Biomedical subjects
Publications and source records attributed to Kumar Alok Pathak.
Cancer of buccal gingival sulcus lie in close proximity to mandible but tend to invade bone late in the course of disease. Segmental mandibulectomy advocated for these tumors results in cosmetic disfigurement and functional impairment. We, for the first time, describe a mandibular preservation alternative, in form of buccal cortical plate excision, for these tumors.
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Selective neck dissection (I-III) for oral cancers offers similar regional control rates with less morbidity as compared with modified radical neck dissection. Charts of 414 patients with oral cancer, who underwent selective neck dissection (I-III) during 1994-2001, were analysed retrospectively. Seventy nine percent of the patients had a primary tumour in the gingivo-buccal complex. Cancer of tongue showed a trend towards higher regional failure (12.3%) as compared to gingivo-buccal cancers (6.5%). Primary tumour was staged as T1-8%, T2-47%, T3-19% and T4-26%. Sixty five percent of the patients were clinically node negative. Isolated neck failure was observed in 4.8% of patients at 2 years and in 5.8% at 5 years. De-differentiation of primary tumour and perineural spread were associated with regional failures. Eighty three percent of the neck recurrences were in the ipsilateral neck and only 16% of these were at levels IV or V. In all, 30% of all regional failures were outside the field of dissection.
BACKGROUND: Carcinoma of the gingivobuccal complex is commonly associated with the use of smokeless tobacco known as "quid." METHODS: We conducted a retrospective chart review of 511 patients with advanced cancer of gingivobuccal complex surgically treated during 1994 to 1995. We evaluated patterns of disease failure in these patients and correlated disease-free survival with various prognostic factors. RESULTS: During a median follow-up of 46 months, 159 locoregional recurrences and 11 distant metastases were detected in 148 patients. Seventy-nine percent of the recurrences appeared within 18 months of surgery, and the median survival for patients with recurrent disease was less than 4 months. Two-year and 5-year disease-free survival rates were 64% and 57%, respectively. On multivariate analysis, disease-free survival showed significant correlation with skin involvement and extracapsular spread. CONCLUSIONS: Gingivobuccal cancers usually fail locoregionally. Soft tissue infiltration and extracapsular spread of nodal disease influence disease-free survival.
The surgical treatment in early cancers of the lower gingivobuccal (GB) complex involves wide resection of the buccal mucosa and GB sulcus with or without marginal mandibulectomy. To reconstruct this defect we endeavour to describe a method of advancement of the lateral floor of mouth and tongue to provide pliable, vascularised tissue to bridge the mucosal defect and achieve tension free, primary closure whilst preserving maximum tongue mobility and maintaining adequate mouth opening, thus offering an elegant and simple solution to the problems of reconstruction in early lesions of the lower gingivo buccal complex.
A 66-year-old man presented with a maxillary carcinoma manifesting as unrelenting spontaneous cerebrospinal fluid (CSF) rhinorrhea. Anterior craniofacial resection of the tumor was performed with multilayered repair of the dura mater. Maxillary carcinoma usually manifests as nasal blockage, epistaxis, or a mass lesion. This case highlights the necessity for a high index of suspicion for malignant tumor and the need for meticulous repair of the dura mater to seal off the CSF leakage.
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