Oral Cavity Carcinoma Research Articles

Identifying Occult Metastase Ratio and the related Factors in Early Stage Oral cavity Carcinoma

Identifying Occult Metastase Ratio and the related Factors in Early Stage Oral cavity Carcinoma

Assessment of sentinel lymph node detection by radioisotope scan and methylene blue alone in operable oral cavity cancer to assess its accuracy for metastasis

Background: Squamous cell carcinoma (SCC) is the most common malignancy affecting the oral cavity. It typically metastasizes into the regional cervical lymph nodes before spreading to distant organs.Methods: A prospective study on sentinel lymph node biopsy (SLNB) in early oral cancers using methylene blue dye and sentinel node localisation using pre-operative lymphoscintigraphy and intraoperative gamma probe in early oral cavity cancer.Results: Present study had a male to female ratio of 1.9:1, with (65.5%) male and (34.5%) female patients. Present study had a side distribution of disease more on left side with 138 patients (62.7%) and ratio of left to right was approximately 1.7:1. In present study most predominating gross morphological pattern of growth was ulcerative (35%) followed by ulcero-infilterative (25%). Buccal mucosa was the most common sub-site of origin of carcinoma in oral cavity, followed by tongue, with 83 (37.7%) and 64 (29.1%) patients. Identification rate of methylene blue dye was 91.7% (100 out of 109 patient). Identification rate of radionuclide tracer was 94.6% (105 out of 111 patient). In methylene blue dye group out of 103 metastatic sentinel lymph nodes, 9 metastatic sentinel lymph nodes were detected on IHC.Conclusions: With the above results it can be concluded the SLNB study is liable in detection of actual positive node and can avoid unnecessary neck dissections in patients with SCC with negative sentinel lymph node, as having very low risk of occult lymphatic metastases in the remaining lymphatic drainage.

Prevalence of submandibular gland involvement in neck dissection specimens of patients with oral cavity carcinoma

IntroductionThe submandibular gland is commonly removed during neck dissection in patients with head and neck cancer. The patient experiences various complications due to the removal of the submandibular gland. Therefore, the necessity of submandibular gland removal should be evaluated. This study aimed to was to determine the frequency of submandibular gland (SMG) involvement in patients with oral cavity squamous cell carcinoma (SCC). MethodsIn this retrospective study, medical records of patients with oral cavity cancer who were referred to Amir Alam Hospital between 2015 and 2020 were reviewed. Patient data includes surgical report, histopathology report (tumor size, number of lymph nodes involved, and SMG tumor involvement), Tumor Location, History of Smoking, History of Opium, and Alcohol consumption was extracted from patients' medical records and statistically analyzed using SPSS software version 20. ResultsOf the total 60 patients, 24 (40%) were female and 36 (60%) were male. Smoking was reported in 55% of patients with a mean of 4.11 pack-year. Alcohol and opium use was observed in 18.3% and 26% of patients. The majority of patients (78.3%) had tongue cancer. More than half of the patients (53.3%) reported tumors of 2 cm or smaller, and 16.7% of patients had tumors larger than 4 cm. The majority of patients (80.3%) did not have cervical lymph node metastasis, 13.1% had 1–2 involved lymph nodes and 4.9% had 3 to 6 involved lymph nodes and there were no cases of metastasis to more than 6 lymph nodes. Finally, no individual had submandibular gland involvement, ie 100% of patients had no submandibular gland metastasis. ConclusionThe results confirmed that SMG involvement is very rare in patients with oral SCC and therefore it is not necessary to remove the gland as part of treatment. Preservation of the submandibular gland prevents complications related to the removal of this gland and reduces morbidity and increases the quality of life of patients after surgery.

Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis

BackgroundInevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with fast-growing tumours in a functionally and aesthetically important area, we wished to quantify the impact of the COVID-19 pandemic on HNC care in the Netherlands. Material and MethodsThis population-based study covered all, in total 8468, newly diagnosed primary HNC cases in the Netherlands in 2018, 2019 and 2020. We compared incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in 2018 and 2019 (i.e. pre-COVID). ResultsThe incidence of HNC was nearly 25% less during the first wave (n = 433) than in 2019 (n = 595) and 2018 (n = 598). In April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities.Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26–28 days) than pre-COVID (31–32 days, p < 0.001). ConclusionThe incidence of HNC during the Netherlands’ first COVID-19 wave was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval.

Frozen Section Analysis and Real-Time Magnetic Resonance Imaging of Surgical Specimen Oriented on 3D Printed Tongue Model to Assess Surgical Margins in Oral Tongue Carcinoma: Preliminary Results.

BackgroundA surgical margin is the apparently healthy tissue around a tumor which has been removed. In oral cavity carcinoma, a negative margin is considered ≥ 5 mm, a close margin between 1 and 5 mm, and a positive margin ≤ 1 mm. Currently, the intraoperative surgical margin status is based on the visual inspection and tissue palpation by the surgeon and intraoperative histopathological assessment of the resection margins by frozen section analysis (FSA). FSA technique is limited and susceptible to sampling errors. Definitive information on the deep resection margins requires postoperative histopathological analysis.MethodsWe described a novel approach for the assessment of intraoperative surgical margins by examining a surgical specimen oriented through a 3D-printed specific patient tongue with real-time Magnetic Resonance Imaging (MRI). We reported the preliminary results of a case series of 10 patients, prospectively enrolled, with oral tongue carcinoma who underwent surgery between February 2020 and April 2021. Two radiologists with 5 and 10 years of experience, respectively, in Head and Neck radiology in consensus evaluated specimen MRI and measured the distance between the tumor and the specimen surface. We performed intraoperative bedside FSA. To compare the performance of bedside FSA and MRI in predicting definitive margin status we computed the weighted sensitivity (SE), specificity (SP), accuracy (ACC), area under the ROC curve (AUC), F1-score, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). To express the concordance between FSA and ex-vivo MRI we reported the jaccard index.ResultsIntraoperative bedside FSA showed SE of 90%, SP of 100%, F1 of 95%, ACC of 0.9%, PPV of 100%, NPV (not a number), and jaccard of 90%, and ex-vivo MRI showed SE of 100%, SP of 100%, F1 of 100%, ACC of 100%, PPV of 100%, NPV of 100%, and jaccard of 100%. These results needed to be validated in a larger sample size of 21- 44 patients.ConclusionThe presented method allows a more accurate evaluation of surgical margin status, and the first clinical experiences underline the high potential of integrating FSA with ex-vivo MRI of the fresh surgical specimen.

Patterns of recurrence after low-dose postoperative radiotherapy for head and neck squamous cell carcinoma

BackgroundPostoperative chemoradiotherapy is recommended for patients with head and neck squamous cell carcinoma with positive margins or extracapsular extension at high risk of recurrence. However, high-dose radiotherapy in the head and neck region often causes severe acute and late radiation-related adversities. In our institution, the radiation dose has been relatively lower than that used in Western countries to reduce radiation-related toxicities. Therefore, in this study, we examined the treatment outcomes of low-dose postoperative chemoradiotherapy.MethodsThe outcomes of 90 consecutive head and neck squamous cell carcinoma patients who received postoperative radiotherapy between June 2009 and December 2016 were retrospectively analyzed. All patients received postoperative three-dimensional conformal radiotherapy with or without concurrent systemic chemotherapy. The median patient age was 65 years. Concurrent chemoradiotherapy was administered at a total dose of 50.4 Gy in 28 fractions (daily fraction, 1.8 Gy). High-risk patients received 10.8 Gy of boost irradiation in six fractions. For radiotherapy alone, the irradiation dose was up to 54 Gy in 30 fractions and 64.8 Gy in 36 fractions for high-risk patients to increase the treatment intensity.ResultsThe median follow-up period was 40.5 months. The 3-year locoregional control and overall survival rates were 67.5% and 82.7%, respectively. A significantly higher proportion of patients with oral cavity carcinoma experienced locoregional failure (p = 0.004). The acute adverse events were mild, and the only late adverse event was grade 3 dysphagia (n = 3).ConclusionThis study suggests that de-escalation of the postoperative radiation dose can potentially reduce the severe adverse events of irradiation in patients while ensuring its effectiveness. In patients with oral cavity carcinoma, it might be necessary to increase the radiation dose.

