Buccal Mucosa Cancer Research Articles

Novel Nomogram for Prediction of Lymph Node Metastases from Buccal Mucosa Squamous Carcinoma Using Histological Parameters

Objective The aim of the study was to construct a nomogram that is easily reproducible, accurate, and cost-effective in predicting cervical lymph nodal metastasis in buccal mucosa cancer. Methodology Patients who underwent radical resection of a primary tumor of the buccal mucosa with neck dissection were enrolled. Clinical characteristics independently associated with lymph nodal metastasis in multivariate analyses were adopted to build the model. Results Patients who underwent surgery (January 2021–December 2021) were included as the model development cohort (n = 127). Depth of invasion, perineural invasion, lymphovascular invasion, and the worst pattern of invasion were independent predictors of lymph nodal metastasis. The nomogram model based on these four predictors showed good discrimination accuracy in percentage prediction of lymph nodal metastasis. Conclusion This study proposes a simple predictive model for the risk of nodal metastasis in buccal mucosa squamous cell cancer. The study has strength that, it is based on a large sample, proposed model being simple size, and based on parameters empirically supported as well as established in literature, easy to use in routine clinical practice, and cost-effective.

A new surgical strategy for T4 stage posterior buccal carcinoma: anatomical unit resection

Objective: To investigate the effect of anatomical unit resection on the overall survival rate of patients with T4 stage posterior buccal carcinoma. Methods: We conducted a retrospective study on 79 patients with T4 stage posterior buccal squamous cell carcinoma underwent radical surgery for buccal mucosa cancer and reconstruction with free anterolateral thigh flap in the Department of Oral and Maxillofacial Surgery, the Second Xiangya Hospital, Central South University from March 2014 to December 2019. The 74 patients were males and the 5 patients were females, aged from 28 to 72 years old. The 40 patients in control group underwent traditional extended resection (1.5-2.0 cm safe margin), and 39 patients in the experimental group underwent anatomical unit resection. The clinicopathological parameters of patients were collected and followed up regularly. The overall survival rate was assessed by Log-rank and Cox proportional risk regression model. Multivariate analysis was performed by linear regression model. Results: There were significant differences between experimental group and control group in overall survival rates (61.53% vs 27.50%, χ2=6.624, P=0.010) and local disease control rates (74.36% vs 27.50%, χ2=17.350, P<0.001). Multiple linear regression analysis showed that local disease control rate was significantly correlated with anatomical unit resection (t=3.880, P<0.001) and lymph node metastasis (t=2.619, P=0.011), and also Cox proportional hazards regression model analysis identified that overall survival rate was significantly correlated with anatomical unit resection (Z=2.421, P=0.016) and lymph node metastasis (Z=2.793, P=0.005). Conclusion: For posterior buccal carcinoma with multiple anatomical units involved, anatomical unit resection can significantly reduce local recurrence and improve overall survival rate of patients.

Demographic profile of head and neck cancer patients: a single tertiary institution-based study in Telangana

Background: Head and neck cancer (HNC) is a broad category of cancerous entity that arise from different types of tissues and organ sites located in the topographical areas of the head and neck (Hand N). H and N squamous cell carcinomas (HNSCC) comprises 30% of all cancer cases in India. The risk factors for HNSCC include tobacco and alcohol consumption. Methods: This study aimed to determine the demographics of HNC patients and classify the incidence of H&amp;N cancers according to the primary histological type and organ of origin along with any recent change in pattern compared with previous study. Results: Highest incidence seen in 41-50 years of age group with majority of cases belonging to urban area. Tobacco chewing was observed as most common habit. Buccal mucosa cancer was seen as most common cancer particularly at gingivo-buccal sulcus. Squamous cell carcinoma was the most common type identified on histopathology. Majority of the cancers presented in locally advanced stage. Conclusions: Male plurality of carcinoma noted indicating male being more likely to be engaged in behaviours increasing risk of carcinoma head and neck. Buccal muscosa carcinoma particularly at gingivo-buccal sulcus noted to be most common site correlating to tobacco chewing habit and keeping tobacco quid at gingivo-buccal sulcus leading to prolonged exposure.

Comparative Study to understand the Importance of Occupational Therapy, Onco Rehabilitation and Dental Prophylaxis in Head and Neck Cancer Patients

This comprehensive study conducted by Dr. Dibyendu Roy and the multidisciplinary team at Apex Hospital in Varanasi, India, sheds light on the significant impact of occupational therapy, onco rehabilitation and dental prophylaxis on the outcomes and quality of life for head and neck cancer patients, specifically those with buccal mucosa cancer who underwent hemimandibulectomy with pectoralis myocutaneous flap or antero lateral thigh flap.

