Floor Of Mouth Research Articles

Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip

AbstractAnterior mandible defects result in loss of support for the tongue, floor of the mouth and lower lip, resulting in impairment of airway, feeding, and speech. We treated four patients with these “Andy Gump” deformities. Reconstruction was performed with two free flaps: a fibula osteocutaneous flap for the anterior mandible and floor of the mouth, and a soft tissue free flap for the lip, chin, and anterior neck. The lower lip was suspended cranially with fascia or tendon grafts ± mini-temporalis turndown flaps. All flaps survived completely. All patients were tube feed-dependent before surgery; they all resumed an oral diet. All tracheostomies were decannulated. Lip competence was restored as evidenced by cessation of drooling. Speech improved from unintelligible to intelligible with frequent repetitions. Objective assessment was performed with the functional intraoral Glasgow scale; the mean FIGS score improved from 3.25 (range 3–4) to 11 (range 9–13). We conclude that composite anterior mandible and tongue defects have large tissue requirements that require multiple free flaps. Reconstruction leads to significant improvement in function.

Therapeutic and Clinical Traits of Ludwig’s Angina: A 10-year retrospective study of 24 patients

Introduction: Ludwig's angina is a life-threatening infection that affects the floor of mouth and originates from odontogenic infections in more than 90% of cases.
 Aim: This study aimed to recognize the clinical and therapeutic traits of Ludwig's angina.
 Method & Materials: In this retrospective study, medical records of hospitalized patients in the Oral and Maxillofacial Department, Tehran Taleghani Hospital between 2006-2016 with deep neck infections and Ludwig's angina diagnosis were checked. Then patients were compared in terms of demographic, anatomical, risk factors, clinical course and treatment characteristics. Data were analyzed with SPSS software version 18.
 Results: The results showed that of 325 studied patients, 24 patients (7.38%) had Ludwig's angina which of these, 3 patients (12.5%) died ultimately. There was a statistically significant relationship between the occurrence of dyspnea, involved anatomical areas and days of hospitalization in ICU and death; however, there was no significant relationship between gender, age, socioeconomic status, fever, maximum and minimum blood pressure, heart rate, white blood cells count, Odynophagia, origin of infection, received antibiotics, hospitalized days and systemic diseases with death.
 Conclusion: Ludwig's angina is a fatal infection and requires immediate intervention and results showed involved about 8% of Deep Infections of Head and Neck Area, and the mortality rate of these patients is approximately 12.5%. Therefore, diagnosis and treatment of this disease is important in emergencies.

Spectrum of the Oral Lesions in a Rural-based Tertiary Care Teaching Hospital in Central India

Background: The oral cavity is a common site for pathological lesion with a wide spectrum of neoplastic and nonneoplastic lesions. They are either symptomatic or asymptomatic. Some lesions may prove to be premalignant and may be a cause of malignancy in future. Histopathological reporting is very important and essential part because the core finding we provide in reporting significantly influences the treatment part.Material and Methods: This study was carried out in the Department of Pathology, Amaltas Institute of Medical Sciences, Dewas (Madhya Pradesh) from May 2021 to March 2023. The study included all the patients admitted in ENT, Surgery and Oncology wards of hospital presenting with oral pathology and given written informed consent. A total 80 cases were taken in to account and were studied, in relation with age, sex, site predilection.All biopsy specimens and resected tissues/organs were received in 10% formalin solution and were processed as per standard protocol and slides of standard thickness were prepared for histopathological examination. After thorough microscopic study, the diagnosis was made and categorized into major groups (non-neoplastic, benign, borderline and malignant) and subgroups according to type of lesion on histopathological examination.Results: The site of involvement of various lesions shows maximum involvement of buccal mucosa 43(53.75%),followed by tongue 19(23.75%), tonsil 7(8.75%), alveolus 4(5%) , floor of mouth 3(3.75%) and least involvement of lip and palate with 2(2.5%) cases in each. Of the inflammatory lesions tonsils were the commonest site of involvement.Conclusion: We conclude our study with the findings that lesions of buccal mucosa is commonest site andsquamous cell carcinoma was the commonest entity with diversity in lesions and a wide age group of presentation. This emphasizes the role of histopathological study and diagnosis in oral lesions and provides us with valuable information of the lesion being neoplastic or non-neoplastic and timely intervention could be planned.

Tongues Tied by Orofacial Myofunctional Therapy about Tongue Tie: A Narrative Review.

