Base Of Tongue Research Articles

Distinct H3F3A Driver Mutation Defines Giant Cell Tumor of Bone: A Necessary Adjunct in the Diagnosis of Such a Lesion in the Hyoid Bone, Presenting as a Base of Tongue Mass

<h3>Introduction</h3> Giant cell tumor of bone (GCTB) is a rare benign tumor mostly affecting the epiphyses of long bones in skeletally mature patients that is rarely described in the head and neck. Conventionally, diagnosis is based on microscopic features, exclusion of mimics, and clinico-radiologic correlation. Morphologic overlap with numerous giant cell-containing lesions of bone and soft tissue complicates the diagnosis. GCTB is characterized by the <i>H3F3A</i> mutation, which can be detected immunohistochemically using H3.3 G34W, a monoclonal antibody specific for this mutation. <h3>Case Findings</h3> A 57-year-old male presented with dysphagia, dysarthria, and right base of tongue (BOT) mass suspicious for carcinoma. Imaging revealed a heterogeneous parapharyngeal lesion extending from BOT to the hyoid bone. A BOT biopsy demonstrated giant cell-rich granulation tissue and non-endothelial lined blood lakes, suggestive of aneurysmal bone cyst (ABC). Fluorescent in situ hybridization (FISH) analysis did not identify <i>USP6</i> rearrangement, effectively eliminating primary ABC and favoring secondary ABC. Base of tongue resection, partial pharyngectomy and hyoid bone resection followed. <h3>Results</h3> Microscopically, the resection revealed a giant cell-rich lesion emanating from the hyoid bone, suggestive of GCTB and thus unlikely soft tissue giant cell tumor. Cellular pleomorphism and atypical mitoses were absent. Stromal cells expressed H3.3 G34W, confirming the diagnosis of GCTB. Zonal features of secondary ABC were juxtaposed to the dominant GCTB. <h3>Conclusions</h3> Hyoid GCTB is exceedingly rare, and such a diagnosis presents a conundrum. H3.3 G34W nuclear staining is an indicator of <i>H3F3A</i>mutation in GCTB that can help distinguish GCTB from other mimics. Prior reports of hyoid GCTB did not employ ancillary studies to identify <i>H3F3A</i> mutation or <i>USP6</i> rearrangements, as these have only been recently available. Our case fulfills current diagnostic criteria for GCTB, and excludes other giant cell-rich lesions. Accurate diagnosis of GCTB in this atypical location allows for appropriate surveillance algorithms.

Demographic, tumor and treatment factors of oral/oropharyngeal cancer in Alberta, Canada

<h3>Introduction</h3> Oral and oropharyngeal cancers have high morbidity and mortality worldwide. Distinct differ- ences exist between oropharyngeal and oral cancers; the former increasing in incidence and the later decreas- ing. The aim of this study was to determine demographic profiles, tumor characteristics and treatment factors of oral/oropharyngeal cancer in the adult population of Alberta, Canada. <h3>Methods/materials</h3> Information regarding oral/oropharyngeal cancer incidence in Alberta residents older than 18 years from 2005-2017 was extracted from the Alberta Cancer Registry database. Demographic factors included gen- der, diagnosis age, diagnosis date, age at death, vital status, death cause and geographic zone diagnosis. Tumor factors included location/site, morphology, histologic grade and clinical stage. Treatment modality was examined. Descriptive statistics was done using SPSS. <h3>Results</h3> 4069 oral/oropharyngeal cancer cases were identified. The mean (SD) age at diagnosis was 62.1 (13.3) years. 53.5% of diagnoses were made between 46-65 years of age, and 68.5% of patients were male. The number of reported oral cancer cases increased from 231 in 2005 to 398 in 2017. Most common cancer sites were tonsil (20%), tongue (19.1%), and base of tongue (15.8%). 78.6% of tumors were squamous cell carcinoma and variants and 39.1% of tumors were moderately-differentiated. 55.7% of cases were diagnosed at stage IV. Most common initial treatments were surgery (63.1%) and radiation (57.6%). As of 2017, 54.3% of patients in the study were reported alive. The main oral cancer-related deaths occurred in patients with tongue (13.9%), base of tongue (9.2%) and tonsil (9.1%) cancers. <h3>Conclusions</h3> There was a higher incidence of oral cancer in older males. Diagnoses were made at advanced stages. Higher mortality was associated with locations/sites that are difficult to examine. These findings are similar to other jurisdictions and support the need for early detection through screening examinations, increased awareness of oral/oropharyngeal cancer and earlier access to care.

