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Varghese JJ, Aithal VU, Sharan K, Devaraja K, Philip SJ, Guddattu V, Rajashekhar B. COMPARISON OF SUBMENTAL sEMG DURING DRY SWALLOW BETWEEN IRRADIATED HEAD AND NECK CANCER SURVIVORS AND NORMAL INDIVIDUALS. Folia Phoniatr Logop 2024:000538732. [PMID: 38599192 DOI: 10.1159/000538732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION This study compared the submental surface electromyography (sEMG) duration and amplitude during dry swallowing between irradiated head and neck cancer (HNC) survivors and age-matched normal individuals. Further, the relationship between submental and infrahyoid sEMG in the irradiated HNC group was explored. METHOD Forty participants (20 HNC survivors and 20 age-matched normal individuals) participated in this study. The HNC survivors had completed organ preservation cancer treatment (at least 1-month post-treatment). They were on a complete oral diet without enteral supplementation (FOIS score> 4). Submental and infrahyoid sEMG activity was calculated for three trials of saliva swallow for each participant using sEMG. The duration and amplitude parameters considered were :Onset duration-duration from the onset of swallowing to the maximum amplitude, Offset duration-duration from the maximum amplitude to the end of the swallowing activity, Total duration, and Maximum Amplitude. RESULTS The study found that irradiated HNC survivors exhibited prolonged temporal measures, particularly in the offset duration, which suggested a delayed descent of the hyolaryngeal complex during swallowing. Additionally, the HNC group showed a positive correlation between submental and infrahyoid sEMG. Furthermore, it was observed that the rate of increase in the duration of submental sEMG during subsequent swallowing was greater in HNC survivors which could be due to reduced salivation. CONCLUSION Compared to age-matched normal individuals, irradiated HNC survivors manifest alterations in the submental muscle activities during dry swallowing as measured using sEMG. The temporal and amplitude changes are likely to have arisen as a consequence of post-radiation changes.
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Devaraja K, Majitha CS, Pujary K, Nayak DR, Rao S. A Simplified Protocol for Tracheostomy Decannulation in Patients Weaned off Prolonged Mechanical Ventilation. Int Arch Otorhinolaryngol 2024; 28:e211-e218. [PMID: 38618595 PMCID: PMC11008947 DOI: 10.1055/s-0043-1776720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/08/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.
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Affiliation(s)
- K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - C. S. Majitha
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kailesh Pujary
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dipak Ranjan Nayak
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shwethapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Mittal M, Pillai S, Monappa V, Devaraja K, Majumdar KS. Desmoid fibromatosis-a diagnostic dilemma. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08558-4. [PMID: 38530459 DOI: 10.1007/s00405-024-08558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Desmoid fibromatosis in head and neck is infrequent and poses a significant challenge to the clinicians due to its non-specific characteristics. METHODS This case report focuses on a 69-year-old male who presented to a tertiary healthcare center in Karnataka, India with a swelling in the oral cavity. RESULTS Despite initial suspicions of malignancy based on clinical examination and findings on computed tomography imaging, subsequent histopathology and immunohistochemistry revealed an unexpected finding. CONCLUSION The case highlights the importance of clinical suspicion and histopathological evaluation as well as the need for greater awareness to facilitate early diagnosis and appropriate management of desmoid fibromatosis. We also present a literature review of varied presentations of desmoid tumors afflicting various subsites of the head and neck.
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Affiliation(s)
- Manaswini Mittal
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Suresh Pillai
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vidya Monappa
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - K Devaraja
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kinjal Shankar Majumdar
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
- Department of Surgical Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Abdulkader RS, Ponnaiah M, Bhatnagar T, S D, Rozario AG, K G, Mohan M, E M, Saravanakumar D, Moorthy A, Tyagi AK, Parmar BD, Devaraja K, Medikeri G, Ojah J, Srivastava K, K K, Das N, B N, Sharma P, Kumar Parida P, Kumar Saravanam P, Kulkarni P, S P, Patil S P, Kumar Bagla R, D R, S Melkundi R, S Satpute S, Narayanan S, Jahagirdar S, Dube S, Kumar Panigrahi S, Babu D S, Saini V, Singh Saxena R, Srivastava A, Chandra Baishya A, Garg A, Kumar Mishra A, Jyoti Talukdar A, Kankaria A, Karat A, Sundaresh Kumar A, Chug A, Vankundre A, Ramaswamy B, MB B, R Jadav B, Dhiwakar M, Ghate G, Shah HV, Saha I, Sivapuram K, J Joshi K, Singh M, Chand Bairwa M, K D, K K, E M, Samagh N, Dinakaran N, Gupta N, Gupta N, M Nagarkar N, Solanki N, Kumar Panda P, Bachalli P, Shanbag R, Patil R, Kumar A R, Narayan Patil R, Thookkanaickenpalayam Vijayaraghavan R, Hanumantappa R, A R, Mandal SK, Kishve SP, Varghese Thomas S, Sarkar S, Thakur S, Patil S, Lakshmanan S, D Rao S, V S, Nayak T, Dixit UR, B U, Backiavathy V, Shenoy V, Hallur VK, Bhatnagar A, Murhekar MV. Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India. Mycology 2024; 15:70-84. [PMID: 38558844 PMCID: PMC10976993 DOI: 10.1080/21501203.2023.2271928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.
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Affiliation(s)
| | | | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Devika S
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Gayathri K
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malu Mohan
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Michaelraj E
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Aditya Moorthy
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhagirathsinh D Parmar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - K Devaraja
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gaurav Medikeri
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Jutika Ojah
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Kajal Srivastava
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nandini Das
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Niharika B
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Parul Sharma
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Pradipta Kumar Parida
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Prasanna Kumar Saravanam
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Priya S
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Pushpa Patil S
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rahul Kumar Bagla
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Ramesh D
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Renuka S Melkundi
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Satish S Satpute
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shubhashri Jahagirdar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Simmi Dube
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Sunil Kumar Panigrahi
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Surendra Babu D
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
| | - Vaibhav Saini
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Rita Singh Saxena
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Abhinav Srivastava
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | | | - Ajai Garg
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Amit Kumar Mishra
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Anjan Jyoti Talukdar
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Ankita Kankaria
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Arathi Karat
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
| | - Arul Sundaresh Kumar
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Ashi Chug
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Vankundre
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharathi MB
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Bhargav R Jadav
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - Muthuswamy Dhiwakar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Girija Ghate
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Hardik V Shah
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Ipsita Saha
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Kavya Sivapuram
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Krupal J Joshi
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Mahendra Singh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mukesh Chand Bairwa
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Divya K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Muthurajesh E
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Navneh Samagh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Nethra Dinakaran
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Nikhil Gupta
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Nitin Gupta
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nitin M Nagarkar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Nitin Solanki
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Prasan Kumar Panda
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prithvi Bachalli
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Raghunath Shanbag
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rajashri Patil
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Rajesh Kumar A
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Rakesh Narayan Patil
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | | | - Ramesh Hanumantappa
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Rathinavel A
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Saleel Kumar Mandal
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Sara Varghese Thomas
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Saurav Sarkar
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Shalini Thakur
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Siddaram Patil
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Somu Lakshmanan
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Srinivas D Rao
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Sumathi V
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Tulasi Nayak
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Umesh R Dixit
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Varsha Backiavathy
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Vijendra Shenoy
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vinay Kumar Hallur
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
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Majitha CS, Nayak DR, Shetty S, Devaraja K, Basheer JI. Distant metastasis at the time of presentation of head and neck squamous cell carcinoma: a retrospective chart review from a tertiary cancer care centre. J Laryngol Otol 2023:1-6. [PMID: 38131132 DOI: 10.1017/s0022215123002323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To evaluate the rates and patterns of distant metastasis in head and neck SCC at the time of presentation and to study the association between distant metastasis with pre-treatment, clinical, and pathological predictors of outcomes. METHOD This is a retrospective study conducted in a tertiary care hospital. All patients with primary head and neck squamous cell carcinoma that had been evaluated at our institute between October 2018 and December 2020 were included in the study. Various clinical data were analysed and pattern of metastasis was studied. RESULT Ten per cent (50 cases) of 501 studied patients had distant metastasis. The most common site of distant metastasis was lung. The rate of distant metastasis was high in patients with poorly differentiated cancers. By Kaplan-Meier analysis, the median survival duration after diagnosis of metastasis was four months. CONCLUSION The rate of distant metastasis was 10 per cent in the study. Patients with poorly differentiated tumours, locally advanced primary lesions, higher nodal stage, particularly with extra nodal extension, and hypopharyngeal primary, tend to exhibit increased risk for distant metastasis at the time of presentation.
