To assess and compare the outcomes of tail of parotid ligation with circumferential sutures versus 2-Octyl-cyanoacrylate glue application in patients undergoing neck dissection for squamous cell carcinoma of oral cavity - a prospective comparative study

To Assess and Compare the outcomes of tail of parotid ligation with circumferential sutures versus 2-Octyl-cyanoacrylate glue application in patients undergoing neck dissection for Squamous cell carcinoma of oral cavity .

 INTRODUCTION:-

 Head and neck cancer remains a significant global public health problem and with the presence of cervical lymph node metastasis it is associated with increased morbidity and diminished overall survival rate. So effective management of neck leads to improved disease specific and overall survival rate in Oral squamous cell carcinoma cases. Neck dissection is a surgical procedure performed in treating head and neck cancer patients with or without cervical nodal neck metastasis. Depending on the location and extent of tumor the type of neck dissection and its complications varies.

During a neck dissection many surgeons will include the parotid tail within the superior extent of the dissection. The transected portion of the parotid gland might be at risk of causing a sialocele and subsequent salivary fistula post neck dissection. Post-operative sialocele and salivary fistula formation is a frequent complication following major head and neck cancer management with incidence varying from 5 to 20% in the literature.

Salivary fistulas result in significant morbidity for the patient, increasing the length of hospital stay, risk of readmission, need for adjuvant procedures, and perhaps most importantly, often delaying the time to adjuvant therapy which compromises oncologic outcomes other risk factors such as preoperative radiation with or without chemotherapy, poor nutritional status, co-morbidities, may also influence the likelihood of fistula formation. Sometimes iatrogenic trauma to parotid gland may results in extravasation of saliva in the soft tissues with subsequent formation of sialoceles, cutaneous fistulas or cysts of the salivary duct.

With an understanding of the anatomical and physiologic constraints an extra barrier over the parotid gland can reduce the incidence of postoperative salivary fistula formation. Parotid ligation using vicryl and chromic sutures have been tried in the past but the results are not to that extent. Some studies have used natural (i.e. fibrin-based sealants) for parotid ligation but fibrin based products offer greater pliability but reduced adhesion and stiffness which led to post operative fistula formations. While most surgeons are aware of the demonstrated efficacy of surgical sealants in cutaneous surgical incision closure, their utility in other surgical sites is often less well recognized. Synthetic sealants provide greater stiffness and adhesion with minimal elasticity and tissue toxicity. So in this study we are using a synthetic sealant n octyl cyanoacrylate for parotid ligation versus circumferential sutures to assess and compare the outcomes in patients undergoing neck dissection for management of oral squamous cell carcinoma.