Base of tongue metastasis of cutaneous malignant melanoma masquerading as a pedunculated reactive lesion. Report of a case with rhabdoid and neuroendocrine features

<h3>Objectives</h3> Metastatic melanoma (ΜΜ) represents a highly aggressive malignancy associated with poor prognosis. ΜΜ has a propensity to microscopically resemble other neoplasms by displaying diverse morphologic variations. Herein, we present a case of cutaneous melanoma metastatic to the base of tongue clinically mimicking a reactive pedunculated lesion and histopathologically exhibiting unusual rhabdoid and neuroendocrine features. <h3>Findings</h3> A 63-year old male presented for evaluation of a painless tongue mass of 5 months duration. The patient had been surgically treated for cutaneous melanoma of the right chest 5 years ago. Clinically, a pedunculated, soft, partially ulcerated, hemorrhagic mass involving the left base of tongue was noted. With a provisional diagnosis of pyogenic granuloma or other reactive lesion, an excisional biopsy was performed. Histopathologic examination revealed invasion of the connective tissue by clusters of epithelioid and/or plasmacytoid neoplastic cells with prominent eosinophilic nucleoli and various degrees of cytoplasmic melanin pigmentation. Interestingly, a small subset of cells showed rhabdoid morphology. Most tumor cells expressed Melan-A, HMB-45, SOX-10, and S-100, while cells with rhabdoid morphology were positive for Myo-D1. Chromogranin and synaptophysin were also positive in a few scattered cells. A final diagnosis of ΜΜ with rhabdoid and neuroendocrine features was rendered. Molecular investigation revealed mutations for the BRAF V600E gene, while multiple brain metastatic foci were detected on further diagnostic work-up. <h3>Conclusions</h3> Divergent differentiation of melanoma cells may cause diagnostic pitfalls necessitating thorough immunohistochemical analysis. The presence of rhabdoid cells, although infrequent in primary melanomas, is relatively common in metastatic tumors. Furthermore, neuroendocrine differentiation in melanomas is very uncommon and its co-existence with rhabdoid features is exceedingly rare. Better characterization of such histopathologic variations in melanomas with evaluation of their potential biologic significance is warranted.

Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy in the treatment of perianal fistulas in Crohn's disease (PISA-II): a patient preference randomised trial

Guidelines on Crohn's perianal fistulas recommend anti-tumour necrosis factor (TNF) treatment and suggest considering surgical closure for patients with surgically amenable disease. However, long-term outcomes following these two strategies have not been directly compared. The aim of this study was to assess radiological healing in patients who received short-term anti-TNF treatment and surgical closure compared with those who received anti-TNF treatment alone. The PISA-II trial was a multicentre, patient preference study done in nine hospitals in the Netherlands and one hospital in Italy. Adult patients with Crohn's disease and an active high perianal fistula with a single internal opening were eligible for inclusion. After counselling, patients with no treatment preference were randomly assigned (1:1) using random block randomisation (block sizes of six without statification), to 4-month anti-TNF therapy and surgical closure or anti-TNF therapy for 1 year, after seton insertion. Patients with a treatment preference received their preferred therapy. The primary outcome was radiological healing assessed by MRI at 18 months, defined as a complete fibrotic tract or a MAGNIFI-CD (Magnetic Resonance Index for Fistula Imaging in Crohn's Disease) score of 0, assessed according to the intention-to-treat principle. Secondary outcomes included clinical closure, number of patients undergoing surgical reintervention and number of reinterventions, recurrences, and impact on quality of life measured by the Perianal Disease Activity Index (PDAI). Analyses were performed on an intention-to-treat basis and additionally an as-treated analysis for radiological healing and clinical closure. This study was registered at the Dutch Trial Registry, NL7625, and with EudraCT, 2018-002064-15, and is closed to accrual due to completion. Between Sept 14, 2013, and Dec 7, 2019, 94 patients were enrolled onto the trial, of whom 32 (34%) were randomly assigned and 62 (66%) chose a specific treatment. 38 (40%) patients were assigned to the surgical closure group and 56 (60%) patients to the anti-TNF group. At 18 months, radiological healing was significantly more common in the surgical closure group (12 [32%] patients) than in the anti-TNF group (five [9%] patients; p=0·005). By contrast, clinical closure was not significantly different between the two treatment groups (26 [68%] patients in the surgical closure group vs 29 [52%] patients in the anti-TNF group; p=0·076). Significantly fewer patients required a reintervention in the surgical closure group than in the anti-TNF therapy group (five [13%] patients in the surgical closure group, median one reintervention [IQR one to three] vs 24 [43%] patients in the anti-TNF group, median two reinterventions [one to two]; p=0·005). Among patients who reached clinical closure during follow-up, four (14%) of 29 in the surgical closure group and five (16%) of 31 in the anti-TNF therapy group had a recurrence, which occurred only in patients without radiological healing. PDAI was significantly lower in the surgical closure group than in the anti-TNF group after 18 months (p=0·031). Adverse events and serious adverse events were similar in both treatment groups and mostly entailed reinterventions. Ten (11%) patients had side-effects associated with anti-TNF treatment. Two serious adverse events unrelated to study treatment occurred (appendicitis and myocardial infarction). One patient died from a tongue base carcinoma, unrelated to study treatment. Short-term anti-TNF treatment combined with surgical closure induces long-term MRI healing more frequently than anti-TNF therapy in patients with Crohn's perianal fistulas. These data suggest that patients with Crohn's perianal fistula amenable for surgical closure should be counselled for this therapeutic approach. Netherlands Organisation for Health Research and Development and Broad Medical Research Program.