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Affiliation(s)
- C S Majitha
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Dipak Ranjan Nayak
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Shama Shetty
- Division of Head and Neck Surgery, Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - K Devaraja
- Division of Head and Neck Surgery, Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Juhi Irfana Basheer
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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Kumar R, Manchanda S, Hota A, Devaraja K, Thakur R, Sherif PM, Sagar P, Khan MA, Bhalla AS, Kumar R. Ultrasound Characteristics of Metastatic Occult Cervical Lymph Nodes in Early Tongue Cancer. Indian J Otolaryngol Head Neck Surg 2023; 75:2786-2791. [PMID: 37974888 PMCID: PMC10645852 DOI: 10.1007/s12070-023-03881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/08/2023] [Indexed: 11/19/2023] Open
Abstract
Introduction: Identification of occult lymph node metastasis is challenging in early tongue cancers. We conducted a prospective study to determine the most characteristics ultrasonic feature suggestive of metastatic node. Material and Methods: A preliminary study based on feasibility was planned on twenty five patients with squamous cell carcinoma of tongue (T1,T2) and N0 neck underwent ultrasonography of neck. The results of each ultrasonic parameters (size, shape, echogenicity, margin and hilum) for suspicion were analysed. Pathologic evaluation of surgical resected neck specimen served as the reference standard. Results: USG yielded sensitivity and specificity by size, by morphology, either size or morphology are 50.0% and 87.5%, 75.0% and 87.5, 75.0 and 83.3% respectively. Morphology alone has highest negative predictive value (NPV:91.3%) with accuracy of 84.3%. Conclusion: Morphology of the lymph node had highest sensitivity and specificity with highest negative predictive value correlating with its metastatic nature.
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Affiliation(s)
- Rajeev Kumar
- Department of Otolaryngology-Head Neck Surgery, AIIMS, New Delhi, 110029 India
| | | | - Ashutosh Hota
- Department of Head & Neck Oncology, AHPGIC, Cuttack, India
| | - K. Devaraja
- Department of Otolaryngology-Head Neck Surgery, KMC, Manipal, India
| | - Rishikesh Thakur
- Department of Otolaryngology-Head Neck Surgery, AIIMS, New Delhi, 110029 India
| | | | - Prem Sagar
- Department of Otolaryngology-Head Neck Surgery, AIIMS, New Delhi, 110029 India
| | | | | | - Rakesh Kumar
- Department of Otolaryngology-Head Neck Surgery, AIIMS, New Delhi, 110029 India
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Devaraja K, Surendra VU. Clinicopathological Features and Management Principles of Tracheobronchopathia Osteochondroplastica - A Scoping Review. Indian J Otolaryngol Head Neck Surg 2023; 75:3798-3814. [PMID: 37974722 PMCID: PMC10646011 DOI: 10.1007/s12070-023-03998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/16/2023] [Indexed: 11/19/2023] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is an orphan disease of the tracheobronchial tree without any known etiological attributes. There are several case reports published on this condition, yet the available information about the TO is discrete and of little clinical value. This scoping review is the first large-scale review on TO that collates individual patient data from the published case reports and descriptively analyses the clinicopathological features of this unique condition along with its management approaches and therapeutic outcomes. The objective was to synthesize comprehensive literature review on TO that can aid clinical practice and further research. An electronic search conducted in five large databases, including PubMed, EMBASE, CINAHL, CENTRAL, and Web of Science, for the published articles of TO yielded 1072 items. After screening, the individual patient data of 371 TO cases from 228 eligible articles were included and analysed in this scoping review. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03998-6.
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Affiliation(s)
- K Devaraja
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Vyshak Uddur Surendra
- Department of Respiratory Medicine, Yenapoya Medical College Yenapoya University, Mangalore, Karnataka 575018 India
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Malapure SS, Oommen S, Bhushan S, Suresh S, Devaraja K. Association of Neutrophil-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte Ratio with Clinicopathological Features and Short-Term Outcome in Well-Differentiated Thyroid Cancer. Indian J Nucl Med 2023; 38:313-319. [PMID: 38390543 PMCID: PMC10880857 DOI: 10.4103/ijnm.ijnm_35_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/30/2023] [Indexed: 02/24/2024] Open
Abstract
Purpose of the Study To assess the association of inflammatory markers with known risk factors and short-term outcome of well-differentiated thyroid cancer. Materials and Methods Well-differentiated nonmetastatic thyroid cancer patients diagnosed and treated between September 2015 and December 2019 at Kasturba Hospital, Manipal, India, were retrieved for the study. Patients' presurgical blood parameters were noted, and neurtrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were calculated. Clinicopathological details along with tumor markers at baseline and at 6 months' follow-up were tabulated. Patients were categorized as complete disease clearance if their clinical examination was normal, stimulated thyroglobulin (Tg) was <1 ng/ml, Anti-thyroglobulin antibodies <65 IU/L or showing a decreasing trend, and follow-up I-131 whole-body scan was negative. The association of the inflammatory markers with known risk factors and short-term outcomes were compared. Results A total of 272 patients were analyzed in the study. The median NLR in our study cohort was 2.55 (mean = 3.96 with standard deviation [SD] =4.20) and the median LMR was 3.72 (mean = 3.79 with SD = 1.94). The disease clearance rate of our study cohort was 73.9%. The median NLR (2.4 vs. 3.1) and LMR (3.13 vs. 3.93) were significantly different among the patients with complete disease clearance and those with persistent disease (P = 0.008 and P = 0.003, respectively). The known risk factors such as multifocality (P = 0.04), tumor size (P = 0.013), lymph node metastases (P = 0.001), and baseline Tg (P ≤ 0.001) were significantly associated with persistent disease at 6 months. The NLR showed a positive correlation and LMR had a negative correlation with the known risk factors, however, the associations were not statistically significant. Conclusions The NLR and LMR are simple yet potential prognostic tools in well-differentiated thyroid cancer.