Evaluation and Comparison of Functional and Aesthetic Outcomes of McGregor and Stepped Lower Lip-Split Incisions for Extirpation of Primary Tumor in Cases of Squamous Cell Carcinoma of Oral Cavity (SCCOC)

Background: Clear surgical margins are of utmost importance in surgical oncological procedures. Secondary consideration includes the functional and aesthetic outcomes of the patients after the procedure. The recognised surgical approach to the posteriorly located oral cavity and oropharyngeal tumors involves the splitting of the lower lip with or without mandibulectomy. In order to perk up postoperative function and aesthetics, quite a lot of modifications of the unique midline lower lip-splitting incision have been projected by various authors till date. A stepped ladder lower lip split incision (LLSI) helps in improved functional and aesthetic outcomes.&#x0D; Objectives: The prime accent of the study is to compare the McGregor LLSI and the stepped LLSI with respect to functional and aesthetic outcomes in tumors ablation for SCCOC.&#x0D; Methodology: The study population (n=22) is assigned randomly in two equal groups as a subject in the ratio of 1:1. Systemically healthy histologically diagnosed patients of SCCOC requiring LLSI for the tumours ablation will be included. In Group A- McGregor LLSI will be performed and in Group B- a Stepped LLSI would performed. Post-operative assessment of functional and aesthetic outcomes will be done.&#x0D; Expected Results: A stepped ladder LLSI used for tumours ablation will be effective in preserving post-operative lip movement, lip competency and cosmesis.&#x0D; Conclusion: Utility of a Stepped ladder LLSI for accessibility and ablation of posterior oral and oropharyngealtumors would be undoubtfully beneficial for improving post-operative functional and aesthetic outcomes and could be executed in routine oncologic surgery.

Factors predicting the perineural invasion in carcinoma oral cavity.

This study to evaluate clinicopathological parameters such as age, tumor location, tumor size, grade, depth of invasion (DOI), lymphovascular space invasion (LVSI), lymph node metastasis, and stage that predict peri-neural invasion (PNI) in oral squamous cell carcinoma (OSCC). A retrospective study on 1716 postoperative OSCC patients who satisfied the eligibility criteria and treated from January 2009 to December 2019 was analyzed using IBM SPSS V23. Mean and percentage were assessed using descriptive statistics. Wilcoxon-Mann-Whitney U-test was used to compare continuous variables, while Chi-square test was used to compare discrete variables between PNI-positive and PNI-negative groups. Two-tailed P < 0.05 was considered to be statistically significant. Out of 1716 patients, 553 were PNI positive. The mean age was 48.76 ± 12.42 years in PNI-positive patients while 51.52 ± 12.51 years in PNI-negative patients. Males outnumbered females. The most common primary was carcinoma buccal mucosa (204, 36.9%), followed by carcinoma of oral tongue (161,29.1%). Maximum tumor size was 3.14 ± 1.20 cm in PNI-positive patients whereas 2.78 ± 1.22 cm in PNI-negative patients. Sixty (10.84%) patients in PNI-positive group and 51 (4.38%) in PNI-negative group had LVSI positive. Lymph node involvement was observed in 305 (55.13%) patients in PNI-positive group whereas 358 (30.78%) patients in PNI-negative group. Maximum number 228 (41.3%) in PNI-positive patients were in Stage IVA disease. PNI is one of the important adverse prognostic factors having a definite correlation with anatomical subsite, tumor size, grade, DOI, LVSI, lymph node involvement, and stage of the disease. PNI should be analyzed in postoperative histopathology report of OSCC that guides the clinician for adjuvant therapy.