The respective review articles aim is to provide an overview as well as describes and enlists different orofacial myofunctional therapy exercises as a modality for tongue tie secondary to surgery.Tongue tie is the basically a connection that joints base of tongue to the floor of mouth. This leads to difficulties various difficulties such as altered speech, oral habits, maligned teeth and many more. During formative years, most children successfully treated of tongue tie by releasing it, but problems start after its correction. That it may can reappear or may lead to same difficulties as prior. Parents and clinicians are only concerned about speech and aesthetics after release of tongue tie. But OMT plays important role ore and post-surgical procedure. OMT help in proper tongue posture along with reducing the probability of tissue reattachment after surgery by exercises. This therapy positively influenced functions by reducing deleterious habits. A review of relevant literature is predicated on articles found using free text terms, mesh terms, and some basic tongue tie as well as tongue tie release pamphlets that were published in English up until the year 2023 in the electronic databases PubMed, EBSCO, Scopus, Google Scholar, and Web of Science. With the aid of mesh keywords, the initial search yielded 38-40 articles; 20-35 were chosen depending on the requirements. Also we searched for orofacial myofunctional exercises or exercises recommended after tongue tie release. Various exercises enlisted in our article that will guide a individual before and after tongue tie release which will give positive outcomes such as proper tongue posture, speech, swallow, regained aesthetics and self-esteem. Tongue plays an important role in development of perioral structures as well as in the swallow to good speech articulation and dental occlusion. So, as pediatric dentist its important know that after release of tongue tie what to do and how to maintain. This review article is focused on the various orofacial myofunctional therapy techniques employed for tongue tie but not a single one to describe them. Our pertaining review act as a guide for clinicians as well as individuals to manage tongue tie after its release. Shah SS, Agarwal PV, Rathi N, et al. Tongues Tied by Orofacial Myofunctional Therapy about Tongue Tie: A Narrative Review. Int J Clin Pediatr Dent 2024;17(1):109-113.

[The analysis of unconventional lymph node metastasis in tongue squamous cell carcinoma].

Objective: To analyze the characteristics of cervical lymph node metastasis in tongue squamous cell carcinoma (TSCC). Methods: A retrospective study was conducted. A total of 329 patients with TSCC who underwent en bloc resection of primary tumor and neck dissection in the Second Xiangya Hospital of Central South University from June 2010 to March 2018 were included. There were 283 males and 46 females, aged from 26 to 80 years. All patients underwent the modified neck dissection. The main difference between the modified neck dissection and the traditional neck dissection lay in the managements of unconventional lymph nodes. The lymphatic adipose tissues adjacent to the superior thyroid artery, the base of facial artery and the branches of external carotid artery were thoroughly dissected. The primary tumor as well as lingual artery, tissues along the lingual artery and lymph nodes in the mouth floor were resected. χ2 test was used for comparison of count data, and linear regression model was used for multivariate analysis. Results: Cervical lymph node metastases were found in 136 patients (41.3%). Among 142 patients (T1-2cN0) with supraomohyoid neck dissection, 22 patients had pathologically occult lymph node metastases (15.5%), with a 5-year overall survival rate of 90.2%, which was similar to the 5-year overall survival rate of 92.1% in 120 patients without lymph node metastasis (χ2=0.156, P=0.693). Multivariate linear regression analysis showed that T stage, clinical stage and unconventional lymph node metastasis were important factors for cervical lymph node metastasis in tongue cancer patients (P<0.05). Unconventional lymph node metastases occurred in 30 patients (9.1%), including the metastases of lymph nodes in the floor of mouth (3.0%), the lingual artery (2.4%), the base of the external maxillary artery (2.1%), the superior thyroid artery (0.9%), and the external carotid artery (0.6%). There were significant differences in the unconventional lymph node metastasis rates between patients with negative and positive conventional lymph node metastases [4.9%(10/203) vs. 15.9%(20/126), χ2=11.242, P=0.001] and also between patients with depth of invasion ≤5 mm, 5 mm <depth of invasion ≤10 mm or depth of invasion >10 mm [3.1%(2/64) vs. 5.7%(6/106) vs. 13.8%(22/159), χ2=7.907, P=0.005]. Conclusion: Supraomohyoid neck dissection can achieve reliable control efficacy in patients with cN0 tongue cancer. All patients with lymph node dissection should undergo unconventional lymph node dissection. Unconventional lymph node dissection is strongly recommended for patients with conventional lymph node metastasis.