Virtual surgical planning in soft tissue reconstruction for oral cancer

Introduction. Reconstruction of soft tissue defects after radical surgeries in cancer patients is important for early surgical rehabilitation and improving quality of life. Our study presents technologies for virtual surgical planning (VSP) of soft tissue defect reconstruction in patients with squamous cell carcinoma of the oral cavity.Case presentation. We described VSP in a report of a 54-year-old patient with locally advanced buccal mucosa cancer after extensive radical resection and reported the results. VSP was used to construct a 3D model from CT images, which was used to accurately assess the margin of radical surgical resection, as well as to develop individually based reconstruction of soft tissue defects. Next, we reported a series of cases of patients with oral cancer of various locations, who, after radical surgery, underwent reconstruction with using of VSP (n=7) or conventional reconstruction (n=10). A comparative analysis of intra and postoperative results was carried out.Results. In a patient with locally advanced left buccal mucosa cancer, reconstruction of the postoperative defect was successful without local complications after reconstruction. Good functional and aesthetic results were obtained. The patient was observed for 2 years without signs of disease. A comparative assessment of the results of the main and control groups showed that patients in the VSP group had a shorter operation time and postoperative hospital stay, as well as fewer and milder postoperative local complications in comparison with the control group.Conclusion. Our results showed the effectiveness of using 3D technology in reconstructive surgery of soft tissue defects after radical surgery for oral SCC. This technology has significantly reduced operative time, hospital stay, and improved flap utilization. This method has great potential for wider application and provides greater benefits with further improvement of technology.

Impact of LINC00312 gene polymorphism coupled with habitual risks on buccal mucosa cancer.

Oral squamous cell carcinoma (OSCC) is a prevalent and lethal malignancy with a diverse etiology. LINC00312 is a long intergenic non-coding RNA that functions as a signal hub to regulate the progression and treatment of head and neck cancer. The aim of this study was to evaluate the effect of LINC00312 single nucleotide polymorphisms (SNPs) on the development of oral cancer. Two LINC00312 SNPs, namely rs12497104 and rs164966, were investigated among 469 male patients with cancer of buccal mucosa and 1194 gender- and age-matched controls. No significant correlation was observed between these two SNPs and the occurrence of OSCC in the case and control groups. While assessing the clinicopathological features, carriers of at least one minor allele of rs164966 (GA and GG) were less prone to develop lymph node metastasis (adjusted odds ratio [AOR], 0.666; 95% confidence interval [CI], 0.447-0.991; p=0.045) in comparison with homozygous carriers of the major allele (AA). Subsequent stratifying surveys revealed that this genetic association with nodal spread was seen only in cases who habitually chewed betel quid (AOR, 0.616; 95% CI, 0.386-0.985; p=0.042) or smoked cigarettes (AOR, 0.612; 95% CI, 0.393-0.953; p=0.029), but undetected in cases free of these main behavioral risks. Our results indicate an interactivity of LINC00312 rs164966 with lifestyle-related risks on modulating OSCC progression.

Prognosis of South Asian Buccal Mucosa Cancer Patients in the United States: Association of Race with Overall Survival.

Squamous Cell Carcinoma (SCC) of the buccal mucosa and gingiva accounts for approximately 10% of oral and pharyngeal cancers diagnosed in the United States each year, with a disproportionally higher incidence in individuals of South Asian descent. However, little has been documented regarding trends pertaining to overall survival. Thus, this research serves to identify predictors of survival and determine if overall survival (OS) differs for South Asians compared to other races once they develop non-metastatic buccal mucosa or gingiva squamous cell carcinoma. A population-based, cohort study of patients registered in the National Cancer Database® (NCDB) between the years 2004-2016 was performed. Kaplan-Meyer Survival Curves were executed to examine overall survival, while univariable (UVA) and multivariable analysis (MVA) was performed to determine the effect of multiple variables on OS. South Asians had longer median OS at 88.7 months, compared to 58.6 months and 38.3 months for Caucasians and African Americans respectively (p<0.001). In UVA, race was highly significant, but when the cohort was selected to include only those who had undergone surgical resection, no statistically significant difference remained. On MVA, lack of surgery, older age, higher grade, higher T and N stage, use of chemotherapy, higher comorbidity scores were associated with worse OS, but race was not significant. South Asians in the US with non-metastatic buccal mucosa or gingiva SCC have better OS compared to Caucasians or African Americans, likely due to younger age at diagnosis (median 59 vs. 71 and 62 years old) and more frequent surgical resection (75% vs. 72% and 64%). In MVA, South Asians have similar OS as Caucasians.