Characterization of the immune response in patients with cancer of the oral cavity after neoadjuvant immunotherapy with the IRX-2 regimen

ObjectiveIRX-2 is a homologous cell-derived multi-cytokine biologic with multifaceted immune modulatory effects that has been shown to induce increased lymphocyte infiltration into primary tumors in oral cavity carcinoma. Our objective was to characterize tumor immune gene expression and epigenomic changes after neoadjuvant IRX-2 immunotherapy in patients with squamous cell carcinoma of the oral cavity. MethodsA randomized phase II trial was conducted of the IRX regimen 3 weeks prior to surgery for previously untreated patients with Stage II-IV oral cavity carcinoma. The treatment regimen consisted of low dose (300 mg/m2) cyclophosphamide (day 1) followed by 10 days of regional perilymphatic IRX-2 cytokine injections and daily oral indomethacin, zinc and omeprazole (Regimen 1) compared to the identical regimen without the IRX-2 cytokines (Regimen 2). The NanoString immune panel (730 genes) and Infinium MethylationEPIC BeadChip were performed to assess the gene expression and DNA methylation signatures, respectively, in pre- and post-immunotherapy tumor samples. ResultsA total of 51 and 79 immune-related genes were found upregulated and downregulated, respectively, in the samples from Regimen 1 patients after treatment, while 51 and 56 were found upregulated and downregulated in the samples for Regimen 2. When comparing the changes between the two regimens, we identified 9 genes significantly different, including DMBT1, a potential tumor suppressor, functioning in tumor invasion of head and neck cancer. The exploration of DNA methylation showed slight overall hypermethylation after treatment in both regimens, especially for Regimen 1 immune responders, and methylation-based cell type deconvolution demonstrated high concordance with tumor infiltrating T lymphocyte cell counts. ConclusionWhile a consistent patient response after treatment was observed, most changes were similar between regimens, indicating a subtle, targeted, or patient-specific effect of IRX-2 cytokines. Change in DMBT1 expression was a unique finding that will require further study to better understand its significance.

Dose Perturbation From Titanium Plates in Post-Operative Oral Cavity Volumetric Modulated Arc Therapy: The Utility of Model-Based Algorithm

Computerized planning and 3D printing of titanium (Ti) plates attached during radical tumor resection allow for patient-specific, personalized solutions for complex osseous reconstructions in locally advanced oral cavity carcinoma. Here, we investigate dose perturbations related to such Ti plates and further interrogate whether the commonly used anisotropic analytical algorithm (AAA) dose calculation algorithm accurately predicts perturbations around Ti plates in comparison to the Boltzmann Solver Acuros XB model (AXB).Twenty-three cases of radically resected oral cavity carcinoma, with or without Ti plate reconstruction, followed by VMAT were reviewed with rates of spontaneous osteoradionecrosis (ORN) documented. Clinical treatment plans using AAA (2.5mm dose grid) were retrospectively re-planned with 1mm dose grids on AAA and AXB. Seven consecutive Ti plate reconstructed cases were compared to 16 control cases (postoperative cases without Ti plate) to understand the extent of dose perturbation near reconstructed bone and surrounding tissues using previously established dose metrics, such as maximum plan dose (Dmax) and maxillary/mandibular doses (Dmax, Dmean, V35, V44). Additionally, a 3mm shell was contoured around each plate to directly assess short-range dose perturbance at tissue-to-Ti interfaces.Of the 23 patients who underwent oral cavity resection followed by adjuvant VMAT, 4 underwent reconstruction with conventional low-profile Ti plates while 3 cases underwent reconstruction with high-profile custom plates. ORN was observed in 3 patients, all of whom had high profile custom plates. Global Dmax was significantly elevated in AXB 1mm (118.0 ± 3.3%) compared to AAA 2.5mm (109.1 ± 0.8%) and AAA 1mm (113.1 ± 2.0%), with most notable increases in the Ti plate cohort (P < 0.001; Table). Within the AXB 1mm plans, all a priori parameters were significantly higher in the Ti plate vs. no plate cohort (global Dmax: +5.7%, osseous Dmax: +4.9%, osseous Dmean: +10.9%, osseous V35: +13.4%, osseous V44: +15.9%). Furthermore, in the Ti plate population, AXB calculated significantly higher local hot spots within the 3mm shell contoured (115.6 ± 4.4% vs. 107.0 ± 1.7%; P < 0.002).Using the AAA model with a clinical standard 2.5mm dose grid does not appear to adequately account for dose perturbation at the tissue-to-Ti interface in comparison to the AXB algorithm at a finer dose grid, resulting in a significant underestimation of global and osseous maximum doses. Care should be taken when delivering radiation to patients with high profile Ti plates. The impact of beam entrance restriction and alternative plate designs to minimize the profile of high-Z materials are currently being explored.

