Migrating foreign bodies in the aerodigestive tract are uncommon but can pose serious complications. Long-standing migrating foreign bodies can exist manifesting chronic and unusual symptoms such as chronic cough, recurrent episodes of dyspnoea and fever. Adverse body reactions to foreign objects such as adhesions can cause difficulty in their diagnosis, localisation and removal. A thorough clinical and radiographical approach is of immense value in such cases. We report two difficult cases of migrated foreign bodies: a 2-year-old child with a long-standing foreign body that migrated to the upper mediastinum, and an adult patient with a fish bone that migrated to the oropharyngeal muscles. Presentations of these cases were not alike, with chronic unusual recurrent symptoms in one and typical acute symptoms in the other. The diagnosis and precise localisation of both foreign bodies was challenging, and an open approach was employed to remove them.
Background: Advanced head and neck cancers are often treated with Chemo-radiation (CT-RT) in an attempt for organ preservation. Loco regional failure following CT-RT is a major challenge for surgical salvage especially in the neck which constitutes bulk of the cases. Aim: To determine the salvage strategy for the management of post CT-RT recurrent squamous cell carcinoma of head and neck region with emphasis on the role of salvage neck dissection with its complications. Methods: This is a retrospective analysis of 105 cases with post CT-RT recurrent cancer of head and neck from 2005 to 2014. Patients were divided into three groups based on the site of recurrence; primary only (I), primary with neck (II) and only neck (III). Imaging was done in all cases. Surgical salvage was performed in all patients. The specimens were assessed for any perineural, peri-vascular, dermal and muscle spread. 3 patients received reirradiation after 1 year. Results: 36 cases in group I, 28 cases in group II and 41 cases in group III. 1 year disease specific survival rate was calculated using Kaplan Meier and data analyzed with STATA 13. It was 83.84% for group-I, 56.25% for group II and 60.8% for group III. Patients in group II and III performed poorly. Extra-capsular spread, muscle invasion, peri-vascular involvement, peri-neural spread and dermal spread was assessed after salvage surgery. Conclusions: Post CT-RT patients always have a poor prognosis and especially when associated with neck recurrence.
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