Rajesh A Kantharia

Abstract

The spinal accessory nerve provides motor innervation to the sternocleidomastoid and trapezius muscle. It is an extremely important structure to be preserved during neck dissection to avoid sequalae related to shoulder dysfunctions. The incidence of shoulder dysfunction and morbidity can be attributed to varied anatomy and branching pattern of the nerve or the contribution by the cervical plexus to the motor innervations of the trapezius muscle. Hence it is important to have knowledge of the varied anatomy and branching pattern of the spinal accessory nerve to avoid the possible shoulder morbidity and dysfunction following neck dissections. Lanisnik B etal’s study showed that there are three recognizable branching patterns of the spinal accessory nerve for innervation of the trapezius muscle. In type 1, the SAN enters the Sternocleidomastoid muscle and a single trapezius muscle branch exits from the posterior border of the SCM after receiving communications from the cervical nerves, especially C2 and C3. In type 2, the motor branch for trapezius muscle separates from the main trunk at level II, before the nerve enters the sternocleido-mastoid muscle. In the type 3 pattern, CN XI enters the SCM in the same way as described in type 1, and the motor branch for the trapezius muscle exits from the SCM muscle behind its posterior border; however, it does not immediately travel to level V and the trapezius muscle, but instead takes a more medial course and mixes with the cervical nerves, predominantly C2 and C3. In this case report, we will discuss an unusual branching pattern of spinal accessory nerve similar to the type 3 variant as explained by Lanisnik that we have encountered during a modified radical neck dissection, in a case of Squamous cell carcinoma of right buccal mucosa. Keywords: Spinal Accessory Nerve, Neck Dissection, Cervical plexus, Macroganglia, Star shaped variation

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Abstract

Background: Suspected growth in the region of base of tongue, pharynx, and larynx need direct/indirect laryngoscopy for establishing Diagnosis and for Staging of the disease. The Covid 19 Pandemic has severely affected these modes of examination because they are Aerosol Generating Procedures and carry very high risk of transmission of the Virus. The Department of Head And Neck Oncosurgery at KCHRC is one of the busiest department at our Institute with an average annual footfall of around 20,000 new patients. The main objective of our study is to know the role of Image Guided Biopsy/FNAC for primary diagnosis in Head and Neck Cancers. Materials and Methods: Retrospective analysis of prospectively collected data of 35 patients was done from April to September 2020. Histopathological records along with patient’s clinical records were reviewed. Results: Of the 35 patients, 23 patients underwent CT Guided biopsies, 11 patients had CT Guided FNA and one patient had USG guided biopsy. In 23 patients (CT Guided Biopsy), the biopsy was taken from tongue in 16 patients, Larynx in two patient, Pyriform sinus(PFS), posterior pharyngeal wall, RMT (retromolar trigone), lower GBS and Tonsil sites had one patient each. Of the 11 CT Guided FNAC patients, the site of FNA was from PFS in 7 patients, Tongue in 2 patients RMT and soft palate had one patient each. One patient had undergone USG Guided biopsy for PFS lesion. Out of 35 patients, tissue specimen taken was adequate in 33 patients and inadequate in two patients. The results were supported both histologically and clinically. The histological confirmation was found in 88.6% cases (31/35), squamous cell carcinoma was found in 74.3% cases (26/35), no malignancy in 8.5% cases(3/35), no specific lesion in 5.7% cases(2/35), no definitive diagnosis in 2.8% cases(1/35) and in inadequate in 8.5% cases(3/35). Repeat biopsy in one patient revealed no malignancy. There were no post procedure complications noted. Conclusion: Image guided biopsy/FNAC is a safe, reliable minimally invasive technique and can be used for primary diagnosis of Head and Neck cancers without the risk of Aerosol generation in the current Covid -19 Pandemic. Keywords : Head and Neck cancer, Image guided, Biopsy, Covid- 19.

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Abstract

The COVID 19 pandemic limited the clinical practice of Surgical Oncologists all over the world to performing emergency procedures and surgeries. During this initial period of two to three weeks we realised that further delay in the treatment of curable oral cancers would have serious adverse prognostic implications. So we started the process to formulate our own institutional guidelines to screen and test all preoperative asymptomatic oral cancer patients for COVID 19. All preoperative oral cancer patients were tested for Reverse Transcriptase Polymerase Chain Reaction (RT PCR) and a negative COVID RT PCR report was followed by HRCT Chest. We share our prospectively collected data of Oral Cancer Surgery patients from 14th April to 31st May 2020 with details of sub site, stage, operative procedure and type of reconstruction offered. Our institutional protocol to test all preoperative patients by the highly sensitive HRCT Chest combined with the gold standard RT PCR assay ensured the safety of our patients, attendants and the hospital staff. Keywords: COVID19, Oral Cancer Surgery, CORADS, RTPCR, HRCT Chest, Guidelines, Permission.

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