The Islanded Nasolabial Flap: A Versatile and Reliable Flap for Reconstruction in Cancers of the Oral Cavity

On the Indian subcontinent, oral cancer represents a significant health burden. Local flaps offer a viable alternative to free flaps in specific reconstructive scenarios where free flaps may not be feasible. The islanded nasolabial flap, based on the facial artery, proves to be a robust and versatile option for single-stage reconstructions of oral cavity defects. In this study, we share our experience employing the islanded nasolabial flap at a high-volume cancer center in Central India for reconstructing buccal mucosa and tongue defects. This prospective observational study focused on approximately 76 patients diagnosed with squamous cell carcinoma of the oral cavity (specifically, the anterior 2/3rd of the tongue and buccal mucosa) at our cancer hospital between August 2021 and January 2023. Initially, 76 patients were included; however, four patients were subsequently excluded due to inadvertent facial vein injury during neck dissection caused by level IB node invasion. Consequently, 72 patients underwent islanded nasolabial flap reconstruction and were monitored for postoperative complications and functional outcomes. Our study's patients fell within the age range of 24 to 81 years, with the majority between 40 and 50 years old. Most of our patients had carcinoma affecting the anterior two-thirds of the tongue (61.11%), followed by carcinoma of the buccal mucosa (38.88%). Surgical site infection occurred in four patients (5.55%) at the donor site, and one patient (1.38%) experienced flap necrosis after tongue carcinoma surgery. However, the majority of our patients (93.05%) experienced no postoperative complications. Speech intelligibility was good for all patients (100%) with buccal mucosa cancer. A significant portion of patients (78.57%) could tolerate a normal diet, while 21.42% required a soft diet. Among patients with tongue carcinoma, 56.81% had good speech intelligibility, and 43.18% had acceptable speech intelligibility. Regarding swallowing capacity assessment, 65.90% of patients tolerated a normal diet, and 34.09% could manage a soft diet. None of our patients had poor speech intelligibility, and none depended on a liquid diet or tube feeding. This study underscores the versatility of the islanded nasolabial flap in oral cancer resection reconstruction. The islanded nasolabial flap proves to be a straightforward, effective, and reliable technique with a low incidence of complications and exceptional functional outcomes, establishing it as a valuable reconstructive option for small-to-medium-sized oral defects. This is particularly noteworthy for high-volume centers and regions with limited resources.

To study the usefulness of islanded tongue flap reconstruction for carcinoma buccal mucosa defect

Background: Carcinoma buccal mucosa is very prevalent among the Indian population. The mainstay of treatment is surgical excision, which leaves tissue defects requiring reconstruction. Various techniques and flaps have been used for reconstruction of such defects, and research is still underway for better cosmesis and functional outcomes. Aims and Objectives: The aims of this study were to assess the usefulness of an islanded tongue flap in buccal mucosa cancer defect reconstruction after segmental mandibulectomy. Materials and Methods: The present hospital-based observational study was conducted on patients with carcinoma buccal mucosa, with an age greater than 20 years and both sexes included after obtaining written and informed consent. The patients underwent islanded tongue flap reconstruction after wide local excision of tumor and segmental mandibulectomy. Results: Twenty-four patients underwent the procedure and were included in this study. The outcome of the surgery was compared in terms of deglutition and difficulty in speech on a scale of good, satisfactory, and poor. The cosmetic outcome was also compared in the same way. During the post-operative period, eight (33.33%) patients developed early complications of hematoma and pus discharge. Three (12.5%) developed wound dehiscence. Two (8.33%) of these patients also developed flap necrosis. All these complications were managed conservatively. Overall, the surgery had a good cosmetic outcome with minimal difficulty in deglutition or speech. Conclusion: Based on results, an islanded tongue flap can be regarded as a good alternative for small and medium-sized buccal mucosa cancer defect reconstruction after segmental mandibulectomy.

Efficacy of adjuvant radiation in early-stage cancers of buccal mucosa: an institutional experience.

