognostic impact, we have studied the incidence and factors predicting ECS in clinically node negative early oral cancers.Materials and Methods: We performed a retrospective chart review of 354 treatment naïve clinically node negative early oral cancer patients operated between 2012 and 2014. Chi-square test and logistic regression were used for identifying predictors of ECS, while cox-regression test was used for survival analysis.Results: The incidence of occult nodal metastasis was 28.5% (101/354). Among them, ECS was seen in 15.3%(54/354) patients. The incidence of ECS in T1 and T2 lesion was 13.4% (21/157) and 16.8% (33/197), respectively. The overall incidence of ECS was 48% and 29% in lymph nodes smaller than 10 mm and 5 mm respectively. We found that tumor depth of invasion (>5 mm; p-0.027) and node (metastatic) size >15 mm (p-0.018) were significant predictors of ECS. p N2b disease was seen in 41/354 (11.6%) of which 31/354 (8.7%) had ECS, i.e. 75.6% of pN2b patients been ECS positive (p-0.000). The 3-year OS of patients without nodal metastasis, nodal metastasis without ECS and nodal metastasis with ECS was 88.4%, 66.9% and 59.2% (p-0.000) respectively.Conclusion: A significant number of patients with metastatic nodal size less than 1 cm have ECS which suggests aggressive behavior of the primary tumor. Thus, elective neck dissection is the only way of detecting ECS in these patients which may warrant treatment intensification. [ABSTRACT FROM AUTHOR]

Background and Objectives: Salivary gland neoplasms are relatively uncommon. They have a wide variety of histopathological types with diverse biological behavior. It involves all the major and minor salivary glands in the head and neck. This article focuses on the various types of major salivary gland tumors treated at a tertiary cancer center along with their surgical morbidities and outcomes.Materials and Methods: Data of all the salivary gland neoplasms operated in the head and neck services between January 2012 and December 2013 were retrieved from a prospectively collected database. The clinical, demographic data and types of surgeries along with the morbidities were collated from the database and the details regarding the follow-up were collected from the electronic medical record.Results: Out of 235. cases registered, 107. patients were treated at our institute. The parotid gland was most commonly involved; majority were malignant lesions. Sixty-two patients were treatment naive at presentation. Majority presented with advanced disease. Superficial parotidectomy was the most common surgery performed and neck dissection was done in 27. patients. Facial nerve palsy was the most common complication following surgery. (16%). Sixty patients received adjuvant treatment. All patients on follow-up were alive at their last visit, with 10. patients having recurrence. Factors influencing the disease-free survival were extracapsular spread, tumor grade, and perineural invasion.Conclusion: The postoperative morbidities and outcomes for major salivary gland neoplasms in our series were acceptable and comparable to the results available in the literature. Appropriate treatment of the salivary gland neoplasm will yield good outcomes with acceptable morbidity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Total laryngectomy (TL) is a well-established procedure for laryngeal and hypopharyngeal cancers. There is an increasing number of TLs done after organ preservation strategies. AIM: The aim of this study was to report 30-day morbidity and survival outcomes in patients undergoing TL at a tertiary referral center. SETTING AND DESIGN: This was a retrospective review of a prospective database of TL patients operated during 2012–2013. MATERIALS AND METHODS: Patient demographics and other data were captured from the database. Surgical complications were graded as per Clavien–Dindo grading system and were also divided into major and minor as per predecided criteria. Recurrence and survival data were computed using Kaplan–Meier survival curves. RESULTS: A total of 169 patients underwent TL during the study period. About 34% of the patients had received prior radiation therapy. Around 18% of the patients had major complications with a pharyngocutaneous fistula rate of 22.4%. Ninety percent of these were managed conservatively. Though used in a small subset, microvascular reconstruction had the least complication rates. The 3-year disease-free survival and overall survival were 66% and 72%, respectively. There was no difference in survival between per primum and salvage surgery cohorts. CONCLUSION: TL is a safe and oncologically sound procedure in patients with laryngeal and hypopharyngeal cancers. A large proportion of patients still undergo TL as a de novo procedure. This denotes that patients still present with locally advanced cancers which are not amenable to organ preservation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Oral cancers are one of the most common cancers in India. Surgery is the main modality of treatment for oral cancer patients. It is important to understand the postoperative morbidity and mortality as it influences patient outcomes. AIM: The aim of this study was to determine oral cancer patients' characteristics, treatment details, 30-day morbidity and mortality, and survival outcomes. SETTINGS AND DESIGN: This was a retrospective analysis of prospectively collected data in a tertiary cancer center. MATERIALS AND METHODS: This study included 850 surgically treated oral cancer cases between January and December 2012. STATISTICAL ANALYSIS: We performed univariate survival analysis by log-rank test, and all significant (P < 0.05) variables underwent multivariate analysis using Cox regression. RESULTS: The median age was 52 years and the male-to-female ratio was 3.4:1. Nearly one-third of the patients received some form of prior treatment. Buccal mucosa (BM) was the most common subsite (64.94%). BM cancers (81.1%) were more likely to present in advanced stage compared to tongue cancers (52%) (P = 0.000). The incidence of postoperative morbidity and mortality was 36.4% and 0.9%, respectively. Complications were higher in cT3-4 (P = 0.000), cN positive (P = 0.000), and those requiring microvascular reconstruction (P = 0.004). The 5-year overall survival of the entire study group was 70.4%. The survival of early and locally advanced stages was 75.1% and 68.4%, respectively. The factors influencing survival were age (>50 years), advanced cT stage, nodal metastasis, overall stage, and presence of orocutaneous fistula. CONCLUSION: The morbidity, mortality, and long-term outcomes of surgically treated oral cancer patients at our center are comparable to those treated in the developed world. Aggressive management of postoperative complications is crucial for early recovery and timely initiation of adjuvant treatment. [ABSTRACT FROM AUTHOR]