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Affiliation(s)
- Sumeet Suresh Malapure
- Department of Nuclear Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sibi Oommen
- Department of Nuclear Medicine, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shivanand Bhushan
- Department of Nuclear Medicine, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sucharitha Suresh
- Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
| | - K. Devaraja
- Division of Head and Neck Surgery, Department of ORL-HNS Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Devaraja K, Ibrahim S, Venkataramanan A, Nayak DR. Clinical relevance of hyponatraemia in olfactory neuroblastoma. Indian J Med Res 2023; 158:88-92. [PMID: 37602591 PMCID: PMC10550061 DOI: 10.4103/ijmr.ijmr_2064_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 07/08/2023] Open
Affiliation(s)
- K. Devaraja
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576 104, Karnataka, India
| | - Sufyan Ibrahim
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576 104, Karnataka, India
| | - Aarthi Venkataramanan
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576 104, Karnataka, India
| | - Dipak Ranjan Nayak
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576 104, Karnataka, India
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Ravindra A, Nayak DR, Devaraja K, Matthew NM, Tiwari S. Functional Outcomes After Surgical Resection of Tongue Cancer; A Comparative Study Between Primary Closure, Secondary Intention Healing and Flap Reconstruction. Indian J Otolaryngol Head Neck Surg 2022; 74:6296-6306. [PMID: 36742906 PMCID: PMC9895170 DOI: 10.1007/s12070-021-03038-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of the study was to assess and compare the quality of speech and swallowing between three reconstruction options (primary closure-group A, secondary intention healing-group B and flap reconstruction-group C), in small to moderate sized onco-surgical defects of oral tongue. 47 patients fulfilled the eligibility criteria during the study period, of which, 15 belonged to group A, 16 belonged to group B, 16 were in group C. Speech and swallowing assessment was done using Speech Intelligibility Assessment score and MD Anderson Dysphagia Inventory, respectively. The above tests were administered pre-operatively, 1 month and 6 months post-operativey in all the study participants. The average scores of speech intelligibility at 1 month were 66.13% (±19.96), 70.04% (±12.28) and 37.31% (±11.29) for groups A, B and C respectively. Similarly, average long term scores for speech intelligibility in these three groups were 72.7% (±17.72), 83.3% (±12.78) and 52.8% (±11.74) respectively. With regards to swallowing the composite scores at 1 month were 73.67 (±13.69), 68.31 (±16.06) and 41.81 (±5.44), and at 6 months were 83.2 (±10.24), 79.31 (±12.29) and 57.88 (±7.37), respectively for groups A, B and C. All the differences were statistically significant (p < 0.05). Healing by secondary intention offered the best functional outcome in terms of speech intelligibility, and primary closure offered best swallowing outcomes in operated cases of oral tongue. This trial has been registered with the Clinical Trials Registry-India in December 2018 (CTRI Reg. No: CTRI/2018/12/016803).
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Affiliation(s)
- Aditi Ravindra
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, 4th floor, New OPD Building, Manipal, Karnataka India
| | - Dipak Ranjan Nayak
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, 4th floor, New OPD Building, Manipal, Karnataka India
| | - K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, 4th floor, New OPD Building, Manipal, Karnataka India
| | - Neethu M. Matthew
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, 4th floor, New OPD Building, Manipal, Karnataka India
| | - Shivani Tiwari
- Department of Speech and Hearing, Kasturba Medical College, Manipal, Karnataka India
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Devaraja K, Malapure SS, Neeraj R, Chandrappa DH. Synchronous carcinoma of thyroglossal duct cyst and native thyroid gland. BMJ Case Rep 2022; 15:15/11/e250853. [DOI: 10.1136/bcr-2022-250853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The unobliterated portion of embryological thyroglossal duct may present as cystic swelling later in life and may contain functional thyroid follicles. This cyst requires excision along with the entire thyroglossal duct remnant and adjacent portion of hyoid bone. At times, the excised specimen could demonstrate a focus of carcinomatous change inside the cyst wall. Very rarely, this thyroglossal duct cyst carcinoma could be associated with malignancy of native thyroid gland. This case report illustrates an interesting case of synchronous carcinoma of thyroglossal duct cyst and native thyroid gland. It also sheds light on the controversies related to the pathophysiology of such association and the dilemmas surrounding the management of thyroglossal duct cyst carcinoma, with or without concurrent carcinoma of thyroid gland.
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Singh CA, Devaraja K, Kumar R. Recurrent Ameloblastoma: Long Term Outcomes with Free Fibular Bone Graft. Indian J Otolaryngol Head Neck Surg 2022; 74:1773-1779. [PMID: 36452534 PMCID: PMC9702040 DOI: 10.1007/s12070-020-01790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022] Open
Abstract
Ameloblastoma is a locally aggressive benign neoplasm of jaw that has high propensity to recur. Pathological subtype and intent of surgical excision during primary surgery are two factors that are known to affect the prognosis in these cases. Nevertheless, there are hardly any studies which have studied recurrent ameloblastoma cases. Apart from sharing a tertiary care cancer center's experience in managing a series of recurrent ameloblastoma cases, we discuss some of the recent literature related to pathophysiology and principles related to their surgical management. Retrospective chart review of all those recurrent ameloblastoma cases which were operated between October 2013 and January 2016 and were subsequently followed up for minimum of 3 years. Total of 9 recurrent ameloblastoma cases were operated in the study period. All our patients had less-radical or non-curative intent surgical treatment in the past, and current treatment consisted wide excision of the involved segment of mandible with free fibular reconstruction. Among the 6 patients who were followed up for more than 3 years, none developed recurrence at 56.5 months of mean follow up duration. Almost all these patients had optimal results with good quality of life in terms of oral speech intellectuality and cosmetic perception of self. Complete excision of the involved segment of bone with reconstruction using the composite free fibular graft can provide optimal functional outcomes and can significantly lessen the chances of further recurrences.
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Affiliation(s)
- Chirom Amit Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
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Gupta N, Srinivas S, Harikumar A, Devaraja K, Nallapati VT, Saravu K. Deoxycholate amphotericin for management of mucormycosis: a retrospective cohort study from South India. Infez Med 2022; 30:432-439. [PMID: 36148169 PMCID: PMC9448307 DOI: 10.53854/liim-3003-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Liposomal amphotericin use is limited in developing countries due to its extremely high cost and availability. Therefore, the study aimed to evaluate deoxycholate amphotericin B's utility and adverse effect profile in patients with mucormycosis. METHODOLOGY This retrospective cohort study from 2019 to 2021 included patients with proven mucormycosis who received deoxycholate amphotericin B for more than or equal to five days and had at least three creatinine values on treatment. Baseline demographic details, risk factors and treatment details of all the patients were recorded. In addition, the details of treatment-related adverse effects and outcomes were ascertained. RESULTS Of the 57 included patients, a history of diabetes, COVID-19 and steroid use was present in 49 (86%), 43 (75.4%) and 33 (57.9%) patients, respectively. Isolated rhino-orbital mucormycosis was the most common presentation (n=49, 86%). The median time of follow-up was 48 (30.5-90) days. A total of 8 (14%) patients died during the hospital stay. The median duration of amphotericin treatment was 21 (14-40) days. Thirty-nine patients (68.4%) developed hypokalaemia on treatment, while 27 (47.4%) patients developed hypomagnesaemia. A total of 34 (59.6%) patients developed AKI on treatment. The median day of development of AKI was 6 (4-10) days. The median baseline, highest and final creatinine values were 0.78 (0.59-0.94) mg/dl, 1.27 (0.89-2.16) mg/dl and 0.93 (0.74-1.59) mg/ dl respectively. The median percentage change from baseline to highest value and last follow-up value was 45% (0.43%-161%) and 25% (-4.8%-90.1%) respectively. The final creatinine was less than 150% of the baseline in 36 (63.2%) patients. CONCLUSION Deoxycholate amphotericin is an acceptable alternative for treating mucormycosis in resource-constrained settings.