Distribution of Laryngopharyngeal Malignancy in the North-East Part of Bangladesh: Fiberoptic Laryngoscopic (FOL) Study of 300 Cases

Introduction: In Bangladesh, laryngeal and hypopharyngeal cancers in 2018 were 3.3% and 4.7% of total cancer cases, 2.6% and 2% of total cancer deaths. Fiber optic laryngoscopy (FOL) has been established as a valuable tool for diagnosis in outpatient department (OPD) setting. The primary objective of this study was to see the distribution of laryngeal and hypopharyngeal cancers and secondary objective was to assess the role of Flexible Endoscopic Biopsy (FEB) in the diagnosis of laryngopharyngeal cancers. Methods: This descriptive cross-sectional study was performed from March 2020 to March 2021 at Mount Adora Hospital, Sylhet, Bangladesh. All suspected patients attending in this hospital for FOL and FEB were included in this study. Results: Total 300 patients of laryngopharyngeal growth were included in this study. The age of the patients ranged from 25 to 100 years with a mean age of 58.1 year (SD=11.8). Male: Female ratio was 4.8:1. Hypopharyngeal growth was most common (47.3%) followed by laryngeal (31.7%) and tongue base growth (21%). In laryngeal growth, supraglottic was more common (69.47%). In hypopharyngeal growth, pyriform fossa was the most common site (88.3%). Synchronous pathology was found in two patients (0.67%). FEB was obtained from 95% of cases. Histopathological examination showed 95.85% positive for malignancy. Sensitivity of FEB was 95.8%. All malignancies were squamous cell carcinoma (100%). Conclusion: Supraglottic region is the most common site for laryngeal cancers and pyriform sinus is the most common site for hypopharyngeal cancers. FEB is highly sensitive in acquiring a definite diagnosis. J Bangladesh Coll Phys Surg 2022; 40: 99-104

Epidemiology and Prognostic Indicators of Survival in Tongue Lymphoma.

Lymphoma, categorized as either non-Hodgkin's lymphoma or Hodgkin's lymphoma, is the second most common malignancy in the head and neck. Primary tongue lymphoma is exceedingly rare, with only case reports or small case series in the literature. This population-based analysis is the first to report the epidemiology and prognostic factors of survival in patients with primary tongue lymphoma. The Surveillance, Epidemiology, and End Results 18 database from the National Cancer Institute was queried for patients diagnosed between the years 2000 and 2016 with tongue lymphoma. Outcomes of interest were overall and disease-specific survival. Independent variables included age at diagnosis, sex, race, marital status, primary subsite, histologic subtype, stage, and treatment type. Seven hundred forty patients met criteria; the male-female ratio was 1.5:1 and the mean age at diagnosis was 67.8 years. The majority of lesions localized to the base of tongue (90.0%), were histologically diffuse large B-cell lymphoma (59.5%), and presented at stage I or II (77.9%). Most early-stage lymphomas were treated with chemotherapy only (40.5%) or a combination of both chemotherapy and radiation (31.3%), while late-stage cancers were primarily treated with chemotherapy alone (68.5%). In multivariate analysis, younger age at diagnosis, female sex, married/partnered marital status, mucosa-associated lymphoid tissue histologic subtype, and earlier cancer stage were found to be associated with improved survival. Chemotherapy treatment with or without radiation was also associated with better survival compared to no treatment or radiation alone, though data regarding immunotherapy was unavailable.

Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation

ObjectiveDysphagia is a common symptom in Parkinson's disease (PD) and it represents a negative prognostic factor because of its complications. This study is to evaluate pharyngeal dysphagia for boluses of various consistencies with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Pharyngeal High-Resolution Manometry (PHRM) in a group of PD patients, making a comparison between the information provided by the two exams. MethodsGroup of 20 patients affected by PD was selected and initially subjected to a qualitative evaluation of the swallowing performing FEES. Subsequently, they were evaluated by PHRM to identify quantitative measures associated with pressures expressed by pharyngeal organs during swallowing. Values obtained in the study group were compared with those recorded in a group of 20 healthy subjects. ResultsStudy showed that Pmax (the maximum pressure elicited by the single pharyngeal muscle structures involved in swallowing) was significantly lower than the control group (p<0.05) for all the boluses and consistency tested, in particular for the Tongue base and the Cricopharyngeal muscle. Pmean pre-swallowing pressure (represents the mean value of a contraction in which basal and maximal pressure where normally calculated) was significantly higher compared to normal subjects for the Tongue base and the Cricopharyngeal muscle (p<0.05). Mean intra-swallowing pressure was higher for the Velopharynx and the Cricopharyngeal muscle, but lower for the tongue base. Pmax and Pmean at PHRM were altered independently to the degree of dysphagia detected at FEES, and they did not correlate either with the location of the residue or with the type of bolus. Images displayed at the FEES, found the corresponding biomechanical explanations in the PHRM, which also allowed us to quantify the extent of the dysfunction, through the calculation of the pressures generated in the various structures studied. ConclusionPHRM is particularly useful in the early detection of dysphagia, when FEES may still show no evidence of abnormal swallowing.

Managing a Fibroepithelial Polyp of the Tonsil

A 17-year-old man was noted to have a left tonsil mass when he attended his family physician with tonsillitis. Following treatment with a course of penicillin his tonsillitis resolved but the mass persisted albeit asymptomatic. Review by an ENT specialist confirmed a smooth oval pedunculated mass arising from the superior pole of the left tonsil (Figure 1 and Figure 2). The mass was freely mobile and rested at the tongue base.

Impact of Oral Cavity Dosimetry on Patient Reported Xerostomia and Dysgeusia in the Setting of Deintensified Chemoradiotherapy

PurposeTo determine the relationship between mean oral cavity (OC) dose (treated as a singular organ at risk) to patient reported xerostomia and dysgeusia. In addition, we will examine the relationship between oral cavity substructure doses to patient reported xerostomia and dysgeusia. All patients were treated in the setting of deintensification (60 Gy). Methods and MaterialsIn the study, 184 and 177 prospectively enrolled patients for de-escalated chemoradiotherapy (CRT) for human papillomavirus (HPV)-positive oropharyngeal cancer submitted PROs at 6 and 12 months, respectively using Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaire. Patient's OC consisting of the following substructures were segmented: oral tongue, base of tongue, floor of mouth, hard and soft palate, cheek mucosa, and upper and lower lip mucosa. Ordinal logistic regression (no/mild vs moderate vs severe/very severe symptoms) was used to compare organs at risk dosimetry to patient reported xerostomia and dysgeusia at 6 and 12 months. Multivariate ordinal logistic regression models were generated. ResultsMean dose to the contralateral parotid (P = .04), OC (P = .04), and baseline patient reported xerostomia (P = .009) were significantly associated with xerostomia severity at 6 months. Only baseline xerostomia (P = .02) and mean dose to the contralateral submandibular gland (P = .0001) were significantly associated with xerostomia severity at 12 months. The only significant factor related to dysgeusia at either time point was mean dose to the OC at 12 months (P = .009). On examining substructures, the mean dose to the floor of mouth was implicated for the dose relationship to 6-month xerostomia (P = .04), and the oral tongue was found to be implicated for the relationship for 12-month dysgeusia (P = .04). ConclusionsThe mean dose to the OC was found to relate to xerostomia symptoms at 6 months post-CRT and dysgeusia symptoms at 12 months post-CRT. The mean dose to the floor of mouth and oral tongue appeared to drive this relationship for xerostomia and dysgeusia symptoms, respectively. This work suggests the floor of mouth and oral tongue should be prioritized during planning over the rest of the OC. The effect of OC dose relative to other salivary structures for xerostomia appeared to depend on time post-CRT.

