Neck Oncosurgery Research Articles

Measuring the outward migration of the nasotracheal tube at vocal cords with head and neck extension: a novel approach using a flexible bronchoscope in patients undergoing head and neck oncosurgery.

Head and neck extension achieves optimal surgical exposure during head and neck oncosurgeries. However, it can lead to cephalad migration of the tracheal tube, causing complications. Preventing shallow intubation is essential, especially in patients with difficult airway. Using an innovative technique, we aimed to measure the proximal migration of the nasotracheal tube at the vocal cords on neck extension in patients with difficult airway. We enrolled 60 adult patients undergoing head and neck oncosurgeries with a mouth opening of less than 1.5 cm. After nasotracheal intubation using a flexible bronchoscope (FB), the FB was introduced into the adjacent nostril and maneuvered to reach the glottis. The FB was used to view and align the intubation depth mark (IDM) on the tracheal tube (TT) with the vocal cords in the neutral position. The outward migration of the TT at the vocal cords with a 30° to 40° neck extension was measured using the same maneuver. Also, the TT tip-to-carina distance was noted in both neutral and extension using FB. The mean proximal migration of the TT at the vocal cords during neck extension was 3±0.3 mm. The TT tip-to-carina distance increased by a mean of 20±7 mm with extension. The proximal migration contributed 15%, whereas elongation of the trachea contributed 85% to this increase. The major contributing factor for the increase in TT tip-to-carina distance on neck extension was tracheal elongation rather than outward migration of the TT at vocal cords.

Effectiveness of Adenoidectomy as a Standalone Procedure in Improving the Quality of Life of Children with Obstructive Sleep Apnea.

Adenoid hypertrophy (AH) and its sequel like nasal obstruction, obstructive sleep apnoea (OSA), recurrent rhinitis and middle ear disorders are common diseases of pediatric age group, forming the major bulk of pediatric outpatient visits. The recommended approach to treating OSA in children is through adenotonsillectomy. Adenoidectomy is the surgical procedure of removal of hypertrophied adenoid tissues, which is the most common surgery performed by Ear, Nose, and Throat (ENT) surgeons. Given that adenoidectomy alone might lead to reduced instances of adverse outcomes, decreased risk of complications, and lower expenses, our objective was to explore the viability and suitability of adenoidectomy as a standalone treatment for pediatric OSA and to learn the significant effect of adenoidectomy on the quality of life (QOL) of children. Multicentric prospective study conducted in Department of ENT, Head and Neck Oncosurgery, Smita Memorial Hospital, Thodupuzha & Department of ENT, Head and Neck surgery, MCS Hospital, Muvattupuzha, Kerala, India from June 2022 to June 2023. Children between the age group of 5-10 years, who underwent adenoidectomy during the study period, satisfying the inclusion criteria were subjected for the study. Adenoidectomy was done for them using endoscope assisted coblation technique. Postoperative improvement in symptoms and change in quality of life were analyzed using obstructive sleep disorders-6 (OSD-6) questionnaire at the end of 3 months follow up. The surgeon observed a statistically significant improvement in all domains of OSD-6; and there by improvement in QOL in all patients, who underwent adenoidectomy in a course of three months. Adenoid hypertrophy is the most common cause of nasal obstruction in pediatric population and is creating a significant negative impact on the quality of life of children. Adenoidectomy is a safe and simple procedure which can provide significant improvement in quality of life of kids. Adenoidectomy in isolation could be a valid and recommended surgical choice for selected population of children displaying symptoms of pediatric OSA.