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Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sourabh Srinivas
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anagha Harikumar
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vishnu Teja Nallapati
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Devaraja K, Kabekkodu SP. Oral microbiome; a potential game-changer in the management of oral cancer? Oral Oncol 2022; 127:105822. [PMID: 35290832 DOI: 10.1016/j.oraloncology.2022.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
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Devaraja K. Platinum-refractory oral cancers could have a poorer therapeutic response to immunotherapy than their non-oral counterparts. Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_307_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Devaraja K. Oral cancer: Are some people lucky or just ignorant? Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_327_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Devaraja K. Second primary tumor versus recurrent oral squamous cell carcinoma: Effect of inconsistent definitions on evidence synthesis. Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_325_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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18
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Devaraja K, Ibrahim S, Venkataramanan A, Doreswamy S. Epidemiological triad of COVID-associated mucormycosis and the ABCD of its management. Indian J Public Health 2022; 66:520-521. [PMID: 37039187 DOI: 10.4103/ijph.ijph_1471_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Devaraja K, Krishnan NV, Bhat VK, Pujary K, Venkatagiri AM, Vijayasekharan K. Palatal mucormycosis in neutropenic children: A Case Report with Review of Literature. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1739188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractPalatal involvement in mucormycosis is mostly secondary to rhino-orbito-cerebral disease, but rarely can be a primary disease of the oral mucosa. This report presents two rare cases of the isolated palatal mucormycosis in neutropenic children and highlights some of the peculiar features of the primary palatal disease and management-related issues in children. A 12-year-old child, who had completed the dexamethasone-based induction phase of chemotherapy for Near Early T cell precursor acute lymphoblastic leukemia, and a 9-year-old boy with a Late Isolated Medullary relapse of B cell acute lymphoblastic leukemia, who was to receive salvage induction chemotherapy, developed palatal discoloration without any other major complaints. Both had neutropenia and were on antifungal prophylaxis. In vitro staining of the discolored mucosa suggested mucormycosis, which was confirmed by pathological examination of the debrided tissue. Computed tomography, done before debridement, showed no significant sinonasal disease enabling us to proceed with the transoral approach. With the help of adjuvant antifungal therapy, the infection could be contained in both cases. This report, along with the reviewed literature, shows that limited palatal mucormycosis can be effectively treated by early diagnosis and debridement and appropriate antifungal therapy. Also, the role of antifungal prophylaxis amongst neutropenic patients has been briefly discussed here.
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Affiliation(s)
- K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neethu V. Krishnan
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva K. Bhat
- Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kailesh Pujary
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Archana M. Venkatagiri
- Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kalasekhar Vijayasekharan
- Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Devaraja K, Pillai S, Pujary K. Minimally invasive approach for retrieval of retropharyngeal foreign body. J Minim Access Surg 2021; 17:554-555. [PMID: 34558431 PMCID: PMC8486068 DOI: 10.4103/jmas.jmas_243_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/23/2020] [Indexed: 11/22/2022] Open
Abstract
Ingested fish bone at times can migrate extraluminally into the surrounding soft tissue, leading to complications. Conventionally, these migrated fish bones are retrieved by open procedures, which could add to the morbidity. We successfully retrieved one such foreign body by a minimally invasive transcervical approach in a 64-year-old female patient. The method offered an easy identification of the foreign body with minimal soft-tissue dissection, which ultimately aided in the early post-operative recovery. This is the first report of a minimally invasive approach to explore the retropharyngeal space, and we propose the technique even for sampling retropharyngeal lymph node.
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Affiliation(s)
- K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
| | - Suresh Pillai
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
| | - Kailesh Pujary
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
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Abstract
First branchial cleft anomalies are quite rare, and the majority of them are found in and around the ear canal, mostly superficial to the facial nerve. Very rarely, the anomalous tract of the first branchial cleft can go deeper to the facial nerve, necessitating a meticulous and extensive surgery. A 21-year-old student presented with slowly increasing cystic swelling in the infra-auricular region. Findings of the magnetic resonance imaging were consistent with the first branchial cleft cyst, which also exhibited a deeper extent of the lesion into the parapharyngeal space. The entire tract was excised along with the superficial parotidectomy by an open approach. In addition to illustrating the presentation and management of this peculiar case, the present report also reviews the latest literature around their management.
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Affiliation(s)
- K Devaraja
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka - 576104, India
| | - Vishwapriya Mahadev Godkhindi
- Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka - 576104, India
| | - Ajay M Bhandarkar
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka - 576104, India
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22
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Devaraja K. Erratum to "The surgical sequence of neck dissection and primary tumor excision could impact the locoregional recurrence rates in oral squamous cell carcinoma" [Oral Oncol. 110 (2020) 104809]. Oral Oncol 2021; 119:105229. [PMID: 33640272 DOI: 10.1016/j.oraloncology.2021.105229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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Devaraja K, Punja R, Kalthur SG, Pujary K. Unmapped landmarks around branches of the Superior Laryngeal Nerve: An exploratory cadaveric study. J Taibah Univ Med Sci 2021; 16:328-335. [PMID: 34140858 PMCID: PMC8178688 DOI: 10.1016/j.jtumed.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Preserving the External Branch of Superior Laryngeal Nerve (EBSLN) and Internal Branch of Superior Laryngeal Nerve (IBSLN) is essential during thyroidectomy. However, due to potential distortions caused by large goitres, the present anatomical landmarks used to identify these nerves are flawed. Although under such circumstances, bony landmarks may offer more stable reference points, not much has been explored in this regard. This study measures the distance between the most vulnerable points of the EBSLN and IBSLN and their relatively unexplored bony landmarks, such as the hyoid bone and thyroid notch as well as soft-tissue landmarks like the origin of the Superior Thyroid Artery (STA) and carotid bifurcation. Methods An exploratory cadaveric study was conducted in a medical school affiliated with a tertiary care hospital. The detailed analysis included 13 sides from 8 cadavers. Results The average distance from the EBSLN piercing site to the greater cornua of the hyoid bone, thyroid cartilage prominence, origin of the STA, and carotid bifurcation was 35.1(±7.2) mm, 33.3(±3.8) mm, 25.7(±6.3) mm, and 31.5(±5.0) mm, respectively and from the IBSLN piercing site was 15.9(±5.9) mm, 32.9(±4.7) mm, 16.3(±4.2) mm, and 20.7(±5.9) mm, respectively. For most cadavers, the distal EBSLN had Cernea type 2a-like relationship with the STA. Certain variations were also observed in the way these nerves branched with respect to the origin of the STA. Conclusions This study provides metric information (linear measurements) regarding the distance between the branches of SLN and certain unique landmarks. This could potentially aid in minimising intraoperative trauma to these branches.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Rohini Punja
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sneha G Kalthur
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kailesh Pujary
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Devaraja K. De-escalation of aggressive adjuvant therapy for limited extranodal extension in head and neck cancer. Oral Oncol 2021; 116:105161. [PMID: 33478844 DOI: 10.1016/j.oraloncology.2020.105161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 12/12/2022]
Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104, India.
