Metastatic Involvement of the Facial Node in Oral Squamous Cell Carcinoma

INTRODUCTION: Oral cancer affects as many as 274,000 people worldwide annually1. Oral cancer is the sixth most common cancer in the world. The most common type of oral cancer is squamous cell carcinoma. The incidence of oral cancer is more than 30 per 100 000 population in India. Oral cancer represented 14% of all cancer cases at the Regional Cancer Centre (RCC), Kerala. It constituted 17% of all cancers in males and 10.5% of all cancers in females, making it the most common cancer in males and the third most common cancer among females. Approximately 20,000 new cases of cancer of the oral cavity are diagnosed each year and there are about 4000 deaths due to the same annually in the US. The relatively small number of deaths is offset by the severe functional and cosmetic disabilities that many of these patients endure in coping with their disease, which is primarily preventable. Unfortunately, when first seen, most patients have an advanced tumor, partly because of self neglect and partly because of the primary physician’s lack of training in the early detection of oral cancer. Oral cancer detected early may be amenable to complete cure, while on the contrary, the presence of lymph nodal and distant metastasis drastically decreases survival by 50%. Moreover, despite adequate local and nodal treatment, recurrences are known to occur. The key to surviving oral cancer is early detection and treatment. AIMS AND OBJECTIVES: 1. To determine the prevalence of metastasis to the facial node in oral carcinoma. 2. To determine whether a palpable facial lymph node correlates with metastasis. 3. To determine whether the presence of metastasis in the facial node correlates with the outcome in terms of local recurrence and long term survival. 4. To determine whether routine facial node dissection is indicated in all patients undergoing a neck dissection for oral malignancies. MATERIALS AND METHODS: Type of study: This was a prospective, observational, cohort study conducted in a single surgical unit from September 2004 to July 2006. Ethics: As this was only an observational study with no interventions, approval of the Ethics committee was not required. As this was an observational study, informed consent was not necessary. Data collection: Inclusion criteria: The study was conducted between September 2004 and July 2006. All adult patients with a diagnosis of squamous cell carcinoma of the oral cavity admitted for surgery under the department of General Surgery unit I (Head and Neck Surgery) between September 2004 and July 2006 were included in the study. Patients included in the study were those scheduled to undergo excision of the primary lesion along with some form of neck dissection, either radical or selective. In addition, only those patients in whom the facial node was either palpable and /or positively identified at surgery were included in the study. Exclusion criteria: Children were not included in the study. Patients with a clinically palpable facial node but not detectable at surgery were not included. The patients who did not have a facial node identified in the surgery were not included in the study. Patients undergoing surgical procedures for head and neck malignancies other than oral cavity carcinoma were not included even if the surgical procedure involved a neck dissection. Patients with oral cavity carcinoma other than squamous cell carcinoma were not included in the study. Patients who had pre-operative radiation were not included in the study. Patients who had neoadjuvant chemotherapy were, however included in the study. RESULTS: During the period September 2004 to July 2006, 110 patients underwent a surgical procedure along with a neck dissection for carcinoma of the oral cavity. Of this, the facial node could be positively identified in a total of 25 patients (22.7 %). SUMMARY AND CONCLUSIONS: 1. The metastatic involvement of the facial node was 12% in patients with oral squamous cell carcinoma. 2. Palpable facial nodes were more likely to be benign. 3. The facial node may be a first echelon node in some buccal and lower alveolar squamous cell carcinomas and its involvement may be upto 20% in these sites. In the light of this, it is suggested that on these grounds, the facial node be routinely biopsied in the neck dissections for carcinoma of the buccal cavity and lower alveolus. 4. Metastasis to the facial node was associated with poor outcome and nodal recurrence

An Uncommon Twist: Isolated Fallopian Tube Torsion in an Adolescent

We report a 13-year-old girl with bilateral paratubal cysts and left isolated fallopian tube torsion (IFTT). Paratubal cysts are uncommon in children, and IFTT is a rare complication. Awareness of this entity and prompt surgical intervention could potentially salvage the fallopian tube preserving fertility

A helping clamp for thoracoscopic plication of eventration of the diaphragm

Background and Aim: It is difficult to suture an extremely thin and billowed up congenital eventration of the diaphragm thoracoscopically, without insufflation. Materials and Methods: The authors describe their technique using an intestinal clamp to control the redundant tissue and a feeding tube as a flexible knot pusher, to perform the thoracoscopic plication without risking hypercapnia. Results: A satisfactory result was obtained in all the four children. Conclusion: This is a useful adjunctive for thoracoscopic plication of diaphragmatic eventration

A Peculiar Cause for Metabolic Acidosis in the Newborn

Metabolic acidosis is often encountered in a sick neonate and intestinal duplication with heterotopic gastric mucosa is a well-established condition.  We present a previously unreported relationship between neonatal metabolic acidosis, resulting from transperitoneal absorption of hydrochloric acid, and a ruptured non- communicating ileal duplication cyst with gastric mucosal heterotopia. The neonate recovered rapidly after resection of the ileal duplication. We present this case to highlight a rare but surgically correctable cause of neonatal metabolic acidosis