Comparison of sedation efficacy of intravenous infusion of dexmedetomidine versus propofol in terms of opioid consumption in patients requiring postoperative mechanical ventilation after head and neck onco-surgeries – A randomized prospective study

Abstract Background: The conventional drug regimen of sedation for patients requiring mechanical ventilation in an intensive care unit (ICU) is propofol or midazolam. Dexmedetomidine is a newer drug for sedation with a better clinical profile. We conducted this study to compare the sedative efficacy of dexmedetomidine versus propofol in patients after head and neck cancer surgeries requiring mechanical ventilation. Methods: After ethics committee approval and written informed consent, 80 patients undergoing head and neck onco-surgery were recruited. The patients were randomly allocated to group I [1 mg/kg of bolus propofol over 15 minutes followed by infusion of 1 mg/kg/hour titrated by increasing or decreasing the infusion dose to Ramsay Sedation Score (RSS) 2–4] or group II (a loading dose of dexmedetomidine 1 mcg/kg over 15 minutes followed by a maintenance dose of 0.4 µg/kg/hour titrated to desired sedation level). The RSS, behavioral pain scale (BPS), heart rate, blood pressure, fentanyl consumption, additional sedative agent, extubation time, length of ICU stays, mechanical ventilation duration, side effects, and patient’s satisfaction were noted. Results: Total fentanyl required was 0.56 ± 0.13 µg/kg/hour in group II and 0.58 ± 0.18 µg/kg/hour in group I (P = 0.75). Extubation time, RSS, BPS, patient satisfaction, and ICU duration were similar in both the groups. The incidence of hemodynamic-related adverse effects were 41.67% in group II and 11.11% in group I (P = 0.006). Conclusion: The fentanyl requirement was comparable in both the groups in the postoperative period. Dexmedetomidine was associated with an increased incidence of bradycardia and hypotension as compared to the propofol group. Propofol should be the preferred sedative for postoperative mechanical ventilation after head and neck onco-surgeries.

Upfront surgery vs radiotherapy for laryngeal cancer: descriptive study on the complications from rural cancer centre

Background: Significant shifts in therapy paradigms for advanced laryngeal carcinoma have occurred more recently. The number of patients receiving surgery alone has significantly decreased, while the number of patients receiving radiotherapy and chemoradiotherapy has significantly increased. Both the treatment modalities have its own advantages and disadvantages. The present study is a consideration to compare the complication rate of both the treatment modalities in the treatment of laryngeal cancer. Methods: The head and neck oncosurgery department at the Kolhapur cancer center in Maharashtra conducted a five-year retrospective record analysis of the patients treated for carcinoma larynx [2017-2022]. The current analysis included all patients with histopathologically confirmed laryngeal cancer. Results: Of the 24 cases if upfront surgery, 8 cases had complications and 8 cases of post RT, 6 cases had complications and this difference was statistically significant (p<0.05). There was significant difference between the pharynocutaneous fistula rates among the two groups. The rates were higher among post radiotherapy patients (p<0.05). Conclusions: The most common complication among post radiotherapy was pharynocutaneous fistula. The most common complications among upfront surgery were pharynocutaneous fistula and stomal stenosis. Pharynocutaneous fistula was significantly higher among post radiotherapy patients when compared to upfront surgery.

Postoperative pulmonary complications following head and neck oncosurgery - Case control study

Head and neck cancers (HNC) constitute about one-third of all cancers in India. A combination of surgery, chemotherapy and radiotherapy is used to manage them. There is a high incidence of PPCs following head and neck surgeries. The probable mechanisms behind it are alteration in swallowing mechanisms and impairment in protective factors of the laryngeal apparatus.To study the association between the clinicodemographic and perioperative parameters and the occurrence of PPCs following head and neck oncosurgery. This case-control study was conducted in150 patients after head and neck oncosurgery. 50 patients as cases with complications and 100 patients as control with no complications were included in the study after getting informed consent and results were statistically analyzed and discussed. A pre-tested semi-structured case study form was used to collect patient information. Mean ages among cases and controls were 58.76 ± 10.40 and 56.10 ± 12.61. Weight loss was present in 26% of patients and 8% of controls. Malignancy of the tongue was the most common among both patients and controls, constituting 22% and 25%, respectively, followed by mouth and larynx. Preoperative albumin levels, presence of ARI within one month of surgery and lack of preoperative pulmonary rehabilitation had a significant association with the development of PPCs.From this study, we concluded correction of the modifiable preoperative risk factors might prove beneficial in reducing the incidence of PPCs.