Background: Total laryngectomy (TL) is a well-established procedure for laryngeal and hypopharyngeal cancers. There is an increasing number of TLs done after organ preservation strategies.Aim: The aim of this study was to report 30-day morbidity and survival outcomes in patients undergoing TL at a tertiary referral center.Setting and Design: This was a retrospective review of a prospective database of TL patients operated during 2012-2013.Materials and Methods: Patient demographics and other data were captured from the database. Surgical complications were graded as per Clavien-Dindo grading system and were also divided into major and minor as per predecided criteria. Recurrence and survival data were computed using Kaplan-Meier survival curves.Results: A total of 169 patients underwent TL during the study period. About 34% of the patients had received prior radiation therapy. Around 18% of the patients had major complications with a pharyngocutaneous fistula rate of 22.4%. Ninety percent of these were managed conservatively. Though used in a small subset, microvascular reconstruction had the least complication rates. The 3-year disease-free survival and overall survival were 66% and 72%, respectively. There was no difference in survival between per primum and salvage surgery cohorts.Conclusion: TL is a safe and oncologically sound procedure in patients with laryngeal and hypopharyngeal cancers. A large proportion of patients still undergo TL as a de novo procedure. This denotes that patients still present with locally advanced cancers which are not amenable to organ preservation. [ABSTRACT FROM AUTHOR]

Background: Oral cancers are one of the most common cancers in India. Surgery is the main modality of treatment for oral cancer patients. It is important to understand the postoperative morbidity and mortality as it influences patient outcomes.Aim: The aim of this study was to determine oral cancer patients' characteristics, treatment details, 30-day morbidity and mortality, and survival outcomes.Settings and Design: This was a retrospective analysis of prospectively collected data in a tertiary cancer center.Materials and Methods: This study included 850 surgically treated oral cancer cases between January and December 2012.Statistical Analysis: We performed univariate survival analysis by log-rank test, and all significant (P < 0.05) variables underwent multivariate analysis using Cox regression.Results: The median age was 52 years and the male-to-female ratio was 3.4:1. Nearly one-third of the patients received some form of prior treatment. Buccal mucosa (BM) was the most common subsite (64.94%). BM cancers (81.1%) were more likely to present in advanced stage compared to tongue cancers (52%) (P = 0.000). The incidence of postoperative morbidity and mortality was 36.4% and 0.9%, respectively. Complications were higher in cT3-4 (P = 0.000), cN positive (P = 0.000), and those requiring microvascular reconstruction (P = 0.004). The 5-year overall survival of the entire study group was 70.4%. The survival of early and locally advanced stages was 75.1% and 68.4%, respectively. The factors influencing survival were age (>50 years), advanced cT stage, nodal metastasis, overall stage, and presence of orocutaneous fistula.Conclusion: The morbidity, mortality, and long-term outcomes of surgically treated oral cancer patients at our center are comparable to those treated in the developed world. Aggressive management of postoperative complications is crucial for early recovery and timely initiation of adjuvant treatment. [ABSTRACT FROM AUTHOR]

Aim To determine the most accurate noninvasive imaging modality for occult metastasis in clinically node-negative necks in oral squamous cell carcinoma from a granulomatous disease endemic region. Method Prospective, observational study comparing ultrasound ( US), contrast enhanced computed tomography ( CECT) and positron emission tomography-computed tomography ( PET-CT). Level wise assessment of neck nodes with each imaging modality was performed and compared with final histopathology. Results Eighty-five necks were evaluated in 70 patients. Sensitivity, specificity and accuracy of the three modalities were 78.9, 68.75 and 73.25% for US, 73.6, 85.4 and 80.2% for CECT, and 81.5, 54.1 and 66.2% for PET- CT, respectively. CECT performed better than US and PET-CT scan particularly in levels IB and II (accuracy of 81.4 and 88.3% for CECT, 73.25 and 79.1% for US, and 68.6 and 68.6% for PET-CT scan, respectively). Concordance with histology was best with CECT (κ = 0.615) followed by US (κ = 0.461) and PET- CT (κ = 0.337). Conclusion The quest for the most accurate imaging modality in clinically node-negative necks continues. US alone is inadequate. While PET-CT may not be a specific imaging modality in detecting occult cervical nodal metastasis in endemic regions of chronic granulomatous diseases, the performance of PET CECT in this setting remains to be evaluated. CECT scan, routinely used in imaging for primary disease, is fairly accurate in detecting nodal metastasis. However, in early oral cancers that are generally treated without any imaging for the primary tumor, management of the neck will largely depend on clinical judgment. [ABSTRACT FROM AUTHOR]