Defining the Shape of the Mylohyoid Muscle: A Morphometric Imaging Study.

Implantable hypoglossal nerve stimulation (HNS) therapy is an evolving therapeutic alternative for patients with refractory obstructive sleep apnea (OSA). The muscular anatomy of this region has implications for surgical access through this zone as well as positioning and anchoring of hardware in this area. The purpose of this study was to radiologically describe the topography of the mylohyoid muscle and adjacent structures across a wide age spectrum. We retrospectively evaluated computed tomography scans of the neck in 102 patients who were imaged for reasons unrelated to the floor of mouth or submental space. Patients with prior surgery or pathology in the area of interest were excluded. Fourteen relevant muscle measurements were made on a midline sagittal image and a coronal image positioned at the midpoint between the hyoid bone and the mandible. We included 49 men and 53 women with an average age of 44 years (range 19-70). The average mylohyoid length was 42 mm; the average distance between the anterior digastric bellies was 17 mm. The average angle of the central mylohyoid was 174° in the sagittal plane and 164° in the coronal plane. Several measurements were significantly correlated with patient age, including the angle measurements and the distance between the digastric muscles. Aberrant digastric anatomy was common. The mylohyoid muscle has multiple radiologically distinct segments with predictable curvatures. An understanding of submental muscular anatomy, along with its variability between patients, may be beneficial to the development of bilateral implantable neurostimulation technology for the treatment of refractory OSA. N/A Laryngoscope, 2024.

Repair of buccal mucosa and floor of mouth defects using keystone design perforator island flap

ObjectiveTo assess the feasibility of utilizing the keystone design perforator island flap (KDPIF) for the repair of small to medium-sized defects in the buccal mucosa and floor of mouth (cT1-2 stage tumor). Study DesignWe conducted a retrospective analysis of eight patients who underwent KDPIF to address oral defects at the Affiliated Hospital of Qingdao University between June 2021 and September 2022. Patient information, including medical history, defect site, flap size, operative time, hospital stay, complications, and postoperative recovery of oral function, was comprehensively evaluated. ResultsEight patients (6 females and 2 males) underwent reconstruction using KDPIF. The mean operation time was 58.5 minutes (55-63 minutes), with an average length of stay of 3.5 days (3 to 5 days). None of the 8 cases (100%) exhibited flap splitting necrosis or infection. Moreover, no scar contracture was observed, and oral functions, including the degree of opening, type of opening, tongue mobility, speech function, and swallowing function, were successfully restored. One patient (12.5%) experienced bleeding from the incision on the first postoperative day, but following compression, hemostasis was achieved, and the incision healed well. ConclusionsKDPIF demonstrates technical feasibility and suitability for repairing small to medium-sized buccal mucosa and floor of mouth defects (cT1-2).

From Pixels to Diagnosis: Algorithmic Analysis of Clinical Oral Photos for Early Detection of Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma (OSCC) accounts for more than 90% of oral malignancies. Despite numerous advancements in understanding its biology, the mean five-year survival rate of OSCC is still very poor at about 50%, with even lower rates when the disease is detected at later stages. We investigate the use of clinical photographic images taken by common smartphones for the automated detection of OSCC cases and for the identification of suspicious cases mimicking cancer that require an urgent biopsy. We perform a retrospective study on a cohort of 1470 patients drawn from both hospital records and online academic sources. We examine various deep learning methods for the early detection of OSCC cases as well as for the detection of suspicious cases. Our results demonstrate the efficacy of these methods in both tasks, providing a comprehensive understanding of the patient's condition. When evaluated on holdout data, the model to predict OSCC achieved an AUC of 0.96 (CI: 0.91, 0.98), with a sensitivity of 0.91 and specificity of 0.81. When the data are stratified based on lesion location, we find that our models can provide enhanced accuracy (AUC 1.00) in differentiating specific groups of patients that have lesions in the lingual mucosa, floor of mouth, or posterior tongue. These results underscore the potential of leveraging clinical photos for the timely and accurate identification of OSCC.

