Qualification: 
MS, MCh
subu@aims.amrita.edu

Dr. Subramania Iyer K. currently serves as Professor & Head at the Department of Head & Neck Surgery, School of Medicine, Kochi.

Qualification : MS (Otorhinolaryngology), MCh (Plastic Surgery), FRCS

Publications

Publication Type: Journal Article

Year of Publication Publication Type Title

2018

Journal Article

N. Subramaniam, Deepak Balasubramanian, Low, T. - H., Murthy, S., Clark, J. R., Thankappan, K., and Dr. Subramania Iyer K., “Factors Affecting Survival in Surgically Salvaged Locoregional Recurrences of Squamous Cell Carcinoma of the Tongue”, Journal of Oral and Maxillofacial Surgery, 2018.[Abstract]


Purpose: To determine the factors affecting outcomes in surgically salvaged, locoregionally recurrent squamous cell carcinoma of the tongue (SCCT). Materials and Methods: In a retrospective cohort of patients who underwent successful salvage of locoregionally recurrent SCCT, we performed this observational analytical study to determine survival and its determinants. Details extracted from our database were patient characteristics (age, gender, tobacco use), treatment characteristics, and characteristics of recurrent disease (stage and adverse pathologic features [APFs] such as grade, perineural invasion, and lymphovascular invasion). Overall survival (OS) curves were plotted using the Kaplan-Meier method. A Cox proportional hazards model was used to determine the impact of patient, disease, and treatment characteristics on OS. Results: Of 52 patients with locoregional recurrences of surgically treated SCCT, 25 (48.1%) underwent surgical salvage with curative intent. The median overall OS for this cohort was 26 months. Factors predictive of worse OS were previous adjuvant therapy (P = .016) and increasing APFs in recurrent tumor histology (P = .008). Lymphovascular invasion in recurrent tumor histology and patients with a disease-free interval of less than 6 months showed worse survival (P = .008 and P = .058, respectively). Conclusions: Among patients with locoregional recurrence, the number who are eligible for curative-intent surgical salvage is small. Those who received previous adjuvant therapy and those with increasing APFs in recurrent tumors had poor outcomes despite attempts at surgical salvage, particularly patients with early recurrence. © 2018 American Association of Oral and Maxillofacial Surgeons.

More »»

2017

Journal Article

N. Subramaniam, Deepak Balasubramanian, Murthy, S., Limbachiya, S., Thankappan, K., and Dr. Subramania Iyer K., “Adverse pathologic features in early oral squamous cell carcinoma and the role of postoperative radiotherapy-a review”, Oral Surg Oral Med Oral Pathol Oral Radiol, vol. 124, no. 1, pp. 24-31, 2017.[Abstract]


The use of postoperative radiotherapy (PORT) in early stage oral cancer with adverse pathologic features (APFs) is controversial. Prognostically relevant APFs reviewed were perineural invasion, lymphovascular invasion, depth of invasion, worst pattern of invasion, and margin status. The current literature remains divided with regard to the benefit of treatment escalation in these patients; although these patients are at high risk for recurrence, the morbidity of PORT needs to be balanced against the likely benefit in disease control. A wide heterogeneity in the literature exists, likely as a result of differences in treatment protocols. We performed a literature review of the role of PORT in early-stage oral cancer with APFs. Based on the current evidence, the decision to administer adjuvant therapy needs to be made on an individual basis; patients with >1 APF are likely to benefit from PORT, and the use of risk-scoring systems may help in decision making.

More »»

2016

Journal Article

Dr. Subramania Iyer K., Thankappan, K., and Balasubramanian, D., “Early detection of oral cancers: Current status and future prospects”, Current Opinion in Otolaryngology and Head and Neck Surgery, vol. 24, pp. 110-114, 2016.[Abstract]


Purpose of review: This article reviews the current literature and summarizes the latest developments in screening and early detection of oral cancers and looks at the future possibilities. Recent findings: Oral cancer is the best model for screening and prevention. The screening for oral cancer can be population based, opportunistic, or targeted. A long-term 15-year follow-up data of a randomized controlled study from a developing country setting indicated a sustained reduction in oral cancer mortality in high-risk individuals. Visual oral examination remains the mainstay in the screening. Several adjunctive techniques have been described to aid in the clinical examination of these lesions. A Cochrane review revealed that there is no evidence to recommend these adjuncts in clinically visible lesions. Salivary biomarkers seem to be promising as a tool for screening in the future. A Targeted Evidence Update for the US Preventive Services Task Force found no evidence on screening either in the general or selected high-risk population for oral cancer in the United States or on benefit of any adjunctive device affecting the performance of the screening examination. Summary: Current evidence shows that community based screening has a value in reducing the oral cancer mortality in high-risk group of population. But this evidence may not be universally applicable. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

More »»