Microvasular Free Flap Reconstruction in Head and Neck Surgery: Complication and Outcome of 80 Flaps.

Head and neck carcinoma can prompt destroying cosmetic and functional deformities with resultant mental, physical and nourishing burden. Regardless of ongoing advances in medication and surgical procedure, the general endurance for patients with head and neck malignant growth has stayed still for as long as 35 years. This endurance rate has prompted the foundation of the standards of tumor extraction with most extreme tissue saving and more up to date endoscopic laser-helped methods for auto-digestive region malignant growths targeting diminishing operational morbidity without influencing the general endurance. This retrospective and prospective study contained 80 patients who went through miniature vascular free flap remaking following a significant head and neck oncosurgery procedure from 01/01/2017-to-31/12/2019. Three kinds of free flaps were fundamentally utilized. The current study was directed to assess the clinical result in patients going through miniature vascular free flap reproduction and to decide the viability after head and neck onco-surgical procedure method. Despite the fact that miniature vascular free flaps are today viewed as cutting edge in head and neck remaking after composite resection with predominant effective and stylish rebuilding, it is as yet not basic in India at numerous focuses. This retrospective and prospective study were conducted for a time of 3 years to know the clinical result, decide the adequacy and assess the occurrence and reasons for pre- and post-surgical intricacies in patients going through miniature vascular free flap recreation after head and neck onco-surgical procedure method. It was inferred that the free flaps were dependable in accomplishing effective reproduction of the head and neck following an effective onco-surgical procedure methodology. Despite the fact that there is a critical loss of delicate tissue and bone however after an effective acknowledgment of free flap, close to ordinary anatomical and physiological capacities can be accomplished in larger part of the patients. The frequency of complexities was straightforwardly related to the co-morbidity level and specialist's working experience.

Image guided biopsy/FNAC in head and neck cancers in covid 19 pandemic

Suspected growth in the region of base of tongue, pharynx, and larynx need direct/indirect laryngoscopy for establishing Diagnosis and for Staging of the disease. The Covid 19 Pandemic has severely affected these modes of examination because they are Aerosol Generating Procedures and carry very high risk of transmission of the Virus. The Department of Head And Neck Oncosurgery at KCHRC is one of the busiest department at our Institute with an average annual footfall of around 20,000 new patients. The main objective of our study is to know the role of Image Guided Biopsy/FNAC for primary diagnosis in Head and Neck Cancers. Retrospective analysis of prospectively collected data of 35 patients was done from April to September 2020. Histopathological records along with patient’s clinical records were reviewed. Of the 35 patients, 23 patients underwent CT Guided biopsies, 11 patients had CT Guided FNA and one patient had USG guided biopsy. In 23 patients (CT Guided Biopsy), the biopsy was taken from tongue in 16 patients, Larynx in two patient, Pyriform sinus(PFS), posterior pharyngeal wall, RMT (retromolar trigone), lower GBS and Tonsil sites had one patient each. Of the 11 CT Guided FNAC patients, the site of FNA was from PFS in 7 patients, Tongue in 2 patients RMT and soft palate had one patient each. One patient had undergone USG Guided biopsy for PFS lesion. Out of 35 patients, tissue specimen taken was adequate in 33 patients and inadequate in two patients. The results were supported both histologically and clinically. The histological confirmation was found in 88.6% cases (31/35), squamous cell carcinoma was found in 74.3% cases (26/35), no malignancy in 8.5% cases(3/35), no specific lesion in 5.7% cases(2/35), no definitive diagnosis in 2.8% cases(1/35) and in inadequate in 8.5% cases(3/35). Repeat biopsy in one patient revealed no malignancy. There were no post procedure complications noted. Image guided biopsy/FNAC is a safe, reliable minimally invasive technique and can be used for primary diagnosis of Head and Neck cancers without the risk of Aerosol generation in the current Covid -19 Pandemic.