Oral Soft Tissue Metastasis from Breast Cancer as the Only Primary Source: Systematic Review

Abstract Background Breast cancer is one of the most lethal neoplasms causing death. Oral cavity is the rare site of distant metastasis from breast cancer. Very little research has been conducted to date to analyze breast cancer as the sole primary source of metastasis to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from breast cancer as the only primary source to date. Methods An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like (“Breast cancer”, OR “Breast carcinoma”) AND (“Metastasis” OR “Metastases”), And (“Oral soft tissues” OR “Tongue” OR “Palate” OR “Tonsil” OR “Buccal mucosa” OR “Floor of mouth” OR “Vestibule” OR “Salivary glands”). We also searched all related journals manually. The reference list of all articles was also checked. Results Our research revealed 88 relevant papers (September 1967–September 2023) with 96 patients in total. The most predominant oral soft tissues involved were salivary glands followed by the gingiva, tonsils, tongue, and buccal mucosa. A total of 23% of patients died with an average survival time of 1 to 15 months. Conclusions Oral soft tissue metastasis from breast cancer is a rare event and has a bad prognosis. More cases need to be published to raise awareness of these lesions.

Epidemiology and management of oral cavity squamous cell carcinoma in Ireland

IntroductionThe epidemiology and management of oral cavity cancer have changed considerably in recent decades. This study examines epidemiological and management trends in oral cavity squamous cell carcinoma (OCSCC). MethodsA retrospective cohort study of data from the National Cancer Registry of Ireland between 1994 and 2014. ResultsA total of 2725 patients were identified. The most common subsites were the tongue (34 %, n = 1025), lip (19 %, n = 575), floor of mouth (FOM) (18 %, n = 550), and retromolar trigone (RMT) (6 %, n = 189). The incidence of OCSCC remained largely unchanged (3.14 cases/100000/year) during the study period. 5-year disease-specific survival (DSS) was 58.6 % overall, varying between subsites (lip 85 %, RMT 62.9 %, tongue 54.7 %, and FOM 47.3 %). DSS improved over the study period (p = 0.03), in particular for tongue primaries (p = 0.007). Primary surgery significantly improved DSS versus radiotherapy (HR 0.28, p < 0.0001). Survival of T4 disease managed surgically was superior to that of T1 disease managed with radiotherapy. In node positive patients, chemotherapy improved overall survival (HR 0.8 p = 0.038) but not DSS (HR 0.87 p = 0.215). ConclusionPrimary surgery remains the standard of care in the management of OCSCC. Prognosis has improved in line with an increase in the use of primary surgery in the same time frame, though the incidence remains unchanged.

Clinical Case and Literature Review of a Potentially Life-Threatening Complication Derived from Mouth Floor Hematoma after Implant Surgery

AbstractThe placement of dental implants is a safe and predictable procedure when performed by qualified staff. The incidence of complications derived from this type of surgery has increased due to the greater number of patients undergoing dental rehabilitation treatments in recent years. Floor of the mouth hematoma is a rare, but potentially fatal, complication that every oral surgeon should recognize for early diagnosis. As part of the clinical case presented here, two implants were removed and a hemorrhage in the floor of the mouth was found, which required an urgent intervention to control the bleeding. Two independent researchers conducted an electronic search of the available scientific evidence in relation to bleeding of the floor of the mouth in dental implant surgery. The research included references, which were written in English or Spanish, and published up to December 2022. Case reports, case series, systematic reviews, and meta-analysis were part of the inclusion criteria. Sixty-four bibliographic references were identified, and 39 full-text articles were selected. There were 30 cases of floor of the mouth hematoma in relation to implant surgery. In 13 patients the main location was interforaminal, in 5 in the canine area, in 6 in the incisor area, and in 6 in the molar premolar region. All cases were caused by perforation of the cortical bone or surgical manipulation (disruption of the periosteum, perforation of the sublingual mucosa by the stiff suture). The sublingual artery was most frequently involved. The clinical sign observed in all cases was elevation of the floor of the mouth. In 21 of the cases there was airway involvement, so the main treatment was intubation or tracheostomy. Floor of the mouth hematoma may be one complication associated with implant surgery. Given the seriousness of this clinical picture, early detection by the dentist and hospital referral are essential. Warning signs are sudden swelling of the floor of the mouth or submandibular area, accompanied by dysphagia and dyspnea.