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Sagar P, Devaraja K, Kumar R. Redefining the 'Handousa sign'. Br J Oral Maxillofac Surg 2020; 59:494-496. [PMID: 33077321 DOI: 10.1016/j.bjoms.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Affiliation(s)
- P Sagar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - R Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
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Devaraja K, Nayak DR. Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature. J Otol 2020; 15:112-116. [PMID: 32884563 PMCID: PMC7451676 DOI: 10.1016/j.joto.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 11/29/2022] Open
Abstract
Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa, which typically spreads to skull base to involve cranial nerves VII. Rarely can it also effect one or more of cranial nerves IX, X, XI, and XII. We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve. The patient though later on had internal jugular vein thrombosis, which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis, and later on, to aggravate the therapy. With proper blood sugar control and appropriate long term antibiotics, not only that the patient is disease free at one year follow up, but the cranial nerve deficits also recovered. Apart from sharing the clinical and management details of this patient, we have reviewed the relevant literature in the discussion, which has shed some light onto some of the interesting facts about this condition and its prognosis.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
| | - Dipak Ranjan Nayak
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
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Rao P, Devaraja K, Pujary K, Nayak DR, Balakrishnan R. Abstract A42: Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.aacrahns19-a42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: With the emergence of organ preservation protocol in head and neck cancer, management of hypopharyngeal carcinoma is generally by nonsurgical approach; however, a significant number of hypopharyngeal cancer patients present in advanced stage and exhibit poor prognosis. For such cases, thorough aggressive surgical excision of laryngopharyngoesophageal complex with appropriate reconstruction might be a viable option.
Objective: To evaluate quality-of-life measures and survival outcomes in hypopharyngeal carcinoma cases undergoing above-mentioned procedure at a tertiary health care center.
Methodology: A retrospective study on patients with hypopharyngeal carcinoma undergoing above-mentioned procedure was done in our tertiary care institute between September 2016 to October 2018.
Results: A total of 12 patients were operated during the study period; however, 3 patients were excluded due to inadequate data. In our study, mean age of presentation was 51.3 years and majority were men (n=8). Most of the patients at the time of presentation were stage IVA or more. Postcricoid was most common subsite, followed by pyriform fossa. 4 out of 12 were operated after failed chemoradiation. Perioperative morbidity primarily in terms of complications and duration of hospital stay and quality-of-life measures consisting mainly of swallowing score were analyzed, which suggested that this procedure is tolerable and produces a reliable outcome.
Conclusion: Total laryngopharyngoesophagectomy with gastric transposition is a feasible and efficacious treatment option with reasonable quality of life in carcinoma hypopharynx patients, especially after failed chemoradiation.
Citation Format: Prerit Rao, K. Devaraja, Kailesh Pujary, Dipak Ranjan Nayak, R. Balakrishnan. Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A42.
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Affiliation(s)
- Prerit Rao
- Kasturba Medical College, Manipal, Karnataka, India
| | - K. Devaraja
- Kasturba Medical College, Manipal, Karnataka, India
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Singh R, Shilpa R, Mukhopadhyay C, Shenoy PA, Balakrishnan R, Devaraja K. Correlation Between Microbiological Profiles of Adenoid Tissue and Nasal Discharge in Children with Co-existent Chronic Adenoiditis and Chronic Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2020; 72:112-116. [PMID: 32158666 DOI: 10.1007/s12070-019-01775-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/02/2019] [Indexed: 10/25/2022] Open
Abstract
Chronic adenoiditis leading to adenoid hypertrophy is common in children. Many cases would also have co-existing chronic rhinosinusitis (CRS). Infact, long lasting bacterial infection of the adenoids has been hypothesized to be the cause for CRS in these children. A cross-sectional study was conducted in the departments of ENT and Micro-biology at Kasturba Hospital, Manipal, India between 2016 and 2017. 20 subjects who were diagnosed with CRS and adenoid hypertrophy took part in the study. Aerobic, anaerobic and fungal culture sensitivity of adenoid tissue was done along with aerobic and fungal culture sensitivity of nasal swabs from middle meatus. 2 out of 20 adenoid samples showed positive culture for aerobes and 19 adenoid samples grew anaerobic organisms. 7 out of 20 nasal swabs grew some aerobes and 2 were positive for fungal organisms. The correlation of microorganisms between adenoid hypertrophy and CRS was seen only in one patient in which methicillin resistant Staphylococcus aureus was grown. The present study showed mixed flora in the adenoid samples with anaerobic predominance. Aerobes were predominantly grown in nasal swabs from patients with CRS along with fungal colonizers. Though the study does not establish any bacteriological association with the CRS in our cohorts, the significant growth of the anaerobes from the core of the inflamed adenoids has prompted us to suggest the inclusion of the antibiotics against the anaerobes in the medical management of these children, whenever feasible. We think the addition of specific antibiotics to tackle anaerobes helps by hampering the further inflammatory hypertrophy of adenoid tissue.
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Affiliation(s)
- Rohit Singh
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - R Shilpa
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Chiranjay Mukhopadhyay
- 2Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Padmaja A Shenoy
- 2Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - R Balakrishnan
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - K Devaraja
- 1Department of Otolaryngology - Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
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Devaraja K, Aggarwal S, Verma SS, Gupta SC. Clinico-pathological peculiarities of human papilloma virus driven head and neck squamous cell carcinoma: A comprehensive update. Life Sci 2020; 245:117383. [PMID: 32007572 DOI: 10.1016/j.lfs.2020.117383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 01/28/2020] [Indexed: 01/11/2023]
Abstract
AIMS The current article provides a detailed account of the current understanding of molecular and clinico-pathological aspects of Human papilloma virus (HPV) driven head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS The literature review included most of the landmark trials and clinical studies related to the HPV driven HNSCC. KEY FINDINGS HPV positive HNSCC differ distinctly from HPV negative tobacco-related HNSCC, especially in oropharyngeal region. Therefore, the American joint committee on cancer`s latest manual for classification and staging of cancer suggests a separate staging system for HPV positive oropharyngeal cancers. Despite the younger patients being affected and the high propensity for cervical metastasis, the HPV positive oropharyngeal cancers respond much better to the treatment. The association with wild type TP53 and low EGFR expression confers the favorable prognosis in HPV driven HNSCC. Since the association is not universal, we suggest checking for p53 and EGFR expression status before considering de-intensification of therapy. In addition, the presence of matted lymph nodes and five or more nodes could mean relatively poorer prognosis, and are not suitable for de-intensification of therapy. The same is also true probably with higher T stage and co-existing tobacco use. The methods for the detection of p16, HPV DNA, HPV E6/E7 mRNA, anti-E6/E7 antibodies, in tissue, in serum and in saliva of patients, along with their clinical implications are also discussed. SIGNIFICANCE This article provides latest developments on the HPV driven HNSCC. 'Diagnosis of transcriptionally active HPV infection,' 'Modalities for surveillance,' 'Implication of de-escalation of therapy' are some of the critical issues that could serve the medical, the research as well as the patient communities.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India.
| | - Sadhna Aggarwal
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sumit Singh Verma
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India
| | - Subash Chandra Gupta
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India.