2016

Journal Article

S. Bhattacharya, Vidhyadharan, S., Dr. Krishnakumar T., and Dr. Subramania Iyer K., “Cross-Cheek Dumbbell-Shaped Radial Forearm Flap for Simultaneous Correction of Oral Cancer and Submucous Fibrosis”, Craniomaxillofac Trauma Reconstr, vol. 9, no. 2, pp. 162-5, 2016.[Abstract]


Simultaneous occurrence of oral submucous fibrosis along with carcinoma of the buccal mucosa is common. We report a novel technique of a single dumbbell-shaped, cross-cheek radial forearm free flap to repair bilateral defects caused by oral cancer resection on one side and the release of fibrosis on the other side in two patients. The dumbbell-shaped flap provided tissue for both the buccal mucosa defects and central released soft palate preventing fibrosis and reapproximation. The interincisor distance improved in both the patients.

More »»

2014

Journal Article

S. Vidhyadharan, Augustine, I., Kudpaje, A. S., Dr. Subramania Iyer K., and Dr. Krishnakumar T., “Site-wise Differences in Adequacy of the Surgical resection Margins in Head and Neck Cancers”, Indian journal of surgical oncology, vol. 5, no. 3, pp. 227–231, 2014.[Abstract]


Adequacy of surgical resection decided by the margin status is important in attaining a good local control and better survival in Head and neck Cancers. Conventionally, a measured distance between the tumor edge and the cut edge of the specimen is taken as the margin. A margin more than 5 millimeter (mm) is considered clear, less than 5 mm is close and less than one mm is denoted as involved. The concept of this adequacy varies between the different sites and subsites in head and neck. The purpose of this paper is to review the current evidence that describes the adequacy of surgical margin status and their variability among the sites and sub-sites in the head and neck. More »»

2013

Journal Article

M. Sharma, Balasubramanian, D., Thankappan, K., Sampathirao, C. L., Mathew, J., Chavre, S., and Dr. Subramania Iyer K., “Propeller flaps in the closure of free fibula flap donor site skin defects”, Annals of Plastic Surgery, vol. 71, pp. 76-79, 2013.[Abstract]


The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It allows for reconstruction of both bone and soft tissue defects. In head and neck reconstruction, the skin paddle harvested along with the flap allows for the reconstruction of skin or oral mucosal defects. After skin paddle harvest, the donor site can be closed primarily or with skin grafts. Grafting the donor area is the common method used. However, this could lead to delayed healing because of the poor graft over the area of peroneal tendons. Propeller flaps have been extensively reported for closure of leg skin defects. We report a series of 10 patients in whom we used a local propeller flap for the closure of the fibula flap skin donor site. The donor defects could be satisfactorily closed without the need of a skin graft in 9 patients. This method is simple, reliable, and suitable for closing small to medium defects. Copyright © 2013 by Lippincott Williams & Wilkins.

More »»

2013

Journal Article

D. Balasubramanian, Thankappan, K., Shetty, S., Jayaprasad, K., Mathew, J., and Dr. Subramania Iyer K., “Cricotracheal reconstruction with free radial forearm flap and titanium mesh”, Head and Neck, vol. 35, pp. E178-E180, 2013.[Abstract]


Background Reconstruction after partial cricotracheal resection is technically demanding and is seldom reported in literature. The purpose of this study was to report a technique of reconstruction of such a defect with a radial forearm flap supported by a titanium mesh. Methods A 75-year-old man who was diagnosed with a case of papillary carcinoma thyroid, underwent excision of the tumor with a partial cricotracheal resection. The defect was reconstructed with a free radial forearm flap with fascia suspended on a titanium mesh. Results At a follow-up of 6 months after treatment, the patient has normal nasal breathing and an acceptable voice. Conclusion This reconstructive technique enabled us to maintain the integrity of the subglottic airway. Our technique was unique in that we used the skin-lined part of the radial forearm flap to line the airway and the fascia to cover the titanium mesh outside, thereby preventing plate exposure. © 2012 Wiley Periodicals, Inc.

More »»

2013

Journal Article

D. Balasubramanian, Dr. Subramania Iyer K., and Thankappan, K., “Tracheoesophageal puncture site closure with single perforator-based deltopectoral flap”, Head and Neck, vol. 35, pp. E60-E63, 2013.[Abstract]


Background Tracheoesophageal puncture (TEP) combined with a voice prosthesis is commonly used for voice production in postlaryngectomy patients. In certain cases, however, leakage occurs around the prosthesis. Many techniques have been described to correct this problem. Surgical closure of the puncture site has to be done if the conservative techniques fail. We present the use of the pedicled deltopectoral flap on the basis of a single perforator in the closure of these fistulae. Methods The reported technique was used in 6 patients over a period 8 years from 2004 to 2011. Results The technique was successful in 5 patients. In 1 case there was dehiscence at the leading edge of the flap because of severe local wound infection. Conclusion The novel technique described by us avoids the need for layered closure or dissection of the trachea and esophagus. It is simple and reliable and provides durable results. © 2011 Wiley Periodicals, Inc.

