Hitesh Rajendra Singhavi

Oral potentially malignant lesions are often underdiagnosed, leading to malignant transformation, progression, and spread of disease. It is also responsible for poor survival outcomes. To save these life years, early detection is a must. Unfortunately, it requires specialist access in many clinical settings. For faster, uniform screening, a quantitative approach, the oral biopsy score (OBS), has been formulated for risk stratification and sooner decision making. The OBS consists of risk factors such as tobacco/alcohol/areca nut use, size of the lesion, morphology, duration, location, and induration of the lesion. Each of these categories has an upper and lower score assigned. Depending on the added score, the inference will guide us in performing the biopsy or keeping it under surveillance. We advocate for validation of the OBS through multicentric prospective studies to assess its diagnostic performance. Incorporation into artificial intelligence-assisted image analysis will enhance the accuracy of the diagnosis. Ultimately, we believe the OBS can play a pivotal role in early detection of oral cancer, leading to reduction in morbidity and improvement in survival.

Objective: Tracheo‐innominate artery fistula (TIF) is a rare but devastating complication of tracheostomy. A systematic review was performed with the aim of identifying the factors associated with favorable outcomes in cases of TIF post‐tracheostomy.Data Sources: Literature search conducted using PubMed/Medline, Semantic Scholar, OpenAlex, Scopus, and Google Scholar.Review Methods: The studies describing the development of TIF as a complication of tracheostomy were included. Various demographic and clinical variables, diagnostic and therapeutic approaches, and patient outcomes were analyzed.Results: The clinical details of 148 cases were extracted from 113 articles meeting the inclusion criteria. The median time between tracheostomy and TIF development was 79.5 days. Sentinel bleeding was present or probably present in 65 (43.92%) cases and was followed by hemorrhage within a week in 41 (27.7%) cases. Radiological modalities were found to have a better diagnostic probability (80.0%) than bronchoscopy (31.48%). Immediate management by cuff overinflation alone was successful in hemorrhage control in 70.59% of instances. Endovascular and open surgical techniques were equally successful in the definitive management of TIF. The interval between tracheostomy and presentation of TIF, and the modality of initial management significantly affect patient survival.Conclusion: This systematic review highlights the importance of anticipation and assessment of risk factors, ensuring early recognition and instituting prompt intervention in cases of TIF. Further research is recommended to better understand the biomechanics of TIF, improve tracheostomy tube designs, and develop standardized management protocols.

Background: Delay in diagnosis of head and neck cancers is responsible for advanced presentation of the disease leading to increased morbidity and mortality. Methods: A questionnaire-based prospective observational study consisting of 150 patients was performed in a tertiary care center established in North India. The factors responsible for professional and patient delay including demographic details and the clinical examination findings, health-related behavior, socio-economic status based on modified Kuppuswamy’s scale, and the health care factors were also evaluated. Results: The mean age of the patients at the time of diagnosis was 48.32 years (S.D: 12.467 and range 27–80 years). Male patients showed predominance with a ratio of 11.5:1. Buccoalveolar cancers were the most common sites, whereas 55% had nodal metastasis and 70% were advanced stage cancers. Overall advanced stage patients (p < 0.02) and node positive patients (p < 0.04) were present significantly more in those with the physician’s delay (P1D). There was higher P1D in patients with no tobacco habits (76.9% vs 53.3%) (p < 0.05). Self-motivated individuals had significantly shorter patient delay (p < 0.00); however, physician delay was similar. Conclusion: Circumventing physicians delay by training and capacity building of the general physicians will lead to early diagnosis and timely treatment of the head and neck cancer patients.

Background Tracheostomy is a common procedure in head and neck cancer surgical treatment, entailing substantial financial and healthcare burdens. This prospective study examines the impact of specialized tracheostomy ward (STW) on decannulation times (DT) and length of hospital stay (LOS). Methods A specialized tracheostomy care unit was established, incorporating educational, patient-centric, and organizational interventions. Data from 88 head and neck surgery patients who underwent tracheostomy were analyzed. Key variables included sex, age, DT, and LOS. Results STW reduced DT, with significant differences between male and female patients (7.92 vs. 11.82 days) (p = < 0.05). LOS was also longer for STW-treated females as compared to male (8.81 vs 11.07). Elderly patients experienced longer DT 11.38 vs 7.62 days (p = 0.029) but similar LOS (p < 0.19). Conclusion STW significantly improved DT and vocalization times, reducing critical incidents and maintenance costs as compared to historical cohorts documented in the literature. Moreover, it enhanced patient outcomes and bed turnover rates, underscoring the importance of specialized tracheostomy care units in head and neck cancer management.