Supraglottic laryngectomy for endoscopic resection: proposal of a new classification

&lt;p class="abstract"&gt;Proposal of a new classification, which includes six types of resections, for supraglottic laser surgical treatment. Our classification defines precisely Type Ia excision as an en bloc procedure. Aside, the lateral supraglottic resections are described in detail, with type Ib, II and III modalities, which encompass excision of lateral supraglottic structures and partial paraglottic space excision, due to the potential for extension to this space present on laterally located tumors. Type IV resection refers to a complete supraglotic laryngectomy, which addresses the preepiglottic spread potential of midline supraglottic lesions. Type Va resection or arytenoidectomy is introduced, leaving types Vb and Vc as previously described cordectomies. A new concept of palliative procedures types VIa and VIb is presented, according to invasion to supraglottic structures and/or tongue base extension in T3-T4 lesions. A classification should be understandable, reproducible and easy to interpret, so that it facilitates comparison of results and potentially translates into better oncologic outcomes. Laser resection of the supraglottis must not be consider curative for all patients, objective are different according to the stage, so the present classification include: Partial,, Extended and Palliative Delbulking Resection.&lt;/p&gt;

Aspiration Patterns Observed in Patients With Free Flap Reconstruction Following T3 and T4 Tongue and Oropharyngeal Cancer Surgery: A Fiberoptic Endoscopic Evaluation of Swallowing

Background and Objectives The objectives of this study were to investigate the aspiration patterns in patients with T3 and T4 oral and oropharyngeal cancers after free flap reconstruction following primary tumor resection and determine the effect of tongue base resection on aspiration patterns in these patients.Subjects and Method The aspiration pattern was evaluated via fiberoptic endoscopic evaluation of swallowing and classified into three groups based on the timing of aspiration in relation to the swallowing process. More than two types of aspiration patterns observed simultaneously in a patient suggested combined aspiration pattern.Results The major pattern of aspiration in 31 patients with oral cavity cancer was aspiration after swallowing in the group with base of tongue (BOT) preserved (83.3%, 10/12) and combined aspiration in the group with BOT resection (63.2%, 12/19), showing a significant difference in aspiration pattern between the two groups (p&lt;0.001). In oropharyngeal malignancies, the major pattern of aspiration was aspiration after swallowing in both BOT-preserving (87.5%, 21/24) and BOT-resecting groups (75.0%, 9/12), showing a significant difference in aspiration pattern between the two groups (p=0.031).Conclusion The most common pattern observed in the advanced T stage tongue cancer patients after glossectomy was aspiration after swallowing. Resection of BOT greater than 25% in the tongue and oropharyngeal cancer was a significant factor causing the combined type of aspiration.

Diagnostic Accuracy of FNA to Determine HPV Status in HPV-Associated Oropharyngeal Squamous Cell Carcinoma

<h3>Purpose/Objective(s)</h3> Accurate diagnosis of human papillomavirus (HPV) status in oropharyngeal squamous cell carcinoma (OPSCC) changes prognosis and can alter the treatment plan. Biopsy with fine needle aspiration (FNA) of cervical adenopathy is often performed during initial workup for OPSCC patients. FNA is limited by the amount of tissue obtained via small needle diameter and frequently requires repeat biopsies to determine HPV status. We evaluated the diagnostic accuracy of FNA biopsies to determine HPV status. <h3>Materials/Methods</h3> Consecutive patients with known HPV-associated OPSCC at a single institution between 2015 and 2021 were retrospectively analyzed. Demographic, clinical, and pathologic details were extracted from the electronic medical record for descriptive statistics. Patients with lymph node metastases undergoing initial biopsy with FNA were included. Pathology samples underwent central review and immunohistochemistry staining for p16 was used as a surrogate marker for HPV status. <h3>Results</h3> Two hundred ninety new cases of OPSCC were evaluated. FNA of lymph node metastases was the initial diagnostic procedure in 153 (52.8%) patients with median age at diagnosis of 57.0 (range 31.7 – 82.0). The population was mostly male (90.2%) with tumors most commonly located in the base of tongue (45.1%) and tonsil (42.5%). Initial FNA was positive for malignancy in 115/153 (75.2%) patients and non-diagnostic in 38/153 (24.8%). P16 staining on diagnostic FNA showed: 54/115 (47.0%) p16 positive, 6/115 (5.2%) p16 negative, 55/115 (47.8%) p16 indeterminate. In patients without a diagnosis of malignancy or p16 indeterminate, repeat FNA was performed in 30/93 (32.3%) patients. Of the repeat FNA patients: 7/30 (23.3%) remained non-diagnostic for malignancy, 16/30 (53.3%) p16 positive, 7/30 (23.3%) p16 indeterminate. In summary, 93/153 (60.8%) patients undergoing initial FNA and 14/30 (46.7%) undergoing repeat FNA were non-diagnostic of malignancy or p16 indeterminate. The final yield of FNA biopsies to determine malignancy status or p16 status was 76/153 (49.7%). <h3>Conclusion</h3> HPV-associated OPSCC patients undergoing FNA for initial diagnosis frequently are not diagnostic for malignancy or are indeterminate for p16 status, requiring repeat FNA or biopsy of the primary site. This can potentially cause treatment delay and increase morbidity and cost to the patient.