Evaluation and validation of Physiological and Operative Severity Score for the enumeration of mortality and morbidity and Portsmouth-POSSUM scores in predicting morbidity and mortality in patients undergoing head and neck cancer surgeries.

Identification of risk factors for perioperative complications helps in the prognostication. We wanted to determine whether Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) can be used in patients undergoing head and neck oncosurgery. We conducted a retrospective analysis of 1265 patients after they had major head and neck oncosurgeries. Demographic, surgical and outcome data was collected. We separately analyzed data for patients who had undergone cancer surgery for oral cavity, pharynx, and larynx. We calculated the POSSUM and P-POSSUM scores. POSSUM scoring system had moderate discrimination (AUC = 0.61) and good calibration (P = .36) for the entire study cohort and in the subgroup. Since there were no deaths in the entire cohort, we were not able to check predictive ability of the scores, for mortality. We found that POSSUM had moderate discrimination and good calibration for morbidity prediction in head and neck cancer surgeries, as well as for the selected subgroup.

Head and Neck Reconstructive Surgery: Characterization of the One-Team and Two-Team Approaches

To the best of our knowledge, no studies have compared the patient profiles for 1- versus 2-team surgery within head and neck oncosurgery. A retrospective study of the data from 2968 patients who had undergone concurrent head and neck extirpative and reconstructive surgery in the National Surgical Quality Improvement Program (2010 to 2017) was conducted. Patients were stratified into 1- and 2-team surgery groups, and the demographic data were compared. Univariate analyses of the outcomes before and after propensity score matching were conducted. Most ablative and reconstructive head and neck procedures (68.5%) were performed using a 1-team approach. The patients who had undergone 2-team surgery were more likely to have a higher American Society of Anesthesiologists classification (P<.001), to require mandibulectomy (P<.001) or glossectomy (P<.001), and to receive a microvascular free flap (P<.001) but were less likely to require parotidectomy (P<.001) or to receive a rotational flap (P<.001). Before propensity score matching, the patients undergoing 2-team surgery had longer operative times (P<.001), longer postoperative stays (P<.001), greater rates of a return to the operating room (P=.001), and an increased rate of complications (P<.001). After propensity score matching, the 2-team approach continued to have longer operative times (P<.001) and an increased incidence of complications (P<.001) but no significant differences in the length of stay or rate of return to the operating room after Bonferroni's correction. Nationally, most head and neck ablative and reconstructive surgeries were completed by 1 team. More complicated reconstructive procedures involving microvascular free flaps have been more commonly performed by 2 teams, resulting in slightly longer operative times and greater associated complication rates.

Do Otolaryngology Patients Show Gender Preference When Choosing a Surgeon? - A Quantitative and Qualitative Analysis.

Introduction Otorhinolaryngology has always been considered a gender-neutral specialty, whereas in several other specialties, such as obstetrics, gynecology and urology, gender preference has been consistently shown by patients when choosing their treating surgeon. To date, no study has been performed to analyze whether this practice of gender preference is prevalent in otorhinolaryngology patients too. Objectives To identify if gender preference exists in the field of otorhinolaryngology, specifically in its four subspecialties, namely otology, pediatric otolaryngology, laryngology and head and neck surgery. Methods Patients attending our outpatient department were asked to complete a preformed proforma. The pro forma consisted of two parts, demographic details of the subjects and gender preference in the following subspecialties: otology, pediatric otolaryngology, laryngology and head and neck oncosurgery. Results A total of 1,112 subjects took part in the study, out of which 1,089 subjects were included in the final analysis. Female gender preference was highest in the field of pediatric otolaryngology, while male preference was highest for head and neck oncosurgery. Conclusion Though otorhinolaryngology and head and neck surgery has been considered a gender-neutral field, subspecialties of this field show considerable gender preference.