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Sharma SC, Panda S, Thakar A, Devaraja K. Petrous Bone Cholesteatoma: Radical Excision with an Endeavour for Hearing Preservation. Indian J Otolaryngol Head Neck Surg 2019; 71:1572-1579. [PMID: 31750219 DOI: 10.1007/s12070-019-01662-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/20/2019] [Indexed: 11/27/2022] Open
Abstract
To describe surgical outcomes following resection of giant petrous bone cholesteatoma. Retrospective cohort study was undertaken at a tertiary care centre on patients who had undergone surgery for petrous bone cholesteatoma (PBC) from August 2014 to September 2017. For patients with serviceable hearing preoperatively, labyrinth preserving techniques, namely, modified transmastoid translabyrinthine approach (massive PBC-1) and supralabyrinthine approach (supralabyrinthine PBC-1) were considered. In the former, bony labyrinth which had been destroyed due to the disease process, membranous labyrinth remained anatomically and functionally intact following meticulous dissection to remove cholesteatoma matrix. In the latter, supralabyrinthine cell tracts were exenterated without disturbing the cochlea and labyrinth with a canal wall down mastoidectomy. For the remaining patients, labyrinth ablative approach was undertaken (translabyrinthine/transotic). Facial nerve function was evaluated using House-Brackman grading system. Hearing was evaluated using pure tone audiometry. 7 patients were identified (massive-2, supralabyrinthine-3, supralabyrinthine apical-1, infralabyrinthine apical 1). None of the patients experienced deterioration of postoperative bone conduction or facial nerve function (preop-grade 5-4, grade 6-3; postop-grade 2-1, grade 3-2, grade 4-4). Facial nerve was decompressed and anatomically intact in 3 cases. In the remaining, facial hypoglossal anastomosis was done in 3 and facial masseteric anastomosis was done in 1 patient. With a median follow-up of 26 months, recurrence in the form of keratin pearl was seen in 1 patient. Modified translabyrinthine approach preserving membranous labyrinth is a promising hearing preservation strategy.
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Affiliation(s)
- Suresh C Sharma
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - Smriti Panda
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - Alok Thakar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - K Devaraja
- 2Department of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, India
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Jainulabdeen T, Ramaswamy B, Devaraja K, Paruthikunnan SM, Bhandarkar AM. Preoperative Staging of Differentiated Thyroid Carcinomas: Comparison of USG and CT with Intraoperative Findings and Histopathology. Indian J Otolaryngol Head Neck Surg 2019; 71:327-333. [PMID: 31559199 DOI: 10.1007/s12070-019-01663-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022] Open
Abstract
To study the efficacy of USG and CECT in preoperative staging of differentiated thyroid carcinomas in comparison to the intraoperative and histopathological findings. A prospective, observational study was conducted in a tertiary care hospital over a period of one and a half years where USG and CECT of 23 subjects with histopathologically proven differentiated thyroid malignancy were analysed to study the characteristics of the primary tumour, lymphatic metastasis and evaluate the sensitivity and specificity of the radiological investigations in comparison to the intra-operative and histopathological findings. When compared with intraoperative and histopathological T-staging, USG had an accuracy of 69.5% and 73.9% and CECT had an accuracy of 78.2% and 73.9% respectively. The sensitivity and specificity of USG and CECT in determining a malignant nodule was 71.4% and 33.3% and 52.4% and 66.7% respectively. The N-staging according to the histopathological examination findings was in agreement with that of USG in 65.2% and CECT in 65.2% patients. The sensitivity and specificity of USG was 94.4% and 41.7% and that of CECT was 92.2% and 44.4% respectively in detecting lymphatic metastasis. The sensitivity and specificity of USG was 94.4% and 44.4% and that of CECT was 92.2% and 27.3% respectively in detecting lateral compartment lymphatic metastasis. USG identifies the characteristics of the malignant nodules better and CECT has a higher identifying central compartment lymphatic metastasis. CECT should be used as an adjunct to ultrasound to determine the extent of lymphatic metastasis and staging of disease.
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Affiliation(s)
- Thasneem Jainulabdeen
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Balakrishnan Ramaswamy
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - K Devaraja
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Samir M Paruthikunnan
- 2Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ajay M Bhandarkar
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Abstract
Mucocele of paranasal sinuses commonly affects frontal or frontoethmoidal air cells. With the evolution of endoscopic sinus surgery, the endoscopic marsupialisation has become the standard of care for these lesions. However, the external approach still has a role in selected cases of frontal sinus mucocele. The location of the mucocele and its communication with the natural outflow tract of the frontal sinus are some of the critical factors to be considered while choosing the surgical approach. We have discussed the management of three cases of frontal mucoceles having different locations and one of them having intervening septa. We emphasise that the successful management of far laterally located mucoceles and those with laterally situated septation require an external approach in conjunction with endoscopic marsupialisation.
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Affiliation(s)
- K Devaraja
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
| | - Hitesh Verma
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rajeev Kumar
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Devaraja K, Kumar R, Sagar P, Barwad A. Intraductal pseudopodia in pleomorphic adenoma of parotid gland. INDIAN J PATHOL MICR 2019; 62:117-118. [PMID: 30706873 DOI: 10.4103/ijpm.ijpm_307_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pleomorphic adenoma is the most common salivary gland tumor. Pseudopodia are finger-like projections extending beyond the tumor capsule, seen in pleomorphic adenoma. If not resected completely, these pseudopodia may increase the risk of recurrence after excision of pleomorphic adenoma. While performing a total conservative parotidectomy for the pleomorphic adenoma of the parotid gland, we encountered tumor in the Stensen's duct. On pathological examination, the tumor was not involving the wall of the duct but was passing through the lumen, like a pseudopod. During parotidectomy, the surgeon should inspect the lumen of parotid duct for the presence of any tumor. Pseudopodia of pleomorphic adenoma may extend into the lumen and if not addressed adequately may lead to recurrence of the tumor.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Sagar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Rhinosporidiosis is a communicable disease prevalent in tropical countries that affects one or more mucocutaneous sites such as the nasal cavity, pharynx, skin, bronchus, genitals, and bone, in isolation or together. We report a case of multicentric rhinosporidiosis involving the nasal cavity, oropharynx, larynx, and cheek skin without disseminated disease outside the head and neck. Although the appearance of mucocutaneous lesions in our patient was similar to that of papilloma or neoplasm, the distinct clinicopathologic characteristics of the rhinosporidiosis guided us in managing the case successfully. In our own experience with 11 patients with rhinosporidiosis on whom we operated over the past 5 years, the nasal cavity and pharynx were the most commonly involved sites in the head and neck. Surgical excision of all lesions along with cauterization of the base and long-term dapsone therapy is the current standard of care for multicentric rhinosporidiosis.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India.