Background: To determine the characteristics of oral erythroplakia (OE) on a global scale, it is important to analyse and evaluate findings from various studies conducted across multiple geographical locations. Objectives: This review was conducted to determine the prevalence and malignant transformation rate (MTR) of OE. Data Sources: A systematic search was performed to identify studies reporting the prevalence and MTR of OE across various databases – PubMed, Web of Science, Google Scholar, Elsevier and ScienceDirect without any restriction for the time of publication. Study Eligibility Criteria: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, and the protocol was registered in the PROSPERO database (ID: 42023395215). Results: The prevalence rate of OE reported across the studies ranged from 0.04% to 1.14% with a mean of 0.25 + 0.002%. The MTRs reported across the studies included ranged from 2.6% to 65% with a mean of 30 ± 0.2%. Limitations and Conclusions: Based on the findings from the present review, it can be concluded that while the range of MTRs of OE varies widely across different geographical locations, the average rate can be considered 30%. The review also identified a need for conducting more studies on the prevalence rates as well as longitudinal studies assessing the MTR across different regions.

Background: Extracapsular spread (ECS) is the extension of cancer cells beyond the lymph node capsule and is a significant prognostic factor in head and neck cancers. This meta-analysis compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. Methodology: The authors conducted a systematic review and meta-analysis of studies that compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. They included studies that were published between 1990 and December 2023 and that used histopathology as the reference standard for ECS. Results: The pooled sensitivity and specificity of CT scan were 0.63 (95% CI = 0.53–0.73) and 0.85 (95% CI = 0.74–0.91), respectively. The pooled sensitivity and specificity of MRI were 0.83 (95% CI = 0.71–0.90) and 0.85 (95% CI = 0.73–0.92), respectively. The pooled sensitivity and specificity of PET were 0.80 (95% CI = 0.74–0.85) and 0.93 (95% CI = 0.92–0.94), respectively. The pooled sensitivity and specificity of USG were 0.80 (95% CI = 0.68–0.88) and 0.84 (95% CI = 0.74–0.91), respectively. MRI had significantly higher sensitivity than CT scan (p-0.05). The specificity of CT and MRI was not significantly different (p-0.99). PET scan had the highest specificity among all imaging modalities. Conclusion: MRI is the most accurate imaging modality for detecting ECS in head and neck cancers. CT scan is a reasonable alternative, but PET scan may be considered when high specificity is required. USG may not add any further benefit in detecting ECS.

The overall outcome of head and neck cancer (HNC) patients undergoing any treatment modality may significantly depend upon their general nutritional condition. Poor nutritional status leading to sarcopenia may be a negative prognostic factor in determining the outcome of HNC patients. PubMed database was searched to identify studies published between 2015 and 2022. All studies reporting the index for sarcopenia as well as its effect on HNC were included. This narrative review was conducted to specifically evaluate the impact of sarcopenia on HNC patients undergoing surgery/ free flap reconstruction/ adjuvant treatment. In oncology, computed tomography assessment of skeletal mass at C3 and L3 is the most suitable index to detect sarcopenia. From the articles yielded, the prevalence rate of sarcopenia ranges from 6 to 70% worldwide. Indian population presents with a significantly higher rate of 31.5% sarcopenia HNC patients. Sarcopenic patients have an increased propensity for surgical site infections, as high as 24.6% owing to the reduced skeletal muscle mass. These patients are also prone to have frequent breaks during radiation treatment of more than 1 week and increased chemotherapy-related toxicities. Further, sarcopenic individuals tend to have higher Ryle's tube dependency of more than 90 days. Sarcopenic patients undergoing surgery have a poor overall survival (OS) and disease-free survival (DFS). In terms of hazards ratio, sarcopenic patients have 1.96 times poor OS and 2.00 times poor DFS when compared to normal individuals who undergo HNC surgery. Sarcopenia is an indispensable part of cancer ailment and it is an independent factor negatively influencing DFS and OS. Thus, nutritional strategy needs to be developed to mitigate sarcopenic effects, especially in the Indian population in preoperative setting.