Clinical Outcome of Inoperable Locally Advanced Carcinoma of Oral Cavity Treated With Definitive Concurrent Chemoradiotherapy: A Retrospective Analysis From Tertiary Cancer Center

The treatment of inoperable locally advanced oral cavity squamous cell carcinoma (OC-SCC) is challenging. In suitable patients, we prefer to treat them by definitive concurrent chemoradiotherapy (CTRT) with or without induction chemotherapy (IC). We intended to retrospectively evaluate the outcome of our cohort of inoperable OC-SCC treated with definitive CTRT.Data of 71 patients (Jan 2017-Jan 2020) of histopathologically proven inoperable OC-SCC treated with definitive CTRT with weekly cisplatin 40 mg/m2 with or without IC were retrieved from departmental archives. Radiotherapy (RT) was delivered with 3-dimensional conformal plan (70 Gray at 2 Gray per fractions delivered 5 days a week in two phases). Toxicities were evaluated using acute morbidity scoring criteria of RTOG. Response was evaluated as per WHO criteria. Loco-regional failure (LRF) and Progression free survival (PFS) were estimated from date of registration using Kaplan Meier method.Patient characteristics are summarized in Table 1. 48 patients (67.6%) received IC (Platinum+5 FU ± Taxane) q 3 weekly, median number of cycles was 3 (2-4). 64 (90%) patients received concurrent chemotherapy with median number of 5 cycles (4-6). Median RT dose was 70 Gray (50-70 Gray). Grade ≥ 3 skin toxicity, oral mucositis, dysphasia was noted in 7(9.9%), 11(15.5%) and 13 (18.3%) patients respectively. Median follow up duration was 15 months (3-52 months). Clinical response rate (CRR) at 1 month after completion of RT was 80%. Overall complete response, partial response, progressive disease and death at the time of last follow up were 37(52.1%), 21(29.6%), 11(15.5%), 2(2.8%) respectively. Age < 50 years was associated with poor outcome (odds ratio, 1.1; 95% CI 0.42-2.86). 3-month LRF rate was 32.4%. Median PFS was 11.4 months (5.3-32.4 months).Inoperable patients of OC-SCC with good performance status treated with definitive CTRT with or without IC yielded complete response in approximately half of patients with acceptable toxicity profile. Loco-regional failure remains the predominant mode of failure. Future research including studies on biomarkers for better patient selection and treatment personalization is warranted.

Liquid Biopsy as a Tool for the Characterisation and Early Detection of the Field Cancerization Effect in Patients with Oral Cavity Carcinoma.

Oral squamous cell carcinoma (OSCC) constitutes approximately 25% of all head and neck cancer, for which the consumption of tobacco and alcohol are the main associated risk factors. The field cancerization effect of OSCC is one of the main reasons for the poor survival rates associated with this disease. Despite some advances, its ccharacterization and early diagnosis continue to challenge modern oncology, and the goal of improving the prognosis remains to be achieved. Among new early diagnostic tools for OSCC that have been proposed, liquid biopsy appears to be an ideal candidate, as studies have shown that the analysis of blood and saliva provides promising data for the early detection of relapses or second tumours.