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Devaraja K, Nayak DR, Kordcal AR, Malapure SS. Cushing's reflex secondary to neck haematoma following thyroidectomy. BMJ Case Rep 2018; 2018:bcr-2018-226639. [PMID: 30257972 DOI: 10.1136/bcr-2018-226639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Neck haematoma following thyroid surgery can present with respiratory distress which is generally attributed to airway obstruction. We recently had a 63-year-old female patient who underwent total thyroidectomy for toxic nodular goitre. However, within 4 hours of surgery, she developed sudden respiratory distress which was managed by prompt evacuation of the neck haematoma. Just before the haematoma evacuation, the patient had hypertension and bradycardia along with the distress. The arterial blood gas analysis sampled at that time was normal. Intraoperatively, the tracheal framework was found rigid and non-pliable. Considering the various clinical-biochemical findings observed, we think that the cause of the respiratory distress in the index case was transiently elevated intracranial pressure, secondary to bilateral internal jugular veins' compression. We hypothesise that in many patients with immediate postoperative neck haematoma, the Cushing's reflex would at least contribute partly, if not solely to the respiratory distress.
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Affiliation(s)
- K Devaraja
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dipak Ranjan Nayak
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhishek Rao Kordcal
- Anasethesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sumeet Suresh Malapure
- Nuclear Medicine Division, Radiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. Eur Arch Otorhinolaryngol 2018; 275:2421-2433. [PMID: 30094486 DOI: 10.1007/s00405-018-5088-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other. METHODS This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers' understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links. RESULTS Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm. CONCLUSIONS So far, no single clinical study, either epidemiological or interventional, has incorporated and isolated all the constitute conditions of cervicogenic dizziness. There is a need for such studies in the future to validate either the reliability of a clinical test or the efficacy of an intervention in cervicogenic dizziness.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India.
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Devaraja K. Vertigo in children; a narrative review of the various causes and their management. Int J Pediatr Otorhinolaryngol 2018; 111:32-38. [PMID: 29958611 DOI: 10.1016/j.ijporl.2018.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/03/2023]
Abstract
Vertigo is a not an uncommon symptom in children, but often the treating doctors are unsure of the diagnosis and the management of these cases. This narrative review of the literature discusses the brief etiopathology, the clinical manifestations and the management algorithm of most of the conditions causing vertigo in children. The relevant information has been condensed into a table for the perusal of the readers, which would assist in the appropriate management of these children.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Udupi, Karnataka, 576104, India.
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Abstract
This case series is about four different foreign bodies lodged in different locations of the aerodigestive tract. All four cases had delayed diagnosis due to inconspicuous history. Radiology in the form of computed tomography aided the appropriate diagnosis in most of these cases. Though all four patients have been successfully managed by removal of foreign body, not all of them have identical outcomes. A brief discussion about predictive factors in the fish bone foreign body has been included. The authors also discuss certain critical aspects of the management, which may aid in reducing the morbidity. We emphasise on the high index of suspicion in peculiar cases and on the low threshold for radiological investigation in doubtful clinical scenarios.
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Affiliation(s)
- K Devaraja
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dipak Ranjan Nayak
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay M Bhandarkar
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Poorvi V Sharma
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Abstract
Sinonasal schwannomas constitute 4% of head and neck nerve sheath tumours; however, schwannomas involving the nasal septum are quite rare. We present a 57-year-old male patient with nasal septal schwannoma who was managed successfully by endoscopic excision. 32 cases of septal schwannoma have been reported so far in the literature. This report discusses certain peculiar features exhibited by schwannomas of the nasal septum. Septal schwannoma does not show any age, sex or side predilection. However, they tend to involve posterior part of the septum and presumed to arise from the nasopalatine branch of the trigeminal nerve. Imaging findings of the sinonasal schwannoma are non-specific, but the histopathological characteristics are diagnostic, with seldom need for immunohistochemistry. Endoscopic excision is the safe and effective treatment option for the septal schwannoma of any size and location. Recurrence has not been reported in the literature following endoscopic excision.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
| | - Dipak Ranjan Nayak
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
| | - Prerit Rao
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka-576104, India
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Devaraja K, Sikka K, Singh PK. Peculiarities of Yolk Sac Tumor in Head and Neck: A Case Report and Literature Review. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_135_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractYolk sac tumor (YST) is the most common malignant germ cell tumor of head and neck region, constituting around 1% of all malignant germ cells. The rarity of the tumor has led to a relatively sparse collective description of clinical and prognostic factors of such a tumor affecting head and neck region. In this case report with review of the literature, we have highlighted certain peculiar features of YSTs affecting the head and neck region. They seem to commonly affect female children. These tumors seem to fare poorly in children of <1 year of age. Multimodality of treatment consisting of combination chemotherapy with the cisplatin-based regimen and surgery and/or radiotherapy helps in achieving long-term disease-free survival in those affected.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Karnataka, India
| | - Kapil Sikka
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Sharma SC, Devaraja K, Kairo A, Kumar R. Percutaneous Trans-Tracheal Endoscopic Approach: A Novel Technique for the Excision of Benign Lesions of Thoracic Trachea. J Laparoendosc Adv Surg Tech A 2018; 28:320-324. [DOI: 10.1089/lap.2017.0224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suresh C. Sharma
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kairo
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Devaraja K, Nayak DR, Kamath PA. Cough Induced Pneumomediastinum due to Tracheal Tear. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/38136.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Devaraja K. Is there enough evidence to refute the antiviral therapy in vestibular neuritis: A best evidence review. Indian J Otol 2018. [DOI: 10.4103/indianjotol.indianjotol_13_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Devaraja K, Sagar P, Chirom AS. Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management. BMJ Case Rep 2017; 2017:bcr-2017-220567. [PMID: 28784888 DOI: 10.1136/bcr-2017-220567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica is a rare airway disease of unknown aetiology. Due to overlapping symptomology and lack of awareness, the condition is often missed resulting in unnecessary medical or surgical treatment. A male patient presented with a long-standing history of hoarseness and had earlier received treatment for bronchial asthma and tuberculosis. On evaluation, he had typical submucosal calcified nodules distributed throughout the trachea sparing the posterior membranous part. Although the biopsy confirmed the diagnosis of tracheobronchopathia osteochondroplastica in our case, histopathological examination is not always needed to make this diagnosis. Our patient has been kept under conservative management and is having non-progression of disease at 1-year follow-up. After having reviewed the literature related to pathophysiology and management of tracheobronchopathia osteochondroplastica, we emphasise on the fact that the treating physicians' awareness about this condition is the key to its diagnosis and management.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Karnataka, India
| | - Prem Sagar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Amit Singh Chirom
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Devaraja K, Sikka K, Kumar R, Sagar P. "Syndrome of Inappropriate Antidiuretic Hormone Secretion" as a Diagnostic and a Prognostic Indicator in Olfactory Neuroblastoma. Indian J Endocrinol Metab 2017; 21:644-645. [PMID: 28670560 PMCID: PMC5477464 DOI: 10.4103/ijem.ijem_94_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Sagar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sagar P, Devaraja K, Kumar R, Bolu S, Sharma SC. Cholesteatoma Induced Labyrinthine Fistula: Is Aggressiveness in Removing Disease Justified? Indian J Otolaryngol Head Neck Surg 2017; 69:204-209. [PMID: 28607891 DOI: 10.1007/s12070-017-1072-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
Issues of complete disease clearance and hearing preservation in cholesteatoma induced labyrinthine fistula cases has been discussed and updated in this article. Successful disease clearance and hearing preservation in a case of cholesteatoma induced isolated cochlear promontory fistula encouraged us to retrospectively analyse 13 more cases of cholesteatoma induced labyrinthine fistula who presented in emergency service as complicated chronic suppurtive otitis media. Pre-operatively nine patients experienced vertigo, two had profound sensori neural hearing loss and radiology was suggestive of labyrinthine fistula in 12 patients. Lateral semicircular canal was involved in 13 cases. In all cases cholesteatoma matrix was completely removed from the fistula site irrespective of the fistula size and hearing status. Hearing was preserved in 11 out of 12 patients. Gentle and meticulous removal of the matrix and careful repair of labyrinthine fistula delivers significant hearing preservation rate along with a safe and dry ear which avoids a second look surgery.