The purpose of this study is to determine if depth of infiltration is the only risk factor that will determine the outcomes in early-stage buccal mucosa patients or do the other minor risk factors have an impact too. It is a retrospective analysis of 226 patients with early-stage buccal mucosa cancer who were treated with curative intent from 2010 to 2020. These patients were grouped in two arms, surgery alone (n = 111) and surgery followed by adjuvant radiotherapy (n = 115). Patients were followed up and local and regional recurrences and distant metastasis were recorded. Our results show that addition of radiation to the standard surgery arm improves overall survival and disease-free survival, though the improvement in overall survival was not statistically significant. This improvement was more pronounced in the depth of infiltration > 5mm and in 5mm or less depth of infiltration this benefit was not statistically significant. Other factors like perineural invasion, lymphovascular invasion, tumour size, node positive, margin positive were considered for univariate analysis. Although there was a trend towards improvement of OS and DFS, it was not statistically significant as far as these factors are concerned. The role of adjuvant radiation in early-stage cancers of buccal mucosa is a crucial tool with definitive DFS benefit and requires more prospective trials to answer the OS benefit.

A preoperative nomogram model for the prediction of lymph node metastasis in buccal mucosa cancer.

We sought to construct a nomogram model predicting lymph node metastasis (LNM) in patients with squamous cell carcinoma of the buccal mucosa based on preoperative clinical characteristics. Patients who underwent radical resection of a primary tumor in the buccal mucosa with neck dissection were enrolled. Clinical characteristics independently associated with LNM in multivariate analyses were adopted to build the model. Patients at low risk of LNM were defined by a predicted probability of LNM of less than 5%. Patients who underwent surgery in an earlier period (January 2015-November 2019) were defined as the model development cohort (n = 325), and those who underwent surgery later (November 2019-March 2021) were defined as the validation cohort (n = 140). Age, tumor differentiation, tumor thickness, and clinical N stage assessed by computed tomography/magnetic resonance imaging (cN) were independent predictors of LNM. The nomogram model based on these four predictors showed good discrimination accuracy in both the model development and validation cohorts, with areas under the receiver-operating characteristic curve (AUC) of 0.814 and 0.828, respectively. LNM prediction by the nomogram model was superior to cN in AUC comparisons (0.815 vs. 0.753) and decision curve analysis of the whole cohort. Seventy-one patients were defined as having a low risk of LNM, among whom the actual metastasis rate was only 1.4%. A robust nomogram model for preoperative LNM prediction is built.

Effectiveness of Spacers in Brachytherapy With 198Au Grains for Patients With Buccal Mucosa Cancer.

The aim of this study was to investigate the use of spacers and their efficacy in brachytherapy with 198Au grains for buccal mucosa cancer. Sixteen patients with squamous cell carcinoma of the buccal mucosa who were treated with 198Au grain brachytherapy were included. The distance between 198Au grains, distance between 198Au grains and the maxilla or mandible, and the maximum dose/cc to the jawbone (D1cc) with and without a spacer was investigated in three out of 16 patients. The median distance between 198Au grains without and with a spacer was 7.4 and 10.7 mm, respectively; this was significantly different. The median distance between 198Au grains and the maxilla without and with a spacer was 10.3 and 18.5 mm, respectively; again this was significantly different. The median distance between 198Au grains and the mandible without and with a spacer was 8.6 and 17.3 mm, respectively; the difference was significant. The D1cc to the maxilla without and with a spacer were 14.9, 68.7, and 51.8 Gy and 7.5, 21.2, and 40.7 Gy in cases 1, 2, and 3, respectively. The D1cc to the mandible without and with a spacer were 27.5, 68.7, and 85.8 Gy and 11.3, 53.6, and 64.9 Gy in cases 1, 2, and 3, respectively. No osteoradionecrosis of the jaw bones was observed in any case. The spacer enabled maintenance of the distance between 198Au grains, and between 198Au grains and the jawbone. In buccal mucosa cancer, using a spacer in brachytherapy with 198Au grains appears to reduce jawbone complications.

A closer look at the resection margins of buccal mucosa cancer: Their influence on local recurrence free survival.

The adequate surgical margin for local control of buccal mucosa squamous cell carcinoma (BMSCC) is under debate. This study investigates surgical margins and other factors associated with local recurrence free survival (LRFS) in a large cohort of BMSCC patients. Multiple factors were evaluated retrospectively in 97 patients with BMSCC. Cox-regression and Kaplan-Meier curves were used for analysis. The local recurrence rate was 23%. The tumor-free margin was <5.0 mm in 89% of the patients and the deep margin was significantly more often inadequate. Multivariate analysis associated pT3-classification, former smokers, tumor-free margin status, and postoperative (chemo)radiation (PO(ch)RT) with local recurrence. Re-resections did not improve LRFS in patients with <5.0 mm tumor-free margins. Adequate tumor-free margins are pivotal for LRFS of BMSCC. PO(ch)RT, not re-resection, can improve LRFS in patients with <5.0 mm tumor-free margins.