The article presents a study which compared the effects of elective neck dissection and therapeutic neck dissection on patients with early-stage oral cancer. Topics include the effectiveness of elective neck dissection in relation to relapse and survival rates, the watchful-waiting approach, and the involvement of the Head and Neck Disease Management Group of the Tata Memorial Centre in India. It also mentions the use of radiography as a treatment method.

Background: Positive cut margin is an important factor affecting the survival of oral cavity cancers. Mucosal and soft tissue margins are equally important. Tumors of buccal mucosa and alveolus involve buccinator muscle early which acts as a barrier in the initial stages. Once invaded, tumor spreads rapidly to involve subcutaneous tissue and skin. The extent of surgical resection required to obtain adequate margin in third dimension is debatable. Many a times clinician is unsure regarding excision of skin to get adequate soft tissue margin. Till now no satisfactory objective method is available to accurately predict the soft tissue invasion. Material and methods: Prospective observational study in a tertiary care center. Histologically proven squamous cell carcinoma of the gingivobuccal complex with no obvious involvement of the skin. Patients subjected to computed tomography (CT) scan. Distance from the outermost edge of the tumor to the skin calculated by a senior radiologist. Thickness of the tumor and fat stranding noted. Patients subjected to surgery and intraoperative decision to excise the skin taken by operating surgeon irrespective of the calculated distance between the tumor and the skin on CT scan. On resected specimen the tumor thickness, distance of tumor from the skin and subdermal lymphatic invasion assessed histopathologically. CT scan findings correlated with histopathological findings. Results: Currently ongoing study. Eight patients studied. Correlation between radiological and histopathological findings in terms of depth of invasion found in 87.5% (7/8) patients. CT found to be accurate in predicting the depth of soft tissue invasion. We are expected to have robust study sample size at the time of presentation. Conclusion: CT scan is an effective radiological tool in predicting the depth of invasion preoperatively. Objective preoperative measurement of distance between the tumor and skin will help guiding the clinician in achieving adequate soft tissue margins. [Copyright &y& Elsevier]

Post laryngectomy voice rehabilitation using primary tracheoesophageal puncture (TEP) and voice prosthesis insertion is considered the 'gold standard' method. No special effort is taken to measure the tracheoesophageal partywall thickness before inserting voice prosthesis. TE puncture related problems (peri-prosthetic leakage) are commonly seen in our population as compared to device failures (central leak). An accurate prosthesis inserted primarily may prevent the development of peri-prosthetic leakage. We surmise that tracheoesophageal party wall thickness (PWT) to be an important factor determining this phenomenon. There is still no consensus on the size of the prosthesis to be inserted during a primary TEP. To cater this, we propose a simple, quick and accurate method of measuring tracheoesophageal PWT intraoperatively. This method will guide us to determine an accurate prosthesis size which can be inserted during primary TEP. We also propose that this method will prevent future TE puncture related problems. [ABSTRACT FROM AUTHOR]

A young male patient was diagnosed to have laryngeal papillomas at the age of 3 years for which he underwent permanent tracheostomy and also multiple surgical and laser excision procedures. Then, later in life, the patient had progressive breathlessness and dysphagia. On examination, he had supraclavicular lymphadenopathy showing squamous carcinoma pathology. Since laryngeal papillomas have a high propensity to transform into laryngeal squamous cell carcinoma, he was first evaluated for laryngeal carcinoma which was negative. Esophagoscopy showed a growth in the esophagus, the biopsy of which was positive for squamous malignant cells. Patient was then started on palliative chemotherapy with combination of paclitaxel and carboplatin, and at progression with weekly nanoxel with stable disease. This is a rare case of childhood laryngeal papillomatosis progressing to metastatic esophageal carcinoma. This case has been presented to highlight the fact that patients with laryngeal papillomas are not only at high risk of progressing to laryngeal carcinoma but can also have other malignancies of the upper aerodigestive tract and lung. Most of them have been correlated to human papilloma virus (HPV), but in our patient HPV DNA was negative. [ABSTRACT FROM AUTHOR]

• The role of NACT in T4 oral cancers remains a contentious issue with sparse evidence in literature. • cT4b oral cancers performed better when they received NACT prior to surgery in comparision to cT4a oral cancers. • Results of our matched pair analysis are hypothesis generating which needs to be tested in a randomized trial. [ABSTRACT FROM AUTHOR]