Neuroendocrine Neoplasms of the Oropharynx—A Literature Review

<h3>Purpose/Objective(s)</h3> Neuroendocrine neoplasms (NEN) are a diverse group of rare tumors. The most common primary sites are gastrointestinal tract and lung, though these neoplasms can occur throughout the body. Neuroendocrine neoplasms of the head and neck are rare, with those of the oropharynx being especially uncommon. Case studies and small series make up most of the literature on oropharyngeal neuroendocrine tumors, and there is no clear consensus on how to treat these unique cancers. Therefore, we aim to explore the current literature describing neuroendocrine neoplasms of the oropharynx. <h3>Materials/Methods</h3> A comprehensive search of several databases including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, and Scopus from inception to May 19, 2021 was conducted. Inclusion criteria included diagnosis of neuroendocrine neoplasm of the tonsil, base of tongue, soft palate, or posterior pharyngeal wall with histopathology available for review. Cases with distant metastatic disease at presentation, review papers, large database studies, papers not in English, papers without outcomes of interest reported, and conference abstracts were excluded. Information including patient demographics, symptoms at presentation, radiologic findings, diagnostic approach, treatment approach, and outcomes were recorded. <h3>Results</h3> The search resulted in 1,154 papers. After title and abstract screening, 93 papers qualified for full review, with 28 were included ultimately in our review. In these papers, 52 unique cases were identified. The average age at presentation was 62 years. Of the patients identified, 73% were male (n=38), 25% were female (n=13), and 2%were unspecified (n=1). The most common site was the tonsil at 36% (n= 21). This was followed by 35% in the tongue base (n=18), 17% in the oropharynx (unspecified) (n=10), 2% in the soft palate (n=1), and 3% unknown primary sites (n=2). The most common histology was small cell neuroendocrine carcinoma at 45% (n= 26). HPV status was reported in 24 patients, with 75% being HPV positive (n=18) and 25% HPV negative (n=6). Treatment modalities varied, with definitive therapy being the most common, in 19 cases. <h3>Conclusion</h3> Neuroendocrine neoplasms of the head and neck are a rare subtype of oropharyngeal cancer, and there is limited data available to drive treatment. More work is needed to elucidate guidelines for how to treat these rare tumors.

Impact of Upper Airway Characteristics on Disease Severity and CPAP Therapy in Chinese Patients With OSA: An Observational Retrospective Study.

ObjectiveThe characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the association of UA characteristics with OSA severity, titration pressure, and initiation of and 3-month compliance with continuous positive airway pressure (CPAP).MethodsThis retrospective study included consecutive patients examined using a semi-quantitative UA evaluation system (combination with physical examination and awake endoscopy) during 2008–2018 at the Department of Respiratory and Critical Care Medicine, Peking University First Hospital. First, the differences in UA characteristics were compared between patients with simple snorers and mild OSA and those with moderate-to-severe OSA. Then, the effect of UA characteristics on the initiation to CPAP therapy and 3-month adherence to CPAP was conducted.ResultsOverall, 1,002 patients were included, including 276 simple snorers and patients in the mild OSA group [apnea-hypopnea index (AHI) <15] and 726 patients in the moderate-to-severe OSA group (AHI ≥15). Tongue base hypertrophy, tonsillar hypertrophy, mandibular recession, neck circumstance, and body mass index (BMI) were independent risk factors for moderate-to-severe OSA. Among those patients, 119 patients underwent CPAP titration in the sleep lab. The CPAP pressures in patients with thick and long uvulas, tonsillar hypertrophy, lateral pharyngeal wall stenosis, and tongue hypertrophy were higher than those of the control group (P < 0.05, respectively). The logistic regression analysis showed that nasal turbinate hypertrophy, mandibular retrusion, and positive Müller maneuver in the retropalate and retroglottal regions were independent predictors for the initiation of home CPAP treatment.ConclusionMultisite narrowing and function collapse of the UA are important factors affecting OSA severity, CPAP titration pressure, and the initiation of home CPAP therapy. Clinical evaluation with awake endoscopy is a safe and effective way for the assessment of patients with OSA in internal medicine.

Inclusion body myositis and dysphagia. Presentation, intervention and outcome at a swallowing clinic.