Multidetector computed tomography in evaluation of buccal mucosa cancer

Background: Squamous cell carcinoma is the most prevalent kind of tumor of the buccal mucosa. For the purpose of planning surgery and radiotherapy for tumors of the tongue, floor of the mouth, and oropharyx, imaging to locate the size and extent of the original tumor is essential. Therefore, it is beneficial to determine the radiation field, to ensure adequate tumor margin excision, and overall to improve the patient’s prognosis. Aims and Objectives: The aim of the study was to evaluate the role of computed tomography (CT) scan in diagnosis of buccal mucosal malignancies and its characteristics. Materials and Methods: Total 50 patients suspecting buccal mucosa cancer were referred to Radiology Department. They were subjected for CT scan examination on 16 slice CT scanner. CT scan evaluation was made for size and extent of primary mass lesion. The staging of disease was performed with TNM classification. Results: In our study, out of 50 patients, the fourth decade (30%) and fifth decade (26%) saw the highest incidence of buccal mucosa cancer. The majority of the patients were suffering from severe disease; 44% had T4 stage and 58% had Stage IV. Conclusion: CT plays a very important role in staging of buccal mucosa malignancy and effectively detects bone erosion (98% sensitive) and invasion to infratemporal fossa. However, during the early stages of cancer, a CT scan might not be very helpful.

Improving Vibrational Spectroscopy Prospects in Frontline Clinical Diagnosis: Fourier Transform Infrared on Buccal Mucosa Cancer.

We report a novel method with higher than 90% accuracy in diagnosing buccal mucosa cancer. We use Fourier transform infrared spectroscopic analysis of human serum by suppressing confounding high molecular weight signals, thus relatively enhancing the biomarkers’ signals. A narrower range molecular weight window of the serum was also investigated that yielded even higher accuracy on diagnosis. The most accurate results were produced in the serum’s 10–30 kDa molecular weight region to distinguish between the two hardest to discern classes, i.e., premalignant and cancer patients. This work promises an avenue for earlier diagnosis with high accuracy as well as greater insight into the molecular origins of these signals by identifying a key molecular weight region to focus on.

EXAMINATION OF THE EFFECT OF SMOKING ON CHEEK CELLS AT A MICROSCOPIC LEVEL

Oral cancer is lifestyle-related cancer, with the consumption of tobacco as a primary factor. The purpose of this study is to determine the impact of smoking on the cheek cells of an individual, using scrapings containing exfoliated buccal cells to correlate the microscopic ndings and observations with the period for which each participant smoked and the frequency of their consumption of tobacco. The association between cells showcasing alterations and indication of buccal mucosa cancer with an abnormally large nucleus to cytoplasm ratio and the time period for which the respective participant has been exposed to smoking is examined. Behaviour intervention to quit smoking may be accelerated if the global public is made aware of risk factors for developing cancer of oral mucosa. Thus, proving the need for increased research on the same.

Nomogram predicting long-term overall and cancer-specific survival of patients with buccal mucosa cancer

BackgroundFew models about the personalized prognosis evaluation of buccal mucosa cancer (BMC) patients were reported. We aimed to establish predictive models to forecast the prognosis of BMC patients.MethodsThe complete clinicopathological information of BMC patients from the surveillance, epidemiology and end results program was collected and reviewed retrospectively. Two nomograms were established and validated to predict long-term overall survival (OS) and cancer-specific survival (CSS) of BMC patients based on multivariate Cox regression survival analysis.Results1155 patients were included. 693 and 462 patients were distributed into modeling and validation groups with 6:4 split-ratio via a random split-sample method. Based on the survival analysis, independent prognostic risk factors (variables that can be used to estimate disease recovery and relapse chance) influencing OS and CSS were obtained to establish nomograms. Then, we divided the modeling group into high- and low-risk cohorts. The low-risk cohort had improved OS and CSS compared to the high-risk cohort, which was statistically significant after the Log-rank test (p < 0.05). Furthermore, we used the concordance index (C-index), calibration curve to validate the nomograms, showing high accuracy. The decision curve analyses (DCA) revealed that the nomograms had evident clinical value.ConclusionsWe constructed two credible nomogram models, which would give the surgeons reference to provide an individualized assessment of BMC patients.