Cutaneous metastasis in a case of carcinoma floor of mouth- A rare case report

The incidence of cutaneous metastasis in head and neck cancers is less than 1%. Carcinoma of the oral cavity is one of the most common cancers of the head neck region with frequent metastasis to internal organs, especially the lungs, liver, and bone.We present a case of Carcinoma of floor of mouth with cutaneous metastasis.A 55 year old lady presented to our department with complaints of non-healing ulcer in the oral cavity and ulcerated nodules over neck and chest. On examination, mouth opening tongue mobility was restricted with grade 2 trismus. An ulcer in left gb sulcus, bilateral lymphadenopathy and multiple ulcerated skin nodules on neck and chest wall were noted. CECT Face and Neck showed heterogenously ehancing mass at the floor of mouth involving left buccal mucosa and erosion of mandible, lymph node mets and skin nodules. ECOGPS was 1.She was treated with palliative systemic chemotherapy and thereafter Palliative radiation. Now she is having stable disease and is on metronomic chemotherapy with regular follow up.Our case has highlighted that cutaneous metastasis can be seen in the cancers of floor of mouth. Palliative chemotherapy and radiotherapy can significantly increase Progression free survival and hence the Quality of life of patients with such presentation.

Surgical excision of sublingual gland ranula - An ambiguous treatment modality?

The term Ranula is derived from the Latin term rana meaning frog. Rupture of one of the ducts of Rivinus in the sublingual salivary gland results in the extravasation of saliva into the surrounding tissues to form an extravasation cyst which is a form of pseudocyst.Ranula may present in two forms: a simple (or intraoral) ranula and a plunging (or cervical) ranula. There has been little consensus on the ideal first-line treatment, but currently, definitive treatment involves excision of ranula along with the involved sublingual gland. Minimally invasive surgical alternatives include marsupialisation and micro marsupialisation which is associated with a high rate of recurrence. In this case report, treatment of oral ranula which was present above the mylohyoid and encompassing the floor of mouth was done by meticulous dissection and surgical excision of the cyst along with the involved sublingual salivary gland.

Oral Lymphangioma: An Original Series of Three Cases with Review

Lymphangiomas are benign hamartomatous tumors of lymphatic origin which results from sequestration of lymphhatic tissues that do not communicate with other lymphatic channels. They may occur with hemangiomas and have high predilections for head and neck region (50-70%). They may occur at birth (60-70%) or till two years of age (90%) and rarely in adults. The most common site of occurrence in the mouth is dorsum of tongue being followed by lips, buccal mucosa, soft palate and floor of mouth. Tongue lymphangioma may present as localized or diffused growth that may result in macroglossia, impaired speech and difficulty in mastication. There are different treatment options; surgical excision being the most effective mode of treatment. Here we have reported three different cases of oral lymphangiomas, two of which occurring in the tongue and one in the buccal mucosa.

Demographic and imaging features of oral squamous cell cancer in Serbia: a retrospective cross-sectional study

BackgroundThe mortality of oral squamous cell cancer (OSCC) in Serbia increased in the last decade. Recent studies on the Serbian population focused mainly on the epidemiological aspect of OSCC. This study aimed to investigate the demographic and imaging features of OSCC in the Serbian population at the time of diagnosis.MethodsWe retrospectively analyzed computed tomography (CT) images of 276 patients with OSCC diagnosed between 2017 and 2022. Age, gender, tumor site, tumor volume (CT-TV, in cm3), depth of invasion (CT-DOI, in mm), and bone invasion (CT-BI, in %) were evaluated. TNM status and tumor stage were also analyzed. All parameters were analyzed with appropriate statistical tests.ResultsThe mean age was 62.32 ± 11.39 and 63.25 ± 11.71 for males and females, respectively. Male to female ratio was 1.63:1. The tongue (36.2%), mouth floor (21.0%), and alveolar ridge (19.9%) were the most frequent sites of OSCC. There was a significant gender-related difference in OSCC distribution between oral cavity subsites (Z=-4.225; p < 0.001). Mean values of CT-TV in males (13.8 ± 21.5) and females (5.4 ± 6.8) were significantly different (t = 4.620; p < 0.001). CT-DOI also differed significantly (t = 4.621; p < 0.001) between males (14.4 ± 7.4) and females (10.7 ± 4.4). CT-BI was detected in 30.1%, the most common in the alveolar ridge OSCC. T2 tumor status (31.4%) and stage IVA (28.3%) were the most dominant at the time of diagnosis. Metastatic lymph nodes were detected in 41.1%.ConclusionOur findings revealed significant gender-related differences in OSCC imaging features. The predominance of moderate and advanced tumor stages indicates a long time interval to the OSCC diagnosis.

