No abstract

Perineural invasion is an underrecognized route of metastatic spread along the nerve bundles within the nerve sheath into the surrounding tissues. It hinders the ability to establish local control as tumour cells can traverse along nerve tracts well beyond the extent of any local invasion rendering them inoperable and unresectable. Perineural invasion is a marker of poor prognosis. Oral submucous fibrosis with oral cancer constitutes a clinicopathologically distinct disease. Our case highlights an enigmatic presentation of oral submucous fibrosis and its coexistence with oral cancer presenting with unusual neurological disturbance of the inferior alveolar nerve and facial nerve and diffuse widening of the mandibular canal. The objective of this case report is to enumerate the significance of perineural invasion in determining the course of the disease and necessitate the need for future studies that can shed light on molecular mediators and pathogenesis of perineural spread.

Objective:To evaluate the four commonly used incisions for Radical Neck Dissection on the basis of certain defined parameters. Patients and Methods:The investigators designed and implemented a prospective comparative study composed of patients with oral squamous cell carcinoma. The predictor variable was time taken to raise and close the flaps, accessibility to the neck lymph nodes, injury to vital structures and scar cosmesis followed up to a period of three months. Descriptive statistics were computed. Results:The sample was composed of 40 patients grouped as follows: Macfee Incision (=10 patients), Modified Macfee Incision (=10 patients), Modified Schobinger Incision (=10 patients) and Reverse Hockey Stick Incision (=10 patients). Group A, consisiting of the patients with Macfee Incision, took the least time to close among all the groups ( Mean= 32.60 minutes) while Group C (patients with Modified Schobinger Incision) required the most time for closure ( Mean= 51.90 minutes). The Modified Schobinger Incision provided best exposure to neck node levels. The Macfee Incision was found to have the best scar cosmesis among the four incisions. Conclusion:The results of this study suggest that Modified Schobinger Incision is the preferred incision for adequate access to neck lymphatics while Macfee Incision was found to provide the best scar cosmesis.

Schwannomas are benign tumors arising from the Schwann cells of nerve fibers. They are extremely rare in the pelvis accounting for only 1-3% of all schwannomas. These tumors are nonaggressive, slow growing, solitary neoplasms with an extremely low possibility of malignant transformation or recurrence after excision. We present a case of a 19 years old male with complaints of radiating pain from lower back to the left thigh associated with altered bowel and bladder habits. Following a detailed work up he underwent laparotomy and mass excision. Histopathological report revealed presacral schwannoma. Post-surgery patient improved symptomatically and is on regular follow up. There are a smaller number of cases of presacral schwannoma reported in the literature. Due to its outlandish striking presentation, diagnosis is very challenging. Although presacral schwannoma is rare, it should be considered as a differential diagnosis in the back of the mind of a surgeon while dealing a case of pelvic mass. In symptomatic and asymptomatic cases, surgical excision is the mainstay of treatment of these tumors.