This study reviewed patients with inclusion body myositis who were referred for assessment of dysphagia at a tertiary swallow clinic. It describes symptoms at presentation, imaging and management strategies. A retrospective review of electronic patient records was performed between 2016 and 2020. Twenty-four patients were included, with a mean age of 72 years. Baseline modified Sydney Swallow Questionnaires identified problems with hard or dry food, food sticking, and repeated swallowing. Twenty-two patients had a Reflux Symptom Index score that could indicate significant reflux. Video swallow identified specific problems, including tongue base retraction (96 per cent) and residual pharyngeal pooling (92 per cent). Seven patients (30 per cent) had features of aspiration on imaging despite a median penetration-aspiration scale score of 2. Four patients received balloon dilatation, and two patients underwent cricopharyngeal myotomy. This study helped to profile features of dysphagia in patients with inclusion body myositis. More evidence is needed to determine the most effective management pathway for these patients.

High Superior-Middle Pharyngeal Constrictor Muscle Mean Dose Correlates with Severe Late Lung Infection and Survival in Nasopharyngeal Cancer Patients.

PurposeThe study aimed to evaluate 1) the correlation of doses of swallowing-related organs at risk (OAR) with severe swallowing-related late adverse effects (AE) in nasopharyngeal carcinoma (NPC) patients and 2) the effect of high mean doses of OARs on overall survival (OS).Patients and MethodsThis retrospective cohort study enrolled non-metastatic Stage I–IV NPC patients from January 2012 to June 2017. OAR mean doses and severe (≥G3) swallowing-related late AE (xerostomia, dysphagia, and lung infection) were evaluated by t-test and validated using receiver operating characteristic curves. The risk factors of OS were calculated by Cox regression methods.ResultsThis study enrolled 185 (43 female, 142 male) NPC patients, mean age 52.4 years, primarily with Stage III (93, 50.3%) or Stage IV (67, 36.2%) disease. The mean doses of pharyngeal constrictor muscle (PCM), superior-middle PCM (SMPCM), and superior PCM (SPCM) were significantly higher in those with severe (≥G3) lung infection than in those without (65.7 vs 62.2 Gy, p = 0.036; 68.1 vs 64.2 Gy, p = 0.015; and 70.0 vs 65.9 Gy, p = 0.012, respectively). Patients with severe (≥G3) dysphagia had significant higher mean doses of base of tongue (56.2 vs 50.2 Gy, p = 0.008), laryngeal box (50.6 vs 46.4 Gy, p = 0.036), PCM (65.4 vs 62.1 Gy, p = 0.008), SMPCM (67.1 vs 64.2 Gy, p = 0.014), and SPCM (69.3 vs 65.8 Gy, p = 0.004). Mean SMPCM dose >64.9 Gy (adjusted hazard ratio [aHR] = 3.2, 95% confidence interval [CI] 1.2–8.8, p = 0.021), age >62 years (aHR = 2.7, 95% CI 1.1–6.9, p = 0.032), N3 status (aHR = 4.0, 95% CI 1.8–9.0, p = 001), and severe late AE of lung infection (aHR = 4.6, 95% CI 1.5–14.0, p = 0.007) significantly affected OS.ConclusionSevere lung infection and dysphagia were associated with significantly higher mean doses of PCM, SMPCM, and SPCM. Among these OARs, only a high SMPCM mean dose was a risk factor for OS in NPC patients.

Facial Artery Musculomucosal Flap Operative Techniques.

Regional flaps are an important component of the reconstructive ladder and represent a versatile option in reconstructing various oral cavity defects. An axial buccal flap based on the facial artery, the facial artery musculomucosal flap, was first described by Pribaz et al. and has been shown to have good functional outcomes with minimal morbidity. Indeed, other surgeons have praised its favorable arc of rotation, reliability, and role as an alternative to free tissue transfer, with shorter duration of general anesthesia and allowance for earlier postoperative mobilization. The facial artery musculomucosal flap has significant versatility, as it can be superiorly or inferiorly based and can be performed in either single- or two-stage fashion. It is of particular advantage for reconstruction of the oral cavity (retromolar trigone, hard palate, alveolar ridge, lip, tongue, and floor of mouth), oropharynx (tongue base, lateral pharynx, and soft palate), and sinonasal structures. Despite its advantages, its widespread use has been limited by a lack of familiarity and difficulty in safely raising a reliable flap consistently. The senior author (S.C.D.) has successfully utilized a high volume of facial artery musculomucosal flaps with a low complication rate in a broad array of oral cavity and oropharyngeal defects. In this article, the authors share technical details on how to harvest and inset this flap by incorporating key landmarks in a reliable fashion.

Temporal trends of women with oral cavity, base of tongue and lip cancers in Brazil: An ecological study covering mortality data from 1980 to 2018.