Parathyroid Carcinoma: Atypical Presentation, Diagnosed on Ultrasound: A Case Report

Parathyroid Carcinoma is a very rare condition and with a very few cases published in literature. It is often suspected and diagnosed clinically in cases of hyperparathyroidism, when there is are very highly elevated serum calcium levels, along with significantly raised serum PTH levels, and the patient is quite symptomatic. We report here a case where the serum calcium levels and PTH, both were not so high, hence the diagnosis was not thought of clinically, but only suggested by ultrasound imaging. The typical ultrasound diagnostic findings of a likely malignant parathyroid mass, prompted the surgeon to go for Hemi thyroidectomy along with, instead of simple parathyroidectomy. Biopsy came as Parathyroid Carcinoma. Case Report and literature review. A 66 year old male, presented with complaints of weight loss, back pain in medical oncology. CECT Spine showed multiple lytic lesions in D10, D12, and L4. Differential Diagnosis of metastasis or multiple myeloma was given. PET –CT showed metabolically active lesions in bones and posterior to left thyroid. Bone marrow biopsy was negative for both myeloma and metastasis. Serum parathormone and serum calcium levels were then suggested. Serum Calcium was 10.8mg/dL. Serum PTH was 947.0 pg/mL & 25– OH Vitamin D 16.3 g/mL. Sestamibi showed left inferior parathyroid adenoma. With an endocrinology diagnosis of primary Hyperparathyroidism and with a left inferior parathyroid adenoma, patient was referred to Head and neck oncosurgery for parathyroidectomy. ULTRASOUND: showed a heterogeneous hypoechoic solid cystic lobulated mass lesion, measuring 38 x21 x29 mm, volume 11.2 cc below the lower pole of left thyroid gland. The margins of the lesion appeared to be in close proximity to the thyroid and adjoining structures. It showed amorphous calcifications and heterogeneous increased vascularity, suggestive of parathyroid mass, likely carcinomaSURGICAL FINDINGS: Left Thyroid lobectomy with left parathyroidectomy was done. The parathyroid gland (30x30x20 mm) was firm to hard at surgery, and adherent to the thyroid. HISTOPATHOLOGY: Parathyroid tissue showed nuclear polymorphism, with large nucleus and prominent nucleoli. Broad fibrous septa are seen. Mitosis1-2/hpf. Capsular invasion is seen as well as invasion in the surrounding soft tissue and parathyroid tissue. Vascular invasion is seen. On IHC: Ki67:2% A pre-operative suggestion of parathyroid carcinoma instead of parathyroid adenoma improved patient counselling for a planned hemi thyroidectomy along with left parathyroidectomy and resulted in better management of the patient. A dedicated high resolution Colour Doppler Ultrasound is a valuable tool for localization and characterization of parathyroid nodules in all cases of raised serum PTH and must be utilized in all cases along with other imaging modalities.

Surgical Incisions: Balancing Surgical and Cosmetic Outcomes in Head and Neck Oncosurgery

ABSTRACTThe oral and oropharyngeal cancer surgery is challenging due to presence of carotid arteries, internal jugular vein and cranial nerves in close proximity to the primary tumor or matastatic lymph node. So surgical incisions should be planned to improve oncologic resection without compromising functional and esthetic outcomes. Macfee and Crile's incision are commonly used in present day oncologic practice. Extension and probable modification of these incisions depending on case scenerio are discussed.How to cite this articleTubachi J, Jainkeri V, Gadagi V, Gunari P. Surgical Incisions: Balancing Surgical and Cosmetic Outcomes in Head and Neck Oncosurgery. Int J Otorhinolaryngol Clin 2013;5(2):47-50.

