Pre-Treatment Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Occult Cervical Metastasis in Clinically Negative Neck Supraglottic and Glottic Cancer

Background. Among patients with diagnosis of Laryngeal Squamous Cell Carcinoma (LSCC), up to 37.5% of cases may have occult metastasis (OM), and this feature is linked to poor prognosis and high rate of local recurrence. The role of elective neck dissection (END) in clinically negative neck (cN0) LSCC remains controversial. It is of great value to search for low-cost and easily detectable indicators to predict the risk of OM in laryngeal cancer. Recent reports have shown that high values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) represent a negative prognostic factor in head and neck cancers. The aim of our study has been to investigate the value of pre-treatment NLR and PLR with regard to predicting occult cervical metastasis in cN0 supraglottic and glottic LSCC. Materials and methods. Data of patients affected by LSCC, who had been surgically treated by means of laryngectomy (total, horizontal partial and supracricoid) and END between January 2006 and January 2021, were retrospectively reviewed, using information retrieved from a database dedicated to such procedures in a single tertiary care referral institute. Results. A total of 387 patients were treated for LSCC at our Institute from 2006 to 2021, but only 108 of them met the inclusion criteria. The median age at the time of diagnosis was 64 years (range, 39–89 years). All the tumors were treated with a laryngectomy and an END. A total of 27.7% of patients were found positive for neck node metastasis (the pN+ group), while 78/108 (72.3%) patients were found to be negative for the presence of neck metastasis (the pN0 group). High values of NLR, but not PLR, significantly correlated with the probability of OM, and according to the iterative algorithm of Newton–Raphson, an NLR value of 2.26 corresponds to a probability of OM of 20%. Conclusion. Our analysis revealed a statistical correlation between high NLR pre-treatment values and positive neck OM in patients with LSCC.

Relationship between Thickness of Early Oral Tongue Carcinoma (T1, T2) with Cervical Lymph Node Metastasis

Background: Carcinoma of oral tongue is the most common oral cancer and because of its structure and function is prone for early local and regional spread of cancer. The final outcome of a primary tongue carcinoma patient depends upon various prognostic factors like thickness of tumor, depth of invasion, size of lesion and neck node 67metastasis. Risk of metastasis and spread to neck nodes increases with increase in tumor thickness Methods: This prospective observational study was carried out in the Department of Otolayngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months. Thirty patients with early oral tongue carcinoma i.e.T1 & T2 as per UICC and AJC criteria were included in this study by purposive non-randomized sampling technique. Result of the study were expressed as mean, standard deviation (+SD), frequency and percentages. Unpaired Student’s t-test and Pearson’s correlation co-efficient (r) test were performed. Results: Result of the study showed the mean (+SD) thickness of the tumor was 3.62 (+1.46) mm. Minimum thickness 1.1mm and maximum thickness 7.8mm. Only 21 (70%) subjects neck node were metastasized from tongue and mean (+SD) tumor thickness of the positive neck node metastasis was 5.54 (+1.07) mm and negative neck node metastasis was 2.87 (+0.75) mm. This indicated a significant difference between the groups. Pearson’s correlation co-efficient r (+0.981) which indicated tumor thickness was positively correlated with neck node metastasis. Conclusion: Tumor thickness of the early oral carcinoma positively correlated with neck node metastasis. Correlation between thickness and metastatic lymph node can help planning the treatment regimen and indicate the disease prognosis. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 25-35

Clinicopathological Correlation between Depth of Tumor and Neck Node Metastasis in Oral (Tongue and Buccal Mucosa) Carcinoma