VIMENTIN EXPRESSION AND ITS CORRELATION WITH LYMPH NODE METASTASIS IN ORAL SQUAMOUS CELL CARCINOMA

Squamous cell carcinoma and Adenocarcinoma are common subtypes of carcinoma of oral cavity. More than six lakh cases of cancers of head and neck are being diagnosed globally every year and worldwide, it’s the 6th most common cancer. Head and Neck cancers mostly take origin from epithelial lining of oral cavity, oropharynx, larynx and hypopharynx and 90% of them morphologically is predominantly squamous cell carcinoma. OSCC has a poor prognosis, the reason being metastasis to lymph nodes and its recurrence. So, the identification of specific markers with metastasis to lymph nodes should be done for early and specific diagnosis. Normal and neoplastic mesenchymal cells contain vimentin as major protein constituent of intermediate filaments. Vimentin does not show expression usually in non-neoplastic epithelial cells, but shows expression in mesenchymal cells. Vimentin as a marker of epithelial to mesenchymal transitionis used in diagnosing lymph node metastasis in cases of OSCC.

Anaesthesia management of a difficult airway patient with severe aortic stenosis for major oncosurgery

Over the past few decades, oncosurgical procedures are increasing in number, require considerable expertise and training for anaesthetising such patients. Aortic Stenosis itself poses great challenge, causes significant increase in morbidity and mortality in the perioperative period. Head, neck oncosurgical procedures with difficult airway requiring awake fiberoptic intubation in such patients adds to the challenge.We describe once such case of previously operated Carcinoma of oral cavity with new growth involving mandible for excision of tumour with neck dissection and mandibular reconstruction with a free Fibula flap. This patient now presented with anticipated difficult airway with restricted mouth opening and a recent diagnosis of severe Aortic stenosis with mean gradient across aortic valve of 52mmHg and valve area 0.8 cm2.Such patient requires multidisciplinary team approach by cardiologist, anaesthesiologist, surgeon and intensivist to prevent perioperative morbidity and facilitate early recovery.

Neuroendocrine Carcinoma of Oral Cavity: A Case Report of an Unusual Presentation

Neuroendocrine carcinoma (NEC) are tumors affecting lungs in the first line. Extra-pulmonary locations are rare, and involvement of the oral cavity is uncommon. The therapeutic strategy of this clinically aggressive entity is not codified. Nevertheless, multimodal treatment combining surgery and radio-chemotherapy is associated with the best results in terms of local control and overall survival. We report a case of a 67-year-old patient, diagnosed with a NEC, the computed tomography (CT) of the facial mass objectified a jugal mass of 2x2.4 cm with two lymph nodes. The patient benefited from an excisional biopsy of the mass, and whose histological examination and immunohistochemical testing returned in favor of a small cell neuroendocrine carcinoma.

Antitumor immune effects of preoperative sitravatinib and nivolumab in oral cavity cancer: SNOW window-of-opportunity study

BackgroundSitravatinib, a tyrosine kinase inhibitor that targets TYRO3, AXL, MERTK and the VEGF receptor family, is predicted to increase the M1 to M2-polarized tumor-associated macrophages ratio in the tumor microenvironment...

Multiple Tobacco Related Lesions with Squamous Cell Carcinoma – A Case Report

Oral squamous cell carcinoma is the most commonly occurring malignant disease worldwide. The oral squamous cell carcinoma shares clinical similarity with various forms of inflammatory gingival lesions and is often misdiagnosed in our routine dental practice. Oral tongue carcinomas represent approximately 25% of oral cavity carcinomas. These lesions are characterized by early infiltration into the underlying tongue musculature with an early and high risk for regional metastases. The dentist should have precise knowledge regarding the clinical manifestation of this deadly disease as early diagnosis and prompt treatment. Early detection of such lesions can help in reducing morbidity and mortality. Keywords: Oral squamous cell carcinoma, tongue malignancy, OSCC, clinical course, tobacco related lesions, leukoplakia, oral submucous fibrosis, smoker’s melanosis

Oxygenated Cembrene Diterpenes from Sarcophyton convolutum: Cytotoxic Sarcoconvolutum A-E.