Carcinoma Expleomorphic Adenoma of the Submandibular Gland

ABSTRACT Background and objectives Carcinoma expleomorphic adenoma (CXPA) is a rare neoplasm of the salivary gland which arises in the epithelial component of a pleomorphic adenoma. It is not automatically a high-grade tumor as is traditionally suggested and should be further qualified as to type, grade of carcinoma and extent, since intracapsular and minimally invasive tumors behave favorably. Setting Department of Head and Neck oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case Report A 38-year-old female was referred to our outpatient clinic with history of a painless swelling in the left side of the neck since 8 years. Fine needle aspiration revealed carcinoma of the submandibular gland. Contrast enhanced CT revealed a large heterogeneously enhancing mass lesion in the submandibular fossa with the gland not seen separately. Lymph nodes in level Ib and II were enlarged. Excision of the tumor revealed CXPA with foci of high grade mucoepidermoid carcinoma. Conclusion CXPA should no longer be considered a specific diagnosis but a category in which the carcinoma should be typed, graded and quantitated to impart more prognostically and therapeutically relevant data for efficient management. How to cite this article Naik SM, Shenoy AM, Chavan P, Halkud R, Biswas S, Kalloli M, Gupta S, kudpaje A. Carcinoma Expleomorphic Adenoma of the Submandibular Gland. J Postgrad Med Edu Res 2013;47(3):162-166.

Surgical Incisions: Balancing Surgical and Cosmetic Outcomes in Head and Neck Oncosurgery

ABSTRACTThe oral and oropharyngeal cancer surgery is challenging due to presence of carotid arteries, internal jugular vein and cranial nerves in close proximity to the primary tumor or matastatic lymph node. So surgical incisions should be planned to improve oncologic resection without compromising functional and esthetic outcomes. Macfee and Crile's incision are commonly used in present day oncologic practice. Extension and probable modification of these incisions depending on case scenerio are discussed.

Supraglottic Laryngeal Paraganglioma: A Rare Clinical Entity managed by Lateral Pharyngotomy Approach

ABSTRACT Background/objectives Laryngeal paragangliomas are benign slow growing tumors with symptoms resembling squamous cell carcinoma. Hoarseness or dysphasia is the commonest presenting symptom and usually it presents as a submucosal mass on laryngoscopy. A total of 90% of these tumors occur in the supraglottic larynx and the rest in the glottis and the subglottic region. Functional activity is seen in a few (2.9%), none are associated with paraneoplastic syndromes. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 35-year-old male presented to us with hoarseness of voice since 4 months duration. Contrast arteriography demonstrated that the left superior thyroid artery supplied greater than 80% of the blood supply to the laryngeal mass. Superselective embolization was done from the right femoral under local anesthesia and sedation which was uneventful. Intervention The tumor was excised from lateral pharyngotomy approach with an elective tracheostomy. Microscopy suggested it to be paraganglioma and immunohistochemistry confirmed it. Conclusion Complete surgical resection or partial laryngectomy with meticulous dissection of surrounding tissues and preservation of neurovascular structures give an excellent prognosis as far as oncological clearance is concerned. Malignant paragangliomas of the larynx are rare and a major meta-analysis is necessary to provide a true biological behavior of this tumor. How to cite this article Naik SM. Supraglottic Laryngeal Paraganglioma: A Rare Clinical Entity managed by Lateral Pharyngotomy Approach. Int J Phonosurg Laryngol 2012;2(2): 69-73.

Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa

ABSTRACT Background/objectives Swallowing problems following total laryngectomy are significantly lesser compared to other partial laryngectomies as a permanent seperation between the trachea and esophagus is seen in the earlier. Sometimes, the patient complains of difficulty in propelling bolus through the oral cavity and pharynx as a result of the loss of hyoid bone, which is the anchor for the tongue. The increased pressure in the narrowed pharyngoesophageal segment following laryngectomy requires the tongue to move with greater force. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 52-year-old man with history of difficulty and pain while swallowing and diagnosed as squamous cell carcinoma of the right pyriform fossa extending to the pharyngoepiglottic fold. Incidently, the patient had an old untreated cleft palate. Assessment of the pharyngeal wall involvement on direct laryngoscopy proved that pectoralis major myocutaneous flap patch was needed to reconstruct the pharyngeal lumen. Cleft palate proved a contraindication for surgery as the oral swallowing phase would be affected. Conclusion Current management protocols of hypopharyngeal cancers include multifactorial assessment of anatomical and functional outcomes and rehabilitation. Even though no literature is found stating cleft palate as the contraindication for total laryngectomy, chemoradiation was preferred citing swallowing problems. How to cite this article Naik SM. Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa. Int J Phonosurg Laryngol 2012;2(1):33-36.

Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation

ABSTRACTBackground/objectivesProsthetic voice rehabilitation after total laryngectomy has proven to be successful in restoring proper speech function in over 90% of patients. The possibility of achieving effective speech using the voice prosthesis is superior to esophageal speech and electrolarynx.SettingDepartment of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru.Case reportA 75-year-old female who had undergone wide field laryngectomy 14 months back came with history of lost voice prosthesis which was later found aspirated. It was removed by the bronchoscopic forceps under topical anesthesia by visualizing it by a nasal 0° wide angle endoscope. The puncture site was cleaned and allowed to cicatrize and narrow down. The fistula was closed by topical application of silver nitrate.ConclusionTracheoesophageal puncture and prosthesis rehabilitation has emerged as the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications.How to cite this articleNaik SM. Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation. Int J Phonosurg Laryngol 2012;2(1):41-45.

A Novel Morbidity Prediction Model for Head and Neck Oncosurgery

The purpose of the study was to construct and validate a risk model to predict morbidity in head and neck oncosurgeries. Potential risk factors of 300 surgically treated head and neck cancer patients like age, sex, tumor site, TNM stage, duration of surgery, adjunctive treatment, comorbidities and alcohol and tobacco usage were analyzed. Postoperative complications were noted. We developed a logistic model to predict the probability of patients developing morbidity based on the statistically significant variables-duration of surgery, preoperative radiation and hypertension. The validity of the test was assessed by the c-index which were 0.79 (95% C.I 0.71-0.87) for the study set (250 patients) and 0.86(95% C.I 0.73-0.90) for the test set (50 patients). The correlation of observed to expected morbidity was 0.709 (P < 0.0001). We validated a risk model and constructed a simple chart that provides us an assessment of the risk of a patient of developing morbidity.

Comparative evaluation of ASA classification and ACE-27 index as morbidity scoring systems in oncosurgeries

The primary intention of the study was to find out whether Adult Comorbidity Evaluation Index (ACE-27) was better than the American Society of Anaesthesiologists’ (ASA) risk classification system in predicting postoperative morbidity in head and neck oncosurgery. Another goal was to identify other risk factors for complications which are not included in these indexes. Univariate and multivariate analyses were performed on 250 patients to determine the impact of seven variables on morbidity-ACE-27 grade, ASA class, age, sex, duration of anaesthesia, chemotherapy and radiotherapy. In univariate analysis ACE-27 index, ASA score, duration of anaesthesia, radiotherapy and chemotherapy were significant. As both comorbidity scales were significant in univariate analysis they were analyzed together and separately in multivariate analysis to illustrate their individual strength. In the first multivariate analysis (excluding ACE-27 grade) ASA class, duration of anaesthesia, radiotherapy and chemotherapy were significant. The positive predictive value (PPV) of this model to predict morbidity was 60.86% and negative predictive value (NPV) was 77.9%. The sensitivity was 75% and specificity 62.2%. In the second multivariate analysis (excluding ASA class) ACE-27 grade, duration of anaesthesia and radiotherapy were significant. The PPV of this model to predict morbidity was 62.1% and NPV was 76.5%. The sensitivity was 61.6% and specificity 70.9%. In the third multivariate analysis which included both ACE-27 grade and ASA class only ASA class, duration of anaesthesia, radiotherapy and chemotherapy remained significant. In conclusion, ACE-27 grade and ASA class were reliable predictors of major complications but ASA class had more impact on complications than ACE-27 grade.