ABSTRACT Aims and objectives (1) To study the depth of tumor invasion in an oral (tongue and buccal mucosa) carcinoma and its correlation with neck metastasis. (2) To know whether the increase in depth of tumor (depth of invasion) increases the chances of cervical nodal metastasis in the oral tongue and buccal mucosa carcinoma and derive cutoff value of depth of invasion at which the metastasis occurs. Materials and methods The study was carried out on 14 tongue and 22 buccal mucosa cases to know the correlation between the depth of tumor and neck node metastasis in the oral (tongue and buccal mucosa) carcinoma. Results Among 36 cases, 10 cases were pN+. Out of 10 cases, 7 (70%) were having depth ≥12 mm and 30% cases (pN+) having depth between 8 and <10. We found it statistically significant and so as the depth of tumor increases the chances of nodal metastasis increases. We found the cutoff for a depth of invasion in both tongue and buccal mucosa carcinomas as 8 out of 22 patients had DOI >10 mm and among them 4 were pN+ and among 14 tongue cases, 3 cases had DOI >8 mm and all of them were pN+. Conclusion For tongue 8 mm and for buccal mucosa, 10 mm of the depth of tumor invasion was calculated as the cutoff depth, above which the incidence of nodal metastasis increases to 75% and 66.66%, respectively. Clinical significance Depth of tumor is an important prognostic indicator in the tongue and buccal mucosa carcinoma to know the cervical nodal metastasis. Hence for an increase in depth of tumor cases, neck must be addressed along with primary tumor excision. Radiological investigations [ultrasonography (USG), magnetic resonance imaging (MRI), computed tomography (CT) scan] play an important role in nodal metastasis detection hence should be considered in carcinoma of the oral tongue and buccal mucosa especially in clinically N0 neck. How to cite this article Shah AH, Parikh RP. Clinicopathological Correlation between Depth of Tumor and Neck Node Metastasis in Oral (Tongue and Buccal Mucosa) Carcinoma. Int J Head Neck Surg 2021;12(1):6–10.

Evaluation of epithelial mesenchymal transition markers snail and slug as predictor of nodal metastasis in oral squamous cell carcinoma

<p><strong>Background: </strong>Presence of regional neck node metastasis in head and neck cancer is a major determinant of overall survival. In patients presenting with neck node metastasis, there is a fifty percent decrease in overall survival, irrespective of the treatment modality. Tumor, nodes, metastases staging system, based on the anatomical extent of disease is used to predict patient prognosis and need for adjuvant treatment. Advent of immune based therapy has led to development of new molecular markers which can predict the disease aggressiveness by predicting lymph node and distal metastasis. Epithelial mesenchymal transition<strong> (</strong>EMT) in cancer is thought to convert the stable epithelial cells to mesenchymal cells that acquire properties of invasion with regional and distal metastasis.</p><p><strong>Methods:</strong> In the current study we evaluated the expression of EMT markers snail and slug in oral squamous cell carcinoma with and without neck node metastasis in 86 patients.</p><p><strong>Results:</strong> In this study, snail positivity was observed in 72 cases (83.72%), slug positivity was observed in 52 cases (60.46%) and either of the two expressions was observed in 77 cases (89.53%). Found that snail was significantly associated with clinical nodal status (p=0.037) and post-op histopathological nodal status (p=0.003). Also found that slug was significantly associated with clinical nodal status (p&lt;0.001), post-op histopathological nodal status (p=0.001) and perineural invasion (p=0.003).</p><p><strong>Conclusions:</strong> Snail and slug positivity correlates with clinical and post-op histopathological nodal status and thus can be used as a predictor of nodal metastasis in oral squamous cell carcinoma.</p>

Thyroidectomy by lateral approach our experience of 218 cases

<p class="abstract"><strong>Background:</strong> Thyroidectomy is one of the most frequently performed surgical procedure worldwide. During the last century, it became an accepted operation. The aim of the study to observe the outcome of thyroid surgery by lateral approach.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted in department of ENT, National institute of ENT, Tejgaon, Dhaka, Bangladesh from July 2015 to June 2019. A total number of 218 patients of thyroid surgeries were selected as a study sample by simple random sampling technique. </p><p class="abstract"><strong>Results:</strong> In our study, male to female ratio was 1:4.3 with an age ranges from 10-70 years. Mean age was 38.5±8.10 years. Among the participants, 80 were carcinoma thyroid and 138 were benign thyroid diseases. Out of 138 benign thyroid lesions, nodular goitres were 126 (91.30%), follicular adenoma was 8 (5.79%), and toxic MNG were 4 (2.89%). Among 80 cases of carcinoma thyroid, papillary carcinoma was 75 (93.75%), follicular carcinoma was 2 (2.57%) and medullary carcinoma were 3 (3.75%). 28 patients of carcinoma thyroid presented with neck node metastasis. We could identify 382 (98.96%) of recurrent laryngeal nerves (RLN). Temporary paresis of RLN was 16 (4.16%), permanent RLN palsy was 03 (0.78%). Temporary parathyroid insufficiency was 47 (27.97%), permanent insufficiency was 2 (1.19%) up to one year follow up.</p><p class="abstract"><strong>Conclusions:</strong> Lateral approach to thyroid is a safe alternative to the standard approach for re-explorative thyroid surgery. Lateral approach to thyroid is an alternative to both conventional thyroidectomy and for parathyroid explorations.</p>