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Affiliation(s)
- Prem Sagar
- Department of Otorhinolaryngology and Head Neck Surgery, AIIMS, ENT Office- 4057, 4thfloor, Teaching Block, New Delhi, 110029 India
| | - K Devaraja
- Department of Otorhinolaryngology and Head Neck Surgery, AIIMS, ENT Office- 4057, 4thfloor, Teaching Block, New Delhi, 110029 India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, AIIMS, ENT Office- 4057, 4thfloor, Teaching Block, New Delhi, 110029 India
| | - Sumanth Bolu
- Department of Otorhinolaryngology and Head Neck Surgery, AIIMS, ENT Office- 4057, 4thfloor, Teaching Block, New Delhi, 110029 India
| | - Suresh C Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, AIIMS, ENT Office- 4057, 4thfloor, Teaching Block, New Delhi, 110029 India
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Aggarwal S, Das SN, Sharma SC, Devaraja K. Abstract A01: Vascular endothelial growth factor (VEGF) expression in patients with oral squamous cell carcinoma and its effects on tumor cell growth. Mol Cancer Ther 2015. [DOI: 10.1158/1538-8514.tumang15-a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: VEGF plays an important role in tumor growth, development and progression by promoting angiogenesis. However its role in oral carcinogenesis is not established. In the present study we investigated serum and tissue expression of VEGF in oral cancer patients and its correlation with clinicopathological parameters; as well as with tumor cell proliferation using OSCC cell lines.
Materials and Methods: Cell and tissue expression of VEGF was determined by qRT-PCR, western blot and immunofluorescence assay while serum level of VEGF was determined by ELISA. Tumor cell proliferation was assessed by MTT assay.
Results: VEGF mRNA in tissue was significantly upregulated in tumor area compared to normal area of the same specimen as observed by qRT-PCR (R=7.28±1.40; p= 0.029) and western blot assay (p=0.0345). Significantly higher expression of VEGF was observed in sera of oral cancer patients (p<0.0001) as compared to normal controls. Serum VEGF levels further showed positive correlation with clinical stage and lymph node involvement. In ROC analysis serum VEGF level distinguished between patients and normals with a higher sensitivity and specificity of 65.71% and 66.67% respectively. OSCC cell lines showed higher expression of VEGF and significantly higher proliferation in response to exogenous VEGF in in vitro assay.
Conclusion: Result of the present study indicates a significant role of VEGF in development, establishment and distant spread of oral cancer, besides tumor cell proliferation. Hence serum level of VEGF may be useful for diagnostic and prognostic purposes as well as potential target for development of chemopreventive agents for oral cancer.
Note: This abstract was not presented at the conference.
Citation Format: Sadhna Aggarwal, Satya N. Das, Suresh C. Sharma, K Devaraja. Vascular endothelial growth factor (VEGF) expression in patients with oral squamous cell carcinoma and its effects on tumor cell growth. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Angiogenesis and Vascular Normalization: Bench to Bedside to Biomarkers; Mar 5-8, 2015; Orlando, FL. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl):Abstract nr A01.
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Affiliation(s)
| | - Satya N. Das
- All India Institute of Medical Sciences, New Delhi, India
| | | | - K Devaraja
- All India Institute of Medical Sciences, New Delhi, India
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Aggarwal S, Devaraja K, Sharma SC, Das SN. Expression of vascular endothelial growth factor (VEGF) in patients with oral squamous cell carcinoma and its clinical significance. Clin Chim Acta 2014; 436:35-40. [DOI: 10.1016/j.cca.2014.04.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/09/2014] [Accepted: 04/28/2014] [Indexed: 01/28/2023]
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Devaraja K, Sikka K, Kumar R, Thakar A. Sinonasal malignancies: long term follow up after surgical management-an analysis of outcomes. Indian J Otolaryngol Head Neck Surg 2014; 67:28-33. [PMID: 25621228 DOI: 10.1007/s12070-014-0742-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/10/2014] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Sinonasal malignancies are rare and survival analysis in affected patients is arduous and perplexing due to various factors. In this review article, attempt has been made to overcome some of those factors while analysing survival outcomes. AIMS AND OBJECTIVES The aim of this study was to share the experience of a tertiary care centre in the surgical management of sinonasal malignancies over 12 years. MATERIALS AND METHODS This study is a retrospective chart review, and in this study, hospital records of 58 patients with biopsy proven sinonasal malignancies were studied. Only the patients undergoing primary or salvage surgery at our institution from May-2000 to April-2012 with a minimum follow up of 2 years were included. Statistical analyses such as means, proportions, Kaplan-Meier analysis and Cox's regression model were done. RESULTS Majority of the patients were males (n = 43) belonging to fourth and fifth decades. Squamous cell carcinoma was the most common (n = 17) histopathological type, followed by adenoid cystic carcinoma (n = 14). Majority presented with stage IV disease (n = 42). 17 patients were operated for recurrent disease. Over all 5 year survival was 72 % and disease free survival was 44 %. Separate analysis for epithelial and matched non-epithelial group showed poorer prognosis with epithelial group (p = 0.0120). Multivariate analysis showed histopathological type (epithelial) and presence of pathological risk factors (positive margins and/or perineural invasion) affecting survival. CONCLUSIONS Advanced stage presentation is the norm for sinonasal malignancies. This study noted a 5 year overall survival of 72 % and disease free survival of 44 %. Epithelial histopathology carries poorer prognosis then other counterparts and incomplete removal is shown to add to poor prognosis independently.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology Head and Neck Surgery,, All India Institute of Medical Sciences, Room No. 4057, 4th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India
| | - Kapil Sikka
- Department of Otorhinolaryngology Head and Neck Surgery,, All India Institute of Medical Sciences, Room No. 4057, 4th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India
| | - Rajeev Kumar
- Department of Otorhinolaryngology Head and Neck Surgery,, All India Institute of Medical Sciences, Room No. 4057, 4th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India
| | - Alok Thakar
- Department of Otorhinolaryngology Head and Neck Surgery,, All India Institute of Medical Sciences, Room No. 4057, 4th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India ; Department of ENT, All India Institute of Medical Sciences, Room No. 4067, 4th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India
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