Myopericytoma of the mouth floor: The diagnostic and therapeutic challenge—A case report and literature review

AbstractMyopericytoma is defined as a rare benign myxoid tumour that is usually found in distal extremities. However, it may rarely affect the oral cavity. Few cases of oral myopericytoma were reported in the literature. A 56‐year‐old female patient presented with a mouth floor lesion. A wedge biopsy performed from the lesion revealed an atypical round cell proliferation, which may be plasmablastic lymphoma or plasmacytoma. Post‐contrast neck MRI described a well‐defined lobulated lesion at the right sublingual region measuring 14 × 21 mm. Transoral wide local excision of the ulcer was performed, and reconstruction of the defect was done using an inferiorly‐based nasolabial flap. Microscopic examination of the excised swelling revealed a tumour proliferation formed of bland‐looking spindle cells alternating with fibroblasts and intervening vascular spaces. No detected mitosis or necrosis in the examined material. IHC staining of the tumour cells was positive for Caldesmon and alpha smooth muscle actin, while Ki67 was positive in 3% of cellularity. Desmin, ALK, B‐catenin, ERG, CD31, and CD138 showed a negative reaction. This led to the diagnosis of bland spindle cell proliferation suggestive of oral myopericytoma with free all surgical margins. Myoepricytoma is a rare benign tumour that rarely affects the oral cavity. Surgical excision is the mainstay of treatment. Local flaps constitute a good choice for the reconstruction of the resection defect.

Head and Neck Cancer Incidence in the United States Before and During the COVID-19 Pandemic

Research about population-level changes in the incidence and stage of head and neck cancer (HNC) associated with the COVID-19 pandemic is sparse. To examine the change in localized vs advanced HNC incidence rates before and during the first year of the pandemic. In this cross-sectional study of patients in the US diagnosed with HNC from 2017 to 2020, the estimated number with cancer of the oral cavity and pharynx (floor of mouth; gum and other mouth; lip; oropharynx and tonsil; and tongue) and larynx were identified from the SEER cancer registry. Subgroup analyses were stratified by race and ethnicity, age, and sex. Data were analyzed after the latest update in April 2023. The COVID-19 pandemic in 2020. The primary outcomes were the annual incidence rates per 100 000 people for localized HNC (includes both localized and regional stages) and advanced HNC (distant stage) and weighted average annual percentage change from 2019 to 2020. Secondary outcomes included annual percentage change for 2017 to 2018 and 2018 to 2019, which provided context for comparison. An estimated 21 664 patients (15 341 [71%] male; 10 726 [50%] ≥65 years) were diagnosed with oral cavity and pharynx cancer in 2019 in the US, compared with 20 390 (4355 [70%] male; 10 393 [51%] ≥65 years) in 2020. Overall, the HNC incidence rate per 100 000 people declined from 11.6 cases in 2019 to 10.8 in 2020. The incidence rate of localized cancer declined to 8.8 cases (-7.9% [95% CI, -7.5 to -8.2]) from 2019 to 2020. The localized cancer incidence during the first year of the pandemic decreased the most among male patients (-9.3% [95% CI, -9.2 to -9.5]), Hispanic patients (-12.9% [95% CI, -12.9 to -13.0]), and individuals with larynx cancer (-14.3% [95% CI, -13.6 to -15.0]). No change in the overall incidence rate was found for advanced HNC. In this cross-sectional study, the incidence of localized HNC declined during the first year of the pandemic. A subsequent increase in advanced-stage diagnoses may be observed in later years.

Impact of tumor subsite on survival outcomes in oral squamous cell carcinoma: A retrospective cohort study from 2000 to 2019

