A. Sagayaraj

Medially placed vagus nerve in relation to common carotid artery: a pointer to a non-recurrent laryngeal nerve

The aim of this study was to highlight a medialized vagus in relation to common carotid artery as an operative marker to a non-recurrent laryngeal nerve during thyroid surgeries. Three patients who underwent thyroidectomy, in who per operative diagnosis of right non-recurrent laryngeal nerve was made and the findings were confirmed radiologically by demonstration of aberrant subclavian artery were included in the study. A medially placed vagus nerve in relation to common carotid artery was the common observation in all the 3 patients. With no operative marker to identify a non-recurrent laryngeal nerve, it is more prone to injury during thyroidectomies. Vagus nerve which was constantly seen medial to the common carotid artery in all our three patients can be used as an operative marker to a non-recurrent laryngeal nerve.

Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa

Objective To evaluate the margins of resected specimen of oral squamous cell carcinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin). Methods Patients who were diagnosed and confirmed with squamous carcinoma of buccal mucosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10% formalin and submitted for gross and histopathological examination. The closest histopathologic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any. Results A total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n = 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin was found to be statistically significant (P < 0.05) in 65% of cases. Conclusion Tumor margin shrinks significantly after formalin fixation by about 25%. The operating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease.

Usefulness of supraclavicular flap in reconstruction following resection of oral cancer

Objective To evaluate the usefulness of supraclavicular artery flap in reconstruction of defects following resection of buccal mucosa cancer. Methods Twenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients underwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depending on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute. Results Seven (28%) patients had complete necrosis of the flap. One patient had a local recurrence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the functional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58%), 3 patients had a good outcome score (13%), while 7 patients (28%) had flap necrosis. Conclusions We find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preserving the external jugular vein and sacrificing supraclavicular nerves give good outcome.

OP016: Island pectoralis major myocutaneous flap an Indian perspective

India has the highest incidence of oral cancer in the world. GB Sulcus cancers are the commonest among them. Tobacco chewing a habit prevalent in both sexes is the aetiology. Most are advanced at presentation needing radical surgery, primary reconstruction and post-op radiation. Pectorallis Major Myo Cuteneous (PMMC) flap was the only method of reconstruction in the past. However bulk, pedicle length, donor site deformity and inherent problems in females were distinct disadvantages. Hence with the advent of free micro vascular flap, PMMC went into disrepute. The superiority of a well conceived and executed free micro vascular transfer is unmatched but it has short comings, especially for cancer centres in the third world countries having large patient volume. Need of well developed plastic and reconstructive department, long learning curve, need for specific infrastructure, cost factor lastly the time constrains. In the absence of above, PMMC minus its drawbacks can still be a viable alternative for our poor patients seeking treatment at overcrowded centres. To serve this purpose, we undertook a prospective feasibility trial of modifying a standard PMMC flap into a compact Island PMMC based on a thin long pedicle to circumvent the two main disadvantages; bulk and flap length especially in females. The study was under taken between 2009 and 2012. Thirty-four patients underwent this procedure, Ten among them were females, 32 patients underwent primary surgery the remaining underwent salvage procedure, 20 patients had Island PMMC for the inner lining while in five it was used to provide the skin cover. None developed major complications. The paper will highlight the indications, technique results and the overall advantage of this modification as an elective alternative to free tissue transplant under our circumstances.