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At the Kidwai Memorial Institute of Oncology, advanced laryngeal cancers are subjected routinely to primary surgery and/or post-operative radiotherapy (RT). The surgery consists of wide field laryngectomy which entails total laryngectomy, ipsilateral/bilateral thyroid lobectomy, bilateral paratracheal clearance, and bilateral clearance of levels 2, 3 and 4 lymphatics. Post-operative RT is indicated in event of the following histopathological (HPE) situations to consolidate local-regional control: (1) T4 primary; (2) significant subglottic extension; and (3) jugular/paratracheal metastatic deposits. This prospective study highlights the therapeutic efficacy of this protocol at our centre in 45 consecutive T4/T3 glottic cancers and specifically evaluates the role of interjugular dissection and/or post-operative RT in prevention of regional recurrence. Fifty-two per cent of primary lesions needed a post-surgical upstaging as against 14 per cent of the neck lesions. Accordingly 91 per cent of the cases (41/45) qualified for post-operative RT and 82 per cent (37/41) complied with the prescribedschedule. Recurrent disease in the lateral neck was noted in 2/37 who received the prescribed schedule and 1/4 non-compliant cases; while a recurrent central neck disease was noted in 1/37 and 1/4 of these cases respectively. All cases were followed-up for a period of two years and 66 per cent of the evaluable cases for a period of five years. This study confirms conclusively that our treatment schedule yields extremely gratifying two-year local-regional control rates of 89 per cent which translates into a two and five-year actuarial survival rate of 92 and 70 per cent respectively.
Regional scalp flaps are invaluable in resurfacing defects resulting from resections in the area of the upper face, orbit and scalp itself. The tissue lies adjacent to the defect, is easy to harvest, and can be termed as a ‘durable one-stage’ procedure. Scalp defects posterior to the vertex lend themselves to resurfacing by a posterior flap based on the occipital arteriovenous system. Anterior scalp defects including upper face and orbit can be resurfaced by an anterior scalp flap based on the superficial temporal arteriovenous system. While large areas can be resurfaced and the donor site effectively camouflaged, this flap finds less of an acceptance amongst patients with defects in the upper facial region when compared to the scalp defects. We recount our experience with these flaps and describe the high points of the reconstructive procedure and the results obtained in ten consecutive cases carried out over a three year period at the Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology, Bangalore, India. The short healing time and minimal morbidity make this reconstructive option an attractive one for the practising Head and Neck Surgeon.
Two cases of chondrosarcoma of the hyoid bone are described. They were managed with surgical resection and postoperative radiotherapy. These patients are disease free at 26 months and 15 months respectively.