BackgroundOral squamous cell carcinoma (OSCC) is responsible for high morbidity and mortality worldwide. Although the oral cavity encompasses different anatomical subsites, it is unclear whether subsite localization of carcinoma influences outcome. MethodsThis retrospective cohort study examined overall survival (OS), recurrence-free survival (RFS) and local recurrence-free survival (L-RFS) at different subsites by Kaplan-Meier survival curves. Cox proportional hazards regression analysis was performed to investigate the impact of subsite on overall death, locoregional recurrence, and local recurrence. ResultsThe cohort included 1702 patients treated with curative intent for OSCC according to standardized national guidelines. The 5-year OS was superior in oral tongue to retromolar trigone as well as in both oral tongue and floor-of-mouth (FOM) compared to tumors involving multiple locations. The 3-year RFS in oral tongue and FOM was superior to tumors involving multiple locations, and in FOM compared to retromolar trigone. The 3-year L-RFS in oral tongue and FOM was higher than gingiva, retromolar trigone and tumors involving multiple locations. Adjusting for relevant covariables using oral tongue as reference, tumors involving multiple locations was the only category presenting higher risk for locoregional recurrence, while risk of local recurrence was higher in gingiva, retromolar trigone, hard palate and to tumors involving multiple locations. The study found no difference in risk of death between subsites. ConclusionThe study found differences in survival outcomes between subsites. After adjusting for covariables, subsite mainly had significant impact on local recurrence, with no distinct pattern of influence on overall death or locoregional recurrence.

Reconceptualizing the Application of Infrahyoid Flap in the Era of Free Flaps in a Developing Country

Objective: To review our clinical experience with infrahyoid myocutaneous flap which is often overlooked in the reconstruction of small to medium-sized tongue, floor of mouth, lower alveolus and gingivobuccal sulcus primary defects. Method: A retrospective study of 12 patients of squamous cell carcinoma involving the tongue, floor of mouth, mandibular gingivobuccal sulcus and alveolus was done in patients who underwent infrahyoid flap as an alternative to free radial forearm flap. This study was conducted in the Tertiary Care Institute. The study included patients treated between March 2020 to May 2021. Patients with T4 and N3 disease, recurrence cases, post-radiation, and chemo-radiation cases who refused to participate in the study were excluded. Results: Out of 12 patients, two patients developed partial flap necrosis. One patient developed a hematoma under the flap and one patient had a neck suture gaping. Postoperative results were found to be phenomenal after one month in all patients. Conclusion: The infrahyoid flap is a dependable, less arduous, and economical option for small to medium-sized defects of the oral cavity. It can be advised as a possible substitute for free flap reconstruction, especially in a developing country where resources are limited.

Dosimetric comparison of postoperative interstitial high-dose-rate brachytherapy and modern external beam radiotherapy modalities in tongue and floor of the mouth tumours in terms of doses to critical organs.

The aim of the study was to dosimetrically compare interstitial high-dose-rate (HDR) brachytherapy (BT) and modern external beam radiotherapy modalities, as volumetric modulated arc therapy (VMAT) and stereotactic radiotherapy with Cyberknife (CK) of tumours of the tongue and floor of the mouth in terms of dose to the critical organs. In National Institute of Oncology, Budapest, between March 2013 and August 2022 twenty patients (11 male/9 female) with stage T1-3N0M0 tongue (n = 14) and floor of mouth (n = 6) tumours received postoperative radiotherapy because of close/positive surgical margin and/or lymphovascular and/or perineural invasion. High-dose-rate interstitial brachytherapy applying flexible plastic catheters with a total dose of 15 × 3 Gy was used for treatment. In addition to BT plans VMAT and stereotactic CK plans were also made in all cases, using the same fractionation scheme and dose prescription. As for the organs at risk, the doses to the mandible, the ipsilateral and the contralateral salivary glands were compared. The mean volume of the planning target volume (PTV) was 12.5 cm3, 26.5 cm3 and 17.5 cm3 in BT, VMAT and CK techniques, respectively, due to different safety margin protocols. The dose to the mandible was the most favourable with BT, as for the salivary glands (parotid and submandibular) the CK technique resulted in the lowest dose. The highest dose to the critical organs was observed with the VMAT technique. The mean values of D2cm3 and D0.1cm3 for the critical organs were as follows for BT, VMAT and CK plans: 47.4% and 73.9%, 92.2% and 101.8%, 68.4% and 92.3% for the mandible, 4.8% and 6.7%, 7.3% and 13.8%, 2.3% and 5.1% for the ipsilateral parotid gland, 3.5% and 4.9%, 6.8% and 10.9%, 1.5% and 3.3% for the contralateral parotid gland, 7.3% and 9.4%, 9.0% and 14.3%, 3.6% and 5.6% for the contralateral submandibular gland. The present results confirm that BT, despite being an invasive technique, is dosimetrically clearly beneficial in the treatment of oral cavity tumours and is a modality worth considering when applying radiotherapy, not only as definitive treatment, but also postoperatively. The use of the CK in the head and neck region requires further investigation.