The soft coral genus Sarcophyton contains the enzymatic machinery to synthesize a multitude of cembrene-type diterpenes. Herein, highly oxygenated cembrenoids, sarcoconvolutum A–E (1–5) were purified and characterized from an ethyl acetate extract of the red sea soft coral, Sarcophyton convolutum. Compounds were assemblies according to spectroscopic methods including FTIR, 1D- and 2D-NMR as well as HRMS. Metabolite cytotoxicity was tested against lung adenocarcinoma, cervical cancer, and oral-cavity carcinoma (A549, HeLa and HSC-2, respectively). The most cytotoxic compound, (4) was observed to be active against cell lines A549 and HSC-2 with IC50 values of 49.70 and 53.17 μM, respectively.

Diagnostic Accuracy of Multislice Contrast CT scan in Detection of Squamous cell Carcinoma of Oral cavity, in clinically suspected Patients

Objective: To evaluate the diagnostic accuracy of multislice computed tomography (CT) in detection of squamous cell carcinoma (SCC) of oral cavity in clinically suspected patients taking histopathology as gold standard. Material and Methods: This cross-sectional study has been conducted at Radiology department of Civil Hospital Karachi from 8th September 2018 to March 2019. All the cases having suspected oral squamous cell carcinoma and either of gender were included. Patients underwent computed tomography by using multislice scanner. Then patients undergone biopsy sampling and patients were labeled as positive or negative for squamous cell carcinoma of oral cavity on MDCT and histopathology. Sensitivity, specificity, and diagnostic accuracy of multislice CT for squamous cell carcinoma of oral cavity were measured taking histopathology as gold standard. Results: Total 168 cases were studied and out of them males were 76.8% and females were 23.2%. Mean gutka addiction history was 11.52±5.21 years. Mean lesion size on CT scan was 2.44±1.43 cm. In our study, 35.1% patients were diagnosed positive by multislice computed tomography and 43.5% through histopathology. Sensitivity, Specificity, PPV, NPV and accuracy were 86.4%, 79.8%, 69.9%, 91.6%, and 82.1% respectively. Conclusion: Multislice CT observed to be the effective diagnostic tool for the detection of SCC of oral cavity. Keywords: Multislice Computed Tomography, cancer, Oral Cavity

Functional and aesthetic outcome with free fibula osteocutaneous flap in reconstruction of anterior mandibular defects in oral malignancies: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; For anterior mandibular defects, vascularized bone flap reconstructions are the best for providing a solid arch necessary to restore form and function, especially in patients receiving tumour excision surgery in head and neck region. Our aim was to study aesthetic and functional outcome of free fibula osteocutaneous flap (FFOCF) in anterior mandibular defects in case of anterior floor of the mouth malignancies with mandibular infiltration.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The clinical data of 15 oral cavity carcinoma patients with involvement of anterior floor of mouth with mandiblular infiltration that underwent FFOCF reconstruction at our institute, government medical college, Jammu, was prospectively collected from January 2018 till January 2020. In this study, the aesthetic and functional outcome of these patients was evaluated at 6 months and 1 year post surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The aesthetic result of reconstruction was excellent in most patients. Also, there was no long-term donor-site morbidity. There was no peri-operative death. Flaps survived in all patients. Functional outcomes including the ability to tolerate oral diet and speech outcome were good in all cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The FFOCF, in reconstruction surgery of advanced oral cavity carcinoma permits more radical resection of tumour with good functional as well aesthetic outcome.&lt;/p&gt;