Nomograms predicting the overall and cancer-specific survival of patients with buccal mucosa cancer

To construct predictive models for predicting overall survival (OS) and cancer-specific survival (CSS) of patients with buccal mucosa cancer (BMC). Data of 936 patients with BMC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Nomograms were constructed based on multivariate Cox regression analyses, and validated using calibration plots, time-dependent receiver operating characteristic curves, and decision curve analyses. Age at diagnosis, marital status, grade, histopathology, SEER stage, tumor size, and surgery were associated with OS, whereas age at diagnosis, grade, histopathology, SEER stage, tumor size, and surgery were associated with CSS (all P < .05). The concordance indexes for OS and CSS were 0.79 and 0.80 in the training cohort, respectively, and those in the validation cohort were 0.78 and 0.80. Time-dependent receiver operating characteristic curves showed great predictability in nomograms. Decision curve analyses demonstrated good clinical value for OS (4%-88%) and CSS (3%-77%) nomograms. Patients were stratified into 3 risk groups, with the worst prognosis in the high-risk subgroup (P < .001). We developed and validated 2 nomograms predicting OS and CSS and established the corresponding risk classification systems in patients with BMC. These models assisted in precise administration of individual therapeutic regimens.

Long term outcomes of Carcinoma Buccal Mucosa treated with High Dose Rate Interstitial Brachytherapy

To analyze the long-term local control, overall survival and toxicity in Carcinoma Buccal Mucosa patients treated with interstitial brachytherapy. This analysis included patients diagnosed as Carcinoma Buccal Mucosa on biopsy and treated with radical brachytherapy or External Beam Radiotherapy (EBRT) followed by brachytherapy boost. All patients received High dose rate (HDR) interstitial brachytherapy. The total dose was 35 Gy in ten fractions for brachytherapy alone. Patients who received EBRT (50-54 Gy) were boosted by brachytherapy to a dose of 18-24 Gy in 6-8 fractions. All patients were treated using CT based planning. Between 2007 to 2017, a total of 24 patients of Carcinoma Buccal Mucosa received HDR interstitial brachytherapy either alone or as a boost. Majority of the patients were tobacco chewers (80%). 17(71%) patients were clinical stage T2N0M0 and 7(29%) were clinically T1N0M0. At a median follow up of 7 years (3-12 years), the local control rate was 100% in stage I and 88% in stage II. The 5 year overall survival rate was 80%. Two patients developed nodal recurrence and one patient developed distant metastasis within two years of treatment. Tumor size and brachytherapy technique (radical vs. boost) did not impact local control or overall survival (p > 0.05). Majority of the acute toxicities were Grade 1 and 2. One patient developed osteoradionecrosis of the mandible. Interstitial brachytherapy in early-stage Buccal Mucosa cancer either alone or as a boost provides excellent long term local control and overall survival. The acute and late toxicities are acceptable with majority of the patients presenting with Grade 1 or 2 toxicity.

Impact of Depth of Invasion (According to Layer) on Lymph Node Metastasis in Buccal Mucosa Cancers.

(1) To study layer of invasion as predictor of cervical lymph node metastasis. (2) To decide a cut off depth according to layer of invasion for neck dissection. It is a prospective study with sample size of 220 patients at tertiary care hospital with previously untreated operable buccal mucosa carcinoma over period of 21months. The factors considered under the study were Tumor layer of invasion, lymph node metastasis, Ultrasonography doppler neck, CT scan and gender. Wide excision of the lesion and reconstruction was done. Histopathologicalanalysis ofresected specimen were recorded as part of data collection for all thecases. Quantitative data represented using Mean ± SD (Standard Deviation) and median and interquartile range compared using Chi square test. Standard principles of univariate analysis was used according to statistical methods. Depth when measured according to layer of invasion, was significantly associated with lymph node metastasis with 89% of the muscle as layer of invasion being Lymph node positive (p = 0.009). There is 1.39 times chances of lymph nodal metastasis in patients with muscle invasion as compared to submucosal invasion. Tumour layer of invasion plays important role in predicting chances of nodal metastasis in clinically N0 neck in buccal mucosa cancer. According to the study, we should electively proceed with ipsilateral lymph node dissection once the layer of tumour invasion is muscle. This study is limited by sample size and short duration of one year and nine months.