LAUSR

A 63-year-old man with a 20-year history of right torticollis and atlantoaxial rotational deformity (figure 1) presented with complaints of a non-healing painless ulcer over the right lateral aspect of tongue and difficulty swallowing for the preceding 3 months. On examination, an ulceroproliferative growth was noted on the right lateral border of tongue, involving the floor of mouth, outer alveolar border of mandible and crossing the midline without reaching the base of tongue. There was no palpable cervical lymphadenopathy bilaterally. An edge biopsy from the lesion revealed squamous cell carcinoma (SqCC) and a staging workup was initiated. Routine haematological investigations and chest X-ray were normal, however, a direct fibreoptic endoscopy revealed another exophytic growth in the left pyriform fossa (PFS) and a biopsy revealed SqCC. The patient underwent an MRI (face and neck) (figure 2a-b), and the case was discussed in our multidisciplinary tumour (MDT) board meeting. The patient was staged as synchronous dual primary of the head and neck, and each site was staged separately (tongue, cT4acNcM, AJCC stage IVa; PFS, cT2cNcM, AJCC stage II). The specific issues discussed in the MDT were: (1) appropriate management of the dual primaries; (2) challenges posed by the spinal deformity on intraoperative anaesthesia and postoperative care and (3) difficulties in radiotherapy target delineation due to unusual anatomy. Figure 1 (A–D) Multiplanar 3D volume rendered, DRRs from the CT dataset, in AP, lateral and top-down views, demonstrate right lateral deviation of the cervical spine. Each cervical vertebra has been rendered in a separate colour to highlight the deformity (C1-white, C2-yellow, C3-cyan, C4-green, C5-purple, C6-orange, …