Obtaining robust evidence about the local mortality levels, trends and impact of oral cavity/base of tongue cancers and lip cancer, especially for women, is imperative in the fight against cancer. This descriptive retrospective ecological time-series study explored trends in oral cavity/base of tongue cancers and lip cancer mortality rates for women in Brazil from 1980 to 2018, by geographic region and anatomical location. The crude and age-adjusted annual mortality rates were obtained by sex, anatomical location and macro-regions of Brazil. The number of deaths from oral cavity/base of tongue cancers and lip cancers in Brazil was based on official population counts and estimates. The annual percentage change was calculated based on age-adjusted rates. Data set were analysed using the Joinpoint Regression program. A total of 81,918 individuals died of oral cavity/base of tongue cancers and lip cancer between 1980 and 2018 in Brazil. The age-adjusted mortality rate for women was 0.47 and 0.57 per 100,000 in 1980 and 2018, respectively. The cumulative female mortality rates standardized by age were 0.01/100,000 for lip cancer and 0.5/100,000 for oral cavity and base of tongue cancers. A decrease in deaths related to oral cavity and base of tongue cancers was identified in the 1980s; however, over the last two decades, there has been an increase in the number of deaths of women with cancer at the base of tongue and neighbouring areas and on the floor of mouth. Importantly, Brazilian regions showed wide variability in trends of oral cavity, base of tongue and lip cancers rate and, in 2018, the regions with the highest rates were the Southeast, South and Northeast for both sexes and specifically for women. The North region showed the greatest recent significant upward trend. During the last 38years, Brazil has shown a significant increase in the trend of the mortality rate due to oral cavity/base of tongue and lip cancers in women. Preventive strategies with control of risk factors should be strongly emphasized in order to improve the survival rates of individuals with oral cavity/base of tongue and lip cancers.

TORS as Part of Multilevel Surgery in OSA: The Importance of Careful Patient Selection and Outcomes.

Transoral robotic surgery (TORS) for Obstructive Sleep Apnea (OSA) is a relatively young technique principally devised for managing apneas in the tongue base area. This study summarizes and presents our personal experience with TORS for OSA treatment, with the aim to provide information regarding its safety, efficacy, and postoperative complications. A retrospective study was conducted on patients undergoing TORS with lingual tonsillectomy through the Da Vinci robot. The effectiveness of the surgical procedure was assessed employing the Epworth Sleepiness Scale (ESS) and overnight polysomnography with the Apnea-Hypopnea Index (AHI). A total of 57 patients were included. Eighteen patients (31.6%) had undergone previous surgery. The mean time of TORS procedure was 30 min. Base of tongue (BOT) management was associated with other procedures in all patients: pharyngoplasty (94%), tonsillectomy (66%), and septoplasty (58%). At 6 months follow-up visit, there was a significant improvement in AHI values (from 38.62 ± 20.36 to 24.33 ± 19.68) and ESS values (from 14.25 ± 3.97 to 8.25 ± 3.3). The surgical success rate was achieved in 35.5% of patients. The most frequent major complication was bleeding, with the need for operative intervention in three cases (5.3%). The most common minor complications were mild dehydration and pain. TORS for OSA treatment appears to be an effective and safe procedure for adequately selected patients looking for an alternative therapy to CPAP.

Cystic lymphangiomas of the tongue: 3 rare cases and a literature review of classifications and therapeutic possibilities

BackgroundCystic lymphangiomas of the tongue are rare. The treatment consists of complete resection and management is generally interdisciplinary due to vital, functional, and esthetic comorbidities.This work is a report of three rare cases of cystic lymphangioma of the tongue, with curious mode of presentation and good outcome, as well as a literature review of clinical features, classifications, and therapeutic possibilities.Case presentationThis work presents three patients. The first one presented with a lymphangioma in the junction between base and body of tongue; the clinical aspect was first similar to hemangioma, and then the diagnosis was re-established after slight enlargement of the mass. The patient was treated with sclerotherapy with great outcome.The second patient presented with a large lymphangioma which presented a clinical resemblance with a tumor of the tongue, the diagnosis was established upon radiological aspect and confirmed upon histological findings.The third patient presented with a macroglossia which appeared 3 years after excision of the cystic hygroma of the neck; the patient was surgically treated with excellent outcome.ConclusionCystic lymphangiomas are rare hamartomatous lymphatic malformations, and they have a predilection for head and neck but the lingual localization is quite rare. Treatment is complete excision. Management is generally interdisciplinary. The main objective is to prevent alteration to function, to treat esthetic comorbidities, and prevent speech impediment especially in very young children.This is the cases of three young children with a rare lingual cystic lymphangioma, with adapted treatment and satisfactory outcome, with a literature review of clinical presentation, classifications, and therapeutic approaches.