Contents Vol. 33 no. 1 January– June 2018

EDITORIAL 4 Peer Review and the PJOHNS: Principles, Problems and Promise Lapeña JF ORIGINAL ARTICLES 6 Endoscopic Sinus Surgery Perioperative Outcomes after Intravenous Tranexamic Acid: A Double Blind Randomized Controlled Trial Quiroga JMC, Jarin PSR 12 Posterior Nasal Neurectomy in Treatment of Intractable Rhinitis: A Preliminary Series Vo MC, Pham HK, Nguyen MH 17 Reliability and Validity of the Filipino Sino-Nasal Outcome Test (SNOT) 22 Maningding CAC, Roldan RA 21 Evaluation of the Newborn Hearing Screening Program in The Medical City Based on Joint Commission on Infant Hearing (JCIH) 2007 Position Statement Quality Indicators Que MHB, Reyes-Quintos MRT 25 Operative Time and Tympanic Membrane Graft Uptake in Endoscopic Transcanal versus Microscopic Post Auricular Tympanoplasty for Chronic Otitis Media Escalderon JRDJ, Lim WL 30 Histopathologically Positive Regional Neck Node Metastasis Among Patients with Laryngeal Squamous Cell Carcinoma Soliman EGL, Pontejos AQY CASE REPORTS 34 Inverted Papilloma of the Middle Ear Presenting as an Aural Polyp Caro DJC 39 Extranasopharyngeal Angiofibroma: A Diagnostic Dilemma Gupta N, Dass A, Saini V, Pol SA, Mittal L 43 Multiple Myeloma Presenting as a Parotid Mass Borbe BB, Castañeda SS 47 Double Ectopic Thyroid Gland in a 10-Year-Old Filipino Boy Mendez TJC, Navarro – Locsin CG FEATURED GRAND ROUNDS 51 Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology Sagun JRM, Cruz ETS FROM THE VIEWBOX 56 Post-Operative Temporal Lobe Encephalocele Bickle IC, Salim F UNDER THE MICROSCOPE 58 Ameloblastic Fibrosarcoma of the Mandible Go JT, Carnate JM PASSAGES 61 Mariano B. Caparas, MD (1932-2017) Pontejos AQY

Contents Vol. 32 no. 1 January – June 2017

EDITORIAL 4 Hubris, Humility and Healing Lapeña JF ORIGINAL ARTICLES 6 Low Frequency Ultrasound in Chronic Rhinosinusitis with Nasal Polyposis and Recovery after Endoscopic Sinus Surgery: A Randomized Controlled Trial De Castro RB, Cruz-Daylo MAB, Jardin MLA 14 Bleeding Time Using Moringa Oleifera (Malunggay) Leaf Extract versus Saline Control in a Rabbit Epistaxis Model: A Randomized Controlled Trial Caballero PLG, Cachuela JE 17 Traumatic Perforation of the Tympanic Membrane: Etiologies and Risk Factors for Healing and Intervention Sannigrahi R, Ghosh D, Saha J, Basu SK 23 Fibular Dimensions for Mandibular Reconstruction among Filipinos Muñoz NP, Fernando AF, Castañeda SS 27 Demographic Profile and Risk Factors of Patients with Benign Vocal Fold Lesions Diagnosed through Laryngeal Videoendoscopy and Stroboscopy Chan TCP, Fortuna MCS, Enriquez PS 30 Laryngeal Cancer Neck Node Metastasis: Patterns of Spread Austria MJDG, Roldan RA 33 Diagnostic-to-Treatment Interval and Disease Progression among Head and Neck Cancer Patients Undergoing Surgery Lapiña GF, Castañeda SS CASE REPORTS 37 Capillary Hemangioma of the Temporal Bone Fernando JZ, Ricalde RR 41 Proboscis Lateralis with Rhinosinusitis Vera Cruz LMN, Vicente GM 44 An Impacted Live Fish in the Oropharynx of an 8-Year- Old Child Joson SN, Almazan NA, Cruz MGY 47 Tuberculosis of the Thyroid Fabito EF, Tipayno-Lubos MJ, Ayahao FD SURGICAL INNOVATIONS AND INSTRUMENTATION 51 Optical Myringotomy Knife De Leon RO, Amable JPM FEATURED GRAND ROUNDS 55 Peripheral T-Cell Lymphoma Presenting as an Auricle Mass Mendoza VMM, Perez De Tagle JRV, Fernando AF FROM THE VIEWBOX 57 Intracranial Complications of Acute Sinusitis on Brain CT Bickle IC UNDER THE MICROSCOPE 59 Middle Ear Paraganglioma Carnate JM, Te VG, Encinas-Latoy MAM