More »»

2012

Journal Article

Dr. Subramania Iyer K., Chatni, S., and Kuriakose, M. A., “Free tensor Fascia Lata-Iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect”, Annals of Plastic Surgery, vol. 68, pp. 52-57, 2012.[Abstract]


Reconstruction of maxillectomy with extensive orbital rim and floor excision defects is a challenging problem. The goal of reconstruction here is to provide adequate orbital support to prevent enophthalmos and diplopia as well as obturation of the palatal defect. The existing methods of the reconstruction fail to simultaneously address these 2 goals of reconstruction. A new method of reconstruction of these defects using tensor fascia lata-iliac crest flap was used in 7 cases of cancers of the maxilla, which necessitated extensive resection of the orbital floor along with the maxillectomy. The flap was raised as a muscle and bone flap in 5 cases and in 2, a skin paddle was included. The immediate and delayed outcome at 6-month follow-up was analyzed. The functional outcome with regards to the ocular position and function, palatal obturation, speech, and swallowing were recorded. The bone viability at 6 months was assessed by computed tomography scan. The flap was successful in all the 7 cases. The delayed outcome assessment showed that the orbital support was excellent with no diplopia in all the cases. The palatal defect could be covered successfully in all the cases, resulting in normal speech and swallowing. The computed tomography scan showed excellent integration of the bone. The free tensor fascia lata-iliac crest flap is a reliable and safe method of reconstruction of the orbitomaxillary defects, addressing the issues of both orbital support and palatal obturation. © 2012 by Lippincott Williams & Wilkins.

More »»

2011

Journal Article

B. Murali, Vijayaraghavan, S., Kishore, P., Dr. Subramania Iyer K., Jimmy, M., Sharma, M., Paul, G., and Chavare, S., “Cross-chest liposuction in gynaecomastia”, Indian Journal of Plastic Surgery, vol. 44, pp. 81-86, 2011.[Abstract]


Background: Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition. Objective: Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery. Materials and Methods: The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method. Results: This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts), belonging to Simon′s Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure. Conclusions : Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar. More »»

2010

Journal Article

Dr. Subramania Iyer K. and Kuriakose, M., “Tensor Facia Lata-iliac crest osteocutaneous flap for orbitomaxillary reconstruction: A preliminary report”, Indian Journal of Plastic Surgery, vol. 43, pp. 8-13, 2010.[Abstract]


Tensor Fascia Lata muscle and musculocutaneous flap has been used in the past for reconstruction of trunk defects and also as a free flap for soft tissue reconstruction elsewhere in the body. Transferring the iliac crest along with the muscle as a free flap has been described earlier, reported for bridging calcaneal defect and small mandibular defects. The use of this flap as a source of free vascularised bone has not been widely practised since these initial few reports. Anatomical studies were carried out to assess the feasibility of using this flap for reconstructing maxillary and other head and neck defects, following which it was successfully used for these indications. The preliminary report describes the flap anatomy, method of harvest and its potential uses in head and neck reconstruction. More »»

2008

Journal Article

N. P. Trivedi, Swaminathan, D. K., Thankappan, K., Chatni, S., Kuriakose, M. A., and Dr. Subramania Iyer K., “Comparison of quality of life in advanced laryngeal cancer patients after concurrent chemoradiotherapy vs total laryngectomy”, Otolaryngology - Head and Neck Surgery, vol. 139, pp. 702-707, 2008.[Abstract]


Objective: To compare quality of life (QOL) of patients with advanced laryngeal cancers treated by total laryngectomy with those who received concurrent chemoradiotherapy. Study Design: This is a cross-sectional study of the patients treated in our institution who have completed one year of follow-up and were disease-free at the time of evaluation. Subjects and Method: Forty patients treated for advanced cancer of the larynx (stage III/IV), either by concurrent chemoradiation (11) or total laryngectomy and postoperative radiation (29), have been included in this study. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4 questionnaire was used. Results: Total scores for overall QOL are equal in both treatment groups (P = 0.69). Scores for individual components are similar in both treatment groups. However, dryness of mouth is significantly worse in the chemoradiotherapy group (P = 0.01) and ability to communicate with others is poorer in the laryngectomy group (P = 0.03). Conclusion: Long-term overall QOL remains similar in all the patients treated for advanced carcinoma of the larynx irrespective of treatment modality. © 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. More »»

207
PROGRAMS
OFFERED
5
AMRITA
CAMPUSES
15
CONSTITUENT
SCHOOLS
A
GRADE BY
NAAC, MHRD
8th
RANK(INDIA):
NIRF 2018
150+
INTERNATIONAL
PARTNERS